Jonathan W. Cardello/Southpointe Heights, LLCm P<AI~~,V~IBEACH
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33~~ ~Q~ '4 ~'~ ~~' ~Z
LOBBYIST REGISTRATION FORM ~ `~ ~.' ~ ~ ~ r;'%+y ° ~ Q F F 3 +~
Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the passage, defeat or modirication of
any ordinance, resolution, action or decision of any commissioner; any action, decision, recommendation of the City Manager ar 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.
Cardello Jonathan W.
NAME OF LOBBYIST: (Last) (First) (M.I)
ADD Inc One Biscayne Tower, Suite 1670, Two South Biscayne Blvd., Miami Florida 33131
---
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 482-8700 jcardello@addinc.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
LOBBYIST RETAINED BY:
SOUTHPOINTE HEIGHTS, LLC
NAME OF PRINCIPAL/CLIENT:
2200 BISCAYNE BLVD. MIAMI, FL 33137
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-374-5700 305-847-3354
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: RUSSELL W. GALBUT
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST: SEE ATTACHED
u.SPECIFIC LOBBY ISSUE:
DESIGN REVIEW APPROVAL OF REDESIGN AND RENOVATION OF EXISTING ADULT CONGREGATE LIVING FACILITY
(NURSING HOME) STRUCTURE TO BOUTIQUE HOTEL WITH ACCESSORY RESTAURANT AND RETAIL USES AT 42 COLLINS AVENUE.
Issue to be lobbied (Describe in detail):
Ilt. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: (Pursuant to city code section 2-4az(g)
include a statement of the extent of any business, financial, familial, professional or other relationship, giving raise to an
appearance of an impropriety, with any City personnel sought to be lobbied; further, pursuant to City Code Section 2-
482(a)(4) include a statement of any contractual relationship (paid or unpaid) from 12 months preceding the
commencement of service of City personnel to be lobbied.)
A Full Name of Individual Title B) Any Financial, Familial or Professional Relationship
DESIGN REVIEW BOARD NO
iV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) $ ~ 0 ~O
PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): $ _~
mdredl. __
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 ~NO' Are you lobbvina on a present or Dendina bid for goods eauigment or services. or on a
present or rsendina award for moods. eauiament or service?
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 ~No Are you representing a not for arofit corporation or entity without special comaensation or
reimbursement. .
V. SIGNATURE UNDER OATH:
ON OCTOBER 1~ OF EACH YI
STATEMENT UNDER OATH. LIST
IN THE CITY OF MIAMI BEACH F
EVEN IF THERE HAVE BEEN NO
I do solemnly swear t tall of th
provisions contained Section 2-4
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICA
^ Produced ID
Forrn of Identification
Personally known (Lobbyist)
Vil. SIGNATURE AND STAMP OF NOTARY:
PRINCIPAL IDENTIFICATION:
~ Produced ID
Form of Identification
U Personally known (Principal)
State of Florida, County of Miami-Dade State of Florida, County of Mi m'-D
uSworn to andsubscribed befor me S nd subscrib b~f 'e rr~Vq.,,~ DAYAMNAt3UlAR
This day (1~ , 2008 day of U ' ` ~;•, NotwY PubMc • 8~ °f Florbs
_ ~ ~"° My won Expires Uer 1$, T011
.,,~R pmmission 0 OD 6N032
Signature o P b is _ -State of .., ~, a -~±~ Si natur of Public Nota ~taX~~p~' Or6ileaed7hrou9hNaaonaiNotanJ-sM-•
Notarization of Lob t signature ;; Notariza on of Princi al'
•~~ ~,L~;
~~ ~~~~ bon: ~',
CLERK'S STAFF ONLY
Annual Registration fee: [ ] Yes~,._ o ;'AmountPaid S C ~ ~ Date Paid
~..
Lobbyist Registration Fonn,rece _t6ed and ve[ifled by:. ~ '
.~Y.1NJ
C.l /`I CR\ 1 /\RR\/iR\ i nMMVitT RunSeFraFintl rn1,R 327~8_det ~ ~ iRBVlSed ~~Z7~z~08
I facts are true and correct and that I ave read or am familiar with the
Miami Beach City Cod~aad~l reporti g requirements.
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On
Real Estate Development Issues":
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office CityClerk@miamibeachfl.gov
Tel: 305.673.741 1 ,Fax: 305.673.7254
JONATHAN CARDELLO
LOBBYIST NAME: _ _
I understand that no la#er than October 1st of each Xear, I must file the following
forms, pursuant to Section 2-485 of the Miami Beach City Code, with the City Clerk's
Office for all active lobbying issues.
1 J Lobbyist Expenditure Form
2) Disclosure Form
Failure to file these forms on a timely basis will result in my name being transmitted to the
Miami-Dade County Commission on Ethics and for code violation evaluation.
In addition, once an issue I have registered to lobby on has been resolved, I am required
to immediately notify the City Clerk's Office of lobbyist withdrawal in writing.
Signature:
u-~-Zoog
Date:
F:\CLERILOBBYIST1Lobbyist Registration Form 32708.doc
CITY OF MIAMI BEACH
DEVELOPMENT REVIEW BOARD APPLICATION
DISCLOSURE OF INTEREST
1. LIMITED LABILITY COMPANY
If the property which is the subject of an application is owned or leased by a CORPORATION,
list the principal stockholders and the percentage of stock owned by each. Where the principal
officers or stockholders consist of another corporation(s), trustee(s), partnership(s) or other
similar entity, further disclosure shall be required which discloses the identity of the individual(s)
(natural persons) having the ultimate ownership interest in the entity."
SOUTHPOINTE HEIGHTS LLC
LIMITED LIABILITY COMPANY NAME
NAME, ADDRESS, AND OFFICE % OF MEMERSHIP INTEREST
SOUTHPOINTE HEIGHTS HOLDINGS, LLC 100%
2200 Biscayne Boulevard
Miami, Florida 33137
Member and Manager
OFFICERS:
SONNY KAHN
2200 Biscayne Boulevard
Miami, Florida 33137
Chairman
RUSSELL W.GALBUT
2200 Biscayne Boulevard
Miami, Florida 33137
President
BRUCE A. MENIN
2200 Biscayne Boulevard
Miami, Florida 33137
Sr. Vice President
SHARON CHRISTENBURY
2200 Biscayne Boulevard
Miami, Florida 33137
Vice President
SHLOMO DACHOH
2200 Biscayne Boulevard
Miami, Florida 33137
Secretary
JOSEPH ZDON
2200 Biscayne Boulevard
Miami, Florida 33137
Treasurer
PABLO DE ALMAGRO
2200 Biscayne Boulevard
Miami, Florida 33137
Asst. Treasurer
IF THERE ARE ADDITIONAL CORPORATIONS, LIST OTHERS, INCLUDING CORP.
NAME(S) AND EACH .INDIVIDUAL'S NAME, ADDRESS, OFFICE AND
PERCENTAGE OF STOCK, ON A SEPARATE PAGE.
NOTE: Notarized signature required on page 8
6
CITY OF MIAMI BEACH
DEVELOPMENT REVIEW BOARD APPLICATION
DISCLOSURE OF INTEREST
1. LIMITED LIABILITY COMPANY .
If the property which is the subject of an application is owned or leased by a CORPORATION,
list the principal stockholders and the percentage of stock owned by each. Where the principal
officers or stockholders consist of another corporation(s), trustee(s), partnership(s) or other
similar entity, further disclosure shall be required which discloses the identity of the individual(s)
(natural persons) having the ultimate ownership interest in the entity.*
SOUTHPOINTE HEIGHTS HOLDINGS, LLC
LIMITED LIABILITY COMPANY NAME
NAME, ADDRESS, AND OFFICE % OF MEMERSHIP INTEREST
CH INVESTMENT HOLDINGS, LLC
2200 Biscayne Boulevard
Miami, Florida 33137
Member and Manager
100%
OFFICERS
SONNY KAHN
2200 Biscayne Boulevard
Miami, Florida 33137
Chairman
RUSSELL W. GALBUT
2200 Biscayne Bou{evard
Miami, Florida 33137
President
BRUCE A. MENIN
2200 Biscayne Boulevard
Miami, Florida 33137
Sr. Vice President
SHARON CHRISTENBURY
2200 Biscayne Boulevard
Miami, Florida 33137
Vice President
5HLOM0 DACHOH
2200 0iscayne Boulevard
Miami, Florida 33137
Secretary
JOSEPH ZDON
2200 Biscayne Boulevard
Miami, Florida 33137
Treasurer
PABLO DE ALMAGRO
2200 Biscayne Boulevard
Miaml, Florida 33137
Asst. Treasurer
IF THERE ARE ADDITIONAL CORPORATIONS, LIST OTHERS, INCLUDING CORP.
