Michael W Larkin - Gary Siegler � 6 a
DocuSign Envelope ID:B1B6EB6F-C87D-4CFO-BOCD-122A242084EE
RECEIVED
tV\I AM I BEACH Office of the City Clerk NOV 30 2021
1700 Convention Center Drive
Miami Beach, FL 33139 CITY OF MIAMI BEACH
305.673.7411 OFFICE OF THE CITY CLERK
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 City Code Chapter 2,Article VII, Division 3, entitled"Lobbyists,"
for additional information.
Instructions: Please complete all sections of this form and submit the completed form,with the applicable fee,to the Office of the City
Clerk. If you need more space to complete an answer, use a separate sheet(s) of paper. If you have nothing to report in a particular
section, you must write "none" or "n/a" in that section. Any change to any information originally filed, or any additional City
Commissioner or personnel who are also sought to be lobbied shall require that the lobbyist file an amendment to the registration form.
The lobbyist has a continuing duty to supply information and amend the forms filed throughout the period that the lobbying occurs.
Separate registration forms shall be required for each principal represented on each specific issue.
I. LOBBYIST INFORMATION:
Larkin Michael W
NAME OF LOBBYIST (Last) (First) (Middle Name)
Bercow Radell Fernandez Larkin&Tapanes,PLLC 200 South Biscayne Blvd.,Ste. 300 Miami,Florida 33131
LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 374-5300 mlarkin@brzoninglaw.com
LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS
II. PRINCIPAL INFORMATION:
Siegler Gary
NAME OF PRINCIPAL (Last) (First) (Middle Name)
5226 North Bay Road Miami Beach Florida 33140
PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
gary@icasset.com
• PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS
• Pursuant to City®ode Section 2-482 h)(1)(a.: G1 principal o any corporation partnersH'ip or ofher entity who appears as a tooby st on behalf of tha
entity,without special compensat o CF reimbursement for t appearance,whether dirt indirect,CP • _ ft)express support of or opposition t•
a in. item shall register wjthithe Sle k as requiredlbYlthis subsecti butrshall notibe required to pa any egistration fees.
O
N
If the principal is a Corporation, Partnership or Trust, the following information MUST be provided
LL pursuant to City Code Section 2-482(c):
LL • NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY(if none,write N/A): Gary Siegler
• NAME OF ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION,PARTNERSHIP OR TRUST(if none,write N/A): Gary Siegler-100%
N ,•
LL -�
Page 1 of 5
CD2oita
Ramos
ea+am — )E-11FE8EBF8FFo Page 1 of 5 I 111FESEBF8FF0 1111
E 'I III 'tl
DocuSign Envelope ID:B1B6EB6F-C87D-4CFO-BOCD-122A242084EE
III. ISSUE TO BE LOBBIED:
Describe with as much detail as is practical, including but not limited to a specific description where
applicable of a pending request for proposal, invitation to bid, or public hearing number.
Development Approvals&Planning Issues,including but not limited to the Historic Preservation Board,
Design Review Board,Planning Board,Board of Adjustment,Land Use Development,City Commission,
and any City Workshops or Committees,if necessary,relating to the property located at 5226 North
Bay Road in Miami Beach,Florida.
IV. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
Pursuant to City Code Section 2-482(a)(4), list the City Commissioner or City personnel sought to be
lobbied, and whether the lobbyist has entered into any contractual relationship (paid or unpaid) with
said City Commissioner or City personnel from 12 months preceding such commencement of service
with the City to the present date, stating the general nature of the subject contractual relationship.
Full Name of Individual and Contractual Relationship (If yes,explain) YES NO
Title of Person to be Lobbied
Staff for the Planning &Building Department None X
Public Works &City Administration,PB,HPB,BOA None X
DRB,City Commission,and Mayor as necessary None X
Land Use&Sustainability Committee None X
Pursuant to City Code Section 2-482(g), every registrant shall be required to state the extent of any
business, financial, familial or professional relationship, or other relationship giving rise to an
appearance of an impropriety, with any current City Commissioner or City personnel who is sought to
be lobbied as identified on the lobbyist registration form filed.
