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Andrea Cochran - Chaim Elkoby i MIAMI City of Miami Beach Office of the City Clerk o� 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. Cochran Andrea NAME OF LOBBYIST: (Last) (First) (M.1) Andrea Cochran Landscape Architect 2325 Third Street#210 San Francisco, CA 94107 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (415) 503-0060 andie(a)acochran.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: Please notify this office if your contact information changes:address,phone, or e-mail address. I. LOBBYIST RETAINED BY: Chaim Elkoby NAME OF PRINCIPAUCLIENT: Crescent Heights 2200 Biscayne Blvd. Miami Florida 33137 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 374-5700 (305) 573-8489 celkoby@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: • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: II.SPECIFIC LOBBY ISSUE: Development Board Armrovals for 600 Alton 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 NO title of person to be lobbied Planning Department and Building Department Staff None X B, HPB, BOA, City Commission, as necessary* None 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(g)Any Financial, Familial or Professional Relationship ,, . - =r l i F ;y . �.9 I - 972 S34 UHL j {� C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LOQB�DH\Lobbyist Registration Formrevised 5-30-2012.doc IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): (REQUIRED). $ 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 X No: Are you lobbvina on a oresent or nendina bid for aoods.eauiument or se rvices.or on a oresent or pending award for goods.eauiument or service? 2) Pursuant to Miami Beach City Code Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": _Yes X No: Are you lobbying on a pending application for a Development Aareement with the City or application WE change of zoning map desianation or change to the City's Future Land Use Map? 3) Pursuant to Miami Beach City Code Section 2-482 (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 clerk as required by this section but, shall not be required to pay any registration fees. _Yes X No: Are you representing a not-for-profit corporation or entity without special compensation or reimbursement. V. SIGNATURE UNDER OATH: ON FEBRUARY 28 OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION RECEIVED, IN THE CITY OF MIAMI BEACH MR THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR QOMPENSADQU 12URINQ THE 01=101r% Signat6re of Lobbyist I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am familiar with the provisions contained in Section 2-482 of the Miami Beach City Code and all reporting requirements. Signature of Lobbyist: Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: Produced ID ! 7 Produced ID Form of dentification Form of Identification k RITA M.,!ONES Personally known(Principal) Personally known (Lobby t .•:Pµ��e-,; y ( p ) Notary Public-State of Florida RITA M JONES VII. SIGNATURE AND STAM Comm.Expires May 21.2015 °` �`"'Ube; =9 A, Commission+ EE 59123 :'2• =: Notary Public •state of Florida 0111114° �' =. ' ;•:My Comm.Expires May 21,2015 State of Florida, County of Miami- Bonded Through National Notary Assn State of y ofdA61AT0sQ!RQ1eEE 59123 Sworn to and subscribed before me Sworn a s' VWl r9kh Nationa,Notary Assn This of , 201 Signature of Public Not —Sta Florida Signature of Public ary State of Florida Notarization of sign ture Notarization of ignature TO BE COMPLETED BY CITY CLERK'S STAFF O Y Z G 1 Annual Registration fee: [ ]Yes[ ]No Amount Paid$ �8 MCR# _Datft Paid Lobbyist Registration Form received and verified by: I C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQD H\Lobbyist Registration Formrevised 5-30-2012.doc F:\CLE istration Form.doc Revised 04/27/2012 IV J BEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamlbeachfl.gov CITY CLERK Office Rafael E. Granado, City Clerk CityClerk@miamibeachfl.gov Tel: 305.673.7411 , Fax: 305.673.7254 LO 8 8 Y.IS T NAME Andrea Cochran I understand that no later than. February 28 of each year, 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, or I am no longer lobbying on that issue or for that principal, 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 and in addition to any other penalties which may be imposed as provided in Section 2-485.1, 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-Dade County Commission on Ethics and Public Trust. Signature: Date: C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc SUPPLEMENTARY DISCLOSURE