Michael W. Larkin - Donahue Peebles

8/15/2019 Michael W. Larkin - Donahue Peebles

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IV.

DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION( DISCLOSE WHETHER HOURLY, FLATRATE

OR

OTHER):

A) LOBBYIST DISCLOSURE:(

Required):$

445.00

B) PRINCIPAL' S DISCLOSURE(

OF

LOBBYIST COMPENSATION):

REQUIRED). $

445.00

The

following information must be

answered:

1

Pursuant

to

Miami

Beach

City

Code Section 2- 488 Enti tled" Prohib ited

Campaign Contributions By Lobbyists On Procurement

Issues :

Yes X No:

Are

you

lobbying

on

a

present

or®

endngbi®

goods.equpment

or

servces.oron

a

Desentor

pe= award for goods. equipment

or

service?

2)

Pursuant

to

Miami

Beach

City

Code Section

2-

49 0 Enti tled" Prohib ited Campaign

Contributions

By Lobbyists On Real Estate

Development Issues :

Yes X

No:

Are

you lobbying

on

a

gendina

application for a Development Agreement with

the City

or application

f

change of zoning

map designation or chanae to the

City'

s Future Land Use Map?

3)

Pursuant to M ia mi B ea ch C ity

Code Section

2 - 482 ( h) Any person (

except

those

exempt

from

the definition

of lobbyist as se

forth

in

Section

2-481

above)

who only appears

as

a representative of a not-for-profit corporation or entity withou

speca

compensaion or

rembursement

for the appearance,

whether direct,

or

indirect,

to

express support of

o

opposition to

any

item, shall register w ith th e clerk as requ ired by

this

section but,

shall

no t be

required

to pay any registratio

fees.

Yes

X

No:

Are you representing

a not-

for-profit

corporation

or entity without

special compensation

or

reimbursement.

V. SIGNATURE UNDER OATH:

ON

FEBRUARY 28

OF

EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO

THE CITY

CLERK

A SIGNED

STATEMENT

UNDE

OATH,

LISTING

LOBBYING

EXPENDITURES, AS

WELL

AS COMPENSATION RECEIVED, IN THE CITY OF MIAMI BEACH

EDB

THE PRECEDING

CALENDAR

YEAR, A

STATEMENT SHALL BE FILED EVEN IF

THERE HAVE BEEN

NO

EXPENDITURES

OR

COMPENSATION

DURING

THE

REPORTING PERIOD.

Signature

of Lobbyist

I do so lemnly swear

that al l

of the foregoing facts are true and correct and that I have read or am

familiar

with the provisions containe

in Section

2 -

482 of the

Miami

Beach City Code and

al l

reporting

requirements.

Signature of Lobbyist:

Signature of

Principal/Clien

VI.

LOBBYIST IDENTIFICATION:

PRINCIPAL IDENTIFICATION:

Produced

ID

9

0r °

v®

QP

iee°

Produced ID

Form

of

Identificati ;,

A. `®

0°°®

TAR

y.

o°°

i

Form ofIdentification

V.̀

ersonally

known(

Lobbyist)

o _

11J°

My

Comm.

EXPir. •

0

Personally known( Principal)

fir

H

c

d `

a

NoveMber 05, 2013 .

VII. SIGNATURE AND

STAMP

OF

NO jla;u

No.®

D

833467

State of

Florida,

County

of

Miami-

Dade

m

N

O®

e `5tate of Florida,

County

of Miami-Dade

SwornV

and

subscri d

befor

me

a,

s3

gq®

Sworn

r

d

subscribed bef9Ie

me

This J

da y

of 2013

N

This

day

of (

0

ga ,

2013

00

0

SigrbW6

of

Public

Notary—

State

of

Florida...,:,

Sig

e o

i

otary-

State

of

Florida

Notarization

of

Lobbyist's

sgnature

Notarization of Principal's signature

TO

BE COMPLETED BY

CITY CLERK'

S

STAFF

O

Y

Annual

Registration

fee: ]

Yes

No

Amount

Paid$

4

MCR#

2-

S & Itl

ate Pa'

Lobbyist Registration

Form received and

verified

by:

ok

C: \

Users\clerhatl\

AppData\ Local\ Microsoft\Wndows\Temporary

Internet

Files\ Content.Outlook\83LGQDDH\Lobbyist

Registration

Formrevised 5-

30-2012.doc


3/4

F:\

CLE

istration Form.

doc

Revised 04/

27/

2012

0

City

oMam

Beach,

1700 Convention Center Drive, Miami Beach.,

Florida

33139, www

rniamibeachtl.

gov

CITY

CLERK Office

Rafael

E.

Granado,

City

Clerk

City

Clerka.

miamibeach fl. gov

Tel:

305.673.

7411 ,

Fax: 305.673.7254

LOBBYIST NAME: Michael

W

Larkin

I

understand

that no

later

than

February

28

ofeachyear,

m ust file the follow ing form

pursuant to

Section

2-

485

of

the

Miami Beach

City

Code,

with the City Clerk's Office for

a

active lobbying issues.

1 LOBBYIST EXPENDITURE AND COMPENSATION FORM

Failure to file these forms on a timely basis

will

result in my name being transmitted to th

Miami-Dade

County Commission

on Eth ics and

for

code

violation evaluation

In

addtion,

once

an

issue I

have regstered

to

lobby

on

has

been

resoved,

or

I am no longe

lobbying

on

that issue or

for

that

princpa,

I am required to immediately notify the City Clerk'

Office

of

lobbyist withdrawal in writing.

Pursuant

to

Section

2-

485 (d), the

City

Clerk shal

notify any

lobbyist (

or

princpa)

wh

fails

to

timely

file

a Statement and in

addition to any

other

penalties which may b

imposed

as

provded

in Section

2-

485.

1 ,

a fine

of

50.

00

a day

shall

be assessed

for

a

Statement(

s)

filed

after

the

due

date.

The

City

Clerk

shal

notify

the

Miami-

Dad

County

Commission onEthics and

Public

Trust ofthe failure of

a

lobbyist (

orprincpa

to

file

the

Statement

or

pay

the assessed

fines

after

notification.

Any

lobbyist,

who

fails to

file the

requred

Statement

by

April 30th, 2012, shal

b

automatically

suspended

from

lobbying

untilal

fines are

pad,

unless the fine has bee

appealed

to the Miami-

Dade

County Commission on Ethics and Public

Trust.

d_-

C

6I)

Signature:

Date:

C: \

Users\

clerhatl \AppData\

Local\

Microsoft\Windows\Temporary

Internet Files\

Content.Outlook\83LGQD DH\ Lobbyist

Registration

Formrevised

5-

30-

2012.

doc


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Michael W. Larkin - Donahue Peebles

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