List any Business, Financial, Familial or Professional Relationship, or other relationship giving rise to an
appearance of impropriety(if none,write N/A):
N
None
LL
LL
LL
LL
V. DISCLOSE RATE AND AMOUNT OF LOBBYIST COMPENSATION — Be Specific. (Note that a
contingency fee is prohibited pursuant to City Code Sec. 2-485.3):
$695 per hour
LL
Page 2 of 5
DocVerify ID:71F1DA2C-1819-0038-91BE-11FE8EBF8FF0 Page 2 of 5 211FE8EBF8FF0 I ,III III I
www.docvenfy.com
DocuSign Envelope ID:B1B6EB6F-C87D-4CFO-BOCD-122A242084EE
The following six(6)questions MUST be answered:
1) Pursuant to City Code Section 2-488,entitled"Prohibited Campaign Contributions By Lobbyists On Procurement Issues":
_Yes X No: Are you lobbying on a present or pending bid for goods, equipment or services, or on a present or
pending award for goods,equipment or service?
2) Pursuant to City Code Section 2-490, entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development
Issues":
-Yes x No: Are you lobbying on a pending application for a Development Agreement with the City or application
for change of zoning map designation or change to the City's Future Land Use Map?
3) Pursuant to City Code Section 2-482(h), any person (except those exempt from the definition of "lobbyist" as set forth in
Section 2-481)who only appears as a representative of a not-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 city clerk as required by this section, but shall not be required to pay any registration fees.
_Yes xNo: Are you representing a not-for-profit corporation or entity without special compensation or
reimbursement?
4) Pursuant to City Code Section 2-481, the term "lobbyist" specifically excludes the following persons: Expert witnesses who
provide only scientific,technical or other specialized information or testimony in public meetings; any person who only appears
as a representative of a neighborhood association without compensation or reimbursement for the appearance,whether direct,
indirect or contingent,to express support of or opposition to any item;and any person who only appears as a representative of
not-for-profit community based organization for the purpose of requesting a grant without special compensation or
reimbursement for the appearance.
_Yes X No: Are you providing only scientific, technical or other specialized information; appearing as a
representative of a neighborhood association without special compensation or reimbursement or
representing a not-for-profit based organization for the purpose of requesting a grant without
special compensation or reimbursement?
5) Pursuant to City Code Section 2-491(1), no campaign consultant shall lobby the City Commission for a period of 12 months
following the swearing in of any elected official(s) for whom the campaign consultant provided campaign consulting services
within the past election cycle.See Section 2-491 for more information.
_Yes XNo: Have you provided campaign consulting services to an incumbent member of the City Commission
within the past election cycle?If yes,please list the incumbent member(s)of the City Commission:
_Yes XNo: If yes, has it been less than 12 months since the elected officialfs) whom you provided campaign
consulting services was sworn inr
6) Pursuant to City Code Section 2-482(a)(4)a., a lobbyist who has within the past election cycle provided campaign consulting
services to an incumbent member of the City Commission (which lobbying activity is not otherwise prohibited by Code section
2-491) shall disclose such particular service on his/her lobbyist registration form and shall orally disclose such particular
service before lobbying the City Commission at a public meeting.
_Yes xNo: Have you provided campaign consulting services to an incumbent member of the City Commission
within the past election cycle?If yes,please list the incumbent member(s)of the City Commission:
O
N
LL _Yes XNo: If yes, were you promised or did you receive economic consideration in exchange for campaign
coc r ultin rservicesr?(--
LL
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
m /
Annual Registration fee: [ ]Yes[ID]No Amount Paid$ MCR# Lrica®t Date Paid 1Q'
Lobbyist Registration Form received and verified•by: c ) "
F:\CLER\$ALL\aFORMS\LOBBYIST,FORMS\Lobbyist Registration Form Revised-09-20-18 REG.doc Revised 09/20/2018
0
Page 3 of 5
Docverify ID:71 F1 DA2C-1819-4036-916E-11 FEBEBFSFFO Page 3 of 5 311 FEBEBFBFFO ,III 656G� lI II I
www.docvenfy,com C:r�•
DocuSign Envelope ID:B1B6EB6F-C87D-4CFO-BOCD-122A242084EE
VI. SIGNATURES UNDER OATH:
ON FEBRUARY 28 OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE OFFICE OF THE CITY CLERK A
SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION
RECEIVED, FOR THE PRECEDING CALENDAR YEAR WITH REGARD TO THE SPECIFIC ISSUE ON WHICH THE
LOBBYIST HAS BEEN ENGAGED TO LOBBY. A STATEMENT SHALL BE FILED EVEN IF THERE HAS BEEN NO
EXPENDITURE OR COMPENSM OP1 DURING THE REPORTING PERIOD.1
Signature of Lobbyist: Date 11/24/2021
32132D3XDOCG410...
