Joaquin Vargas - South Beach Heights I, LLC f soo-ookbc.v. c C cc(
V IAMIBE �
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 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.
Varaas Joaauin
NAME OF LOBBYIST: (Last) (First) (M.I)
Traf Tech Engineering, Inc. 8400 N. University Drive, Suite 309 Tamarac Florida 33321
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(954) 582-0988 (954) 582-0989 ioaauint7a traftech.biz
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes:address,phone, or e-mail address.
I. LOBBYIST RETAINED BY:
Russell Galbut
NAME OF PRINCIPAUCLIENT:
South Beach Heights I, LLC, 500 Alton Road Ventures, LLC, and 1220 Sixth, LLC
2200 Biscayne Blvd Miami
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 573-4127 (305) 573-8489 raalbut( crescentheiahts.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 Galbut
- IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH Cp,RPORATION,
PARTNERSHIP OR TRUST: See attached —
II.SPECIFIC LOBBY ISSUE:
Development Board Approvals for 500-600 Alton Road. Miami Beach—Parkina Lot r.. �
Issue to be lobbied(Describe in detail):
ul. 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 theilobbylst has..entered
into any contractual relationship (paid or unpaid) with said city commissioner or personnel from 12 months proceding such
_person's commencement of service with the city to the present date,stating the general nature of the subject contractual ielatpnshp. _
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
PB, 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
NnnP
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required) z�����Y�
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): 2, `
(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 lobbying on a present or pending bid for goods.eauioment or services.or on a present or pending
award for goods.eauioment 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 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 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 SH L SUBMIT TO THE CITY CLEFK A SIGNED STATEMENT UNDER
OATH. LISTING LOBBYING EXPENDITURES. AS WELL A COMPENSATION RECEIVE . IN THE CITY OF MIAMI BEACI-t
EQ$ THE PRECEDING CALENDAR YEAR. A STATE ENT SHALL BE FIL E E IF THERE HAVE BEEN NO
EXPENDITURES OR COMPENSATION DURING THE REPOR NG PERIOD,
o 7 e
Signature f Lobbyist
I do solemnly swear that all of the fo going facts are true Id cv,rect a that I have read or am familiar with the provisions contained
in Section 2-482 of the Miami Beach ity Cod and all r • • r°quir a ts.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFI ATI N: PRINCIPAL IDENTIFICATION:
- -Produced ID VC. r 2S- C2-- ' — Produced ID
Form of Identification Form of Identification
Personally known(Lobbyist) Personally known(Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Flo ida, County of Miami-Dade State of Florida, County of Miami-Dade
Sworn : .. • subscribed before me ;e<!a.....e� z_ orn and subscribed before me
:* *' COMMISSION PATEL is day of , e
Th'' �? •ay of �`�� , 2015 MY COMMISSION#FF053408 2015
,: ''FOF iti�P� EXPIRES September 11,2017
Signature of Public Notary-State of Flor 398'0153 FloridallotaryserviOi ture of Public Notary-State of Florida
Notarization of Lobbyist's signature Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY _
Annual Registration fee: [ ]Yes[ No Amount Paid$ � MCR# (lot, 3 Date Paid �ti: 11
Lobbyist Registration Form received and verified by: (0- _ t
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required) $ 2 , SOO
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): 2
(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 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 Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
_Yes X No: Are you lobbvina on a oendina application for a Development Aareement with the City or application
f�chanae of zoning map designation or chanae 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 reoresentina 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 BEACI-j
FQB THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO
EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD.
