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Adrian K. Dabkowski - Sobe Center, LLc /6c7.55 0,54( i, n c r Ci 1 BEACH q p� , A ifVt, Office of the City Clerk 2u)��r-�� 26 o )• 1700 Convention Center Drive _ Miami Beach, FL 33139 305.673.7411 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, dedsion 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 Cleric. 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 "Na" in that section. Any change to any information originally filed, or any additional City Commisdoner 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: Dabkowski Adrian K. NAME OF LOBBYIST (Last) (First) (Middle Name) Kimley-Horn 600 North Pine Island Road, Suite 450 Plantation Florida 33324 LOBBYIST BUSINESS NAME AND ADDRESS (Number aryl Street) (City) (State) (Zip Code) (954)535-5144 adrian.dabkowski@kimley-hom.com LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS Il. PRINCIPAL INFORMATION: Finvarb Ronald NAME OF PRINCIPAL (Last) (First) (Middle Name) Sobe Center, LLC 9425 Harding Avenue Surfside Florida 33154 PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305)861-3500 PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS If the principal is a Corporation, Partnership or Trust, the following information MUST be provided pursuant to City Code Section 2-482(c): • NAME OF CHIEF OFFICER, PARTNER,OR BENEFICIARY(if none,write N/A): Ronald Finvarb • 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): See Attached Page 1 of 5 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 and Permitting Issues,including,but not limited to the 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 1685 Washington Avenue, 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 Department,Building Department None X Public Works and City Commission, 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. List any Business, Financial, Familial or Professional Relationship, or other relationship giving rise to an appearance of impropriety(if none,write N/A): None V. DISCLOSE RATE AND AMOUNT OF LOBBYIST COMPENSATION — Be Specific. (Note that a contingency fee is prohibitedlpursuant to City Code Sec. 2-485.3): n; b. / V10 Page 2 of 5 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 XNo: 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 XNo: 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 spedalized 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 XNo: 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 renuesting a grant without special comoensatlon 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: nave you provided campaign consulting services to an Incumbent member of the City Commission within the oast 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 °Mclel(s)whom you provided campaign connultlno services was sworn In? 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: _Yes XNo: if yes, were you promised or did you receive economic consideration in exchange for campaign consulting services? TO BE COMPLETEDCBY CITY CLERK'S STAFF/ONLY /� / (y Annual Registration fee: [ I Yes 9CNo Amount Paid$�A�JG'Cr' MCR# 4�I I � 1 Date Paid Ce 2-/3 Lobbyist Registration Form received and verified by: /Y ,10Ni S A'L-\ ).A1C)7 iro- n r:\CLER\SALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Rave 01-01-18 REGAoc Revised 01/01/2018 Page 3 of 5 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 COMPENSATION/—��DURING THE REPORTING PERIOD. Signature of Lobbyist: G _4_03 Date G/?5 ),6 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����PPPggg���ing quirements.(en Signature of Lobbyist: “-- ) Date t"fzs��6 p Signature of Principal: (7.----Lf(..-.— Signature Date 6/2 S(O VII. NOTARY SIGNATURE AND SEAL: //// LOBBYIST: PRINCIPAL �j State of Florida State of 1,�I r b14 GI County of: Miami Dade County of: .am I O 4dR' Sworn yl.{or affirmed) nd subscribed before me Swor i,to(or affirmed nd subscribed before me this -{`o day of Wal 2018, by this %h day of r 201k by A. 'aby,u,,1ck, V hnvaM NAME OF LOBBYIST NAME OF PRINCIPAL Produced ID P/roduced ID FO IDENTIFICATION 10'�n OFIDENTIFICATION V/ Personally ` 1 V Personally n Signature of Nota P blic Signature of Notary\'3 blic S)lUk l 92tMuiyi(kvYM R1b-1 Name of Notary,Typed. Printed or Stamped Name of Notary.Typed, Printed or Stamped (NOTARY S )EAL e uk Notaryp Public state of Florida (NOTARY SEAL) . * raw aubhc Stmewmorua DEN ana Ramos N.:41.0.1 rn c m on FF zones C s Gana Ramos y pA 1012019 j 1 My commission FF 207919 p E P at 'r Expires 0400/2019 I 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. Page 4 of 5 CIFy M Miami loath, 1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeochfl.gov Office of the City Clerk Rafael E. Granada, City Clerk CityClerk@miamibeachfl gov Tel: 305.673.741 1, Fax: 305.673.7254 NAME OF LOBBYIST: Adrian K. Dabkowski 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. Sig ature of Lobbyi Date F CLER'SALL\aFORMS\LOBBYIST FORMSLobbybl Reglsratlon Form Revised 01.01.la REG d c Page 5 of 5 DISCLOSURE OF INTEREST SOBE CENTER,LLC SOBE Center Manager, LLC Percentage of Interest Ronald Finvarb and Richard Finvarb %5O 9425 HARDING AVENUE SURFSIDE, FL 33154 Credus I Corporation %50 Credus I Corp is JAJ Consulting SA Jacques Chahine, President 9425 HARDING AVENUE SURFSIDE, FL 33154 I Miscellaneous Cash Receipt CITY OF MIAMI BEACH No. 421179 r ❑ Cash Credit Card Check#______- 20151,_ MBF ( CI0 t( 1i�Ci ( co k,v171wn fir CCUnnr'°'( �. R-eGqrpi25iyAiaf .�„ ,,,1 AA i i . F . a .u(. ' pr).� n 0./ : A*+�cN:2+01C- 9 _ • _.• Y MGR•EN L .)t..) �. .. �J t y.' Mr -... g9/2NLS S Sr OA p is Office of Finance Director (THIS INFORMATION MUST SE COMPLETED) _CU' Or!- 1160- 1;6141-14 -00-72D 2-3S`I - �0 By t. , Account Number. / : ,L//f tk Dept: l r k1 i^ @ Preparer. ✓—,