2024 Lobbyist Registration Form - 1250 West Ave (Michael Stern) ���o Wes� �]V� .
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1700 Convention Canter Drive
Miami Beach, FL 33139
305.6737411 CITY OF MIAMI BEACH
OFFlCE OP THE CITY CLERK
LOBBYIST REGISTRATION FORM
LobCyist means all persons employetl or retaineQ whether paitl or not, by a pnncipal who seeks to enwurage the passage, defeat or
modifcation of any ortlinance, resolutian, action or tlecision of any commissioner, any action, decision, recommentlation ot the Ciry
Manager or any City baard or committee;or any action,decision or recommandation of any Ciry personnel tluring Ihe time period of Ihe
entire tlecision-making pmcess on such aclion, tlecision or recommentlation ihat foreseeably will be heaM or reviewed by Ihe Ciry
commission, or a City boaN or commiVee. The lertn speuficalty inclutles ihe pnncipal as well as any employee engaged in lobbying
activities.The term"Lobbyists° has specifc ezclusions. Please refer to Ciry Code Chapter 2,Article VII, Division 3, entitled"LobOyisis,"
(or additional in(ormation.
Inatmclions: Please complete all sections of t�is Porm and submit the compleletl fortn,with the applicable fee, to ihe Otfice of the City
Clerk. If you need more space to wmplete an answer, use a separate sheel(s)of paper. If you have rrothing to report in a particular
section, you musl wnte "none" or "Na" in t�at section. My change to any information onginalty fleQ or any adtlitional City
Commissioner or personnel who are also sought to be IOEbied shall require Ihat the lobbyisl file an amantlment to the registration form.
The lobbyist has a continuing tlury to supply informalion antl amend the fortns fled [hroughout Me periad that ihe lobbying occurs.
Separale regisird�ion(orms shall be requiretl Por each pnncipal represenletl on each specific issue.
I. LOBBYIST INFORMATION:
Dabkowski Adrian K.
NAMEOFLOBBVIST (Last) (First) (MitltlleName)
Kimley-Horn 8201 Peters Road,Suite 2200 Plantation Florida 33324 Florida 33131
LOBBVISTBUSINESSNAMEANDAODRE55 (NumCerantlSireM) (Cily) (State) (ZipCotle)
954-535-5144 Adrian.Dabkowski@Kimley-hom.com
LOBBVISTBUSINESSTELEPHONENUM9Eft GEILULARTELEPHONENUMBER EMAILAO�RE55
II. PRINCIPAL INFORMATION:
Stem Michael
NAME OF PRINCIPAL (Lasi) (Firsl) (Middle Name)
JDS Development FL LLC 120 NE 27 Street,Suite 200 Miami Florida 33137
PRINCIPALBUSINESSNAMEANDAODRE55 (Numbe�anG51ree1) (City) (S�a�e) (ZipCatle)
646-625-3649 msternQjdsdevelopmentcom
PRINQPALBUSINESSTELEPHONENUMBER CELWLARTELEPHONENUMBER EMAILA�ORESS
Pu�suanl to City Cotle Sadion 2<82�h)(1)(a): A pnncipel of any corpordtion, patlnerehip, or otM1er entiry who appears as a lobbyist on behalf ol Nal
entity,vnthout special compensation«raimbursemant for cM1e appearanca,whether tlirect,intllrecp or confingent,b express suppotl of or opposilion to
an item shall register with Ue Cladc as required by ihis subsection but shall not be requiretl to pay any registration feas.
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 BENEFICIARV(if none,write N/A): M Stern
. NAME OF ALL PERSONS HOLDING, OIRECTLV OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION,PARTNERSHIP OR TRIlST(ii none,write N/A): M1CIlae1 Stein -100�
Page 7 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.
Development Approvals and Code Amendments including but not limited to the Historic Preservafion
Board, Design Review Board, Planning Boazd, Board of Adjustment, Land Use Development, City
Commission, and any City Workshops or Committees,if necessary,relafing to the property located
at 1250 West 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 contrectual relationship.
Full Name of Individual and Con[ractual Rela[ionship (If yes, explain) YES NO
Ti[le of Pereon to be Lobbied
Staff for the Plannuig& Building Department None X
Public Works&City Adminisiration,PB, HPB, BO None X
DRB, City Commission, and Mayor as necessaro None X
Land Use &Sus�inability Committee None X
Pursuant to City Code Section 2-082(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
appearence of an impropriety, with any current City Commissioner or City personnel who is sought to
be 1o66ied as identified on the lobbyist regis[ration form filed.
