Michael Larkin/J. Cubed, 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:
LOBBYIST RETAINED BY:
J Cubed, LLC
NAME OF PRINCIPALJCLIENT:
1691 Michioan Avenue. Suite 320 Miami Beach FL 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(847)675-0005
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: Adam Schwartz
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: Virginia Bender, Jakub Kosiba, Kryzstof Karbowski, Jack Franco, and Adam
Schwartz
II. SPECIFIC LOBBY ISSUE:
Redevelopment of 421 and 425 Meridian Avenue -Modification of COA and variance approvals
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 Dept., HPB, BOA, Planning Board, City Commission * None
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* Unless an issue is legislative in nature, HPB, BOA, Planning Board, and City Commission me e~ r~HbCff~te~-8de of a public hearing setting.
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY
` FLAT RATE OR OTHERx ~
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A) LOBBYIST DISCLOSURE: (Required) 5~2G'OtTcer hour
385.oa
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). ~~ ~~ 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 aoodsgguipment or services or on a
present or pending award for goods equipment 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 ~u lobby~g on a cending application for a Development Agreement with the City or
g~~'--~~~ ~~r w ~~^° ^~' mina map designation or chance to the C~tv's Future Land Use
Mau?
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 deck as required by this
section but, shall not be required to pay any regimeration fees..
^ Yes X No Are you represe~ing a not-for-profit corporation or entity without special compensation
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. /° I
Sig re o%f/LowV/bbyist
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.
Signature of Lobbyist:
Signature of Principal/Client:
o M VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
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_N N Form of Identfcation Form of Identification "
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VII. SIGNATURE AND STAMP OF NOTARY:
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~ State of Florida, County of Miami-Dade
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Swom to State of Florida, County of Miami-Dade
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Sworn _and subscn ~S.O D
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Sig re of Public Notary State of Flo Signatu Public Notary -State of Fkxida
Notarization of Lobbyi signatu Nota ' n of Prindpal's signature
FOR CLERK'S USE ONLY J
Annual Registration fee: [ ]Yes [ ] No Amount Paid ~ MCR # ~ Dat Paid ~ ~r D °
Lobbyist Registration Form received and verified by: S Entered By:
F:\CLER\~ALL\MARIA-M\Lobtryist\LOBBYLST FORM OS.doc Revised 12(0811
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City of Miami Beach, i 744 Caravertian Center Drive, Miami Beach, ffori~a 33139, wrvw.m'somibea~hfl.gav
C3TY ~LfRK Office CilyGlerk~maamibeachfl.~av
Tel; 345.673.74 i 1 ,fax: 345.673.7254
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I understand that na later than Cktober 1st of each year, I must file the following
farms, pursuant to Section 2-4$5 of the Miami Seoch City Code, with the City Clerk`s
Office for all active lobbying issues.
1 ~ Lobbyist Expenditure Form
2~ Disclosure Form
Failure to file these farms an a timely basis will result in my name being transmitted to the
Miami-Dade County Commission on Ethics and for code viola#ion evaluation.
fn addition, once an issue I have registered to lobby on has been resolved, l am required
to immediately notify the City Clerk`s C)ffice of lobbyist withdrawal in writing.
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Signature: - _ _ Date:
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