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James E. Rauh - Shelborne Associates4 ~ ~'o~ ~~ • ~ ~ ~ City of IVliami Beach Office of the City Clerk 1700 Convention Center Drive, Miami.Beach, 1=L 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 ally ordinance,. resolution, actioh 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. Rauh. ~ .James E • , ~ NAME OF LOBBYIST: (Last) (First) ~ (M.I.) . c/o Terminello &Terminello P.A. 1111 Lincoln Road Miami Beach, FL 33139 BUSINESS NAME AND ADDRESS •(Nurnber and Street) {City) (State) (Zip Code) : (786).276-2343 (305) 673-5505 jrauh@terminello.com -TELEPHONE NUMBER: FAX NUMBER: EMAIL: L LOBBYIST RETAINED $Y '' ~ ` • ' .Shelborne Associates, Costello Investments, Inc., Shelborne Ocean Beach Hotel Corp., and Beach Group III, LLC _NA,ME-0F'PRINCIPAL/CLIENT: ,. ; :::: Shelborne Hotel ~ 1.801 Collins Avenue Miami. Beach . FL 331'39 BUSINESS NAME AND ADDRESS (Number and' Street) (City) (State) (Zip Code) (305) 531-1271 (305) 531-2206 mkramer crescenthei hts.com TELEPHONE NUMBER; FAX NUMBER: (Optional) ~ EMAIL: (Optional) 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 INTF_REST IN`SUCH CORPORATION, PARTNERSHIP OR TRUST: See attached Disclosures of Ihterest. II.: SPECIFIC LOBBY ISSUE: .- -- . • Certificate of Appropriateness forahe partial demolition, renovation and restoration of the existing 15-story, 8-story, and 3-story :buildings, including design, modifications to the ground floor,. including lobby, pool deck, and cabanas, and the demolition of the existing main entrance facade and porte-cochere and construction of anew entrance and new porte-cochere, fior ttie property located at 1801 Collins Avenue, Miami Beach, Florida 33439. ` -Issue to be lobbied (Describe in detail): IIL CITY AGENCIES/INDIVIDUALS TO BE.LOBBIED: {Pursuant to~City Code Section 2-482(8) 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. 42 months preceding the cormmencement of service of City personnel to be lobbied.) A)~Full (Jame of Individual/Title B) Any Financial, Familial or Professional Relationship City of Miami Beach Planning Staff • None 5~ .~ IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER):: LOBBYIST DISCLOSURE: (Required) $ 375 per hour. B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $ 375 per hour. 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 ~J No• Are you lobbying on a present or pendina bid for aoods eauipment or services or on a present or pending award for aoods eauipment or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real. Estate Development Issues": ^Yes 6a No• Are you lobbvina on a pendina 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 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 anot-for-profit corporation or .entity .without special compensation or reimbursement. V. SIGNATURE. UNDER OATH: AEI I1/~T/\I"fCA ASt /~C L'A/'. LI VL•AL of Lobbyist -James Rauh ~~ D ~ ' O ~ ' LL in o ro ®~ O N ~ ~ 0 C (11 SON ~t.