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Jonathan w. Cardello/~ `~`r (' m n,s,~;~r,',IBEACH 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 bond 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.) c/o ADD, Inc. One Biscayne Tower, Suite 1670, Two South Biscayne Boulevard, Miami , FL 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 482-8700 (305) 482-8770 jcardello@addinc.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: LOBBYIST RETAINED BY: IC, LLC NAME OF PRINCIPAL/CLIENT: IC, LLC 2200 Biscayne Boulevard Miami FL 33137 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 374-5700 (305) 847-3354 mkramer@crescentheights.com 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 and Irving Cowan IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: Russell W. Galbut (50%), Managing Member Irving Cowan (50%), Managing Member II. SPECIFIC LOBBY ISSUE: Certificate of Appropriateness for the construction of a new robotic parking garage at 1826 Collins Avenue, including an accessory commercial space containing a restaurant, which will replace an existing surface parking lot. Issue to be lobbied (Describe in detail): III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: (Pursuant to City Code Section 2-482(g) include a statement of the extent of any business, financial, familial, professional or other relationship, giving rise 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) An Financial, Familial or Professional Relationship City of Miami Beach Historic Preservation Board None City of Miami Beach Planning Staff None City of Miami Beach Mayor/Commissioners None City of Miami Beach Committees None ./ IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): LOBBYIST DISCLOSURE• (Required) $ ~Oo~ / °~• ~ B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $ ~ ~Q ~- 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 pending bid for goods equipment or services, or on a present or pending 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": ^Yes 6~ No• Are you lobbvina on a pending application for a Development Agreement with the City or application for change of zoning map designation or chance to the Citv's Future Land Use Map? 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 snot-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 6~ No• Are you representing snot-for-profit corporation or entity without special compensation or reimbursement. V. SIGNATURE UNDER OATH: PERIOD. Signature of L~t}By s -Jonathan w. Cardello I do solemnly swear that all of for oing facts are true and correct an that I have read or am familiar with the provisions contained in Sectio -482 of a Miami Beach City Code and all eporting requirements. Signature of Lobbyist: Signature of Principal/Client: Russell W albut, as VI. LOBBYIST IDENTIFICATION: ^ Produced ID ~ Form of Identification Personally known (Lobbyist) ig Member of IC, LLC PRINCIPAL IDENTIFICATION: ^ Produced ID Form of Identification `~J Personally known (Principal) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade .:_ ate of Florida, County c Sworn to and sub ribed b ---- ~gpAd,VANZANI orn to and su scribed This ~ day of '~'~,;y ~pMMISSION M D~ 2p11"' T • i day of '~ ~:_~;~tRES:August2u ,n,~{, ' hN NOUrY tic Signature of Publi otary - Sign ture Public otai Notarization of Lobbyist's signature Nota izati of Pnncip~ ZO BE COMPLETED BY CITY CLERK'S USE ONLY DAYAMIAGUTA Notary PubNc -State of Fbrida ~ lion Expires Mar 16, 2011 mission # DD 644032 B__Throupn National Notary Alen. Annual Registration fee: [ ]Yes [t,YNo Amount Paid $~00~_~ IY~R# iE~r~ Date Pald o! Lobbyist Registration Form received and verified by: ~-..LSsI-~~B $q,1Ck / - F:\CLER\LOBBYIST\Lobbvist Registration Form 32708.doc Revised m '~lIAMIBEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.pov CITY CLERK office CityClerkCa~miamibeachfl.gov Tel: 305.673.7411, Fax: 305.673.7254 LOBBYIST NAME: Jonathan W. Cardello I understand that no later than October 1g` of each vear, 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) 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 for lobbyist withdrawal in writing. (-9~~~ Date: