Kurt Dannwolf - 5333 Collins Acquisitions LP, A Delaware limited partnership 5333 Ca , s
IAMI
UN1 20aceoe . .
- '
1700.Conve tion l enter Drive • • ?1 MI 63E1q�l-I .
o IFTY OF T�,
,Miami Beach, FL 33139 .. CI'TY,CLER(( ::
::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, defeator
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,decisionor 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, ora-Ci y board or committee.:The•term specifically includes:the principal as wellFas an employee.engaged in'lobb in ..
Y .. Y 9
.. activities.The term "Lobbyist"'has specific exclusions. Please refer to City Code Chapter.2, Article VII,•Division 3,.entitled"Lobbyists,"::
for additional information.
I• nstructions: 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 psheet(s)of paper. If you have nothingtore ort in a•particular '
P Pseparate . PP. Y P p
section,.yoU•:must write "none".or:•"n/a" in that section. Any change to any information originally filed, be: any additional City I :
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:
Dannwolf.. .. ....: Kurt .. ..
: : :. NAME OF LOBBYIST•. :. (Last): :: :_ :• (First).- : : :::.(Middle Name)
• ODP.Architects 2432 Hollywood Blvd :Hollywood FL 33020
• •'LOBBYIST BUSINESS NAME AND ADDRESS : (Number and Street) ••' (City) : : (State) (Zip Code)
954-518-0833 - ---
• LOBBYIST BUSINESS TELEPHONE NUMBER . .: : : :CELLULAR TELEPHONE NUMBER .. . :•..:. EMAIL ADDRESS . :. .
II. PRINCIPAL INFORMATION:
.
. . .. . Kornberg.. .. ....:- Jordan .. . .. . .. . . .. .
_NAME OF PRINCIPAL • •:; Last First:
- (Last). ... . ( ) (Middle Name)
• 5333 Collins Acquisitions LP,:a Delaware limited partnership 2601 Bayshore Drive;Suite 850,Coconut:Grove, Florida,33133:•::
• :•PRINCIPAL BUSINESS NAME AND ADDRESS :: (Number and Street) (City) • , :: :• (State) .(410 Code) • '
305=360-0541 - -: • ••:: - - -: jkornberg@mastcapital.com ' •
PRINCIPAL:BUSINESS TELEPHONE NUMBER . .. :CELLULAR TELEPHONE:NUMBER . . : EMAIL ADDRESS•. :•.: .
ENrsuant toy:City,Code Section:2 48Z(h)(c;1)(a) A.�principal of any corporation;partnership or other entity who appears,as a lobbyist;on behalf°of tha#t
., `ntity w.t,,44,sp`eeial compensationror rermbursement;forSS e appearance,whether direct induuaeet or contingent;to express,suoportaof or-opposition:tq. -
ri itemishall register wrthvthe`.Cierk as r';equ;red!Oi,rINs subsection but shall not be required to•pay;any,)registration fees.{
.
If the principal•is; a•Corporation, Partnership or Trust; the following information MUST be. provided
._ : pursuant to City Code Section 2-482(c) .. . : __ .
'i : NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY(if none;write NIA):Camilo MiguelJr.::Jr. : .
:
• i 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 Exhibit A.
... 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.
Land Use and Zoning approvals for 5333.Collins Avenue.
IV. CITY AGENCIES/INDIVIDUALS TO BE-LOBBIED:
Pursuant to Cit Code Section 2-.482 a 4 list the CityCommissioner or
. Y� .. O( ), ... ... 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 .N9.;
Title of Person to be Lobbied.:
Design Review Board X
:Planning Board
City Commission and Staff :: 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):
•
:V. DISCLOSE RATE AND AMOUNT OF LOBBYIST COMPENSATION =:Be Specific: (Note that a
• c_ o_ntin enc ee.is .rohibited: ursuant to Ci Code Sec. 2-435.3):9 Y p p
y0�� .. .tip
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The following six(8).questions MUST be answered:
1) Pursuant to City Code Section2-488,entitled"Prohibited Campaign Contributions By Lobbyists On Procurement Issues":
Yes x No: :Are'you lobbying ona present be 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 indirectto express support of or opposition to any item,shall register with
• the city clerk as required by this section;but shall not bp required to pay any registration fees:
Yes x No: Are you representing a not-for-profit corporation orentity without special compensation .or
reimbursement?.. .
•
4) Pursuant tor 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 supportof or opposition to any item;and any person who only appears as a representative of
not-for-profit community basedorganization 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 otherspecialized information; appearing as.a
.representative.of a neighborhood associationwithout 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 ithe City Commission for period of 12 months
following the sweanng 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 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 theincumbent member(s)of the City Commission:.
•Yes x No: If yes, has it been less than 12-months since the elected official(sL whom you provided campaign :
6onsultinq services was sworn in?i.