OF INTEREST Interests in South Beach Heights I, LLC Percentage of Interest SBH Holdings I, LLC 99% 2200 Biscayne Blvd. Miami FL 33137 SBH Management Company, LLC 1% 2200 Biscayne Blvd. Miami FL 33137 Interests in SBH Holdings I, LLC Percentage of Interest CH Investment Holdings, LLC 89.89% 2200 Biscayne Blvd. Miami FL 33137 David Galbut and Gita Galbut 10.11% 2200 Biscayne Blvd. Miami FL 33137 Interests in SBH Management Company, LLC Percentage of Interest CH Investment Holdings, LLC 100% 2200 Biscayne Blvd. Miami FL 33137 Interests in 500 Alton Road Ventures, LLC Percentage of Interest 500 Alton Road Holdings, LLC 100% 2200 Biscayne Blvd. Miami FL 33137 Interests in 500 Alton Road Holdings, LLC Percentage of Interest CH Investment Holdings, LLC 100% 2200 Biscayne Blvd. Miami FL 33137 Interests in 1220 Sixth, LLC Percentage of Interest 500 Alton Road Holdings, LLC 100% 2200 Biscayne Blvd. Miami FL 33137 Interests in CH Investment Holdings, LLC Percentage of Interest S Kahn CH Investments, LLLP 18.685% 2200 Biscayne Blvd. Miami FL 33137 S Kahn CH Holdings, LLLP 18.351% 2200 Biscayne Blvd. Miami FL 33137 Galbut CH Investments, LLLP 18.685% 2200 Biscayne Blvd. Miami FL 33137 Galbut CH Holdings, LLLP 18.351% 2200 Biscayne Blvd. Miami FL 33137 Menin CH-BT Co, LLLP 19.56% 2200 Biscayne Blvd. Miami FL 33137 Menin CH Holdings, LLLP 6.435% 2200 Biscayne Blvd. Miami FL 33137 Interests in S Kahn CH Investments, LLLP Percentage of Interest S Kahn CH Investments 1, LLC 1% 2200 Biscayne Blvd. Miami FL 33137 SK Business Trust 99% 2200 Biscayne Blvd. Miami FL 33137 Interests in S Kahn CH Investments 1, LLC Percentage of Interest SK Business Trust 100% 2200 Biscayne Blvd. Miami FL 33137 Interests in SK Business Trust Percentage of Interest Sonny Kahn 100% 2200 Biscayne Blvd. Miami FL 33137 Interests in S Kahn CH Holdings, LLLP Percentage of Interest S Kahn CH Management, LLC 1% 2200 Biscayne Blvd. Miami FL 33137 Kahn 2009 Investments Irrevocable Trust 99% 2200 Biscayne Blvd. Miami FL 33137 Interests in S Kahn Management, LLC Percentage of Interest Kahn Management Trust 100% 2200 Biscayne Blvd. Miami FL 33137 Interests in Kahn Management Trust Percentage of Interest Sonny Kahn 100% 2200 Biscayne Blvd. Miami FL 33137 Interests in Kahn 2009 Investments Irrevocable Trust Percentage of Interest Sonny Kahn 100% 2200 Biscayne Blvd. Miami FL 33137 Interests in Galbut CH Investments, LLLP Percentage of Interest Galbut CH Investments 1, LLC 1% 2200 Biscayne Blvd. Miami FL 33137 RF Business Trust 99% 2200 Biscayne Blvd. Miami FL 33137 Interests in Galbut CH Investments 1, LLC Percentage of Interest RF Business Trust 100% 2200 Biscayne Blvd. Miami FL 33137 Interests in RF Business Trust Percentage of Interest Russell W. Galbut 100% 2200 Biscayne Blvd. Miami FL 33137 Interests in Galbut CH Holdings, LLLP Percentage of Interest Galbut CH Management, LLC 1% 2200 Biscayne Blvd. Miami FL 33137 Galbut 2009 Investments Irrevocable Trust 99% 2200 Biscayne Blvd. Miami FL 33137 Interests in Galbut CH Management, LLC Percentage of Interest Galbut Management Trust 100% 2200 Biscayne Blvd. Miami FL 33137 Interests in Galbut Management Trust Percentage of Interest Russell W. Galbut 100% 2200 Biscayne Blvd. Miami FL 33137 Interests in Galbut 2009;Investments Irrevocable Trust Percentage of Interest Russell W. Galbut 100% 2200 Biscayne Blvd. Miami FL 33137 Interests in Menin CH-BT Co., LLLP Percentage of Interest Menin CH-BT Co., LLC 1% 2200 Biscayne Blvd. Miami FL 33137 Menin 1998 Business Trust 99% 2200 Biscayne Blvd. Miami FL 33137 Interests in Menin CH-BT Co., LLC Percentage of Interest Menin 1998 Business Trust 100% 2200 Biscayne Blvd. Miami FL 33137 Interests in Menin 1998 Business Trust Percentage of Interest Bruce Menin 100% 2200 Biscayne Blvd. Miami FL 33137 Interests in Menin CH Holdings, LLLP Percentage of Interest Menin CH Management, LLC 1% 2200 Biscayne Blvd. Miami FL 33137 Menin CH Holdings, LLC 99% 2200 Biscayne Blvd. Miami FL 33137 Interests in Menin CH Management, LLC Percentage of Interest Menin Management Trust 100% 2200 Biscayne Blvd. Miami FL 33137 Interests in Menin Management Trust Percentage of Interest Bruce Menin 100% 2200 Biscayne Blvd. Miami FL 33137 Interests in Menin CH Holdings, LLC Percentage of Interest Menin 2009 Investments Irrevocable Trust 100% 2200 Biscayne Blvd. Miami FL 33137 Interests in Menin 2009 Investments Irrevocable Trust Percentage of Interest Bruce Menin 100% 2200 Biscayne Blvd. Miami FL 33137 CV wu v r °w Je W. 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