Adrian Dabowski/304-312 Ocean Drive, LLCm MIAMIBEACH
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
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 Ordinance 2004-3435.
Dabowski Adrian K.
NAME OF LOBBYIST: (Last) (First) (M.I)
Kimley-Horn and Associates, Inc. 5200 NW 33rd Avenue, Suite 109 Fort Lauderdale Florida 33309
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(954) 535-5144 (954) 739-2247 Adrian.DabkowskiCa~Kimley-horn.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
304-312 Ocean Drive, LLC
NAME OF PRINCIPAL/CLIENT:
600 North 3rd Street. 2nd Floor Philadelphia PA 19123
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(215) 625-9722 (215) 625-0167 IouisjorocofskviCaearthlink.net
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: Phillip McFillin, Louis Orocofsky
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: Phillip McFillin
II. SPECIFIC LOBBY ISSUE:
Redevelopment of 304-312 Ocean Drive - COA, Variance Approvals, and Conditional Use Permit
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship
Planning Dept., HPB, BOA, Planning Board, City Commission * None
~~!~~o s.~~.~~~i~ ~,~.i~
6s .fi un ~ ~ inn ~ooa
* Unless an issue is legislative in nature, HPB, BOA, Planning Board, and City Commission members are ~~a ~u,~idgpj~ ~lic hearing setting.
lV. UlJI:LU~UKt Vt 1 tKM, AMU AMUUIV 1 D Ut LVlStSTl~l l.UP7F'tIVDA11V1V (Ul,I.LV~t WI'7t1 r1CK /'f(lUKL1,
FLAT RATEOR OTHERf
A) LOBBYIST DISCLOSURE: (Required) $1,3a Doer hour
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $ ~~i~ .~o Der hour
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":
0 Yes X No• Are you lobbying on a present or Dendina bid for goods eauipment or services or on a
present or pending award for goods equipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
i7Yes X No• Are you lobbvina on a pending application for a Development Agreement with the Citv or
application for change of zoning man designation or change to the City's Future Land Use
Man?
3) Pursuant to Miami Beach City Code 2-484 (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 anot-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 X No• Are you representing anot-for-profit corporation or entity without special compensation
or reimbursement. .
V. SIGNATURE UNDER OATH:
ON OCTOBER 1~ OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION
RECENED, IN THE CITY OF MIAMI BEACH FOR 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 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 reporting
requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
^ 'Produced ID
Form of Identification
^ Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This day of , 20_
^ Produced ID
Form of Identification
laf Personally known (Principal)
Q~ Pti~ (a ,
State of Fl~la, County of Mia~wi-9aEle
Swor n subscrib before me
This~~day of ,J~(K?~
Signature of Public Notary -State of Florida Signature of ublic~~~~~~;~'
Notarization of Lobbyist's signature Notarizatio of pr~~ 11~~
t+*^miccir~n
FOR CLERK'S USE ONLY
Annual Registration fee: [ ]Yes [ ] No Amount Paid MCR # Date Paid
Lobbyist Registration Form received and verified by:
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST FORM OS.doc
Entered By:
Revised 12/08/04
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHERf
A) LOBBYIST DISCLOSURE: (Required) $ 132.46 oer hour
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $ ~3~ . ~ ~P
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
O~n Procurement Issues":
Yes X No:l Are you lobbvina on a uresent or ~endina bid for goods, eauiument or services, or on a
iaresent or ~endina award for goods, eaui~ment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
apulication for chance of zoning mau desi4nation or chance to the Citv's Future Land Use
Ma°?
3) Pursuant to Miami Beach City Code 2-484 (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 anot-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..
or reimbursement. .
V. SIGNATURE UNDER OATH:
ON OCTOBER 1~ 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 FOR THE PRECEDING CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPEND~1'i! RE~,OR~~OMPENSA URING THE
REPORTING PERIOD. // ~ \
Signatur~Cobbyist
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 Secti n 2-482 of the mi Beach City Code and all reporting
requirements. /,~ ~/
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
Produced ID
rm of Identification
~.~;Y:y~e~ DA3 r~N1~ilcno (Lobbyist)
1 MY DD 4 74
~~. .=' X.~ D STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn t an~ subscribe before e
i day of 520
Signature of ublic otary -State of Florida
Notarization of Lobbyist's signature
PRINCIPAL IDENTIFICATION:
Produced ID
Form of Identification
Personally known (Principal)
State of Florida, County of Miami-Dade
Sworn and subscribed before me
This day of , 20_
Signature of Public Notary -State of Florida
Notarization of Principal's signature
FOR CLERK'S USE ONLY c
Annual Registration fee: [ ]Yes [ ] No Amount Paid ~~_ MCR # (SGo 3 Date Paid ~y ~
Lobbyist Registration Form received and verified by: Entered B
F:\CLER\$ALL\MARIA-M\LObbyist\LOBBYIST fORM OS.doc Revised 12/08/04
City of Miami BQd1th, 17Q0 Convenkion ~en~r L}rive, Miami 6eoch, Florida 3339, www.miomibeochN.gov
~{TY ~lERK Office
Tel: 3Q5.673.7A1 1 ,Fax: 305.673J25e
City {erk@miam ibeachfl. gav
~4B8YIST NAME: ~ / ~U
E understand that no later than October 1 s~...of ~edc~i yr, !must File the following
forms, pursuant to Section 2-4$5 of the Miami Beach City Code, with the City Clerk's
CJffice For all active lobbying issues.
1 ~ lobbyist Expenditure Form
2} Disclosure l=oan
Failure to file these forms on a timely basis will result in my name being transmitted to the
Miami-Dade County Commission on Ethics and for cue violation evaluation.
In addition, once an issue I have registered to tabby on has been resolved, (am required
to immediately notify the City Clerk's C>ffice of lobbyist withdrawal in writing.
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Signature: Dade:
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