List any Business, Financial, Familial or Professional Relationship, or other relationship giving rise to an
a earance of im ro rie if none,wri[e NIA :
None
V. DISCLOSE RATE AND AMOUNT OF LOBBYIST COMPENSATION — Be Sqecific. (Note that a
contingency fee is prohibited pursuant to City Code Sec. 2-485.3):
$395.00 per hour
Page 2 of 5
The following six(6)queslions MUST be answereE:
1) Pursuant to City Cotle Section 7�88,entiHetl"ProhibRetl Campaign Coniributions By Lobbyisls On Procurement Issues":
Yes X No: A i oo � res [ d' b'tl f d I � �
oendna award tor 000tls.eauiomenl or service7
2) Pursuant�o City Code Section 2-090, en�itletl"Prohibited Campaign ConMbutions By Lobbyists On Real Estate Development
Issues":
Vas X No: Are vou lobbv'no on a oend'nq aool'cat'on for a Devalooment Apreemant with tha Cilv or aoolication
for chanae of zon'no mao tles'anat'on or chanae to the Citv's Future Land Use MaoT
3) Pursuant ro City COEe Section 2-d82�h�, any person (except Ihose exempt from the tlefinition ot "lobbyist" as set forih in
Section 2-081�who only appears as a representative of a no4for-proft coryordlion or entiry without special compensation or
reimbursement for t�e appearance,whether Eirect or intlirect to express support of or opposition to any item,shall regisler with
the ciry clerk as requiretl by lhis section,but shall nat be requiretl lo pay any registralion fees.
YesXNo: A C a 61 f! t'o fN 'lh t BC'al C o f
reimbursement7
4) Pursuant to City Cotle Section 4187, the lerm "lobbyisf' speci(cally ezcludes the following persons: Ezpert witnesses who
provide only scientifq techniwl or olher specialized information or�es�imony in public meetings;any person who onty appeers
as a representative of a neighborhootl association without wmpensation or reimbursement for ihe appearence,whether tlirect,
inCirect or wntingent,ro express support of or opposition ro any item;antl any person who only appears as a represenlative of
not-for-proft community based oryanization for the purpose of requesting a gan� wi�hout special compensation or
reimbursement for Ihe appearance.
Ves XNo: A o �d I Yf t h ' I th 'al' etl InMrmation� a r'n
o �tativ oi a nelohborhood assoc'aCon without soee'al eomcensation or reimbursement or
p tl bi - ft b ed o a I f f �h mo f E t w'lh t
soec'al comoensation or relmbursemantl
5) Pursuant to City COCe Section Pd91�1�, no campaign consullant shall labby the Ciry Commission for a penod of 12 monihs
following ihe sweanng in of any electetl offcial(s)for whom the campaign wnsul�an� pmvided campaign wnsulling services
wilhin Ihe pas�election cycle.See Sec�ion 2-091 (or more information.
Ves XNo: H o 0 0 'E d Iti a s t be t E f ih C'N C 'ss'on
Yh' th oa t I f I '+If nl f Hh ' b � be 1 1 f lh CN C mm' ion'
Yes x No: If v h 't been less than 12 monihs sinee Me elected oRc'al(sl whom vou oravided camoaian
— — eonsuHina servicos was sworn In7
6) Pursuant ro Ciry Cotle Section 7d82�a��4)a., a lobbyis�who has within ihe past elec�ion cycle proviEetl campaign consuiting
services to an incumbent member of ihe City Commission(which lobbying activity is not olherwise prohibited by Code section
2-491) shall disclose suc� particular service on �islher lobbyist registration form antl shall orallv tlisclose such oaNcular
b fo I bb ' N G't C [ Ef ti
Yes X No: H 'tl tl Iti t Ee t be (th G'N G i
Ithi th � I ct' I 71f I I' t th ' b t be 1 1 f[h C'N G ' n'
Ves X No: H vou o d dd elve eeonom c cons'deratlon In exchanae for camoalan
consuNinn servlees7
( TO BE COMPLcETE�D'�BY CRY GLERK'S STAFF ONLY
Annual Registntlon fee: [1]Yes� ]No Amoun[Pa�iE S1�,� MCR N Dah Paitl/��l�X
Lobbylst Repistmtion Form receiveE antl verifietl by:�I
rnatv�sau��aFoams��ooeru� roen�s.�obnyisva.:g�r.�aeonrormucvixaov-io-isaee.mo RevISM09/20/2018
Page 3 ot 5
VI. SIGNATURES UNDER OATH:
ON FEBRUARY 28 OF EACH YEAR. EACH L08BYIST 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 TME SPECIFIC ISSUE ON WHICH THE
LOBBYIST HAS BEEN ENGAGED TO LOBBV. A S7ATEMENT SHALL BE FILED EVEN IF THERE HAS BEEN NO
EXPENDITURE OR COMPENSATION DURING THE REPORTING PERIOD.'
SignaNre of LobbyisC Da�e
I do solemnly swear or affrm that all o!ihe toregoing facts, statements, and disclosures in �his form are lme and correcL
and that I have read or am lamiliar with Ihe provisions contained in Chapter 2, Art. VII, Division 3, entitled °Lobbyists" of
the Miami Beach Ciry Code and all reporting requirements.
