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Eric Isicoff - Russell Galbut m Am, BEAc H 210 City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 (" JUL f"r � i°A� s� 201 UL 2r PH 2• Li 3 LOBBYIST REGISTRATION FORM Lobbyist means all persons employed or retained, whether paid or not, b y.a principal who seeks to encoura a p assa9 e,ldefeat;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. Isicoff Eric NAME OF LOBBYIST: (Last) (First) (M.I) Isicoff Ragatz & Koenigsberg 1200 Brickell Avenue, Suite 1900 Miami Florida • 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 373-3232 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: Crescent Heights 2200 Biscayne Blvd. Miami Florida 33137 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 374-5700 raalbut aacrescentheiahts.corn 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 CORPORATION, PARTNERSHIP OR TRUST:See attached II.SPECIFIC LOBBY ISSUE: Development Board Approvals for 709 Alton Road, Miami Beach. Florida Issue to be lobbied(Describe in detail): Ill. 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 Staff, PB, HPB, BOA, DRB, Commission 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 NONE C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc t IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) 441 51 4 B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): 4 147 S Rk (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 pendina application for a Development Aareement 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 SHALL SUBMIT TO TH i ft' • RK A SIGNED STATEMENT UNDER . OATH. LISTING LOBBYING EXPENDITURES. AS WELL AS COMPENSATI J I_ IN THE CITY OF MIAMI BEACI( EQB THE PRECEDING CALENDAR YEAR. A STATEMENT SHAL .1 FIL � E r IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD, I ' \ i &v Signature of Lobbyist I do solemnly swear that all o ore.. • i:.;� - e true and correct and that I have read or am familiar with the provisions contained in Section 2-482 of the Miami h Cty ••'- :.� • :11 reporting requirements. Signature of Lobbyist: 0..... Signature of Principal/Client: , 13',-----' dio VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: Produced ID Produced ID Form of Identificati ,%raliUUl4ii, Form of Identification J 4 5 40 •EMISSION' - a N Personally known(Lobbyist) 0 3,2 'a, e )( Personally known(Principal) $g t. :.4.- °'o'eg.,: % M a" VII. SIGNATURE AND STAMP OF iri$1ARY:•.,0 a*= a 7 #EE 167948 Qr. t6„,>c. State of Florida, County of Miami-Dade .,4 J.? eo„c ,�f. (t-4". State of Florida, County of Miami-Dade Sworn to and subscribed before me A�• ;�Mc ••'F���` Sworn and subscribed before me This day o e- Am ,2015 �/C STAIS`-'0�` This &''-day of <r1 iy , 2015 dt...r�:j 11W0)11100 J _ t 4---Jana,L. Earne `_ter� '24:i;� : `ure of Public otary mate •f Flo .-:a Signature of Pu.�' Qa .I tate of Florida Ly,. .rization of Lobbyist's signature - Notarization of p (ps Dal's signature TO BE COMPLETED BY CITY CLERK'S STAFF ONLY /� Annual Registration fee: [ Yes[ ]No Amount Paid$ _i • MCR# Lj Ott ci� Date Paid ') c. "11 Lobbyist Registration Fo received and verified by: I1% 1 C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temp•rary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc F:\CLE istration Form.doc Revised 04/27/2012 MIAMi MIAMIBEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeach8.gov CITY CLERK Office Rafael E. Granado, City Clerk CityClerk @miamibeachfl.gov Tel: 305.673.7411 , Fax: 305.673.7254 LOBBYIST NAME Eric Isicoff 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 sus •bbying until all fines are paid, unless the fine has been appealed to th is i i-'ade` •• I ty Commission on Ethics and Public Trust. bis _ -//4.1-7 /c. Signature: • D te: 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 II, LLC Percentage of Interest SBH Holdings II, LLC 99% 2200 Biscayne Blvd. Miami FL 33137 SBH Management Company, LLC 1% 2200 Biscayne Blvd. Miami FL 33137 Interests in SBH Holdings II, 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 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 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 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 \ f - _ t $ to R,i'-,,p8. -4.y� 6 Y}-r-3'f`F� ,.X 1 '- 44- -f i /j 1 A iscellane us Cash Receipt - ,s.5 4 q '8't r. - - - 1°a+ {y+`f- `¢ 7., t '�J r .Y - +gip * 1,7 �� '1 '_ Yi '•', ` ° �' Cs� Or; AMi BEACH ' 5\ N ^fit_ _ 1 ,=.1 r`n 7 r r� r Noe - -.•'''.-r 5 G _TSYrK.3'. 3- � `*i _ -t If t x -.t71.., r �'' Cash .Credit Card ck#`" P' r _5 Y I r iL )t_ 1- Received r-* C ?Address 1. o l:,...':::-... 4 �: �� � 1'. . . For : v.46t .I -der .< ,� i p 1 t y:, -- , (THIS INFORMATION UST EE COMPLETED) -` .Office of Finance Director S.d 1- , T _ _ \ s �. + °t Account Number. -Cwt r + } \ tPre p arer: � p F - 'Dept. L'•�j � _t� >�` ;' , EXT.. 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