Michael W. Larkin - Russell Galbut 600 MA Q z
MIAMI BEACH 20-0 5 -rtg14-
City of Miami Beach Office of the City Clerk E : ` '
1700 Convention Center Drive, Miami Beach, FL,33139; fi 10 13
• 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.
Larkin Michael W.
NAME OF LOBBYIST: (Last) (First) (M.I)
Bercow Radell&Fernandez 200 South Biscayne Blvd., Suite 850 Miami, Florida 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-374-5300 mlarkinabrzoninalaw.corn
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:
500 Alton Road Ventures, LLC and 1220 Sixth, LLC c/o Crescent Heights 2200 Biscayne Blvd. Miami, FL 33137
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-374-5700
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:
[tDevelopment-Approvals_an.d:P_ermitting_Isues including, but not limited to the Design Review Board, Planning Board, Board of
Adjustment, Land Use Development Committee, City Commission, and any City Workshops or Committees, if necessary,
Crelatina-to-the-Droperta-located 11 500.-Alton-Road-and-1220-Sixth-Street;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
Staff for the Planning Department, Building Department, None. X
Public Works and City administration, PB, HPB, BOA, None. X
City Commission, and Mayor 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 •
None.
None
None
C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\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)$550 per hour
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): $550 per hour
(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 XNo: Are you lobbying on a present or oendina bid for goods.ea ioment or services.or on a present or pending
award for goods.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 XNo: Are you lobbying on a oendina application for a Development Agreement with the City or application for
chanae of zoning map desianation or change to the City's Fut re Land Use Mao?
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 BEACI{
EQE THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO
EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD,
J
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:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
_Produced ID _Produced ID
Form of Identifi '=? . Form of Identification
aPi°ic Notary Public State of Florida _V
Personally known(Lobbyist) Diana Ramos //Personally known(Principal)
My Commission FF 207719
4'oe tr. Expires 04/10/2019
VII. SIGNATURE D STAMP OF
State of F,•9•a, Cou y of Miami-Dade St. - of Florida, o
Son and subsc�•e a me
Sworn 1.7.i.• sus lbe b��fgJ 4 d.�,. g DAYAMI AGUTAR
This �r da ofU/(JCS •'�'{ +, DAYAMI AGUIAR I is 0V day Of �: .`,- ,1�ry public State of Florida
r� s. Notary Public•State of Florida
'401*•; Commission#FF 196144 / Commission#FF 196144
�I �mm.Expires Mar 16,2019
Signat 'e •'Public Notary—State •' ��•-Bondeditm Expires National Notary Assn. .Signatur:of Pu•; Notary—Stgteu `flor�ledthrough National Notary
Assn.•
Notariz,ti•n of Lobbyist's signatu ,Notariza ion of s g • ,. ..
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY l
Annual Registration fee: [ ]Yes[ ]No Amount Paid yef- '0M CR# 9f/O �2 Date Paid 67/7 r?/col
Lobbyist Registration Form received and verified by: .c
MIAMI 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(ulmiamibeachfl.gov
Tel: 305.673.7411 , Fa x: 305.673.7254
LO B B Y IS T NAME Michael W. Larkin
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.
,C c(ig
Signature: Date:
C:\Users\clerhatlWppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration
Form revised 5-30-2012.doc
•
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
•
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
0 ;I
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