Signature ofLobbyist: Date
Signature of Principal: I A � Date��
VII. NOTARY SIGNATURE AND SEAL:
LOBBYIST: PRINCIPAL
State of Florida State of Florida
Counry of: Miami-Dade County of: Miami-Dade
Swom to (or affirmed)and subscnbed bafore me, Swom to(or aRrm,gd)and subscribed before me,
by means of 0 physical presence by means of CC�Yphysical presence
or O online no�arization, or O online notarization,
this day of . 20_, by this�''�day ot ,�7iil-D f�-�r .20 Z47y
Adrian Dabkowski Michael Stem
NAME OF LOBBVIST NAME OF PRINCIPNL
_Produced ID _Produced ID
FORM OF I�ENTIFICATION FORM OF IOENTIFIGATION
Personally Known v`p¢reonally Known
/�a`1--
Signature of Notary Public Signatur�'of No ary Public
�;tic.�.C�t, ��al d i rrr rz�—
Name o(Notary, Typed, Printed or Stamped Name of No[ary, Typed, Printed or Stamped
(NOTARV SEAL) (NOTARY SEA ,
�, .....
�p;. "'M�., SNEILAW�LLIAMS
MY COAIMISSION N HH 413350
`::�: E%PIRES:PuWs�19.2047
�The term"lobbyisC'specifcally azdutles ihe following persons:
Ezpert witnesses who provide only scientifq technical or olher specializetl information or testimony in public meetings;any person who
only appears as a rapresenWtive of a neighborhood association without compensation or reimGursement for the appearance, whether
tlirect, intlirect or conlingent,ta express support of or opposition lo any item; antl any person who anly appears as a rep2sentative af
noFfor-pro�t community basetl organization for the purpose of reques�ing a grant without special compensatian or reimbursement for
the appearonce.
Page 4 of 5
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.'
Signature of Lobbyist I 0.�.YtaU. �z. �aL�DU/5�1 Date l0/8/202a
�seee�vxvmuu...
I do solemnly swear or affrm 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 [he provisions con[ained in Chap[er 2, Art. VII, Division 3, entdled "Lobbyists" of
the Miami Beach City Codey��Rejyprting requirements.
Signature of Lobbyist: I QA�Y�. S. V�DW5�1 Date lo/8/m24
58]B1F9M'CE3YJ..
Signature of Principal: Date
VII. NOTARY SIGNATURE AND SEAL:
LOBBYIST: PRINCIPAL
State of Florida Sta[e of Florida
County of: h4iami-Dade County of: Miami-Dade
Sworn to(or�r•r��4�med) and subscribed before me, Swom to(or affrmed)and subscribed before me,
by means f�5hysi I presence by means of 0 physical presence
or 0 o tarizat or 0 online notarizatioq
this day of ��y Ihis_day of . 20_, by
Adrian Dabkowski Michael Stern
NAME OF LOBBVIST NAME OF PRINCIPAL
�roducedlD _ProducedlD
FORM OF I�ENTIFICATION FORM OF IDENTIFICATION
Pers nally Known _Personally Known
I `
ur of N ry Pu ic Signature of Notary Public
��iF��l ��i �/✓�
Name of Notary, Typed, Printed or Stamp � Name of Notary, Typed, Printed or Stamped
�T Y SEYI!!WAsunow�arec (NOTARY SEAL)
n� \, . Nu�ary✓ubli<-StaleofRotlda
���" CommissionMHH3�J0��
���!'uri� My Comm.ExplresApr�,3016
faU !y C4n.
� The A - following persons.
Expert witnesses who provide onty scientifiq technical or other specialized information or teslimony in public meetings�, any person who
only appears as a representative of a neighborhood association without compensalion or reimbursement for the appearanw, whelher
direcl, indirect or contingenl, to express support of or opposition to any item; and any person who only appears as a representative of
nobforvprofit community based organization for the purpose of requesting a grant without special wmpensation or reimbursement for
ihe appeardnce.
Page 4 of 5
;'` ' ! ;', � :�'�, I E3 c E�.C, f-i
Ciy of Miami Beaoh, V00 Convention Center Drive,Miami Bea<h, Florida 33139,www.miamibeochfl.go.
Office o(ihe Ciy Clerk
Rafoel E.Granado,Cily Clerk CityClerk@miamibeachfl gov
Tel: 305.673 7411, Pox: 305.6737254
NAME OF L0B8YIST: Adrian Dabkowski
1) LOBBYIST FEE EXPENDITURE AND COMPENSATION STATEMENT
Pursuant to City Code Section 2-485(d), the Ciry 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 fle the Statement or pay the
assessed fines aker notification.
Any lobbyist, who fails to file the required Statement by April 30�" of each year, shall be
automatically suspended from lobbying until all fnes 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 immediatety 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 ihe Miami Beach City Code.
�u«..m•ww:
IQ 1..� � ila��� 10/8/2024
SM� y
Si @l�SP'�'bbbyist Date
i WlER1EPlL�aFORM6�LOBBYI6T PoRMSLoeeylsl ReglNalim Form ReNcea O193D FEQ.Eoc
Page 5 of 5
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