I do solemnly swear or affirm that all of the foregoing facts, statements, and disclosures in this form are true and correct,
and that I have read or am familiar with the provisions contained in Chapter 2, Art. VII, Division 3, entitled "Lobbyists" of
the Miami Beach City Code and all reporting requirenitmet+ edbby:
Signature of Lobbyist: —DocuSgnedby: Date 11/24/2021
aarti �(� `—atrseb bbuatb4iu...
Signature of Principal: Si 0(11 Date 11/24/2021
c523866ofE9g46�...
VII. NOTARY SIGNATURE AND SEAL:
LOBBYIST: PRINCIPAL
State of Florida State of Florida
County of: Miami-Dade County of: Miami-Dade
Sworn to(or affirmed)and subscribed before me, Sworn to(or affirmed)and subscribed before me,
by means of❑ physical presence by means of❑physical presence
or®online notarization, or®online notarization,
this 24 day of November ,20 21, by this 2,1 day of November ,2021, by
Michael W. Larkin Gary Siegler
NAME OF LOBBYIST NAME OF PRINCIPAL
_Produced ID _Produced ID
FORM OF IDENTIFICATION FORM OF IDENTIFICATION
x Personally Kno n X Personally Kno
Signature of Notary Public Signature of Notary Public
Diana Ramos Diana Ramos
Name of Notary,Typed, Printed or Stamped Name of Notary,Typed, Printed or Stamped
LL 1 Diana Ramos 1 Jana Ramos ` 1
co Commission#GG 308355 1 1 commission#GG 308355
1 Notary Public State of Florida 1 Notary Public-State of Florida
Icy Commission Expires Apr 10,2023 1 I My Commission Expires Apr 10,2023
1 Thy ° — —- Ng persons: ° 1
Bunvs.mPFmtn Brz.m.s lB Psi 9CMBF1.4
rYY.y sYmp Aifnirz.m.B I.Psi
Expert witnesses who provide only scientific,technical or other specialized information or testimony in public meetings;any person who
only appears as a representative of a neighborhood association without compensation or reimbursement for the appearance,whether
direct, indirect or contingent, to express support of or opposition to any item; and any person who only appears as a representative of
a not-for-profit community based organization for the purpose of requesting a grant without special compensation or reimbursement for
the appearance.
Page 4 of 5
Dvnw✓.docverfy.00mlDA2C-1819-0036-91BE-11FEBEBF8FF0 Page 4 of 5 __411FE8EBF8FF0 - r i-I III ,
• DocuSign Envelope ID:B1B6EB6F-C87D-4CFO-BOCD-122A242084EE
MIAMI BEACH
City of Miami Beach,1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.gov
Office of the City Clerk
Rafael E. Granado, City Clerk CityClerk@miamibeachfl.gov
Tel: 305.673.741 1, Fax: 305.673.7254
NAME OF LOBBYIST: Michael W. Larkin
1) LOBBYIST FEE EXPENDITURE AND COMPENSATION STATEMENT
Pursuant to City Code Section 2-485(d), the City Clerk shall notify any lobbyist (or
principal)who fails to file timely a Lobbyist Fee Expenditure and Compensation Statement
(Statement). In addition to any other penalties that may be imposed as provided in
Section 2-485.1, a fine of $50.00 a day shall be assessed for Statements filed after the
due date. The City Clerk shall notify the Miami-Dade County Commission on Ethics and
Public Trust of the failure of a lobbyist (or principal) to file the Statement or pay the
assessed fines after notification.
Any lobbyist, who fails to file the required Statement by April 30th of each year, shall be
automatically suspended from lobbying until all fines are paid, unless the fine has been
appealed to the Miami-Dade County Commission on Ethics and Public Trust.
I hereby acknowledge that on February 28 of each year, I shall submit to the City Clerk a
signed Statement under oath listing all lobbyist expenditures, as well as compensation
received, for the preceding calendar year with regard to the specific issue on which I have
been engaged to lobby.
