Nicholas Rodriguez-Caballero - SWC Miami Beach Botanicals, LLC • DocuSign Envelope ID:DDB1B36C-7D67-45D5-9AD1-C849A5891873 I53 �((��L� i&�
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MIAMIBEACH `l
Office of the City Clerk NOV 2 u!f 2020
1700 Convention Center Drive
Miami Beach, FL 33139 CITY OF MIAMI• T OFFICE OF `SEI LAC'I
IHECi-TY CLARK
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:
Rodriguez-Caballero Nicholas
NAME OF LOBBYIST (Last) (First) (Middle Name)
Bercow Radell Fernandez Larkin&Tapanes,PLLC 200 South Biscayne Blvd.,Ste. 850 Miami,Florida 33131
LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State)
(Zip Code)
(305)374-5300 nrodriguez@brzoninglaw.com
LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER
EMAIL ADDRESS
II. PRINCIPAL INFORMATION:
Whitcomb James
NAME OF PRINCIPAL (Last) (First) (Middle Name)
SWC Miami Beach Botanicals,LLC 1523 Alton Road Miami Beach Florida 33139
PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(813)417-1023
PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS
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If the principal is a Corporation, Partnership or Trust, the following information MUST be provided
pursuant to City Code Section 2-482(c):
(V
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LL • NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY(if none,write N/A): J Whitcomb
a
m • NAME OF ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH
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a CORPORATION,PARTNERSHIP OR TRUST(if none,write N/A):
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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 1531 Lincoln
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
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
N
O
r
LL
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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):
v $200 per hour
N
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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 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 x No: 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: f .es has i been less than 12 months since the -lected official s horn ou .rovided cam•ai.n
consulting serviceswas sworn imro
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:
N
O
N
_Yes X_No: If yes, were.you promise. or did you receive economi consideration in exchange for campaign
,consulting seicespl
LL
LL
m TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
a AnnuaJ Registratiori fee: [ ]'Yes"[ ]No Amount Paid$ 5° MCR# 'i 2�-10 TS Date Paid [�'�I
MLobbyist Registration Form received and.verified by: - CA) c y1-11., 4 F-
FACLER\$ALL\eFORP4SV:OBBYIST'FORMS\Lobbyist Regi$tration,FormRevised.09-2b-18,RESa:
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DocuSign Envelope ID:DDB1B36C-7D67-45D5-9AD1-C849A5891873
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
Signature of PrincipaI )
. C .1 Date , 01A- 910
VII. NOTARY SIGNATURE AND SEAL:
LOBBYIST: PRINCIPAL
State of Florida State of Florida
County of: Miami-Dade County of: -Dad (,(eh
Sworn to(or affirmed)and subscribed before me, Sworn to(or aff�irp ed)and subscribed before me,
by means of 0 physical presence by means ofI pphysical presence
or 0 online notarization, or ■ • I e notarization, AA („
this day of September .2020, by this,.„ day of mer IJ �r 1 20 2Q by
Nicholas Rodriguez-Caballero —ja'rAiS 01161410NAME OF LOBBYIST NAME OF PRINCIPAL
_Produced ID _Produced ID
FORM OF IDENTIFICATION /P.-
FORRM OF IDENTIFICATION
Personally Known -.on Kn��'n
o I /
Signature of Notary Public /. .../_.,;Si• -ture of Prta Public ublic
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Name of Notary, ed, Printed or Stamped , i i k1
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,Typed, Name me of Notary,Typed, Printed or Stamped
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"; (NOTARY SEAL) •. •
N (NOTARY SE •I� +�w .,,, RISALOVETT
f, t a+ ;,, MY COMMISSION#GG 174368 :
LL f ---7.1z.-;o`,; EXPIRES:January 29,2022
Q 1 The term"lobbyist"specifically excludes the following persons: '.4i Me� Bonded ThruNotary Pelle Underwrtltere
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.
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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 CONPENSAIKMDURING THE REPORTING PERIOD.1
Signature of Lobbyist: h{dtialas �`""' Date 10-22-2020
g y �a7c9e7Fc0431439...
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 IndDafl18't5 *in requirements.
IUcketaS rt. Date 10-22-2020
•
Signature of Lobbyist: ` S78sc7F3o131"3�.
Signature of Principal: Date
VII. NOTARY SIGNATURE AND SEAL:
LOBBYIST: PRINCIPAL
State of Florida State of
County of: Miami-Dade County of:
Sworn to (or affirmed)and subscribed before me, Sworn to(or affirmed)and subscribed before me,
by means of 0 physical presence by means of 0 physical presence
or Il online notarization, or 0 online notarization,
this 22 day of October ,2020, by this_day of •20 , by
Nicholas Rodriguez-Caballero
NAME OF LOBBYIST NAME OF PRINCIPAL
_Produced ID _Produced ID
FORM OF IDENTIFICATION FORM OF IDENTIFICATION
x Personally Known _Personally Known
Signati}rwtereit,tarr ruurfc Signature of Notary Public
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Diana Ramos
Narne_otkotDry,Iype_d,PLnIegi,Qr$tar p-d Name of Notary,Typed, Printed or Stamped
{Diana Ramos
j Commission#GG 308355 (NOTARY SEAL)
LL Notary Public-State of Florida
LL Qy Commission Expires Apr 10,2023
u_
• 1 Thi.! _ -, C..r, ,,g persons:
a
• 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.
