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Jonathan W. Cardello/South Beach Heights I, LLC (5)~ MIAMIBEACH City of Miami Beach OfFce 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 bond 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. Cardello Jonathan W, NAME OF LOBBYIST: (Last) (First) (M.I.) c/o ADD, Inc. One Biscayne Tower, Suite 1670, Two South Biscayne Boulevard Miami FL 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 482-8700 (305) 482-8770 jcardello addinc com TELEPHONE NUMBER: FAX NUMBER: EMAIL: LOBBYIST RETAINED BY: South Beach Heights I, LLC NAME OF PRINCIPAUCLIENT: South Beach Heights I, LLC 2200 Biscayne Boulevard Miami FL 33137 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 374-5700 (305) 847-3354 mkramer crescenthei hts 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 W. Galbut • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: See attached. SPECIFIC LOBBY ISSUE: Redevelopment of former South Shore Hospital assemblage and nearby properties, including properties between 6 and 8 Street on both the east and west sides of Alton Road. Issue to be lobbied (Describe in detail): III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: (Pursuant to City Code Section 2-482(g) include a statement of the extent of any business, financial, familial, professional or other relationship, giving rise to an appearance of an impropriety, with any City personnel sought to be lobbied; further, pursuant to City Code Section 2- 482(a)(4) include a statement of any contractual relationship (paid or unpaid) from 12 months preceding the commencement of service of City personnel to be lobbied.) A Full Name of IndividuallTitle B An Financial, Familial or Professional Relationshi City of Miami Beach Planning Board Cit f Mi i B None ~ ~ ~ }'; ~ .~.~(1 ~. ~, (~.,t .:~ ? ~ ~r y o am each Design Review Board None , ` City of Miami Beach Planning Staff Cit of Miami Beach M /C None ~Z :~ I~I~ 9 I ~ y ayor ommissioners None 3a BpDZ City of Miami Beach Land Use & Development None Committee Ci f M ~ "~ .~ ~`~ "` / ~ I ' ty o iami Beach Committees None -~ l~ W' IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): LOBBYIST DISCLOSURE: (Required) $ f~, B) PRINCIPAL'S DISCLOSURE (OF LO BYIST COMPENSATION): (Required). $ .--._._____ ~ [`j, ~t_'j 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 6a No: Are you lobbvina on a present or pending bid for aoods eauipment or services or on a present or Dendina award for aoods eauipment or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": Yes ^ No: Are you lobbvina on a pending application for a Development Agreement with the City or application for chance of zoning map designation or chance to the Citv's Future Land Use Maps 3) Pursuant to Miami Beach City Code 2-484 (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 anot-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 6a No: Are you representing anot-for-profit corporation or entity without special compensation or reimbursement. V. SIGNATURE UNDER OATH: ON OCTOBER 1g~ OF EACH YEAR EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED CTATG~~L-SIT ~~-~r~r~ ~~~~. ..w~..... .-~~.,...~ -_,--_.