Jerry H. Bell - Deco Capital Group 0.33- 1750( P,A4-4--/ Ave
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City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION FORM `_1 `
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.
Bell Jerry H.
NAME OF LOBBYIST: (Last) (First) (M.I)
Bell David Planning Group 1019 NE 104 Street Miami Shores Florida 33138
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-215-6302 ierrv@belldavid.corn
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes:address,phone, ore-mail address.
I. LOBBYIST RETAINED BY:
Bradleu W. Colmer
NAME OF PRINCIPAUCLIENT:
Deco Capital Group 119 Washington Avenue, Suite 505 Miami Beach Florida 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(786)360-0541 bradleu.colorer( -lecocapital.corn
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: st,G K -Fi0
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: Please see attached
II.SPECIFIC LOBBY ISSUE:
Development Approvals and Permitting Issues, including, but not limited to the Historic Preservation Board, Design Review
Board, Planning Board, Board of Adjustment, Land Use Development Committee, City Commission, and any City Workshops or
Committees, if necessary,'relating to the property located at 1 733-1 759 Purdy Avenue and 1724, 1738, 1752 Bay Road, Miami
Beach.Florida.
Issue to be lobbied(Describe in detail):
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
Pursuant to City Code Section 2-482(a)(4)include the commissioner or personnel sought to be lobbied,and whether the lobbyist has entered
into any contractual relationship (paid or unpaid) with said city commissioner or personnel from 12 months preceding such
person's commencement of service with the city to the present date,stating the general nature of the subject contractual relationship.
Sec 2-482(a)(4)Full Name of Individual and Contractual Relationship(Explain) YES NO
title of person to be lobbied
Staff for the Planning Department, Building Department, None. X
Public Works and City administration, PB, HPB, BOA, None. X
City Commission, and Mayor as necessary 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.
Sec 2-482(g)Any Financial, Familial or Professional Relationship
None_
None_
None_
C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files1Content.Outlook\83LGQDDH\Lobbyist Registration
Formrevised 5-30-2012.doc
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required)$\50 per hour
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): $`Sh per hour
(REQUIRED).
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled"Prohibited Campaign Contributions By Lobbyists On Procurement
Issues":
_Yes XNo: Are you lobbying op a gresent or oendina bid for goods.eauioment or services.or on a present or pending
award for goods.eauioment or service?
2) Pursuant to Miami Beach City Code Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
_Yes XNo: Are you lobbying on a pending application for a Development Agreement with the City or application for
change of zonina map designation or change to the City's Future Land Use Map?
3) Pursuant to Miami Beach City Code Section 2-482(h)Any person (except those exempt from the definition of"lobbyist"as set
forth in Section 2-481 above) who only appears as a representative of a not-for-profit corporation or entity without
special compensation or reimbursement for the appearance, whether direct, or indirect, to express support of or
opposition to any item,shall register with the clerk as required by this section but, shall not be required to pay any registration
fees.
_Yes aC No: Are you reoresentina a not-for-profit corporation or entity without special compensation or reimbursement
V. SIGNATURE UNDER OATH:
ON FEBRUARY 28 OF EACH YEAR. EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER
OATH. LISTING LOBBYING EXPENDITURES. AS WELL AS COMPENSATION RECEIVED. IN THE CITY OF MIAMI BEACH
EQ$ THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO
EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD,
'''-`d1 rifi-0-4
Signature of Lobbyist
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,rreporting requirements.
Signature of Lobbyist: k ( ` c ,t vo -
9 Y _ e•ak.
Signature of Principal/Client: 11
V I. LOBBYIST IDENTIFICATION: 40•40 PRINCIPAL IDENTIFICATION: "''
7 24, rn g 0 z
Produced ID ‘4.417.
". Produced ID igil
Form of Identification ,g o z • Form of Identificati• S w.0 m
Personally known(Lobbyist) g �_ Personally known(Principal) m^s e a
VII. SIGNATUR ND STAMP OF NOTARY: o `" o
"� Z N s.
State of Florid;, CoUn of Miami-Dade '4 s St. e • lorid , County of Miami-Dade
Sworn�• ubscri before me g Swo�� .�d sues rib d before me
This , daby of -e-tonic ,2016 This �'L dap' oic ,2016
Ia I
Signature of "u;.Iic Notary—State of Florida Signature of Pub . 3ary—State of Florida
Notarization of Lobbyist's signature Notarization of - '.■ , ' signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: []Yes[ ]No Amount Paid$ %5O• MCR# {O'iii j Date Paid 02. 13- 'C,
Lobbyist Registration Form received and verified by: 13 SkV �
SUPPLEMENTARY DISCLOSURE OF INTEREST
Interests in Sunset Land Associates, LLC.
Percentage of Interest
Sunset Harbor Holdings, LLC 100%
c/o Deco Capital Group
1691 Michigan Ave., Suite 510
Miami Beach, FL 33139
Interests in SH Owner, LLC.
