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Adrian K. Dabkowski - Bradley Colmer • RECEIVED • 1\/\I !\f\/\IEACH Office of the City Clerk MAR 1 7 2020 1700 Convention Center Drive Miami Beach, FL 33139 CIT1` : `: "'VAIVll BEACH • 305.673.7411 OFFICE HE 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: • Dabkowski Adrian K. NAME OF LOBBYIST (Last) • (First) (Middle Name) Kimley-Horn 600 North Pine Island Road,Suite 450, Plantation FL 33324 LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) • 954-535-5144 Adrian.Dabkowski@Kimley-horn.com LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS II. PRINCIPAL INFORMATION: • . • Colmer • Bradley NAME OF PRINCIPAL (Last) (First) (Middle Name) . Sunset Land Associates, LLC/SH Owner, LLC 1691 Michigan Ave Miami Beach FL 33139 • PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-74.9-0921 bradley.colmer@decocapital.com PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS • "uT—r uiapt to at Gude Section )'('ail: A principal of EN corporation, partnersfiip,CG'o her entity cAko .n o-. m a lobbyist CSA behalf of t at -ntity, na special compensation CIFIEMEIERMEIRatIMG appearance, ii indirect,fspcontingent,Q7( 5 000 COQ? ooa to Med with ifir; m re uired ENEIB subsection l l3 ICQlb alit 7fS2 iii 7 o irk 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): Please see attached. •• • 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): Please see attached. Pagel of 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 &permitting issues, including, but not limited to Members of City Administration, Members of City Staff and Members of PB, DRB and BOA, City Commission and.Mayor, relating to the properties located 1752 Bay Rd (folio 02-3233-012-0550),1738 Bay Rd (folio 02-3233-012-0530),1759 Purdy Ave(folio 02-3233-012-0540) , 1747 Purdy Ave(folio 02-3233-012-0520),1743 Purdy Ave (folio 02-3233-012-0500), 1733 Purdy Ave (folio 02-3233-012-0480), 1724 Bay Rd (folio 02-3233-012-0490) and 1730 Bay Rd (02-3233-012-0510). 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 Members of City Administration and Members City Staff X Members of Planning Board (PB) , Design Review X Board (DRB) and Board of Adjustment (BOA) X City Commission and Mayor 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, Familialor Professional Relationship, or other relationshik.giving rise to an appearance of impropriety(if none,write N/A): n/a 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): /4,0/6"b ?.e( rhe ve_ 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 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/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_No: If yes, has it been less than 12 months since the elected officials) whom you provided campaign consItinq services was sworn ins: 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_X No: 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 No: If yes, were you pro ised or did you receive economic consideration in exchange for campaig consu time seruicesr. TO BE COMPLETED BY CITY CLERK'S STAFF ONLY e l 7 Annual Registration fee: r[` yes[ ]No Amount Paid$ ��.CO MCR# t! ��: 'Yt��� )�� Date Paid o ar (�' Z� Lobbyist Registration Form received and verified by: \./c'z". 1 T�-,-• +` .\CLEF:\VALE_\a FORMS FORKS\Lobl!;:st Reg€s2rai:ion Form Revises? OD-20-15 REC doc Revised 09/20/2018 ' Page3of5 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 DURI G THE RE RTING PERIOD.' Signature of Lobbyist: Date 2(17/Zd 9 y 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 r ortin re uirem . Signature of Lobbyist: "r Date- Z fel tO Signature of Principal: Date VII. NOTARY SIGNATURE AND SEAL: LOBBYIST: PRINCIPAL State of .Florida State of . County of: BroWard County of: Sworn to (or affirmed) and subscribed before - Sworn to (or affirmed) and subscribed before me this 27th day of February , /A4.y this_day of , 20_, by Adrian K Dakowski NAME OF.LOBBYIST NAME OF PRINCIPAL _Pr.•uced ID _Produced ID FORM OF IDENTIFICATION FORM OF IDENTIFICATION 'Personally Known _Personally Known _ ',17a 1'e .f Nota Pub lc Signature of Notary Public Shanda Sutton Layne Name of Notary, T ped Printed or Sta •ed Name of Notary,Typed, Printed or Stamped t;P�r4g SHANDA SUTTON LAYNE . � ``q.• Vi, .. ... 