Raymond Fort - KGTC LLC No;{-+& .e To kA)h Cit kr
RECEIVED
M IA\t'/\ I BEACH Office of the City Clerk SEP 11 2019
1700 Convention Center Drive
Miami Beach, FL 33139
305.673.7411 CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK #,
LOBBYIST REGISTRATION FORM n 6�� b`� et A
Lobbyist means all persons employed or retained, whether paid or not, by a principal who se s o encou ge 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 City Code Chapter 2,Article VII, Division 3, entitled "Lobbyists,"
for additional information.
Instructions: Please complete all sections of this form and submit the completed form,with the applicable fee,to the Office of the City
Clerk. If you need more space to complete an answer, use a separate sheet(s) of paper. If you have nothing to report in a particular
section, you must write "none" or "n/a" in that section. Any change to any information originally filed, or any additional City
Commissioner or personnel who are also sought to be lobbied shall require that the lobbyist file an amendment to the registration form.
The lobbyist has a continuing duty to supply information and amend the forms filed throughout the period that the lobbying occurs.
Separate registration forms shall be required for each principal represented on each specific issue.
I. LOBBYIST INFORMATION:
Fort Raymond
NAME OF LOBBYIST (Last) (First) (Middle Name)
Arquitectonica 2900 Oak Avenue Miami Florida 33133
LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-372-1812 rfort@arquitectonica.com
LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS
II. PRINCIPAL INFORMATION:
Cohen Matis
NAME OF PRINCIPAL (Last) (First) (Middle Name)
KGTC LLC P.O. Box 414318 Miami Beach FL 33141
PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS
If the principal is a Corporation, Partnership or Trust, the following information MUST be provided
pursuant to City Code Section 2-482(c):
• NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY(if none,write N/A): Matis Cohen
• NAME OF ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION,PARTNERSHIP OR TRUST(if none,write N/A): Attached Exhibit "A"
Page 1 of 5 '
III. ISSUE TO BE LOBBIED:
Describe with as much detail as is practical, including but not limited to a specific description where
applicable of a pending request for proposal, invitation to bid, or public hearing number.
Redevelopment of properties located in the North Beach Town Center
IV. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
Pursuant to City Code Section 2-482(a)(4), list the City Commissioner or City personnel sought to be
lobbied, and whether the lobbyist has entered into any contractual relationship (paid or unpaid) with
said City Commissioner or City personnel from 12 months preceding such commencement of service
with the City to the present date, stating the general nature of the subject contractual relationship.
Full Name of Individual and Contractual Relationship (If yes, explain) YES NO
Title of Person to be Lobbied
Board of Adjustment, Dept. of Public Works X
Historic Preservation Board X
City Commissioners and Mayor X
City Manager, City Attorney X
Planning Board, Design Review Board X
Building Department, Planning Department 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.
List any Business, Financial, Familial or Professional Relationship, or other relationship giving rise to an
appearance of impropriety (if none, write N/A):
None
V. DISCLOSE RATE AND AMOUNT OF LOBBYIST COMPENSATION — Be Specific. (Note that a
contingency fee is prohibited pursuant to City Code Sec. 2-485.3):
o cu1Ly
Page 2 of 5
The following six(6)questions MUST be answered:
1) Pursuant to City Code Section 2-488, entitled "Prohibited Campaign Contributions By Lobbyists On Procurement Issues":
_Yes✓ENo: 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?
2) Pursuant to City Code Section 2-490, entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development
Issues":
_YesONo: 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 City Code Section 2-482(h), any person (except those exempt from the definition of "lobbyist" as set forth in
Section 2-481) 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 city clerk as required by this section, but shall not be required to pay any registration fees.
YesENo: Are you representing a not-for-profit corporation or entity without special compensation or
reimbursement?
4) Pursuant to City Code Section 2-481, the term "lobbyist" specifically excludes the following persons: Expert witnesses who
provide only scientific, technical or other specialized information or testimony in public meetings; any person who only appears
as a representative of a neighborhood association without compensation or reimbursement for the appearance,whether direct,
indirect or contingent, to express support of or opposition to any item; and any person who only appears as a representative of
not-for-profit community based organization for the purpose of requesting a grant without special compensation or
reimbursement for the appearance.
YesI 1o: Are you providing only scientific, technical or other specialized information; appearing as a
representative of a neighborhood association without special compensation or reimbursement or
representinq a not-for-profit based organization for the purpose of requesting a grant without
special compensation or reimbursement?
5) Pursuant to City Code Section 2-491(1), no campaign consultant shall lobby the City Commission for a period of 12 months
following the swearing in of any elected official(s) for whom the campaign consultant provided campaign consulting services
within the past election cycle. See Section 2-491 for more information.
_YesENo: Have you provided campaign consulting services to an incumbent member of the City Commission
within the past election cycle? If yes,please list the incumbent member(s)of the City Commission:
Yes❑✓No: If yes, has it been less than 12 months since the elected official(s) whom you provided campaign
consulting services was sworn in?
