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Rishi Kapoor - Urbin Miami Beach II Phase I LLC — it DocuSign Envelope ID:B6369C59-F7B3-444B-BC46-59203854E531 I 0� 5`5 t n "V • RECEIVED M I AM I BEACH Office of the City Clerk SEP 14 2022 1700 Convention Center Drive CITY OF MIAMI BEACH Miami Beach, FL 33139 OFFICE OF THE CITY CLERK 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, 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: Kapoor Rishi NAME OF LOBBYIST (Last) (First) (Middle Name) Urbin Miami Beach II Phase I LLC 299 Alhambra Circle,Suite 510 Miami Florida 33134 LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 404-386-7404 rkapoor@location.ventures LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS II. PRINCIPAL INFORMATION: Kapoor Rishi NAME OF PRINCIPAL (Last) (First) (Middle Name) Urbin Miami Beach II Phase I LLC 299 Alhambra Circle,Suite 510 Miami Florida 33134 PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 404-386-7404 rkapoor@location.ventures PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS Pursuant to City Code Section 2-482(h)(1)(a): A principal of any corporation, partnership, or other entity who appears as a lobbyist on behalf of that entity,without special compensation or reimbursement for the appearance,whether direct,indirect,or contingent,to express support of or opposition to an item shall register with the Clerk as required by this 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): • NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY(if none,write N/A): R. Kapoor a • NAME OF ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH LL CORPORATION, PARTNERSHIP OR TRUST(if none,write N/A): Please see the attached. m m Page 1 of 5 pDocVerify ID:DCC6B5E9-34884EF9-AD B4-55DB84A8E81 D Page 1 of 5 155D884A8E81 D 'III i ll III I • DocuSign Envelope ID:B6369C59-F7B3-444B-BC46-59203854E531 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. Legislation regarding Washington Avenue Land Development Regulations, Development Approvals & Permitting 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 1509-1515 Washington Avenue 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 Land Use &Sustainability Committee 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 w 0 V. DISCLOSE RATE AND AMOUNT OF LOBBYIST COMPENSATION — Be Specific. (Note that a w contingency fee is prohibited pursuant to City Code Sec. 2-485.3): $0.00 per hour co m Page 2 of 5 1 DDwwAocfver ry DCC6B5E9-3488-4EF9-ADB4-55D884A8E81 D Page 2 of 5 255D884A8E81 D 1III 11 II I DocuSign Envelope ID:B6369C59-F7B3-444B-BC46-59203854E531 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 x No: 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 offcial(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 X_No: If yes, has it been less than 12 months since the elected official(s) whom you provided campaign consulting 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 8 services to an incumbent member of the City Commission (which lobbying activity is not otherwise prohibited by Code section aP 2-491) shall disclose such particular service on his/her lobbyist registration form and shall orally disclose such particular S 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 00 within the past election cycle?If yes,please list the incumbent member(s)of the City Commission: N O N 0 a — Yes X No: If yes, were you promised or did you receive economic consideration in exchange for campaign m consulting services? 