--__--_ -- ___... Sig I do solemnly swear that all of tly~foregoing provisions contained in Section X482 of the P Signature of Lobbyist: Signature of Principal/Client: Russel VI. LOBBYIST IDENTIFICATION: ^ Produced ID Form of Identification are true and correct n that I have read or am familiar Beach City Code and reporting requirements. Personally known (Lobbyist) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Sworn to and subscribed f"~°~°° , DEBRA J.VANZANT This Icj day of ~C_ gftp ':*. MY COMMISSION # DD 708540 //~- ' / Iy ft : ~= EXPIRES: August 26, 20t t /i~li _ / l ~/A.. e A ._ v i °'~ 4~,is' Bonded'rhru Notsry Public Underv+mers of Pu~c Notary -State of Florida ono obbvist's signature each Heights I, LLC PRINCIPAL IDENTIFICATION: the ^ Produced ID Form of Identification Personally known (Principal) ate of Florida, County of Miami-Dade orn to and su cribed bef is j~ day of ~, 2 8 ,:'~Y"'~•., O~Yr~A ?o i+ NOitllry PItbNC ' 8tih1 d FIOf10~ riplMl~i0f1 E>fpYM ~ 1)8, 4tlt Si na re of ubl Notary - S ~ aC0^~~0^ ~ ~ ~09Y hN lN T f A Notari ation of Principal's s na~lf7~" otMr 8onded hap ~ aw Mi TO BE COMPLETED BY CITY CLERK'S USE ONLY Annual Registration fee: [ ]Yes [ ] No Amount Paid $ MCR # S Date Paid Lobbyist Registration Form received and verified by: F:ICLER\LOBBYIST1Lobb ist Re istration Form 32708.doc Revised 03/27/2008 m MIAMIBEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov CITY CLERK office CitvClerkCc~miamibeachfl.gov Tel: 305.673.7411, Fax: 305.673.7254 LOBBYIST NAME: Jonathan W. Cardello I understand that no later than October 1St of each vear, I must file the following forms, 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 Form 2) Disclosure 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 additio nce an issue I have registered to lobby on has been resolved, I am required to immediately notify the City CI 's O for lobbyist withdrawal in writing. ~ r 1 1 12 - ~~_~ Sign onath W. Cardello Date: CITY OF N11AMt BEACH DEVELOPMENT REVIEW BOARD APPLICATION DISCLOSURE OF INTEREST '1. LIMITED LIABILITY COMPANY If the property which is the subject of an application is owned or leased by a CORPORATION, list the principal stockholders and the percentage of stock owned by each. Where the principal officers or stockholders consist of another corporation(s}, trustee(s), partnership(s) or other similar entity, further disclosure shall be required which discloses the identity of the individual{s) (natural persons) having the ultimate ownership interest in the entity.'' SOUTH BEACH HEIGHTS I LLC LIMITED LIABILITY COMPANY NAME NAME, ADDRESS, AND OFFICE SBH HOLDINGS I, LLC 2200 Biscayne Boulevard Miami, Florida 33137 Member SBH MANAGEMENT COMPANY, LLC 2200 Biscayne Boulevard Miami, Florida 33137 Member and Manager OFFICERS; SONNY KAHN 2200 Biscayne Boulevard Miami, Florida 33137 Chairman RUSSELL W. GALBUT 2200 Biscayne Boulevard MEami, Florida 33137 President BRUCE A. MENIN 2200 Biscayne Boulevard Miami, Florida 33137 Sr. Vice President SHARON CHRISTENBURY 2200 Biscayne Boulevard Miami, Florida 33137 Vice President SHLOMO DACHOH 2200 Biscayne Boulevard Miami, Florida 33137 Secretary JOSEPH ZDON 2200 Biscayne Boulevard Miami, Florida 33137 Treasurer PABLO DE ALMAGRO 2200 Biscayne Boulevard Miami, Florida 33137 Asst.. Treasurer OF MEMERSHIP INTEREST 99% 1% IF THERE ARE ADDITIONAL CORPORATIONS, L/ST OTHERS, INCLUDING CORP. NAME(S~ AND EACH !ND/VIDUAL'S NAME, ADDRESS, OFFICE AND PERCENTAGE OF STOCK, ON A SEPARATE PAGE, NOTE: Notarized signature required on page S 6 GITY OF MIAMI BEAGH DEVELOPMENT REVIEW BOARD APPLICATION DISCLOSURE OF INTEREST 1. LIMITED LIABILITY COMPANY If the property which is the subject of an applica#ion is owned or leased by a CORPORATION, List the principal stockholders and the percentage of stack owned by each. Where the principal officers or stockholders consist of another corporation(s), trustee(s), partnerships} or other similar entity, further disclosure shall be required which discloses the identity of the individual(s) (natural persons) having the ultimate ownership interest in the entity.