NAME(S) AND EACH INDIVIDUAL'S NAME, ADDRESS, OFFIGE AND
PERCENTAGE OF STOCK, ON A SEPARATE PAGE.
NOTE: Notarized signature required on page 8
6
CITY OF MIAMI BEACH
DEVELOPMENT REVIEW BOARD APPLICATION
DISCLOSURE OF INTEREST
1. LIMITED LIABILITY COMPANY
If the property which is the subject of an application is owned or leased by a CORPORATION,
list the principal stockholders and the percentage of stock owned by each. Where the principal
officers or stockholders consist of another corporation(s), trustee(s), partnership(s) or other
similar entity, further disclosure shall be required which disc{oses the identity of the individual(s)
(natural persons) having the ultimate ownership interest in the entity.
CH INVESTMENT HOLDINGS LLC
LIMITED LIABILITY COMPANY NAME
NAME, ADDRESS, AND OFFICE
SK BUSINESS TRUST
2200 Biscayne Boulevard
Miami, Florida 33137
Member
OF MEMERSHIP INTEREST
37
RF BUSINESS TRUST
2200 Biscayne Boulevard
Miami, Florida 33137
Member
MENIN 1998 FAMILY TRUST
2200 Biscayne Boulevard
Miami, Florida 33137
Member
MANAGERS:
SONNY KAHN
2200 Biscayne Boulevard
Miami, Florida 33137
Manager
RUSSELL W.GALBUT
2200 Biscayne Boulevard
Miami, Florida 33137
Manager
BRUCE A. MENIN
2200 Biscayne Boulevard
Miami, Florida 33137
Manager
37%
26%
IF THERE ARE ADDITIONAL CORPORATIONS, UST OTHERS, INCLUDING CORP.
NAME(S) AND EACH INDIVIDUAL'S NAME, ADDRESS, OFFICE AND
PERCENTAGE OF STOCK, ON A SEPARATE PAGE.
NOTE: Notarized signature required on page 8
6
CITY OF M1AM1 BEACH
DEVELOPMENT REVIEW BOARD APPLICATION
DISCLOSURE OF INTEREST
2. TRUSTEE
if the property which is the subject of an application is owned or leased by a TRUSTEE, list the
beneficiaries of the trust and the percentage of interest held by each. Where the
beneficiaries/beneficiary consist of corporation(s), another trust(s), partnership(s) or other
similar entity, further disclosure shall be required which discloses the identity of the individual(s)
{natural persons) having the ultimate ownership interest in the entity.*
SK BUSINESS TRUST
TRUST NAME
NAME, ADDRESS, AND OFFICE % OF INTEREST
SONNY KAHN
2200 Biscayne Boulevard
Miami, Florida 33137
Beneficiary
100%
NOTE': Notarized signature required on page 8
7
GtTY OF MIAMf BEACH
DEVELOPMENT REVIEW BOARD APPLiCAT10N
DISCLOSURE OF INTEREST
2. TRUSTEE
If the property which is the subject of an application is owned or (eased by a TRUSTEE, list the
beneficiaries of the trust and the percentage of interest held by each. Where the
beneficiaries/beneficiary consist of corporation(s), another trust(s), partnership(s) or other
similar entity, further disclosure shall be required which discloses the identity of the individuals}
(natural persons) having the ultimate ownership interest in the entity.*
RF BUSINESS TRUST
TRUST NAME
NAME, ADDRESS, AND OFFICE
RUSSELL W. GALBUT
2200 Biscayne Boulevard
Miami, Florida 33137
Beneficiary
OF INTEREST
100%
NOTE,- Notarized signature required on page 8
7
CITY OF MIAMI BEACH
DEVELOPMENT REVIEW BOARD APPLICATION
DISCLOSURE OF INTEREST
2. TRUSTEE -
If the property which is the subject of an application is owned or leased by a TRUSTEE, list the
beneficiaries of the trust and the percentage of interest held by each. Where the
beneficiaries/beneficiary consist of corporation(s), another trust(s), partnership(s) or other
similar entity, further disclosure shall be required which discloses the identity of the individual(s)
(natural persons) having the ultimate ownership interest in the entity.*
MENIN 1998 FAMILY TRUST
TRUST NAME
NAME, ADDRESS, AND OFFICE % OF INTEREST
BRUCE A. MENIN
2200 Biscayne Boulevard
Miami, Florida 33137
Beneficiary
100%
NOTE: Notarized signature required on page S
7