Michael Larkin/Xenia 2206 LLC~ 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) c~ (Code)
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(305) 377-6231 (305) 377-6222 rzon
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TELEPHONE NUMBER: FAX NUMBER: EMAIL: n ~ ~
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I. LOBBYIST RETAINED BY: -
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Xenia 2206, LLC ~
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NAME OF PRINCIPAL/CLIENT: ..
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119 Washinoton Avenue, Suite 101 Miami Beach FL ~ 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(786) 443-6395 dg@nereo.it
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: Daniel Goldstein
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: Renzo Rangoni, Renato Rangoni
II. SPECIFIC LOBBY ISSUE:
Redevelopment of 2206 Park Avenue and 427 22 Street - COA, 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, Ciry Commission * None
* Unless an issue is legislative in nature, HPB, BOA, Planning Board, and City Commission members are not lobbied outside of a public hearing setting.
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHERr
A) LOBBYIST DISCLOSURE: (Required) $ 385.00 per hour
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $ 385.00 per 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 lobbying on a present or vending bid for goods, eauipment or services, or on a
present or Wending 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 you lobbying on a Wending avnlication for a Develovment Agreement with the City or
~p~lication for change of zoning maW designation or change to the City'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 snot-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 representing snot-for-profit corporation or entity without svecial comvensation
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. _ ~ ,. /
Signature of 1~6bbyi
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I do solemnly swear that all of the foregoing
familiar with the provisions contained in Sectio
requirements.
Signature of Lobbyist:
nature of Principal/C
LOBBYIST IDENTIFICATION:
^ Produced ID
Form of Identification
Personally known (Lobbyist)
.. SIGNATURE AND STAMP OF NOTARY:
orida, County o Mi
and subscri ed fc
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PRINCIPAL IDENTIFICATION:
Produced ID
Form of Identification
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ersonally known (Principa ,••„~p,,,~ p~ARbIgARRAMEDA
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a '~,=. Notary PuDllc - Slats of FIOrM
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State of Florida, County of Mia i-[7~~`t~«~•'••• e~nx~iNaBotrNO~'t'A'
Sworn and subscribed before
This aP~ ay f . 20~~
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Signature of Publ' Not -State of Florida
Notarization o Prin ipal's signature
FOR CLERK'S USE ONLY
Annual Registration fee: [ ]Yes [ ] No Amount Paid ~!' MCR #~~~ ~ / D Paid U Z~ f
Lobbyist Registration Form received and verified by: Entered By:
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYISr FORM OS.doc Revised 12/08/04
facts are true and correct and that I have read or am
n 2-482 of the Miami Beach City Code and all reporting
City of Miami Beach, 17(3(} Convention Center Drive, Mivmi Beach, ~Ioridg 33 i 39, www.miamibea~hfl,gov
CITY CLERK O£fite CiiyCferk~m"rarnibeac~;f[.gav
TeE: 305.b73,7d1 T , FQX: 305.b73.72b4
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1 understand that no later than CHCbber 1st of ecch yeah, 1 must file the following
forms, pursuant to Section 2-485 of the Miami Beach City Code, with the City Clerk's
Office for all active lobbying issues.
1 } Lobbyist Expenditure Form
2) Disclosure Form
Failure to file these forms an a timely basis will result in my name being transmitted to the
MiamiAade County Commission on Ethics and for code violation evaluatian.
In addition, ante an issue I have registered to lobby on has been resolved, I am required
to immediately notify the City Clerk's C7ffice of lobbyist withdrawal in writing.
Signature: Date:
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