~~ m~.so ~~E•- ~ E ~ 0 da iU ii z°~~u'S ~bo` `lr. s~ I do solemnly swear that all of the foregoing facts are provisions contained in Section 2-482 of lam ea Signature of Lobbyist: and correct and that I have read or am familiar with the t~Code and all reporting requirements. Signature of Principal/Client: !/ .mil/ Russ . Galbut, on behalf of Shelborne Associates, Costello Investments, Inc., Shelbome Ocean Beach Hotel Corp., and Beach Group III, LLC. VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: ^ Produced ID Form ofldentification '~ Personally known (Lobbyist} ^ Produced ID Form of Identification Personally known (Principal) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade Sworn to and subscribed before me This ~r day of ~, 2010 Signatur~'~6f Public Notary-F State of Florida Notariza{{ion of Lobbyist's signature State of Florida, County of Miami-Dade Sworn to and su i DAYAMIAGUTAR a~ ~. hi day of ••'~~ °•' Notary Public • State of Fbrida . My Commission Expires Mar 16, 2011 ' ~~ ommission # DD &44032 Si natu of Public a ~,,,~~~~ idf32fi~i~ughNationalNotaryAssn. N tarization of Prin _ TO BE COMPLET Y ITY CLERK'S U ,O Y F Annual Registration fee. ]Yes [ ] No Amount Paid $ MCR # $ - ate Paid !"~ Lobbyist Registration Form received and verified by: t V j F:\CLER\LOBBYIST1Lobb ist Re istration Form 32708.doc Revised 03/27/2008 m I~1IAMIBEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www_miamiiseachfl_gov CITY CLERK office CityClerk(c~miamibeachfl.gov Tel:. 305.673.7411, Fax: 305.673.7254 LOBBYIST NAME: James Rauh I understand that no later than October 15` of each year, 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 1 have registered to lobby on has been .resolved, I am required to immediately notify the City Clerk's Office for lobbyist withdrawal in writing. Mi4-`1 ~ t 2CS ~ b Date: REVEL®PIViENT REV(EW ~®ARD APPLICA~'IO V ' ~DISGL®SURE OF INTEREST . `I..C®RPO~RATI®N . If the property which is the subject of an application is owned or leased by a CORPORATION, -' list fhe• 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.* •~SBH 'LNVESTORS, 'INC. _ CORPORATION' NAME ' ' NAME AND ADDRESS % Of STOCK Russel W. Galbut ~ 50% ` 2220 Biscayne Blvd. . ~ .Miami; FL 331.37 - Abraham A. Galbut, and Nancy K. Galbut, his wife 50% - - 4770: Biscayne Blvd., St. 1400 • ~IVliami,`FL 33137 . .. lF THERE ARE'ADDITIONAL' C®RPORATIQNS, LIST ®THERS, INCLUDING CORP. ' _ NAltalE(S) ., AN® EACH IND/VIDUAL'S NAt1e1E, ADDRESS; ®FFICE AND PERCENTAGE OF STOCK, ON A SEPARATE PAGE. ~ ' . !~I®TE: N®tariaed signature required ®n page ~ ~ ' 6-A ~LTY ®F ~fIIAIViI ~EACI~ . . . ®EVL®P~V1(~J~ REVIV!/ ~OAR® APPLfCA~'IOIV bISGL®SURE OF INTEREST 1. CORPORATION . If the, property which is the subject of an application is owned or leased b.y a CORPORATION, list :the priricipat 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.* ` MAR IRV Investment, Inc - CORPORATION-NAME NAME' AND-ADDRESS ~ % OF STOCK Irving Cowan ~ 100% 3725; South Ocean Drive, Suite 718 ~ . Hollywood; FL 3301 - IF THERE ARE ADDITIONAL CORPORATIONS; LIST OTHERS, INCLUDING CORP. NA,lVIIE(S) AIVD ~ EACH lND1V/DUAL'S NAtVIE, ADDRESS, OFFICE AND PERCENTAGE OF STOCK, ®N A SEPARATE PAGE. NOTE: Notarised signature required on page ~ ` ~. 