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MIAMI
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
Tel: 305.673.7411, Fax: 305.673.7254 CityClerk@miamibeachN.gov
NAME OF LOBBYIST: Nicholas Rodriguez-Caballero
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.
0
0
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.
DocuSigned by:
LL \4l.(1.614iS [fib
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Signature of Lobbyist Date
4
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Exhibit A
Disclosure of Interest
Owners of Greater than 5%of SH Parent,Inc.
(with an indirect interest of>5%in SWC Miami Beach Botanicals LLC)
Name and Address %of Ownership
Green Health Endeavors LLC 16.093%
c/o WWJr. Enterprises, Inc.
1 N. Franklin Street,Suite 3175
Chicago, IL 60606
Owned 100%by Trust#101,William "Beau"Wrigley,Jr. as Trustee and sole beneficiary
11465 Old Harbour Rd.
North Palm Beach,Florida 33408
Aegis MA,LLC 12.617%
871 Thornton Parkway
Thornton,CO 80229
Owned 50%by Kevin Fisher(no other owner of Aegis MA,LLC holds 6.309%
more than 5%indirectly)
3407 Apres Ski Way
Steamboat,Colorado 80487
ST Partnership of Tampa,LLC(no individual or entity owner owns more than 8.628%
5%indirectly)
201 N. Franklin St.,7th Floor
Tampa, Florida 33602
Delray Investments, LLC(no individual or entity owner owns more than 5% 8.238%
indirectly)
333 Palm Trail
Delray Beach Florida,33483
N
Enviro Technologies, LLC 6.474%
3321 Club Drive
Miramar Beach, FL 32550
LL
Owned 100%by Colomb Family Trust, Danielle Colomb Becker as Trustee and sole beneificary
3321 Club Drive
Miramar Beach, FL 32550
to
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The Star Trust dated March 21,2017,J.P. Carolan, III,Esq.as Trustee(no 5.932%
trust beneficiary owns more than 5%indirectly)
239 Park Avenue North,2nd Floor
Winter Park,Florida,32786
Howard J. Kessler
120 Casa Bendita 5.784%
Palm Beach, FL 33480
Applicant hereby certifies as of this 21St day of September,2020 that all ultimate beneficiaries with a 5%
interest or greater are disclosed herein.
SWC MIAMI BEACH BOTANICALS LLC,a Florida limited liability company
By:PARALLEL FLORIDA,LLC,a Florida limited liability company, its sole member
By: SURTERRA HOLDINGS,INC.,a Delaware corporation, its sole member
A4k
Na •: James Whi comb
Title. Chief Development Officer&Secretary
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DocuSign Envelope ID:DDB1B36C-7D67-45D5-9AD1-C849A5891873 *Property owner certifies that all holders with interests
greater than 5%are identified in this disclosure
EXHIBIT
Property:1511-1539 Alton Road
C Folio:02-3234-018-0480
Adam Leavitt Owner:BB Plaza LTD
1581 Brickell
Avenue#1001
Miami, FL 33129
Fryd Family Ltd 100%
Partnership The Bessie Giller Trust FBO Alton Road Partners,
523 Michigan Avenue, 15.926%
Miami Beach,FL 33139 Jonathan Fryd LTD
523 Michigan Avenue 1581 Brickell Avenue
Miami Beach,FL 33139 #1001
-.551% Miami, FL 33129
50%
100%, 50% Gary Dix
r "NJonathan FrydDix Hammer 1581 Brickell
523 Michigan Avenuer Avenue#1001
James Resnick Lionel Resnick Investment Partners Miami,FL 33129
♦ J
Miami Beach,FL 523 Michigan 1228 Alton Road 1581 Brickell Avenue •-/
100% Avenue -19% Miami Beach,FL #1001
Miami Beach,FL 50% Miami, FL 33129
a F.J.I. Properties, Inc. I Fern Resnick
LL
(Florida Corporation) 50% Sarita Holding,LLLP 1228 Alton Road
15 1228 Alton Road Miami Miami Beach,FL
523 Michigan Avenue Beach,FL 33139 115%
-10% 33139
x Miami Beach, FL 33139
U -20% 10%
-1% -20%
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BB Plaza LTD
523 Michigan Avenue
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Lobbyist Registration Form - NR - fully executed.pdf
DocVerify ID: 74CC807C-1052-430C-AB84-2FBAOFF7142A
Created: October 22, 2020 12:22:35 -8:00
Pages: 9
Electronic Notary: Yes / State: FL
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E-Signature Summary
E-Signature Notary:Diana Ramos(dra)
October 22,2020 12:23:29-8:00[8B46DAF14FBD][162.244.152.118]
dramos@brzoninglaw.com
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E. Miscellaneous Cash Receipt
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CITY OF MIAMI BEACH-. . w , . ,
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