Russell W. Galbut - Shelborne AssociatesP
m MIAMIBEACH ,g~~
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 en
passage, defeat or modification of any ordinance, resolution, action or decision of any commissioner;
decision, recommendation of the City Manager or any city board or committee; or any action,
recommendation of any city personnel during the time period of the entire decision-making process on
decision or recommendation that foreseeably will be heard or reviewed by the city commission, or a
committee. The term specifically includes the principal as well as any employee engaged in lobbying ac
term "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435.
Galbut Russell W.
OF LOBBYIST: (Last)
Boulevard Miami FL
(M.I.)
~~
age the
action,
sion or
action,
bond or
:s. The
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 374-5700 (305) 847-3354 rgalbut@crescentheights.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
Shelbome Associates, Costello Investments, Inc., Shelbome Ocean Beach Hotel Corp., and Beach Group tll, LLC
NAME OF PRINCIPAUCLIENT: ~
Shelborne Hotel 1801 Collins Avenue Miami Beach FL 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) I
(305) 531-1271 (305) 531-2206 mkramer@crescentheights.com
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) ~
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 Disclosures of Interest.
C-) tV
__.. p
II. SPECIFIC LOBBY ISSUE: ~-~ ~ ~~1
r G~ ~.~
Application for variance's for~the property located at 1801 Collins Avenue, Miami Beach 33139. ' ' ` ~
s~ ::°i i
Issue to be lobbied (Describe in detail): vi a~ ~~i
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: (Pursuant to City Code Section 2-482(g)~cludey a
statement of the .extent of any business, financial, familial, professional or other relationship, giwhg to--a~
appearance of an impropriety, with any City personnel sought to be lobbied; further, pursuant to City ~' de coon 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 IndividuallTitle B An Financial, Familial or Professional Relationshi
City of Miami Beach Board of Adjustment 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
HOURLY, FLAT RATE OR OTHER):
DISCLOSURE: (Required) $0. No additional compensation for
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
(Required). $0. No additional compensation for lobbying.
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By L
On Procurement Issues°:
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On
Real Estate Development Issues":
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..
reimbursement.
V. SIGNATURE UNDER OATH: ~
AAI w~Twl~~w •SZ Ar r•AAII VCAII rAAll 1 /1~l9V1l~T l1lJA1 1 l~11~\IIT TA TVC /'ITV /~1 C~V A QI/'!\ICA
PERIOD.
- Russell W.
I do solemnly swear that all of the foregoing facts are true and correct and the have read ram familiar~with the
provisions contained in Section 2-482 of the Miami Beach City Code and all r 'n
Signature of Lobbyist:
i
Signature of Principal/Client:
Ru a ut, on elf of Shelborne Associates, Costello Investments; Inc.,
Shelbome Ocean Beach Hotel Corp., and Beach Group III, LLC. ~
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: !
^ Produced ID
Form of Identification
^ Produced ID
Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
S orn o and su c ' ed before me
day of , 2010
~~
igna re of Public otary -State of Florida
tan tion of Lobbyist's signature
TO BE
^ Personally known (Principal)
State of Florida, County of Miami-Dade
Sw~or~ to and su sc 'bed before me
T 's' da of 2010
Sigr~tur~of Public AYotary -State of Florida
Notarize on of Principal's signature
Y
Paid
Lobbyist Registration Fonm received and verified by:
F:\CLER\LOBBYIS11Lobbvist Registration Form 32708.d
~a~11r"'w~ WIYAMIAGUtAR
,• ~ 'y NoW1- Public -State of Florida
- - ~~ ~ Cpmnii~ion Expires Mar 18, 2011
~. Caamission # OD 644032
. y
~'•.'~oF ~~,~~ 801108dThrou9hNatiOnalNOtaYAssa.
DAYAMIAGUTAR
<<~; Notary Public • Stets Oi Flo
My Commission Expires Mar ttt,
,~ ' ~= ..Commission # OD 8410.1
,,,,, 'Bolldedrnrou~nttauorslNotary,
I
,.
m MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK office CityClerk(a~miamibeachfl.gov
Tel: 305.673.7411, Fax: 305.673.7254
LOBBYIST NAME:
Russell W. Galbut
I understand that no later than October 1St 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 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..
7- Z9- 2oto
Sign abut Date:
EXHIBIT "B"
DISCLOSURE OF INTEREST
NAME AND ADDRESS % OF INTEREST
SHELBORNE ASSOCIATES. A FLORIDA GENERAL PARTNERSHIP
Mar Irv Investment, Inc. 50
3725 South Ocean Drive, #718
Hollywood, Florida 33137
SBH Investors, Inc. 50
2200 Biscayne Boulevard
Miami, Florida 33137
MAR IRV INVESTMENT. INC.
Irving Cowan 100
3725 South Ocean Drive, #718
Hollywood, Florida 33137
SBH INVESTORS. INC.
Russell W. Galbut 50
2200 Biscayne Boulevard
Miami, Florida 33137
Abraham A. Galbut, and Nancy K. Galbut, his wife 50
4770 Biscayne Blvd., Suite 1400
Miami, Florida 33137
COSTELLO INVESTMENTS. INC.
Russell W. Galbut
2200 Biscayne Boulevard
Miami, Florida 33137
50
Abraham A. Galbut, and Nancy K. Galbut, his wife 50
4770 Biscayne Blvd., Suite 1400
Miami, Florida 33137
SHELBORNE OCEAN BEACH HOTEL CORP.
Russell W. Gaibut 50 %
2200 Biscayne Boulevard
Miami, Florida 33137
Abraham A. Galbut, and Nancy K. Galbut, his wife 50
4770 Biscayne Blvd., Suite 1400
Miami, Florida 33137
[CONTINUED TO NEXT PAGEJ
Page 1 of 2
BEACH GROUP III. LLC
ARC Investors, LLC 50
2200 Biscayne Boulevard
Miami, Florida 33137
Russell W. Galbut, as Manager 0
2200 Biscayne Boulevard
Miami, Florida 33137
Irving Cowan, as Manager 0 %
3725 South Ocean Drive, #718
Hollywood,. Florida 33137
IMZ Investments, LLC 50
3725 South Ocean Drive, #718
Hollywood, Florida 33137
ARC INVESTORS. LLC
Russell W. Galbut 50
2200 Biscayne Boulevard
Miami, Florida 33137
Abraham A. Galbut, and Nancy K. Galbut, his wife 50
4770 Biscayne Blvd., Suite 1400
Miami, Florida 33137
IMZ INVESTMENTS. LLC
Irving Cowan
3725. South Ocean Drive, #718
Hollywood, Florida 33137
100
Page 2 of 2