Percentage of Interest
Sunset Harbor Holdings, LLC 100%
c/o Deco Capital Group
1691 Michigan Ave., Suite 510
Miami Beach, FL 33139
Interests in Sunset Harbor Holdings, LLC.
Percentage of Interest
Deco Capital Investments, LLC 10%
c/o Deco Capital Group
1691 Michigan Ave., Suite 510
Miami Beach, FL 33139
RWNIH-REP Sunset Harbor, LLC 90%
c/o Deco Capital Group
1691 Michigan Ave., Suite 510
Miami Beach, FL 33139
Interests in Deco Capital Investments, LLC.
Percentage of Interest
Brad Colmer 2.65%
do Deco Capital Group
1691 Michigan Ave., Suite 510
Miami Beach, FL 33139
Dan Marinberg 9.90%
c/o Deco Capital Group
1691 Michigan Ave., Suite 510
Miami Beach, FL 33139
M-1752 Deco Investor, LLC 4.98%
do Deco Capital Group
1691 Michigan Ave., Suite 510
Miami Beach, FL 33139
Michael Beattie 4.42%
do Deco Capital Group
1691 Michigan Ave., Suite 510
Miami Beach, FL 33139
Frederic Khalil 10.00%
do Deco Capital Group
1691 Michigan Ave., Suite 510
Miami Beach, FL 33139
David Neithardt Beaumont 6.86%
do Deco Capital Group
1691 Michigan Ave., Suite 510
Miami Beach, FL 33139
Douglas Silverman 13.53%
do Deco Capital Group
1691 Michigan Ave., Suite 510
Miami Beach, FL 33139
Noelle Villaneuva 1.60%
do Deco Capital Group
1691 Michigan Ave., Suite 510
Miami Beach, FL 33139
Boris Marinberg 2.94%
do Deco Capital Group
1691 Michigan Ave., Suite 510
Miami Beach, FL 33139
Deco Capital Group, LLC 3.58%
do Deco Capital Group
1691 Michigan Ave., Suite 510
Miami Beach, FL 33139
Ralph Bekkevold 18.95%
do Deco Capital Group
1691 Michigan Ave., Suite 510
Miami Beach, FL 33139
Joseph Furst 1.69%
do Deco Capital Group
1691 Michigan Ave., Suite 510
Miami Beach, FL 33139
Eric Doelle 6.76%
do Deco Capital Group
1691 Michigan Ave., Suite 510
Miami Beach, FL 33139
Christopher Roe 2.56%
c/o Deco Capital Group
1691 Michigan Ave., Suite 510
Miami Beach, FL 33139
Gloria Canasi 9.59%
do Deco Capital Group
1691 Michigan Ave., Suite 510
Miami Beach, FL 33139
t
Interests in RWNIH-REP Sunset Harbor LLC.
Percentage of Interest
RWNIH-REP, LLC 95.9588%
do Deco Capital Group
1691 Michigan Ave., Suite 510
Miami Beach, FL 33139
Ari Shalam-REP, LLC 0.4822%
do Deco Capital Group
1691 Michigan Ave., Suite 510
Miami Beach, FL 33139
Joshua Shapiro 0.0698%
do Deco Capital Group
1691 Michigan Ave., Suite 510
Miami Beach, FL 33139
Barry Kringstein 3.4892%
do Deco Capital Group
1691 Michigan Ave., Suite 510
Miami Beach, FL 33139
Interests in RWNIH-REP LLC.
Percentage of Interest
Marc Rowan and family 94.7036%
do Deco Capital Group
1691 Michigan Ave., Suite 510
Miami Beach, FL 33139
Ken Glassman 1.2176%
c/o Deco Capital Group
1691 Michigan Ave., Suite 510
Miami Beach, FL 33139
Mary Harada 0.1259%
c/o Deco Capital Group
1691 Michigan Ave., Suite 510
Miami Beach, FL 33139
Ari Shalam 0.0122%
do Deco Capital Group
1691 Michigan Ave., Suite 510
Miami Beach, FL 33139
Barry Kringstein 0.0224%
do Deco Capital Group
1691 Michigan Ave., Suite 510
Miami Beach, FL 33139
Limited/Non-Controlling Investors 3.9183%
(no involvement with development)
do Deco Capital Group
1691 Michigan Ave., Suite 510
Miami Beach, FL 33139
,
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Miscellaneous Cash Receipt
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CITY OF MIAMI BEACH 0.,,;) i- ty I i.:1'it liC4136Sf'j $8.f.40.00
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0 Cash 0 Credit Card 'Check# I I R'.4 $ so 5 - -.'
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Address lot A)6- 1 0" CT , AA 1,44111 St-434( ,.fr L 3 31 ?
For i ,4-tv Ai kAA-L- ie (--r57-1-(40-1 Cod 4 I i S SC4e. 4
(THIS INFORMATION MUST BE COMPLETED) _ Office of Finance Director
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'--IP'47 Account Number: 01 1 - 2 o o' 76'1. Li L/ti -
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