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Michael Larkin/Seth Gadinsky/745 Collins Avenuem 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 Ordinance 2004-3435. Larkin Michael W. NAME OF LOBBYIST: (Last) (First) (M.I) Bercow, Radell & Fernandez 200 S. Biscayne Blvd., Suite 850 Miami Florida 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 377-6231 (305) 377-6222 MLarkinCalbrzoninglaw.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: I. LOBBYIST RETAINED BY: Seth Gadinsky, President NAME OF PRINCIPAL/CLIENT: Matacumbe Enterprises, Inc 325 South Biscavne Blvd ,Suite 1724 Miami Florida 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 347-5415 SethColGadinskyrealestate.com 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: • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: II. SPECIFIC LOBBY ISSUE: Development approvals for property located at 745 Collins Avenue. Issue to be lobbied (Describe in detail): III. CITY AGENCIES/INDMDUALS TO BE LOBBIED: A) Full Name of Individual/Title ~ B) Any Financial, Familial or Professional Relationship Planning and Zoning Department Staff, DRB, BOA, Planning I None Board, City Commission x11. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY Fa,,t;r~rz~ oR orNC~r A) LOBBYIST DISCLOSURE: (Requirod) 5385 DDS hour B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Relquir~ed). 5385 OD oar hour The folOmlving irrfarrnation must be ar>tsMrered: 1) Pursuant bo Miami Beach City Code Sedan 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists On Procurement Issuesp: ~ Yes ~. Nom. Ara you lobb,a or taendino bid for g eauioment or services. or on a ar oendhw award fg,BQ~,ealuiomerrE or setvk~?_ 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Devebpment Issues": ~, Yes X Na A~you r+eorasenti~ a not-tor-e>trotit aorvQratl>Qn or enti!`v without sal conwensatiott ~lhlitIIta Y. SIGNATURE UNDER OATH: ON tXTOBER 1~ OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATIION RECEIVED. IN THE CM OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SMALL BE FILED EVEN IF THERE HAVE BEEN IMO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. i/I/J~ i. ~-- Signature bf Lobbyist '~ w ~ ° :~ ~~ ~~ .~ t- F ~, ~ `c ~ ~~~~ Jr ~~~I ~~.>~' 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 captained in Section 2-482 of the Miami Beach City Code and atl reporting requirements. _ _ ,, Signature of Lobbyist: Signature of Principal/Qient: Vi. LOBBYIST IDENTIFICATION: ~ Produced ID Form of Identification Personally known (L obbyi~) VII. SIGNATURE AND STAMP OF NOTARY: State of F~,rida, County This PRINCIPAL IDENTIFICATION: ^ Produced ID Form of Identification .e-PErsonally known (Prin w,~„rr~w,+~.~,~,r~, ap`-"r °~ Notary Public State of Florida Marc R Halpern y ~ My Commiasion 00789014 State of Ronda, County o ~j Expires 0 312 9/2 01 2 Swom and subscribed befo me This t7 day of 2p0 Y Signature of Pubik No ry -State of Fbrida Notarizatbn of Prindpai's signature of Public Notary - Stat~bf Fbrida ti~on of Lobbyist's signature FOR CLERK'S USE ONLY Annual Registration fee: [ ]Yes [ ] No Amount Paid ~~ MCR # Lobbyist Registration rrorm received and verified by: Entered By: ;Paid ~ Z ~ 3) Pursuant to Miami Beach City Code 2-484 (h) Any person (except those exempt from the definition of "lobbyist" as set fortfi in Section 2-481 above) who only appears as a representative of anot-for-profit corporation or entity wigaout special compensation or reimbursement for the appearance, whether direct, or indirect, to express support of or opposit~n to any item, shalt register with the clerk as required by this section but, shall not be required to pay any registration fees.. EXHIBIT B DISCLOSURE OF INTEREST Matacumbe Enterprises, Ltd. 325 S. Biscayne Blvd, #1724 Miami Beach, FL 33131 NAME OF INTEREST HOLDER 1. Matacumbe Enterprises, Inc. Seth Gadinsky, President 325 S. Biscayne Blvd, #1724 Miami Beach, FL 33131 Seth Gadinsky 50% 325 S. Biscayne Blvd, #1724 Miami Beach, FL 33131 Lyle Stern 50% 1665 Washington Avenue, PH Miami Beach, FL 33139 Subtotal 100% 2. Seth Gadinsky 325 S. Biscayne Blvd, #1724 Miami Beach, FL 33131 3. Lyle Stern 1665 Washington Avenue, PH Miami Beach, FL 33139 4. Marylyn Gadinsky 325 S. Biscayne Blvd, #1724 Miami Beach, FL 33131 5. Bruce Koniver 1665 Washington Avenue, PH Miami Beach, FL 33139 INTEREST 1.0 24.5 24.5 25.0 25.0 TOTAL 100.0