Cory Dorman - Shore Club Property Owner, LLC 401collfd� /�-�-(
DocuSign Envelope ID:C6EEA09A-7BA1-4BEA-AF1B-FE6A5FED4302 RECEIVED
MAY 10 2022
tV\I A/V\I B EAC H Office of the City Clerk cow OF MIAMI BEACH
1700 Convention Center Drive ORME OF THE CITY CLERK
Miami Beach, FL 33139
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:
Dorman Cory
NAME OF LOBBYIST (Last) (First) (Middle Name)
Kimley Horn 355 Alhambra Circle,Suite 1400 Coral Gables Florida 33134
LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(954)535-5114 cory.dorman@kimley-horn.com
LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS
II. PRINCIPAL INFORMATION:
Witkoff Alex
NAME OF PRINCIPAL (Last) (First) (Middle Name)
Shore Club Property Owner,LLC 233 Broadway,Suite 2305 New York, New York 10279
PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
O
(212) 672-4750 alex@WITKOFF.com
PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS
0
Pursuan tl ilft •• principaloff e corporationpartnership,OI C n(1T-�1 appearsfS ail Cif at("tr[-Cab. j 2-482�h� G� • . artnershi • • a�t7 Qo•o • .- •
entity,&Role special compensa ion(•1f : •�foraliG)appearance,dd1 t•TI flinEta CT contingent,mt ••• (Su o••osrfon t't
an item shal register with he elerk as required by his subsection but s;all not be required to eav any reels a ion fees
N
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): A. Witkoff
• 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): Please see the attached.
N �y_
c Page 1 of 5 scanty,
--4-*
1 i
MAY 2 5 2022
['Tana'Rp„Lh )D-5D60C24DCCCA I ,III BRAE II II I
15060C24DCCCA
DocuSign Envelope ID:C6EEA09A-7BA1-4BEA-AFIB-FE6A5FED4302
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 &Planning 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 1901 Collins
• 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
N
appearance of impropriety(if none,write N/A):
None
U
❑
U '
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):
260
$ per hour
U
Page 2 of 5
DocVerify ID:22114C52-9181-4CE8-BE3D-5D60C24DCCCA Page 2 of 7 I 25D60C24DCCCA ,Ill p(qY 'I III
www.docvenfy.com CSs1;.T'
DocuSign Envelope ID:C6EEA09A-7BA1-4BEA-AF1B-FE6A5FED4302
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 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 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 XNo: If yes, ha it been less than 12 months since the elected official(s) whom you provided campai,o
consulting services was sworn inr.
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:
0
U
0
o Yes XNo: If yes, were you ®romised or did you receive economic consideration in exchange for campaig
Gonsultlnq Senvicest.
a
0
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
co
Z
Annual Registration fee: l�j Yes[ ]No Amount Paid$ 5�' MCR# 1740� Date Paid dsr (�� 2
m Lobbyist Registration Form received and verified by:
F:\CLER\$ALL;aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 09-20-18 REG.doc Revised 09/20/2018
Page 3 of 5
fM DocVerify ID:22114C52-91B1-4CE8-BE3D-5D60C24DCCCA www.docverify.com Page 3 of 7 _—� 35D60C24DCCCA ,III INFISII III
— ---- ---
DocuSign Envelope ID:C6EEA09A-7BA1-4BEA-AF1B-FE6A5FED4302
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 CO 3=ION DURING THE REPORTING PERIOD.1
Signature of Lobbyist: Corti VOMM• Date 05/09/2022
766 E18DC91E4B9...
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 Cocke-dtictititintaporting requirements.
Nvout!/t.
Signature of Lobbyist: \-� tinoa.9itges DocuSignedby: Date 05/09/2022
Signature of Principal: [ Date 05/09/2022
8683aDr,5o9'a2r 1 E...
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 0 physical presence by means of 0 physical presence
or Cl<online notarization, or Llonline notarization,
this day of 05/09/2022 120 , by this_day of 05/09/2092 ,20_, by
Cory Dorman Alex Witkoff
NAME OF LOBBYIST • NAME OF PRINCIPAL
Produced ID —Produced ID
FORM OF IDENTIFICATION FORM OF IDENTIFICATION
x Personally Kno X Personally Kn -�
r.
Signature of Notary Public Signature of Notary Public
0
Diana Ramos Diana Ramos
Name of Notary,Typed, Printed or Stamped Name of Notary, Typed, Printed or Stamped
O / Diana Ramos ► / Diana Ramos
O I Commission#GG 308355 > 1 t;ommission#GG 308355
IC!otary Public-State of Florida ( 1 Rotary Public-State of Florida
My Commission Expires Apr 10,2023 1 fly Commission Expires Apr 10,2023
•
cl
1 The g persons:
m
LIJ 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.