0 I TO BE COMPLETED BY CITY CLERK'S STAFF ONLY ch Annual Registration fee: [ ]Yes(�]No Amount Paid$ -� `MI �CR# Date Paid 1"iL) 2" Lobbyist Registration Form received and verified by: -�+ m F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 09-20-18 REG.doc Revised 09/20/2018 m o o Page 3 of 5 IDocVerify ID DCCSBSE9-3468-4EF9-ADB4-55D884A8E81D 'III O 'I III www.docverify.com Paps 3 of 5 l 3550884ABE81 D • DocuSign Envelope ID:B6369C59-F7B3-444B-BC46-59203854E531 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 COMPENSATOOODURING THE REPORTING PERIOD.' �tSLt t 6yetr Signature of Lobbyist: ayeos�te�rcevse Date 09/08/2022 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-an@pEffiiiMpbfting requirements. l°tSI,UObr Signature of Lobbyist: 39089518e.ce498_ /--DocuSignedby: Date 09/08/2022 Signature of Principal: Date 09/08/2022 J968951tlt11,tl4y8 VII. NOTARY SIGNATURE AND SEAL: LOBBYIST: PRINCIPAL State of Florida State of Florida County of: Miami-Dade County of: Miami-Dade Sworn to (or affirmed)and subscribed before me, Sworn to (or affirmed) and subscribed before me, by means of❑ physical presence by means of❑ physical presence or ® online notarization, or® online notarization, this 8 day of September ,20 22, by this 8 day of September ,2022, by Rishi Kapoor Rishi Kapoor NAME OF LOBBYIST NAME OF PRINCIPAL Produced ID Produced ID FORM OF IDENTIFICATION FORM OF IDENTIFICATION X Personally Know x Personally Known o � . Signature of Notary Public Signature of Notary Public o, o Diana Ramos Diana Ramos N Name of Notary, Typed, Printed or Stamped Name of Notary, Typed, Printed or Stamped 07, Diana Ramos Diana Ramos Commission#GG 308355 Commission#GG 308355 Notary Public-State of Florida Notary Public-State of Florida 4 My Commission Expires Apr 10,2023 My Commission Expires Apr 10,2023 o ' Th: ng persons: - LL w.mxurroavn„n„ .__ ,.,.,.. ,n., sup mvmnae,�mvne w EXpEii rruncaaco vvi,v Nivvi�c vluy aviciiuiw, icviniii;al Or other speclali74 ununilauvil ul ICJIIIIIUIIy III puuliu any person who monly 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 mnot-for-profit community based organization for the purpose of requesting a grant without special compensation or reimbursement for the appearance. Page 4 of 5 ' DDocNd Verify fD:DoCrC6B5E9-3468-4EF9-ADB4-55D684A8E81D Page 4 of 5 455DB84A8E81D 1111 'I III DocuSign Envelope ID:B6369C59-F7B3-444B-BC46-59203854E531 MIAMIBEACH 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: 305.673.741 1, Fax: 305.673.7254 NAME OF LOBBYIST: Rishi Kapoor 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. -Docu Signed by: m f slti r-arbor 09/08/2022 o LasoesIlaEicegso Signature of Lobbyist Date ro F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 03-11-20 REG.doc co m Page 5 of 5 ' DDooVtlonfy�Dy DocrC6B5E9-34B8-4EF9-AD64-SSDB84A8EE1D Pope 5dS 555oe64ME51D ,III F E. s tl III Disclosure of Interest - URBIN Miami Beach II Phase I, LLC Member Entity Address Percentage Interest URBIN LLC 299 Alhambra Circle, Suite 510, Coral Gables, FL 33134 100.00% URBIN, LLC Members Address Percentage Interest Location Equity Holdings, 299 Alhambra Circle, Suite 510, Coral Gables, FL 33134 28.57% LLC Kapoor Capital 299 Alhambra Circle, Suite 