Adrian Dabkowski/Margules Properties, Inc.4 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.
Dabkowski Adrian K.
NAME OF LOBBYIST: (Last) (First) (M.I)
Kimley-Horn and Associates, Inc. 5200 NW 33nd 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.dabkowski@kimley-horn.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
Margules Properties, Inc.
NAME OF PRINCIPAL/CLIENT:
381 Park Avenue South Suite 1420 New York NY 10016
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(212) 684-7079 ext 19
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: Eric Margules
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: Eric Margules
II. SPECIFIC LOBBY ISSUE:
Redevelopment of 1155 Collins Avenue
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
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHERf
A) LOBBYIST DISCLOSURE: (Required) $ ~~ ~ ~O / ~ f
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). ~ ' ~ G I"~ ~
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":
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, eauiument or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled °Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
Yes X No: Are you lobbvina 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
Mau?
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
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDIT RES OR COMPENSATION DURING THE
REPORTING PERIOD. h~ (~ /I
Sig ture 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:
~~
Produced ID
.. .. ....... ..l=orm. of Id_.__ e_ n~ ation
~~"'"',~"'S 3NAII~~d SUTTON L~1YNE
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,~ EXPIRES:
rnn,iu D STAMP OF NOTARY:
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 Lobbyists signature
Signature of Public Notary -State of Florida
Notarization of Principal's signature
FOR CLERK'S ,1SE ONLY ~j /1 17 r
Annual Registration fee: [ ~ ]Yes [ ] No Amount Paid y ~ MCR # ~ / f a ( Date Paid ~ ~ v
Lobbyist Registration Form received and verified by: Entered By:
F:\CLER\yALL\MARIA-M\Lobbyist\LOBBYIST fORM OS.doc Revised 12/08/04
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHERf
A) LOBBYIST DISCLOSURE: (Required)
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $
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":
o Yes X No Are you lobbvina on a present or nendina bid for goods equipment or services or on a
present or nendina 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":
oyes X No Are you lobbying on a ep nding application for a Development Agreement with the Citv or
application for chance of zoning man designation or chance to the City's Future Land Use
Mau?
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-proft
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..
p Yes X No• Are you representing anot-for-profit corporation or entity without special compensation
gr 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 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 YDENTIFICATI
^ 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_
Signature of Public Notary -State of Florida
Notarization of Lobbyist's signature
PRINCIPAL IDENTIFICATION:
^ Produced ID
Form of Identification
personally known (Principal)
M~ y,
State of ounty of-f~i~~~~~~e-
Sworn and subscribed before me
This ~_day of ~'1 <- , 20~'
Signature of P~blic~fotary -State of F~e~id~-w
Notarizati of Principal's signature
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FOR CLEfit1C S USE ONLY, ~ /! t~ I
Annual Registration fee: [ ]Yes [ ] No Amount Paid ) SU ^"MCR #~ T D Da a Paid [
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Lobbyist Registration Form received and verified by: Entered By:
F:\CLER\$ALL\MARIA-M\LOUbylst\LOBBYIST fORM OS.da Revised 12/08/04
C'+ty of tVlromi t9~eacth, l7t)E? Convention Cen6e~ Drive, Miami Beach, Floriclo 33l 39, www.miamibeocbfl.gov
CITY CLERK Office CityClerk~miamibecrchfl.gav
Tel: 3QS.G73.7di t ,fax: 3f}5.673J25d
! understand tha# no later than Eat#ober 1 s# of eatch~ear, !must file the following
forms, pursuant to Section .2-485 of the Miami Beaeh City Code, with the City Clerk's
CJffice For all active lobbying issues.
1 ~ Lobbyist Expenditure Form
2~ Disclosure Form
Failure to file these. farms on a timely psis will result in my name being transmitted b the
Miami-Dade County Cammissian an Ethics and for Cade violation evcaluatian.
#n addition, once tan issue 1 heave registered to lobby an has been resolved, l om required
to immediately notiFy the City Clerk's Cfffice of lobbyist withdrawal in writing..
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ignature; Date:
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