Michael Larkin/Collins Corner, LLCm MIAMIBEACH
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION FORM
Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the passage, defeat
or modification of any ordinance, resolution, action or decision of any commissioner; any action, decision, recommendation of the
City Manager or any city board or committee; or any action, decision or recommendation of any city personnel during the time
period of the entire decision-making process on such action, decision or recommendation that foreseeably will be heard or reviewed
by the city commission, or a city board or committee. The term specifically includes the principal as well as any employee engaged
in lobbying activities. The term "Lobbyists" has specific exclusions. Please refer to Ordnance 2004-3435.
Larkin Michael W.
NAME OF LOBBYIST: (Last) (First) (M.I)
Bercow, Radell & Fernandez P.A. 200 South Biscayne Blvd., Suite: 850 Miami, Florida 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 377-6231 (305) 377-6222 mlarkin@brzoninglaw.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
L .LOBBYIST RETAINED BY:
Collins Corner LLC
NAME OF PRINCIPAL/CLIENT:
381 Park Avenue South Suite 1420 New York NY 10016
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(212) 684-7079 ext 19
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Eric Margules
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
Redevelopment of 1201, 1221, and 1225 Collins Avenue
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/Title
Planning Dept., HPB, BOA, Planning Board, City Commission
B) Any Financial, Familial or Professional Relationship
None
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHERf
A) LOBBYIST DISCLOSURE: (Required) $ 375.00 per hour
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $ 375.00 Der hour
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled ~~Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
^ Yes X No• Are you lobbvina on a present or pending bid for goods eauinment or services or on a
present or vending award for goods eauinment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled °Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
_^Yes X No• Are you lobbvina on a pending a~olication for a Development Agreement with the City or
aunlication for change of zoning map designation or change to the Citv's Future Land Use
Mai?
3) Pursuant to Miami Beach City Code 2-484 (h) Any person (except those exempt from the definition of
"lobbyist" as set forth in Section 2-481 above) who only appears as a representative of anot-for-profit
corporation or entity without special compensation or reimbursement for the appearance, whether direct, or
indirect, to express support of or opposition to any item, shall register with the clerk as required by this
section but, shall not be required to pay any registration fees..
^ Yes X No• Are you reuresenting anot-for-profit corporation or entity without suecial comuensation
or reimbursement. .
V. SIGNATURE UNDER OATH:
ON OCTOBER 1~ OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE
REPORTING PERIOD.
~" l~,ti
Signat re of Lobbyist
I do solemnly swear that a
familiar with the provisions
requirements.
Signature of Lobbyist:
Signature of Principal/C
VI. LOBBYIST IDENTIFICATION:
~ ^ Produced ID
~ $
Form of Identification
~' Personally known (Lobbyist)
~w
Z I. SIGNATUR D STAMP OF NOTARY:
~~E tat , Co o i i- de
t~~ • ~ w u sc be
hi ay 0_
S' re of Public Notary -State Florida
otarization of Lobbyist's signature
PRINCIPAL IDENTIFICATION: ~ .v~
^ Produced ID >- ~ N
Form of Identification ?
C3 .- ~
p CV
personally known (Principal) ~ ~-- ~o.,.. ,,, O
~~ -
U3 ^ -
Sworn and subscribed before me
~
~ _
~
~ ~
This day of OCiU6m- , 2(
? C
to
~
a
._
Signature of Pub N ry -State of flericfa
Notarization Principal's signature
FOR CLER 'S USE ONLY c~ < / ~~ Z-~ ~
Annual Registration fee: [x ]Yes [ ] No Amount Paid ~ S~ C'~~ MCR # ~/~ ~~` Date Paid
Lobbyist Registration Form received and verified by: Entered By:
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST FORM OS.dac / ~/ 3 Revised 12/08/04
II of the foregoing facts are true and correct and that I have read or am
contained in Section 2-482 of the Miami Beach City Code and all reporting