510, Coral Gables, FL 33134 7.14% • CCG Urbin LLC 5959 Blue Lagoon Drive Ste 200, Miami, FL 33126 7.14% • Halpern Family Trust 1711 N Fort Lauderdale Beach Boulevard, Fort 7.14% Lauderdale, FL 33305 MMG Limited 9171 South Dixie Highway, Pinecrest, FL 33156 7.14% Investments III, LLC Urbin Partners LLC 110 SE 6th Street, 17th Floor, Fort Lauderdale, FL 33301 7.14% JV Urbin LLC 3471 Main Highway#414, Miami, FL 33133 7.14% DR Urbin LLC 2665 S. Bayshore Drive Ste 1020, Miami, FL 33133 7.14% Allen S. First Revocable 3540 ROYAL PALM AVENUE 0.268% Trust COCONUT GROVE, FL 33134 Otto L. Porter Jr. 3109 GRAND AVENUE 0.89% PMB 447 COCONUT GROVE, FL 33133 Jared Kaplan 6195 SW 92nd St., Pinecrest, FL 33156 1.07% Ghislain Gouraige 8601 SW 54th Ave., Miami, FL 33134 1.07% Jonathan Abel / 10598 NW South River Dr., Miami, FL 33178 1.78% Irrevocable Trust II E. Gutlohn Marital Trust 2511 ANDERSON ROAD 1.43% CORAL GABLES, FL 33134 Aaron Hollub 1.43% Location Equity Holdings, LLC Members Address Percentage Interest Location Ventures, LLC 299 Alhambra Circle, Suite 510, Coral Gables, FL 33134 100.00% Kapoor Capital, LLC Owners Address Percentage Interest Rishi Kapoor 299 Alhambra Circle, Suite 510, Coral Gables, FL 33134 50.00% Brij Kapoor 1055 Huntcliff,Atlanta, GA 30350 50.00% CCG Urbin LLC Owners Address Percentage Interest Thomas P. Murphy Jr. 5959 Blue Lagoon Drive Suite 200, Miami, FL 33126 20.00% • Leslie B. Murphy 5959 Blue Lagoon Drive Suite 200, Miami, FL 33126 20.00% Thomas C. Murphy 5959 Blue Lagoon Drive Suite 200, Miami, FL 33126 20.00% Sean M. Murphy 5959 Blue Lagoon Drive Suite 200, Miami, FL 33126 20.00% Patrick E. Murphy 5959 Blue Lagoon Drive Suite 200, Miami, FL 33126 20.00% Halpern Family Trust Beneficiary Address Percentage Interest Martin Halpern 1711 N. Fort Lauderdale Beach, Ft. Lauderdale, FL 33305 100.00% MMG Limited Investments III, LLC Owners Address Percentage Interest Martin Pico 9171 South Dixie Highway, Pinecrest, FL 33156 33.33% Marcel Navarro 9171 South Dixie Highway, Pinecrest, FL 33156 33.33% Gabriel Navarro 9171 South Dixie Highway, Pinecrest, FL 33156 33.33% Urbin Partners LLC Owners Address Percentage Interest Vivian Bonet 110 SE 6th Street, 17th Floor, Fort Lauderdale, FL 33301 25.00% Torry Watson 110 SE 6th Street, 17th Floor, Fort Lauderdale, FL 33301 25.00% Thomas Tharrington 110 SE 6th Street, 17th Floor, Fort Lauderdale, FL 33301 50.00% JV Urbin LLC Owners Address Percentage Interest Jonathan Vilma 3471 Main Highway, #414, Miami, FL 33133 100.00% DR Urbin LLC Owners Address Percentage Interest David Martin 2665 S. Bayshore Drive Ste 1020, Miami, FL 33133 50.00% Rudy Touzet 2665 S. Bayshore Drive Ste 1020, Miami, FL 33133 50.00% Location Ventures LLC Members Address Percentage Interest Patriots United, LLC 299 Alhambra Circle, Suite 510, Coral Gables, FL 33134 47.917% Diana Ulis as Trustee of 50 W. Street,Apt. 63A, New York, NY 10006 32.930% DARE Trust Halpern Family Trust 1711 N Fort Lauderdale Beach Boulevard, Ft. Lauderdale, 2.500% FL 33305 Thomas J Tharrington 110 SE 6th Street, 17th Floor, Fort Lauderdale, FL 33301 4.167% Torry Watson 110 SE 6th Street, 17th Floor, Fort Lauderdale, FL 33301 0.125% Jared Kaplan 6195 SW 92nd St., Pinecrest, FL 33156 0.625% Ghislain Gouraige 8601 SW 54th Ave., Miami, FL 33134 0.417% Jonathan Aibel 10598 NW South River Dr., Miami, FL 33178 