Damian J. Gallo/Greensreet Real Estate Partners, LLP G
MIAMI BEACH �oo � �
City of Miami Beach Office of the City Clerk 41
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 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.
Gallo Damian J.
NAME OF LOBBYIST: (Last) (First) (M.I)
Damian J. Gallo &Associates, 775 17th Street, Miami Beach, FL 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-447-0123/305-522-5215 786-216-7246
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes:address,phone, or e-mail address.
I. LOBBYIST RETAINED BY:
Greenstreet Real Estate Partners LP
NAME OF PRINCIPAUCLIENT: Jeffrey A. Safchlk, Managing Member
1800 Bay Road Investors, LLC, 2601 S Bayshore Drive, Suite 800, Miami, FL 33133
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-858-4225 305-858-2334 jsafchlk agreenstreetpartners.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: Jeffrey A. Safchlk, Managing Member
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: Please See Attached
u.SPECIFIC LOBBY ISSUE:
Proposed Ordinances re Parking District No. 5 (Planning Board File No. 2604) - 1800 & 1820 Bay Road
Issue to be lobbied(Describe in detail):
iii.CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
Pursuant to City Code Section 2-482(a)(4)include the commissioner or personnel sought to be lobbied,and whether the lobbyist has entered
into any contractual relationship (paid or unpaid) with said city commissioner or personnel from 12 months preceding such person's
commencement of service with the city to the present date,stating the general nature of the subject contractual relationship.
Sec 2-482(a)(4)Full Name of Individual and Contractual Relationship(Explain) YES I NO
title of person to be lobbied
Planning and Zoning Department X
Planning Board X
Mayor and City Commission 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.
Sec 2-482 Any Financial,Familial or Professional Relationship
N/A
j ) , 14 �l3 'kilo
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR
OTHER):
A) LOBBYIST DISCLOSURE:(Required) $ /J5 66Per Hour
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): $ f y.�Q Per Hour
(Required). / N
The following information must be answered:
I) Pursuant to Miami Beach City Code Section 2-488 Entitled"Prohibited Campaign Contributions By Lobbyists On Procurement
Issues":
O 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?
I
2) Pursuant to Miami Beach City ode 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
O Yes Q 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?
1
3) Pursuant to Miami Beach City Code 2484(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 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 clerC as required by this section but,shall not be required to pay any registration fees.
O Yes ® No: Are you reoresentma a not-for-profit corporation or entity without special compensation or reimbursement.
V. SIGNATURE UNDER OATH:
ON FEBRUARY 28th OF EACH YEAR.EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER
OATH LISTING LOBBYING EXPEND RES AS-WELL'AS COMPENSATION RECEIVED IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR.I A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
I
Signature of Lobbyist
i
do solemnly swear that all of the foregoing facts are true and ct and that I have read or am familiar with the provisions contained
in Section 2-482 of the Miami Beach City Code and all rep requirements.
Signature of Lobbyist:
Signature of Principal/Client: I
VI. LOBBYIST IDENTIFICATION: I PRINCIPAL IDENTIFICATION:
L Produced ID I Produced ID
Form of Identification Form of Identification
Personally known(Lobbylst) Personally known(Principal)v1
VII. SIGNATURE AND STAMP OF NOTARY:
Sta rids,County of Miami-Dade State of Florida,County of Miami-Dade
S Am to and subscribed before me _ Sworn and ubscri before me
Th of JOSE DAMIPIN GALLO This 2.z gay of wn-L �9�
MY C04ttdi9SION U pDS31772 gpgY PLBLICSTATB OF FLORIDA
oy mt3 Georgia Williams
�.» ti2013 C"�`� „ =Cotnmission;rDD902b90
re o P otary—St ri r4rmr.r� Si atu of Public Notary—State of FIcb ,;Expires:.
01,2013
-Notarization of Lobbyist's si Notarization of Principal's signature Bohti® 1UA17-k\T1g30NDLNGCa,¢+c
TO BE COMPLETED BY CITY CLERK'S STAFF
,016Y
Annual Registration fee: [ ]Yes i j No Amount Paid$ MCR Date Paid
FACLERI$ALL\aF0RMS\L0BBYIST 7RMS\Lobbyist Registration Form.doc
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®_ /MIAMI BEAR. H
City of Miami Beach,1700 Cornet Lion Center Drive,Miami Beach,Florida 33139,www.miomibeo'chfl.gov
CITY CLERK Office CityClerk @miamibeachll.gov
Tel:305.673.7411 ,Fax:305.673.7 54
I
LOBBYIST NAME: Damian J. Gallo
I
I understand that no later than February 28th of each yeatr. I must file the Following
form, 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 and Compensation 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.
Pursuant to Section 2-485 (d), the City Clerk shall notify any lobbyist (or principal) who fails to
timely file a Statement nd in addition to any other penalties which may be imposed as
provided in Section 2-4 5.1, a fine of $50.00 a day shall be assessed for all 'Statement(s)
filed after the due date. The City Clerk shall notify the Miami-Dade County Commission on
Ethics and Public Trust of the failure of a lobbyist (or principal) to file the Statement or pay the
assessed fines after notification.
Any lobbyist,—who fails to file the required Statement by April 30th, 2012; shall be
automatically suspended from lobbying until all fines are paid, unless the fine has been
appealed to the Miami-D de County Commission on Ethics and Public Trust.
Signature:
,
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FACL.ER1.$ALL1aF0RMS\L0BBYIST FORMLobbyist Registration Form.doc
Omanizadon Chart-Beach Investment Partners Platform
Steven J.Green-
100%shareholder
Jeffrey A.Safchik-
President 6 CEO
1 100% "Limited Partner"
"General Partner" Greentreet Capital,LP "Limited Partner"
Beach Investment Partners, (Delaware Limited VO V Purdy LLC
Inc. Partnership)
(Florida Corporation) EIN#65-0745876
EIN#20-2701896
65.6667% 33.3333%
1 0
Beach Investment Partners,LLLP
(Florida Limited Partership)
EIN#20-2702104
100%
"General Partner"
Purdy Avenue,LLC
(Florida Limited Liability
Company)
"Disregarded Entity for Tax
Purposes"
EIN#20.2702256
100% 100%
1%
/99%
Purdy Avenue,LLLP 1800 Bay Road Investors,LLC 1827 Purdy Ave.Investors,LLC
(Florida Limited Liability Limited (Florida LLC) (Florida LLC)
Partnership) "Disregarded Entity for Tax "Disregarded Entity for Tax
"Disregarded Entity for Tax Purposes" Purposes"
Purposes"
EIN#20-8559681 EIN#20-8559731
EIN#20-2702346
Stanoff;
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