6) Pursuant to City Code Section 2-482(a)(4)a., a lobbyist who has within the past election cycle provided campaign consulting
services to an incumbent member of the City Commission (which lobbying activity is not otherwise prohibited by Code section
2-491) shall disclose such particular service on his/her lobbyist registration form and shall orally disclose such particular
service before lobbying the City Commission at a public meeting.
_YesQNo: Have you provided campaign consulting services to an incumbent member of the City Commission
within the past election cycle? If yes, please list the incumbent member(s)of the City Commission:
YesENo: If yes, were you promised or did you receive economic consideration in exchange for campaign
consulting services?
TO BE COMPLETED BY CITY CLERK'S STAFFr� ONLY
Annual Registration fee: [ ]Yes[)0 No Amount Paid$ � —1
,i` ` MCR# Date Paid
Lobbyist Registration Form received and verified by: ="J`A.A.
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 01-01-18 REG.doc Revised 01/01/2018
Page 3 of 5
VI. SIGNATURES UNDER OATH:
ON FEBRUARY 28 OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE OFFICE OF THE CITY CLERK A
SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION
RECEIVED, FOR THE PRECEDING CALENDAR YEAR WITH REGARD TO THE SPECIFIC ISSUE ON WHICH THE
LOBBYIST HAS BEEN ENGAGED TO LOBBY. A STATEMENT SHALL BE FILED EVEN IF THERE HAS BEEN NO
EXPENDITURE OR COMP NSATION DURING THE REPORTING PERIOD.1
"'"'. Z°1
Signature of Lobbyist: � Date C1$
I do solemnly swear or a irm that all of the foregoing facts, statements. and disclosures in this form are true and correct,
and that I have read or am familiar with the provisions contained in Chapter 2, Art. VII, Division 3, entitled "Lobbyists" of
the Miami Beach City nd all repo quirements. O� ,
Signature of Lobbyist: , Date q
Signature of Principal: Date
VII. NOTARY SIGNATURE AND SEAL:
LOBBYIST: PRINCIPAL
State of FloridaState of Florida
County of Miami-Dade County of Miami-Dade
Sworn to (or affirmed) and subscribed before me Sworn to (or affirmed) and subscribed before me
this day of , 20_, by this day of , 20_, by
Raymond Fort Matis Cohen
NAME OF LOBBYIST NAME OF PRINCIPAL
_Produced ID _Produced ID
FORM OF IDENTIFICATION FORM OF IDENTIFICATION
• onally Kn.lON Personally Known
_,� / it A
Sig ' t re of Notary Public Signature of Notary Public
6fliliT1612 —
me of Notary, Typed, Printed or Stamped Name of Notary, Typed, Printed or Stamped
•
;rg%_:'. MARJBELDIAZ
( -1�''•'.,Y OMMISSION0GG307471 (NOTARY SEAL)
L.fi`` : EXPIRES:June 29,2023
°a•;Bonded Tiro Pubic tledei*Nters
' The term"lobbyist"specifically excludes the following persons:
Expert witnesses who provide only scientific, technical or other specialized information or testimony in public meetings; any person who
only appears as a representative of a neighborhood association without compensation or reimbursement for the appearance, whether
direct, indirect or contingent, to express support of or opposition to any item; and any person who only appears as a representative of
not-for-profit community based organization for the purpose of requesting a grant without special compensation or reimbursement for
the appearance.
Page 4 of 5
VI. SIGNATURES UNDER OATH:
ON FEBRUARY 28 OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE OFFICE OF THE CITY CLERK A
SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION
RECEIVED, FOR THE PRECEDING CALENDAR YEAR WITH REGARD TO THE SPECIFIC ISSUE ON WHICH THE
LOBBYIST HAS BEEN ENGAGED TO LOBBY. A STATEMENT SHALL BE FILED EVEN IF THERE HAS BEEN NO
EXPENDITURE OR COMP NSATION DURING THE REPORTING PERIOD.11
_...
Signature of Lobbyist: Date o$ ZotA
I do solemnly swear or a Irm that al(of the foregoing facts. statements, and disclosures in this form are true and correct,
and that I have read or am familiar with the provisions contained in Chapter 2, Art. VII, Division 3, entitled "Lobbyists" of
the Miami Beach City nd all rep quirements.
Signature of Lobbyist. Date 00/241M6
Signature of Principal: Date 9/5/2019
VII. NOTARY SIGNATURE AND SEAL:
LOBBYIST: PRINCIPAL
State of Florida State of Florida
County of• Miami-Dade County of: Miami-Dade
Sworn to(or affirmed)and subscribed before me Sworn to(or affirmed)and ubscribed beforee
this 8 day of August ,2019. by this _5 day of s 20/7. by
Raymond Fort Matis Cohen
NAME OF LOBBYIST NAME OF PRINCIPAL
_Produced ID Produced ID
FORM OF IDENTIFICATION FORM OF IDENTIFICATION
r e- ovally Kn. ` Pey Known
Sig t re of Notary Public Sign*re of Notary Public
f Gam-- G� fs,22,0 ,A
me of Notary. Typed. Printed or Stamped Name of Notary. Typed. Printed or Stamped
AIARe'ELDIAZ _ - - - - - - - - -
( •• �fKC0A1MISSK)N 0 GG 307471 (NOTAF�':��y---,
JULIO CESAR ESPANA 0
=. ( Notary Public.State of Florida
EXPIRES:June 29,2023pi Commission#GG 222172
BondedDry Notary PublicUnoerwirert I orn My Comm.Expires May 28,2022 `
Bonded through National Notary Assn.