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 x No f yes,rwere you promised or;did you receive economic consideration it exchange.for'campaign/
—..:.. �. is_ .. ..
cons ifing`services?4 •
TO BE COMPLETED BY CITYY CLERK'S STAFF ONLY .. ;
Annual.Registration fee Amount Paid$"-7S4`5 '��MCR# Date Paid
LobbyistRegistration Fora received and verified by: •
'F;\CLER\$ALL\aFORP'S\L.O,BBYIS1 FORMS\lobbyist Registration Form Revised 03:X1-30 REG.doc Revised 03/11/2020.
Page 3of5
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 COMP ATION-D NG THE REPORTING PERIOD.?.:
1
Signature of Lobbyist: Date 6' Vii!
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 fa with the provisions contained in Chapter 2:, Art. VII, Division:3, entitled"Lobbyists of :
:the Miami Beach City Code -;#• . 'ep:, ' ::•-, irements.
' i:: :. ,fi . • :•
Signature of:Lobbyist: _ ,, Date
Signature of Principal: Dae
t ��. .
VII. NOTARY SIGNATU-E AND.SEAL:
LOBBYIST: ... PRINCIPAL...
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State of C� : : State o .:..
C
ount of
Countyof �J?ro�-�U�� ��L
Sworn to(or affi ed)and subscribed before me; Sworn to(or affirmed)and subscribed before me,
bymeans ofl
physicalpresence
by means of physical presence
or 0 online notarization, or EllNe e notarizapci, :.
J
this : 0 day of Eli u&..t_i " . ,201;:by this ay of '44- : , 207-"-/, by
1 6f-T T) cP :
or •i: doh
:. NAME OF LOBBYIST: : :NAME OF PRINCIPAL : _- :
_Produced ID 3�L Dr ri�e� L r u'�5-
Produced ID
FORM OF IDENTIFICATION : : FORM OF IDENTIFICATION
Personally:Known : P rsonally Known: : ::
r
Sig ature ofgCe?,
oPublic
ry- Signature of Notary Pub..c
.
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Nameof Notary,Typed:Printe�or Stamped Name of — — —
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A.��•�Y�w�,c . -�(➢AFOLA NAZARK ICH 1-
(N• • '"o�-Ar ) : :(NOTAR :.= MY COMMISSION#Gd 290927:
. .. . . .. . . �'�. . . . :
����;��P;,�%; PRLSYLA.AGUAYO '?.F�`oP �PIRES:Apri17,2023: i.
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*�'�_Notary Public-State of Florida
GG 946194
1:The term....': sp ty+@9it desafperlilowNng persons: -
January 12, 2024; ..
Expert wi nesses who provide only spur] IGT lecIHuta]orother specialized iinformation.or testimony in public meetings;any person who only appears as a representative ofa neighborhood association Without compensation or reimbursement for the appearance,whether
direct, indirect or contingent,to expresssupport 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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MAM IBEAS«
City of Miami Beach,1700 Convention Center Drive,Miomi Beach,Florida 33139,www.miamibeachf1.9av
Office of the City Clerk - - . ..
Rafael E.Granado,City Clerk CityClerk@miamibeachf.gov
:Tel::305.673.741 1,:Fax::305:673.7254 . .: :. .
NAME OF LOBBYIST: Kurt Dannwoff
1) LOBBYIST FEE EXPENDITURE AND.COMPENSATION STATEMENT
Pursuant :to City Code Section 2-485(d), the City Clerkshall notify any lobbyist (or
principal)who fails to file timely a Lobbyist Fee Expenditure and.Compensation.Statement
(Staternent). In addition to any other penalties that:may be imposed: as provided in ...
Section 2-485:.1,:a fine of $50.0.0 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 failsto file the required.Statement by April 30th of each year, shall be - :
automaticall suspended from lobbying until all fines are Paid;,unless the.fine'has been.
Y P Y g.
P
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): H LOBBYIST WITHDRAWAL
Once an issue I haveregistered to lobby.has concluded or t am no lonser 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 : r;'
commencing:October 1 of each::year, and the fee for such annual registration shall be
$50 .0.0:pursuant to Section 2-482 of the Miami Beach City Code:
Si atureof Lobbyist 3 Date :
F:ICLER\SALL1aFORMSILOBBYIST FORMS1Lobbyist Registration Form Revised 03-11.20 REG.doc'..
Page5of5. .. . •
Exhibit A..:
5333 Collins Acquisitions,LP
• 5333 Collins Mezzanine,LP(100%)
o 5333 Collins Associates,LP(100%)
II M-5333 Collins Associates,LLC(100%)
M-5333 Collins Investor,LLC(10%)*.
SOF-XII 5333 Collins Holdings LP,L.P. (90%)*
{{
*All persons own less than 5% interest in 5333 Collins Acquisitions,LP. .. .
58397530;1
- w
Miscellaneous Cash Receipt
„
CITY OF MIAMI BEACH -
42$1;I
Credd Card Check# `
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t3 L ,S ' , t- � i°
f.,..:,....::: �� tsce aneous-N�ctt.:aura - �-
Payment Pmount: �ThO 60
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