6-B ,. CITY OF i!~'IAt~ll ~EACFI . - . ~. ~ ®EVELOPIVIENT REVIEV~U OAR® APPLLCATI®N DISCLOSURE OF INTEREST ~. CARP®RATI®N - " If the properfiy 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 priricipal 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.' . SHELBORNE OCEAN BEACH HOTEL CORP.. . CORPORATION NAME - . - NAME AND ADDRESS. % OF STOCK Russell~W: Galbut 50% 2200 Biscayne Blvd. " Miami,. FL 331.37. " Abraham A. Galbut, and Nancy K. CJalbut, his wife 50% . ~~770 Biscayne Blvd., St. -1400 , ' Miami; FL 331"37 , /F THERE°ARE ADDITIONAL CORPORATIONS, LIST. OTHERS; INCLUDING CORP. NAME(S) . AND . EACH , INDPVIDUAL'S NAME, ..ADDRESS, OFFICE AND PERCENTAGE OF STOCFC, ON A SEPARATE PAGE. " ~ NOTE: Notarised signature required ®n page 8 . ~ 6-C ~. - CI~°Y ®F N1IAM1 EACH; . ~~ . ~ DE!lELOPIVIhl1' REVIEVV~~®AR® APPLICA°I ION . " ~ . ~ DISCLOSURE OF INTEREST = ,1. CORPORATION' 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) {nafural persons)'having_the ultimate. ownership interest in the entity. . ' COSTELLO INVESTMENTS, INC. CORPORATION NAME - ' ~ .NAME AND ADDRESS' % OF STOCK Russell W: _Galbut 50% " 2200 Biscayne Blvd. `'Miami; F'L 33137 Abraham A: Galbut, and Nancy K. Galbut,. his wife 50% 4770 Biscayne Blvd`.; St. 1400 - .Miami, F:L 3313:7 - ". ~ ~lF THERE ARE ADDITIONAL CORPORATIONS, LIST OTHERS, INCLUDING C®RP. - IOIAME(S) AIVD EACH /NDIVIDUAL'3 NAME, ADDRESS, ®FFICE .AND ~. PERCENTAGE OF.$TOCK, ON A SEPARATE. PAGE. ; ~. `NOTE: N®tarized signature required ®n page 8 6~D - . ~ . cI~Y ®Ia ~IIA~I EAC~I . . ~ DEVELOPNIERIT REVLEIJV ~®ARD APPLfCATI®N . DISCLOSURE OF INTEREST 1'. LIMITED LIABILITY C®t!lIPANY . If the property which is the subject of an application is ownedor leased by a LIMITED LIABILITY COMPANY, Gist the principal. stockholders and the percentage of stock owned by each. -Where fhe principal officers or stockholders consist of another corporation(s), trustee(s); partnership(s) or other similar enfity, .further. disclosure shall be required which discloses the identity of the individual(s) (natural persons) havirg the ultimate ownership interest in the entity.*, ' _ BEACH GROUP III; LLC ~ ~ _ LIMITED .LIABILITY COMPANY NAME, NAME'ANp ADDRESS % OF MEMBERSHIP INTERESTS ARC Investors, LLC 50% ' 2200. Biscayne Blvd. . Miami,. FL 33137 . Russell W. Galbut, as Manager 0% - _ 2200 Biscayne Blvd. Miami; FL 33137 ~ , t -. Irving :Cowan, as Manager 0%. . 3725 S': OceanDrive, #707 ' .Hollywood,. FL 33019 IMZ Iriv_ estments; LLC 50% 3725 S Ocean Drive, #707 ~' Hollywood, FL; 3301.9 A , /F THERE ARE ADDITIONAL GP~RPORATIONS, LIST OTHERS, INCLUDING CORP. NAME(S), -AND .EACH INDIVIDUAL'S NAIIsIE, .ADDRESS, OFFICE AND PERCENTAGE OF STOCK, ON A SEPARATE PAGE, ` NOTE: Notarized signature required ®n page ~ 6-E CITE ®F fV11A(V11 BEACH , ®EVEL®PNiENI° R~VIEVII ~®ARD APPLfCA~'i®N ®ISCLOSURE OF INTEREST -1. LIMITED LIABILITY C®MPANY If the property which is the.subject of art application is owned or leased by a LIMITED LIA81'LITY COMPANY, 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.