41% My COMMISSION#GG 203858 (NO AR n�E1 L�.; ' )(PI (NOTARY SEAL) I ;.4 rXPIRES:April 4,2022 L fifVL" Bonded Thru Notary Public Underwriters 1 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 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.1 Signature of Lobbyist: Date 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 requirements. Signature of Lobbyist: Date CvA Signature of Principal: Date 74 2.55 Zc 20 VII. NOTARY SIGNATURE AND SEAL: LOBBYIST: PRINCIPAL State of State of rim County of: County of: WI\ A 1,N Sworn to (or affirmed) and subscribed before me Sworn to(or affirmed) and subscribed before me this day of , 20_, by this . day of FES , 2024>by -610,0t-'0` �d .-�i& rza Cit cw> NAME OF LOBBYIST NAME OF PRINCIPAL FLAE,t L.-LceNst _Produced ID (/Produced ID C- 415(:)-C> -r71- V3-b FORM OF IDENTIFICATION FORM OF IDENTIFICATION Personally Known Personally Known ::: Signature of Notary Public Sign ture of Not-ryPubfl 4,,E1 ta- jA cj\h� r,,-t Name of Notary,Typed, Printed or Stamped Name of Notary,Typed, Pried-Id-or Stamped NOTARY SEAL) (NOTARY SEAL);. :=r°?•> ` PAMELAJACKSON GG 160789 �.. `�= MY COMMISSION#GG 160789 "• "k.:vz EXPIRES:December 17,2021 ot',Y $" Bonded Thru Notary Public Underwriters 1 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 MIAMLBEACH City of Miami Beach, 1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.gov Office of the City Clerk • Rafael E.Granada,City Clerk CityClerk@miamibeachfl.gov Tel:305.673.7411,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 $500.0 ursuant to Section 2-482 of the Miami Beach City Code. • 9 afr'/zo gnature of Lo Date F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 09-20-18 REG.doc Page 5 of 5 • EXHIBIT "A" DISCLOSURE OF INTEREST Interests in Sunset Land Associates, LLC Percentage of Interest Sunset Harbor Holdings, LLC 100% do 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% do 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% do Deco Capital Group 1691 Michigan Ave., Suite 510 Miami Beach, FL 33139 RWNIH-REP Sunset Harbor, LLC 90% do Deco Capital Group 1691 Michigan Ave., Suite 510 Miami Beach, FL 33139 Interests in Deco Capital Investments, LLC Percentage of Interest Brad Colmer 5.41% do Deco Capital Group 1691 Michigan Ave., Suite 510 Miami Beach, FL 33139 Dan Marinberg 9.90% do Deco Capital Group 1691 Michigan Ave., Suite 510 Miami Beach, FL 33139 M-1752 Deco Investor, LLC 5.01% do Deco Capital Group 1691 Michigan Ave., Suite 510 Miami Beach, FL 33139 Michael Beattie 4.84% c/o Deco Capital Group 1691 Michigan Ave., Suite 510 Miami Beach, FL 33139 Frederic Khalil 8.87% do Deco Capital Group 1691 Michigan Ave., Suite 510 Miami Beach, FL 33139 David Neithardt Beaumont 12.19% do Deco Capital Group 1691 Michigan Ave., Suite 510 Miami Beach, FL 33139 Douglas Silverman 10.19% do Deco Capital Group 1691 Michigan Ave., Suite 510 Miami Beach, FL 33139 Boris Marinberg 1.70% c/o Deco Capital Group 1691 Michigan Ave., Suite 510 Miami Beach, FL 33139 Deco Capital Group, LLC 4.69% do Deco Capital Group 1691 Michigan Ave., Suite 510 Miami Beach, FL 33139 Ralph Bekkevold 19.32% do Deco Capital Group 1691 Michigan Ave., Suite 510 Miami Beach, FL 33139 Joseph Furst 1.7% do Deco Capital Group 1691 Michigan Ave., Suite 510 Miami Beach, FL 33139 Max and Roger Leifer 5.82% do Deco Capital Group 1691 Michigan Ave., Suite 510 Miami Beach, FL 33139 Christopher Roe 1.46% do Deco Capital Group 1691 Michigan Ave., Suite 510 Miami Beach, FL 33139 Gloria Canasi 5.54% do Deco Capital Group 1691 Michigan Ave., Suite 510 GJ Toggle Holdings LLC 3.12% do Deco Capital Group 1691 Michigan Ave., Suite 510 Miami Beach, FL 33139 DCP Sunset Harbour LLC 0.24% do Deco Capital Group 1691 Michigan Ave., Suite 510 Miami Beach, FL 33139 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 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 Carolyn Rowan, 98.5603% as Husband and Wife do Deco Capital Group 1691 Michigan Ave., Suite 510 Miami Beach, FL 33139 Ken Glassman 1.2972% do Deco Capital Group 1691 Michigan Ave., Suite 510 Miami Beach, FL 33139 Mary Harada 0.1299% do Deco Capital Group 1691 Michigan Ave., Suite 510 Miami Beach, FL 33139 Ari Shalam 0.0126% do Deco Capital Group 1691 Michigan Ave., Suite 510 Miami Beach, FL 33139 M-1752 Deco Investor, LLC Percentage of Interest Camilo Miguel 100% do Deco Capital Group 1691 Michigan Ave., Suite 510 Miami Beach, FL 33139 Deco Capital Group, LLC Percentage of Interest Brad Colmer 100% do Deco Capital Group 1691 Michigan Ave., Suite 510 Miami Beach, FL 33139 � k { 5 Miscellaneous:Cash Receipt CITY OF MIAMI BEACH' No 425773 0 Cash Credit Card ©Check# v k,:-..,;:::,,,,,,:.i.,:',:,-,,::::::,,,,,,:,:.,-.,,,,,,i'',',:,::,::,,,,,:::.:4-11:,(:-1' ` 24 A r,a , =Nits lllagnseoys tlt,K 2 u j J i1Fri7 i . `{/ Q-,--,.'',:,!,,-..k,,,',,,",,-.,:' ? 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