The term"lobbyist"specifically excludes the following persons
Expert witnesses who provide only scientific,technical or other specialized information or testimony in public meetings: any person who
only appears as a representative of a neighborhood association without compensation or reimbursement for the appearance, whether
direct, indirect or contingent, to express support of or opposition to any item: and any person who only appears as a representative of
not-for-profit community based organization for the purpose of requesting a grant without special compensation or reimbursement for
the appearance.
Page 4 of 5
MIAMI BEACH
City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov
Office of the City Clerk
Rafael E. Granado, City Clerk CityClerk@miamibeachfl.gov
Tel: 305.673.741 1, Fax: 305.673.7254
NAME OF LOBBYIST: Raymond Fort
1) LOBBYIST FEE EXPENDITURE AND COMPENSATION STATEMENT
Pursuant to City Code Section 2-485(d), the City Clerk shall notify any lobbyist (or
principal) who fails to file timely a Lobbyist Fee Expenditure and Compensation Statement
(Statement). In addition to any other penalties that may be imposed as provided in
Section 2-485.1, a fine of $50.00 a day shall be assessed for Statements 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 of each year, 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.
I hereby acknowledge that on February 28 of each year, I shall submit to the City Clerk a
signed Statement under oath listing all lobbyist expenditures, as well as compensation
received, for the preceding calendar year with regard to the specific issue on which I have
been engaged to lobby.
2) LOBBYIST WITHDRAWAL
Once an issue I have registered to lobby has concluded or I am no longer lobbying on
that issue, I shall immediately file a Notice of Withdrawal with the Office of the City Clerk.
3) ANNUAL LOBBYIST REGISTRATION FEE
I understand annual registration of all lobbyists shall be required for each 12-month period
commencing October 1 of each year, and the fee for such annual registration shall be
500.00 pursuant to Section 2-482 of the Miami Beach City Code.
Sig atur of Lobbyist itils6i/ I 1
Date
F'\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 01-01-18 REG.doc
Page 5 of 5
DISCLOSURE OF INTEREST
INTEREST IN KGTC, LLC
Percentage of Interest
Ronruss Partners, LTD 50%
KGP3545, LLC 50%
INTEREST IN KGP3545,LLC
Matis Cohen 94.5%
Edward Brogen 3.5%
Harel Levy 1 %
David Baron 1 %
1
ACTIVE 44413457v2
INTEREST IN RONRUSS PARTNERS, LTD
Russell Galbut 44.1%
Ronalee Galbut 44.1%
Marisa Galbut LLLP 5.52%
Jenna Galbut LLLP 5.28%
Ronruss Corporate 1%
INTEREST IN JENNA GALBUT LLLP
Jenna Galbut 99%
Russell Galbut 1%
INTEREST IN MARISA GALBUT LLLP
Marisa Galbut 99%
Russell Galbut 1%
INTEREST IN RONRUSS CORPORATION
Russell Galbut 49.5%
Ronalee Galbut 49.5%
Abraham &Nancy Galbut 1%
2
ACTIVE 44413457v2
Salvatore, Jason
From: Julio Espana <jespana@arquitectonica.com>
Sent: Wednesday, September 11, 2019 9:47 AM
To: Salvatore,Jason
Cc: Tom Westberg
Subject: Raymond Fort lobbyist registration for Redevelopment of Properties located in the
North Beach Town Center
Attachments: Complete Disclosure of Interest Form.DOCX
THIS MESSAGE COMES FROM AN EXTERNAL EMAIL-USE CAUTION WHEN REPLYING AND OPENING LINKS OR
Hi Jason,
Please find attached Exhibit "A" Should you need any further information, please do not hesitate to contact me.
Regards,
Julio Espana
JULIO ESPANA
Marketing
jespana(a arquitectonica.com
P +1 (305) 372-1812 Ext. 1017
2900 Oak Avenue
Miami,Florida 33133,United States
ARQUITECTQN/CA www.arouitectonica.com•AAC000465
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1
Miscellaneous Cash Receipt
CITY OF MIAMI BEACH
No, 424384
0 Cash 0 Credit Card 0 Check# ,5,771.1„
$ 7 c.:-.)
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F6FR OPEN(MCR) i S5 v-t/ : NO/41% Oe'tc h 'To/
Payment Amount: 350.00
MCR424384
(THIS INFORMATION MUST BE COMPLETED) Office of Finance Director
By
Account Number: (17--- l • c)(--1.--'(3 -' i LIL/'i' --)(). -3(-7 3 i.,.• ,-,-, -., ,...„„
Preparer: - 1S .) 5.i.t,,, Dept: EXT:
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