* ARC INVESTORS, LLC - LIMITED LIABILITY COMPANY NAME -NAME AND ADDRESS % OF MEM$ERSHIP INTERESTS 'Russell W. Galbut 50% 2200 Biscayne Blvd._ Miami, FL 33137 Abraham A. Galbut 50% 4770 Biscayne. Blvd., St. 1400 , Miami, FL 33137 IF THERE ARE ADDITI®NAL CORPORATIONS, LIST OTHERS, INCLUDING CORP. NAIiIIE(S) AND EACH INDIVIDUAL'S NAME, .ADDRESS, OFFICE. AIOID PERCENTAGE OF ST®CIC, ON A SEPARATE PAGE. - - NOTE:.Notari~ed signature required on page S 6-F CI~°'Y ®F ~filAl~11 ~AC~ ', ,®E1/ELOP~iE~ll° R.E!/IE1lV ~®ARD APPLI~A°~i~N DISCLOSURE OF INTFRES~ 1. LIMITED L1A~ILITY COIIflPAIVY If the property which is fihe subject of an application is owned or leased by a LIMITED LfABILITY COMPANY,:-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. -. ~IMZ INVESTMENTS, LLC ~` ~ - - LIMITED LIABILITY COMPANY NAME .' . ~ NAME AND:ADDRESS - % OF MEM$ERSHIP INTERESTS ' Irving,Cowan ~ 100% 3725 South Ocean Drive, Suite 718 Hollywood, FL 33019. ' .E. . ~ 3 _ . r OF THERE-ARE ADD/TI®NAL CORPORATIONS, LIST OTHERS, iNCLUD/NG CORP. NAME(S) AND . EACH INDdV/DUAL'S NAME, A®DRESS, OFFICE AND PERCENTAGE OF STOCf{, ON A SEPARATE PAGE. . . N®T~: N®tarized signature required ®n page ~ 6-G .. ~El~~~ ®F ~ill~~il ~EA~I~ DEVIL®PIVLEIV~ REVIEVi/ ~OAR® APPLI~ATI®~! ®ISCLO~.URE OF INTEREST ~ . - ~1: G:ORP®RATION ~ . " If the property which .is the subject of an application is owned-or ieased 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 fhe ultimate ownership interest iri the entity. - SHELBORNE OCEAN BEAC1-i HOTEL CONDOMINIUM ASSOCIATION INC:* . CORPORATION NAME " NAME AND ADDRESS % OF STOCK ' Adam Gruber ~ 0% ' 1801 Collins Avenue ` ~ Miami Beach;. FL 33139 . ' Title;' President Keith' Meriin . - 0% " 1801 Collins Avenue - . . -1Vliami Beach, FL 33139 - Title;; Vice President Rochelle Morse ~ ~ 0% . 18.01 :Collins Avenue Miami Beach, FL~33139 . ~ Title: Secretary.:. *Dsclosure of 'the individual owners of Shelborne Ocean Beach Hotel Condominium Association, Inc. is not required because no one person or entity holds more-than a total of 5% of the ownership. interests in the entity. . - - /F THERE ARE ADDITIONAL CORPORATIONS, L/ST OTHERS, /NCLUD/NG CORP. NAME(S). AND. SACK IND~iVIDUAL'S NAME, ADDRESS, ,OFFICE AND PERCENTAGE OF STOCK, ON A SEPARATE PAGE. ` NOTE; Notarized signature required on page 8 " .. 6-H Cf T Y 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.* 'Not Applicable TRUST NAME NAME, ADDRESS, AND OFFICE % OF INTEREST 3. PARTNERSHIP/LIMITED PARTNERSHIP If the property which is the subject of the application is owned or leased by a PARTNERSHIP or LIMITED PARTNERSHIP, list the principals of the partnership, including general and limited partnerrs. Where the ...partner(s) consist of other partnership(s), corporation(s), trust(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* SHELBORNE ASSOCIATES, A FLORIDA GENERAL PARTNERSHIP PARTNERSHIP NAME AND ADDRESS % OF STOCK MAR IRV'I'nvestment, Inc. 50% 3725 South Ocean Drive, #718 Hollywood, Florida 33019 SRN Inyec}nrc Irlr. 5vp~° ~~ 2200 Biscayne Boulevard Miami, Florida 33137 NOTE; Notarized signature required on page 8 7