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Nicholas Rodriguez Caballero - Rishi Kapoor N I c o z.,5 A''( DocuSign Envelope ID:BB6320E2-635B-4BE2-B8FF-B7742B18C363 RECEIVED m i Am I B EA CH Office of the City Clerk DEC 08 2022 1700 Convention Center Drive Miami Beach,FL 33139 CITY OF MIAMI BEACH 305.673.7411 OFF!�'F rr THE 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: Rodriguez-Caballero Nicholas NAME OF LOBBYIST (Last) (First) (Middle Name) Bercow Radell Fernandez Larkin&Tapanes,PLLC 200 South Biscayne Blvd.,Suite 300,Miami,FL 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: Kapoor Rishi NAME OF PRINCIPAL (Last) (First) (Middle Name) 13th Street Garage,LLC 2665 S. Biscayne Blvd.,Suite 1101 Coconut Grove,FL 331333 PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 404-449-4931 rkapoor@location.ventures PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS ursuant Qj(y Code Section 2-482(h)(1l)a): a principal(liQipy mitpirjbab partnership,Cp G ,l 'iD - m E1 lobbyist m C it 2fl,"- anti dinpill special compensation t 1?rei .ursement(IJl!)E appearance,agliQTCEM,indirect ciy contingent,It)(aJor ivm '7.,eL3i2cy0.,osition tlr =n item shall register with the Clerk as required b this subsection but shall not be required to pa 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 LL ri • NAME OF ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH th CORPORATION, PARTNERSHIP OR TRUST(if none,write N/A): 100% -Rishi Kapoor 0 Page 1 of 5 11 fi:'Se` D05-76D4-4C06-9C42-F28EC26A069B L Page 1 of5_ 1_ 1F28EC26A0698_J ,1I f70rt�`-7G'I III —_— — I3ocuSign Envelope ID:BB6320E2-635B-4BE2-B8FF-B7742B18C363 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 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 1301 Collins Avenue Drive in Miami Beach,Florida. 1V. 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 2 LL 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): Q $325.00 per hour LL Page 2 of 5 I Dwww do ocVerify elr ty com9AD05-76D4-4C06-9C42-F28EC26A0698 I page 2 of 5 .I 2F28EC26A0698 a 'I III I DocuSign Envelope ID:BB6320E2-635B-4BE2-B8FF-B7742B18C363 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 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 XNo: 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 X No: if yes, has it been less than 12 months since the elected official(s)whom you provided campaign consulting services was sworn ini 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. N _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: O _Yes XNo: If yes, were you p,omised or did you receive economic consideration in exchange for campaig consulting services, LL TO BE COMPLETED BY CITY CLERK'S STAFF ONLY th Annual Registration fee: [ ]Yes[ ]No Amount Paid$ MCR# Date Paid 0 Lobbyist Registration Form received and verified by: o F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 09-20-18 REG.doc Revised 09/20/2018 w Page 3 of 5 DocVerify ID:F6E9AD05-7604-4C06-9C42-F28EC26A0696 I— Page 3 of 5 3F28EC26A069B ,rl 'I III www docvenfy.com 9tibe DocuSign envelope ID:BB6320E2-635B-4BE2-B8FF-B7742B18C363 , 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 ATHaNdWJRING.THE REPORTING PERIOD.' Signature of Lobbyist: 146.olas O4,i"�^"7 Date 11/28/2022 b/bb9/I-2U4314J9... 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 requ►renaenttp^edby: /,�,',. A Signature of Lobbyist: Docusigned by: M(u.6L Ls glo "J"L'7 Date 11/28/2022 \—bfbb9/h104.114J9... Signature of Principal: �15�ubOV Date 11/28/2022 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 0 physical presence or M online notarization, or IxJ online notarization, this day of 11/28/2022 . 20 , by this_day of 1,/7R/9m, ,20_, by Nicholas Rodriguez-Caballero Rishi Kapoor NAME OF LOBBYIST NAME OF PRINCIPAL _Produced ID _Produced ID FORM OF IDENTIFICATION FORM OF IDENTIFICATION x Personally Known T— i x Personally Known [—T.-- ci3O Signature pf Notary Public Signature o otary ublic Diana Ramos Diana Ramos c. Name of Notary,Typed, Printed or Stamped Name of Notary, Typed, Printed or Stamped co o Jana Ramos 1 tans Ramos ► 3 Commission#GG 308355 ► 1mmission#GG 308355 / gotary Public-State of Florida / Igotary Public-State of Florida ► u_ 1 Th filly Commission Expires Apr 10,2023 �g persons: ' oy Commission Expires Apr 10,2023 , U .? a,. ter. --.. ...��....�`-. O Ex �":°:`D'""'''?0°°' ' " ' "'°'m'�°al or other specializes nTom mon or testimony in puonc meetings;any person who 0 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 o not-for-profit community based organization for the purpose of requesting a grant without special compensation or reimbursement for g the appearance. LL Page 4 of 5 DocVerify ID:F6E9AD05-76134-4C 06-9C42-F28EC26A0898 r ,II 'I III I ...verify., Page 4 of 5 4F28EC26A069B , DocuSign Envelope ID:BB6320E2-63513-4BE2-B8FF-B7742B18C363 MIAMIBEACH 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 CityClerk@miamibeachfl.gov Tel: 305.673.7411, Fax: 305.673.7254 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. 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 $500.00 pursuant to Section 2-482 of the Miami Beach City Code. "--D' oeuS,igned by: N Mks rbblairli) 11/28/2022 Signature of Lobyls2U4314'y Date 4 F:\CLERL$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 03-11-20 REG.doc LL Page 5 of 5 DocVerify ID: do en com9AD05-76D4-4C06-9C42-F28EC26A0698 I Page 5 of 5 T 5F28EC26A069B ,III 11I III 1 .y �, docv'erify OOCVEIO 4 Lobbyist Registration Form - NR - 13 ST Garage Urbin - EXECUTED.pdf DocVerify ID: F6E9AD05-76D4-4C06-9C42-F28EC26A069B Created: November 28, 2022 10:21:04 -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 www.docverifv.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(DR) November 28,2022 10:23:45-8:00[36F49A054DE9][74.220.90.117] dramos@brzoninglaw.com 11111111 I IIIIII IIIII IIIIII IIII IIIII IIIIII IIII IIIII 11111 111111 11111 111111111111 DocVerify documents cannot be altered or tampered with in any way once they are protected by the DocVerify 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. 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