0.521% Vivian Bonet 299 Alhambra Circle, Suite 519, Coral Gables, FL 33134 1.686% LVVL, LLC 14500 Tarpon Drive, Coral Gables, FL 33158 2.083% Scott Robins 230 5th Street, Miami Beach, FL 33139 5.000% Claudio Ravinet 11100 SW 84th Ct., Ste 510, Coral Gables, FL 33134 .100% Dmitry Levkov and 42 West 15th St.,Apt. 4, New York, NY 10011 .150% Inessa Lipovetskaya Jeff Donnelly 415 East 57th St.,Apt. 904, New York, NY 10022 .150% Robert S. Porges and 515 Valencia Ave.,Apt. 202, Coral Gables, FL 33134 .417% Mary Gimeno Porges Patrick James Dwyer and 311 Meridian Ave., #204, Miami Beach, FL 33139 .809% Marisa Elena Dwyer Bradley D. Houser 3630 Plaza St., Miami FL 33133 .404% Patriots United LLC Members Address Percentage Interest • Rishi Kapoor 299 Alhambra Circle, Suite 510, Coral Gables, FL 33134 45.05% Daniel J. Motha 299 Alhambra Circle, Suite 510, Coral Gables, FL 33134 45.05% Kapoor Capital LLC 299 Alhambra Circle, Suite 510, Coral Gables, FL 33134 8.65% Jan Kapoor 1055 Huntcliff, Atlanta, GA 30350 1.25% Kapoor Capital LLC Owners Address Percentage Interest Rishi Kapoor 299 Alhambra Circle, Suite 510, Coral Gables, FL 33134 50.00% Brij Kapoor 1055 Huntcliff, Atlanta, GA 30350 50.00% DARE Trust Beneficiaries Address Percentage Interest Michael Ari Kleyner 50 W. Street, Apt. 63A, New York, NY 10006 33.33% Mia Brook Kleyner 50 W. Street, Apt. 63A, New York, NY 10006 33.33% Nathaniel Derek Kleyner 50 W. Street, Apt. 63A, New York, NY 10006 33.33% Halpern Family Trust Beneficiary Address Percentage Interest Martin Halpern 1711 N. Fort Lauderdale Beach, Ft. Lauderdale, FL 33305 100.00% LVVL, LLC Owners Address Percentage Interest Edwin Villegas 14500 Tarpon Drive, Coral Gables, FL 33158 50.00% Luis Leon 14500 Tarpon Drive, Coral Gables, FL 33158 50.00% A P• 1 • � A C F docferify . g .. • • 4()CVERN Q Lobbyist Registration Form - R. Kapoor - Urbin Miami Beach II Phase I LLC - executed.pdf DocVerify ID: DCC6B5E9-34B8-4EF9-ADB4-55DB84A8E81 D Created: September 08, 2022 13:00:10 -8:00 Pages: 5 Electronic Notary: Yes / State: FL This document is a DocVerify VeriVaulted protected version of the document named above. It was created by a notary or on the behalf of a notary,and it is also a DocVerify E-Sign document.which means this document was created for the purposes of Electronic Signatures and/or Electronic Notary.Tampered or altered documents can be easily verified and validated with the DocVerify veriCheck system. Go to wwwdocver .com at any time to verify or validate the authenticity and integrity of this or any other DocVerify VeriVaulted document. E-Signature Summary E-Signature Notary: Diana Ramos(dra) September 08,2022 13:06:27-8:00[52D4C559E0A9][162.244.152.118] dramos@brzoninglaw.com • I 111111.1111111111 I IIIIII IIIII IIIIII IIII IIIIII IIII IIIII IIIII IIIIII IIII IIIIII IIII IIII IIII DocVerify documents cannot be altered or tampered with in any way once they are protected by the DocVerity VeriVault System.Best viewed with Adobe Reader or Adobe Acrobat. All visible electronic signatures contained in this document are symbolic representations of the persons signature,and not intended to be an accurate depiction of the persons actual signature as defined by various Acts and/or Laws. DocVerify ID:DCC6B5E9.34B8-4EF9-ADB4-55DB84A8E81D -Generated Cover Page 55DB84A8E81D www.docverify.com ,III&V'X. '- 'I I)