Page 4 of 5
DocVerify
do eiD:21114C52-9181-4CE8-8E3D-5D60C24DCCCA Page 4 of 7 45D60C24DCCCA J ,III pr. 'I III
DocuSign Envelope ID:C6EEA09A-7BA1-4BEA-AFIB-FE6A5FED4302
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: Cory Dorman
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
m
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.
DocuSigned by:
Ron? ObVtMAAa,
05/09/2022
0 7cr c10DCo1c409...
Signature of Lobbyist Date
rn
F:ICLER\$ALL1aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 03-11-20 REG.doc
U
Page 5 of 5
I DocVerify ID:
en'fy cam 4C52-9181-4CE8-BE3D-SD60C24DCCCA Page 5 of 7 I 55D60C24DCCCAJ ERNE"III
DocuSign Envelope ID:C6EEA09A-7BA1-4BEA-AFIB-FE6A5FED4302
Owners of Monroe Management Holdco,LLC:
:MS DJ (36.87%)
Bonaccord Mammoth
Monroe Management Holdco, LLC
(Delaware) Aggregator MH,LP
(Delaware)
83.33%
• 16.6
GP u Le
0
9
Monroe Capital Investment Holdings, L.P.
N
(Delaware)
a, 99
0 100% 100%
N
Monroe Capital Management Advisors, LLC Monroe Capital BDC Advisors, LLC Monroe Capital Fund 0,LLC
0
(Delaware) (Delaware) (Delaware)
❑
Investment Manage Investment Manag r 100%
N
❑
Monroe Capital Corporation Monroe Capital Income Plus Corporation MC Financing SPY I,1.,LC
(Maryland) (Maryland) (Delaware)
U
a0
rn
0
U
N
N
DocVerify ID:22114C52-91B1-4CE8-BE3D-6D60C24DCCCA ,III 'I III
www.docvenfy.com Page 7 of 7�75D60C24DCCCA�
DocuSign Envelope ID:C6EEA09A-7BA1-4BEA-AFIB-FE6A5FED4302
The Shore Club,
Miami Beach, Florida
MonfdO Capital Private Credit Fund II(Unleveraged),LP 5576%
Monroe Capital.Private_Credit Fund Ill(Unleveraged),LP 6.908%
Monroe Capital Private Credit Fund 11-0,(Unleveraged Offshore)LP 5:096%
Various funds managed and/or Monroe Capital FundSV.S.a.r.l. Fund III(Unleveraged)Compartment 7.139%
controlled by Monroe Capital Monroe Capital Private Credit Fund III(Lux)Financing Holdco LP - 7.958%
Management Advisors;LLC(or Monroe Capital Opportunistic Private Credit Master Fund SCSp 7.770% Steven Witkoff
affiliates thereof)' Corbin Private Credit Opportunity Fund II,L.P. 24.932%
CEOF Holdings LP 26.848%.
Corsun LLC 7.773%
•
Monroe Capital Corporation.
(DE)'
soot
MRCC Holding Company X, Monroe Capital Private Monroe Capital Private MC Industrial Blocker,LLC
LLC(DE)** Credit Fund II,LP*(DE) Credit Fund III,LP*(DE) (DE)*
15.86% 18.84% 11.48% 53.82%
•
•
o MC Asset Management WG Shore LLC(DE)
1O (Corporate),LLC(D9*
co
25%Develo e
N 75%Financial Mem Developer Member
U Shore Club Owners JV LLC(DE)
U
U
100%
`? Shore Club Property Owner LLC(DE)
❑
Lu
W
m
W
U
rn
N
N
*See page 2 for upper-tier holdings.
**Managed by Monroe Capital Management Advisors,LLC.
e DocVerify ID:22114C62-91131.4CE8-BE3D-5060C24DCCCA - -www.docvenfy.com Page 6 of 7 65060C24D000A 1111
}� 11 III
isr 3
:::::,.., , s '' T.:', j ., ' :IT .. g 13 . ' . 1 81 1'—,;.'
:7 - 2 ,r, ' o -.4 .
, = -.i,,, L 1 _ _a_ ::?.. , , ---- tr..,... E
"Th
MBF c� (` S 9 * n
Customer Service Center +` "'�
1755 Merdian Ave Suite 100 3 ' 5
Miami Beach , FL 33139 es ''*,v a z �. ,,
305-573-7420 ' i-
n Q
005478-0001 Carmen V 05/10/2022 08:45AM - - ' 5`
MISCELLANEOUS fi
Reference 1: 428602 cIt
2022 Item: MCR
NCR OPEN (NCR) 850.00 - - -
850.00
r -
Subtotal - ,
Total 850.00
850.00 : , -1... 0
AMERICAN EXPRESS 850.00 `::
Ref Number3004/828664
Change due 0.00 . I`. 4% .
•
Paid by: FRANCISCO CANESTRI m00
,K1 Cr) .
Thank you for your payment 0
CUSTOMER COPY i"