Adrian Dabkowski - Di Lido Beach Hotel Corporation IL44cAD 1''1 /6 7 ` C I1t•15 f/,/E/
DocuSign Envelope ID F08F44E3-56D4-4635-944E-30940401C86E
RECEIVED
IV\I/\/\/\ B Ei\C Office of the City Clerk �CT 2� 2022
1700 Convention Center Drive
Miami Beach, FL 33139 CITY OF MIgMI BEACH
305.673.7411 OFFICE OF THE CI
LOBBYIST REGISTRATION FORM TY CLFRK
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 foreseeahly 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 "Lobbyist" 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:
Dabkowski Adrian
NAME OF LOBBYIST (Last) (First) (Middle Name)
Kimley-Horn&Associates 8201 Peters Road, Suite 2200 Plantation Florida 33324
LOBBYIS-T BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
954-535-5144 Adrian.Dabkowski@kimley-hom.com
LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS
II. PRINCIPAL INFORMATION:
Granda Javier
NAME OF PRINCIPAL (Last) (First) (Middle Name)
Di Lido Beach Hotel Corporation 4100 NE 2 Avenue,Suite 202 Miami Florida 33137
PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-728-8240 javier@lionstone.net
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): J.Granda
• 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.
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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.
Lincoln Road Improvements,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 Commissin,and any City Workshops or
Committees,if necessary,relating to the properties located at 1 Lincoln Road and 1671 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
appearance of impropriety(if none,write N/A):
None
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):
$355.00 per hour
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The following six(6)questions MUST be answered:
1) Pursuant to City Code Section 2-488,entitled"Prohibited Campa:gn Contributions By Lobbyists On Procurement Issues":
_Yes£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 "FMMili ted 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 LNo: 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 intormation 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 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:
_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
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:
_Yes x No: If yes, were you promised or did you receive economic consideration in exchange for campaign
consulting services?
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
1.4
Annual Registration fee: [ j Yes[ No Amount Paid$�5O • °' MCR# I 301� - Date Paid 0 2 1
Lobbyist Registration Form received and verified by: J�
F: CLER\SALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 03-11-20 REG.dut. Revised 03/11/2020
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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: Date
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 requirements.
Signature of Lobbyist: c---DocuSrgned by Date
Signature of Principal: j1uki�
9 P 3674114rrJCUYM Date 10/19'2022
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 C physical presence
or i online notarization, or 2 online notarization,
this day of October ,2022, by this 19 day of October ,2022, by
Adrian Dabkowski Javier Cranda
NAME OF LOBBYIST NAME OF PRINCIPAL
Produced ID _Produced ID
FORM OF IDENTIFICATION FORM OF IDENTIFICATION
x Personally Known x Personally Knot
Signature of Notary Public Signature of Notary Public
Diana Ramos Diana Ramos
Name of Notary, Typed, Printed or Stamped Name of Notary, Typed, Printed or Stamped
(NOTARY SEAL) (NIA
Diana Ramos
Commission#GG 308355
Notary Public-State of Florida
My Commission Expires Apr 10,2023
1 The term lobbyist"specifically excludes the following persons: 1,
•
Expert witnesses who provide only scientific, technical or other specializedinrormauon or testimony in punuc meetings;any person who
only appears as a representative of a neighborhood association without compensation or reimbursement tor 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.
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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 COMPEfD,QRI,DURING THE REPORTING PERIOD.'
Signature of Lobbyist: Qt 'E ' VitaDWSU Date 1alyizo22
--586B7r36FC83443
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-al uMlweporting requirements.
Signature of Lobbyist: a/YIAln ValkowStI Date 1o;19izozz
`—bC06'1-J6-UCJ44,
Signature of Principal: Date
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 f1 physical presence
or LXonline notarization, or❑ online notarization,
this day of 1oi]v2o22 , 20 , by this day of ,20 , by
Adrian Dabkowski Javier Granda
NAME OF LOBBYIST NAME OF PRINCIPAL
_Produced ID Produced ID
FORM OF IDENTIFICATION FORM OF IDENTIFICATION
x Personally Know Personally Known
L
Signature of Notary Public Signature of Notary Public
Diana Ramos
Name of Notary, Typed, Printed or Stamped Name of Notary, Typed, Printed or Stamped
(NOTARY SEAL)
li Diana Ramos
I.Commission#GG 308355
Notary Public-State of Florida
The My Commission Expires Apr 10,2023
g persons:
1
Expe " '"-'°"m'"n`' ,. ', ' "'''""31 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.
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MI AM BEACH
City of Miami Beath,1700 Convention Center Dive. Miami Beach, Florida 33139,www.miamibeachf.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: Adrian Dabkowski
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 301h 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.
DocuSigned by.
LQ GILI Uai6WSO 1 0/1 91202 2
- c[srrs ✓a cv
Signature ot�.obr yis( Date
F:ICLERISALL1aFORMSLLOBBYIST FORMS1Lobbyise Registration rn,m Revised 03-11-20 RFG disc
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EXHIBIT "A"
Organizational Chart of
FRi Sagamore LLC
•( nog DI Lida 1 Ras Di lido 1 Uansoone of L a `,I tiaesteiss Di lido EBJ Properties,LLC I E8J Sapeunore PI LLC operatlng Cam-(FL) Ventures,Ltd.ER.) LP Li.0(Ft) ( vv,loc.(a) (OP
toll
J J ` l fj i
.6796 f 29,5% 35% 1.5% 31.66%
1.67%
I
DI Ude Latch Rp_tOrt
Managers of(f)Di tido Beach Resort Parent LLC,and v t U.0(De)
On EN SagarnOre U-C:
Lionstone Group:
1. Diego Lowenstein I(X)55
2. layer Granda 1
Kanavos Group: �I
1. Paul C.tanavos
( 7- Deyss/OlartedeKanavos
Ben-Josef Group:
i 1. ROn Ben-Josef
2. Ronen Ben-lcsef
i
• tionstone entities on page 2.
` - Kanavos entities on page 3.
Ben-Josef entities on page 4.
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uoart one f
Di lido LP LlC i
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ti
Kanavos entities on page 3; Di Lido Beads Resort
Ben-Jose enfroes on page 6- Vary 11C
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Lien-Josef Group
( RONR ; RON BEN- ( Roe u / PAVfT
\ NEUMAN 1 JOSEF . BEN-JOSEF \ KM"5
25% \ 25%
j The Edeed den- _1
lose and!Ala Ben-
linking;Group
Each ofRonk Neuman, (s Josef Irrevocable Fide)
(1) (if) Ron Ben-.Josef, (iii)
Konen Ben-lcsef and(iv)Ravit Kraus are the trustees Trust 1
of The Edeed Ben-Josef and lldia Ban-Jwef
irrevocable Trust 100% 1
E8J Properties,LLC i _csa :R7
1 I
3266%
1.67%
L.ionstone entities on page 2; DI lido Desch
Kanams entities on page 3. I Nowt Parent 11C
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Miscellaneous Cash Receipt No 430782
CITY OF MIAMI BEACH
❑Cash ❑Credit Card ❑Check# $
20
Received of
Address
For
teal F
Mbii eilaneous-1vICR-2023
51-0008 Adrian V... '10/2112022 11:30AM
{fit OPEN(MCR)
Pa4ment Amount: 1 900.00
(THIS INFORMATION MUST BE COMPLETED) Office of Finance Director
Account number: By
Preparers
Dept: EXT:
4