Signature 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: 4jl/ / '
�l
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced ID Produced ID
Form of Identification /ersonally Form of Identification
Personally known(Lobbyist) known(Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida,County of Miami-Dade State of Florida, c- • •
Sworn to and subscribed before me Sworn and subs !•- ,� :,w.- me DAYAMI AQU1AR
This day of ,2015 This y o %;`'��, � ,Natty Public-Rafe of Florida
Commission 4'FF 198144
l /fiat " '� My Comm.Expires 16
M ar 2019
,
Signature of Public Notary—State of Florida Sign' turn of Publi •tary: , :.c_ • RAMtrao�NRlpg yr 1p
Notarization of Lobbyist's signature No .riz ion of principal's signa r-
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY"
Annual Registration fee: [ ]Yes[ No Amount Paid$ ®.. MCR# '1 0(1 I3-3 Date Paid fir
Lobbyist Registration Form received and verified by:
Cf—_
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L F:\CLE istration Form.doc Revised 04/27/2012
MI AAA BEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office
Rafael E. Granado, City Clerk CityClerk @miamibeachfl.gov
Tel: 305.673.7411 , Fax: 305.673.7254
LOBBYIST NAME Joaquin Vargas
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 obbyist, who fails to file the required Statement by April 30th, 2012, shall be
auto ,.atically suspended from lobbying until all fines are paid, unless the fine has been
appe:led to the Miami-D. .e County Commission on Ethics and Public Trust.
5
l
Sig aure: / Date:
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outn tseacn heignts I, LLU Check Number: 00591
To: City of Miami Beach 03555 Date: 05/21/2015
Invoice Number Date Description Amount Discount Paid Amount
052115 May 21,2015 Lobbyist Reg J.Vargas $350.00 $0.00 $350.00
TOTALS: $350.00 $0.00 $350.00
MisceJiane®us Cash Receipt -, . . -, ,. r .ra z 4::s54-.).00
CITY (iF MIAMI BEACH
No
® Cash In Credit Card Check#
Lion 1 $ 3 0
.5 —) 6 20 ( i
Received of • 13 ci ; C r,-11.--C- -• Le--C- _ ',�-. ''; 0 ' ° :=
SUPPLEMENTARY DISCLOSURE OF INTEREST
Interests in 500 Alton Road Ventures, LLC
Percentage of Interest
KGM Equities, LLC 100%
2200 Biscayne Blvd.
Miami FL 33137
Interests in 1220 Sixth, LLC
Percentage of Interest
KGM Equities, LLC 100%
2200 Biscayne Blvd.
Miami FL 33137
Interests in KGM Equities, LLC
Percentage of Interest
Sonny Kahn 2004 Irrevocable Trust 37%
2200 Biscayne Blvd.
Miami FL 33137
Russell W. Galbut 2004 Irrevocable Trust 37%
2200 Biscayne Blvd.
Miami FL 33137
Bruce A. Menin 2004 Irrevocable Trust 26%
2200 Biscayne Blvd.
Miami FL 33137
Beneficiaries of Sonny Kahn 2004 Irrevocable Trust
Percentage of Interest
Child of Sonny Kahn 20%
2200 Biscayne Blvd.
Miami FL 33137
A
Child of Sonny Kahn 20%
2200 Biscayne Blvd.
Miami FL 33137
Child of Sonny Kahn 20%
2200 Biscayne Blvd.
Miami FL 33137
Child of Sonny Kahn 20%
2200 Biscayne Blvd.
Miami FL 33137
Child of Sonny Kahn 20%
2200 Biscayne Blvd.
Miami FL 33137
Beneficiaries of Russell W. Galbut 2004 Irrevocable Trust
Percentage of Interest
Child of Russell Galbut 50%
2200 Biscayne Blvd.
Miami FL 33137
Child of Russell Galbut 50%
2200 Biscayne Blvd.
Miami FL 33137
Beneficiaries of Bruce A. Menin 2004 Irrevocable Trust
Percentage of Interest
Child of Bruce Menin 33.33%
2200 Biscayne Blvd.
Miami FL 33137
Child of Bruce Menin 33.33%
2200 Biscayne Blvd.
Miami FL 33137
Child of Bruce Menin 33.33%
2200 Biscayne Blvd.
Miami FL 33137