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Michael Larkin/Plaza Hotel, LLcm MIAMIBEACH City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 LOBBYIST REGLSTRATION 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 Ordinance 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: LOBBYIST RETAINED BY: Plaza Hotel, LLC NAME OF PRINCIPAL/CLIENT: 1691 Michigan Avenue. Suite 320 Miami Beach FL 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Eric Margules • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A S% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: II. SPECIFIC LOBBY ISSUE: Redevelopment of 418-422 8e 426 Meridian Avenue Issue to be lobbied (Describe in detail): III. CITY AQENCIES/INDIVIDUALS TO BE LOBBIED: A) Full Name of Individual/Title I B) Any Financial, Familial or Professional Relationship None f ~: . ^ ~F :~ IV. DISCLOSURE OF TERMS AND AMOUNT5 OF LOBBYLST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHERr A) LOBBYIST DISCLOSURE: (Required) ~ 375 00 per hour B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $ 375 00 per hour The following information must be answered: 1) Pursuant to Miami Beach City Code Section 2-458 Entitled "Prohibited Campaign Contributions By Lobbyists On Procurement Issues": ^ Yes X No• Are you lobbvina on a present or pending bid for goods eauipment or services, or vn a present or pending award for goods, eauipment or service? 2) Pursuant to Miami Beach City Code 290 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": ^Yes X No• Are you lobbvina on a pending application for a Development Agreement with the Citv or application for chance of zoning map designation or chance to tf~e Citv's Future Land Use Map? 3) Pursuant tp Miami Beads 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 speaal 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 representing anot-for-profit cornoration or entity without special compensation or reimbursement. . V. SIGNATURE UNDER OATH: ON OCTOBER 1ST 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. „ ~',' ~ Signatur~of Lobbyi I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am familiar with the provisions contained in Section 2-482 of the Miami Beach City Code and all reporting requirements. ~, f ~ % Signature of Lobbyist: / ~ N Signature of Principal/Client: 2 °$' VI. LOBBYIST IDENTIFIGATION: 'S d ._ ° ~ Produced ID ~ _ Form of Identification ~.~ .. .~ ~ Personally known (Lobbyist) n z ~ ~ w VII. ~'e ~ ~ . ~ State of Swom~ This AND STAMP OF NOTARY: of Lobbyist's of Florida O~ ~x~a-a ~ 1,~~.~ iI.C~C 1~Produced ID p.~ Form of Identific OFFICWL SEAL `Personally known (Principal) RENEE $UTOR HOTAR1f pUBI.IC, STATE OF ILLftlt)IS ~~ ~~ ~~ MV C01AMN3810M EXPIRES 9-24.2011 State of ~IarieFaN County of Mi~e Sworn a_nd subscribed before me ~ ~ This ~'~ ddy of ~' '!uC'. r , 20_ ~~~~ sti Signature of Public Notary -State offiarida ~~-~-i Nom' S Notarization of Principal's signature MCA ~ ~~ ~~S X5.00 ~a ~ o~1n6 fc~