2) LOBBYIST WITHDRAWAL
Once an issue I have registered to lobby has concluded or I am no longer lobbying on
that issue, I shall immediately file a Notice of Withdrawal with the Office of the City Clerk.
3) ANNUAL LOBBYIST REGISTRATION FEE
I
understand annual registration of all lobbyists shall be required for each 12-month period
commencing October 1 of each year, and the fee for such annual registration shall be
$500.00 pursuant to Section 2-482 of the Miami Beach City Code.
LL
DocuSigned by:
w C
wv/ \v 11/24/2021
L ac c sSapa vi0.
Signature of Loltyls Date
0
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 03-11-20 REG.doc
•
Page 5 of 5
Docverify ID:71FIDA2C-1819-0036.91BE-11FEBEBFBFFOMara
III
Page 5 of 5 511FE8EBFBFFO
www.docverify.com - "Y'
docv'erify
Lobbyist_Registration_Form__MWL - EXECUTED.pdf
DocVerify ID: 71 F1 DA2C-1 819-4036-91 BE-11 FE8EBF8FF0
Created: November 24, 2021 05:43:55 -8:00
Pages: 5
Electronic Notary: Yes / State: FL
This document is a DocVerify VeriVaulted protected version of the document named above.It was created by a notary or on the behalf of a
notary,and it is also a DocVerify E-Sign document,which means this document was created for the purposes of Electronic Signatures and/or
Electronic Notary.Tampered or altered documents can be easily verified and validated with the DocVerify veriCheck system.
Go to www.docverify.com at any time to verify or validate the authenticity and integrity of this or any other DocVerify VeriVaulted document.
E-Signature Summary
E-Signature Notary:Diana Ramos(dra)
November 24,2021 05:46:14-8:00[9CA88F339B4B][162.244.152.118]
dramos@brzoninglaw.com
I 11.11 �11111
I IIIIII IIIIII IIIII IIII IIIII IIIIII IIII IIIII IIIII IIIIII IIII IIIIII III IIII
DocVerify documents cannot be altered or tampered with in any way once they are protected by the DocVerify VeriVault System.Best viewed with Adobe Reader or Adobe Acrobat.
All visible electronic signatures contained in this document are symbolic representations of the persons signature,and not intended to be an accurate depiction of the persons actual signature
as defined by various Acts and/or Laws.
I DocVerify
www.docverDy7r1Am1DA2C-1619-4036-91BE-11FEBEBF8FF0 ,III Ch PREll III I
Generated Cover Page, 11FE8EBF8FF0
' ty ,
MBF - �\ '
City Ffa`'rl. 0 v
1700 Convention Center Dr. ''' 0 N -.�; J IN
Miami Beach , FL 33139 '
3Beach -7420 .N W t 1 Q
Welcome a� Q .� `� t
.'• N Fes,,. %
005164-0041 Carmen V 11/30/2021 04:04PM c i ") 5 `'r
j z ..`,.
MISCELLANEOUS d• y _ ,.
Reference MCR429206
2022 Item:1: NCR ' ' (7' '
MCR OPEN (NCR) 700.00 1 ` i
:\ J
700.00 v -,
Subtotal 700.00 '
Total 700.00 .‹.
CHECK 350.00 it �. rj.
Check Number00007445 r .� ,
CHECK 350,00 _�, '. 4
' i -'` ,. ' ..— .
Check Number00007446 ,
Change due 0G ` :
Paid by: BERCOW RADELL FEP,NANDEZ & LARKIN ''.6'V V. ,. 4
.,„,...,,,,,.:% ,, ,,,,,:,..,..,,_ 1, ry.),:.i,,,.., ,„,,,,,,...- ,,:, :
_______„,-,„----,--.---,i.,---,---,..-._...,r ',,,i,,,, ..1., :
9fa' t,.
. 1 _ sI.n,:,,,.:,n,_,,..2gtu -,7,.;‘ rEj,t z
gr 1
" 1112— .— ----•• '''.'116 6 ...'::',-- .,2, ...t, : r : (:'''',"3 2 .„ %'.,
Wm,... an...--- ----gym
Thank you for your payment
CUSTOMER COPY