* SBH MANAGEMENT COMPANY LLC LIMITED LIABILITY COMPANY NAME NAME, ADDRESS, AND OFFICE CH INVESTMENT HOLDINGS, LLC 2200 Biscayne Boulevard Miami, Florida 33137 Member and Manager OFFICERS: SONNY KAHN 2200 Biscayne Boulevard Miami, Florida 33137 Chairman RUSSELL W. GALBUT 2200 Biscayne Boutevar~d Miami, Florida 33137 President BRUCE A. MENIN 2200 Biscayne Boulevard Miami, Florida 33137 Sr. Vice President SHARON CHRISTENBURY 2200 Biscayne Boulevard Miami, Florida 33137 Vice President SHLOMO DACHOH 22D0 Biscayne Boulevard Miami, Florida 33137 Secretary JOSEPH ZDON 2200 Biscayne Boulevard Miami, Florida 33137, Treasurer PABLO DE ALMAGRO 2200 Biscayne Boulevard Miami, Florida 33137 Asst. Treasurer OF MEMERSHIP INTEREST 100% IF THERE ARE ADDITIONAL CORPORATIONS, LIST OTHERS, INCLUDING CORP. NAMES} -AND EACH INDIVIDUAL'S NAME, ADDRESS, .OFFICE AND PERCENTAGE OF STOCK, ON A SEPARATE PAGE. NOTE: Notarized signature required on page 8 6 CITY OF MIAMI BEACH DEVELOPMENT REVIEW BOARD APPLICATION DISCLOSURE OF [NTEREST 1. LIMITED LIABILITY COMPANY !f the property which is thetsubject of an application is owned or leased by a CORPORATION, list the principal stockholders and the percentage of stock owned by each. Where the principal officers or stockholders consist of another corporations}, trustee(s), partnership(s) or other similar entity, further disclosure shall be required which discloses the identity of the individual(s) (natural persons} having the ultimate ownership interest in the entity.'` , SBH HOLDINGS ( LLC LIMITED LIABILITY COMPANY NAME NAME, ADDRESS, AND OFFICE CH INVESTMENT HOLDINGS, LLC 2200 Biscayne Boulevard Miami, Florida 33137 Member and Manager DAVID GALBUT 2200 Biscayne Boulevard Miami, Florida 33137 Member OFFICERS: SONNY KAHN 2200 Biscayne Boulevard Miami, Florida 33137 Chairman RUSSELL W. GALBUT 2200 Biscayne Boulevard Miemi, Florida 33137 President BRUCE A. MENlN 2200 Biscayne Boulevard Miami, Ftorlda 33137 Sr. Vice President SHARON CHRISTENBURY 2200 Biscayne Boulevard Miami, Florida 33137 Vice President SHLOMO DACHOH 2200 Biscayne Boulevard Miami, Florida 33137 Secretary JOSEPH ZDON 2200 Biscayne Boulevard Miami, Florida 33137 Treasurer PABLO DE ALMAGRO 2200 Biscayne Boulevard Miami, Florida 33137 Asst Treasurer °lo OF MEMERSHIP INTEREST 89.89% 10.11% 1F THERE ARE ADDITIONAL CORPORATIONS, LIST OTHERS, INCLUDING CORP. NAME(S) AND EACH INDIVIDUAL'S NAME, ADDRESS, OFFICE AND PERCENTAGE OF STOCK, ON A SEPARATE PAGE. NOTE: Notarized signature required on page 8 6 CITY OF MIA~Mt BEACH DEVELOPMENT REVIEW BOARD APPLICATION DISCLOSURE OF INTEREST '1. LIMITED LIABILITY COMPANY If the property which is the subject of an application is owned or leased by a CORPORATION, list the principal stockholders and the percentage of stock owned by each. Where the principal officers or stockholders consist of another corporation(s), trustee(s), partnership(s) or other similar entity, further disclosure shall be required which discloses the identity of the individual(s) (natural persons) having the ultimate ownership interest in the entity.* CH INVESTMENT HOLDINGS LLC LIMITED LIABILITY COMPANY NAME NAME, ,4DDRESS, AND OFFICE % OF MEMERSHIP INTEREST SK BUSINESS TRUST 37% 2200 Biscayne Boulevard Miami, Florida 33137 Member RF BUSINESS TRUST 37% 2200 Biscayne Boulevard Miami, Florida 33137 Member MENIN 1998 FAMILY TRUST 26% 2200 Biscayne Boulevard Miami, Florida 33137 Member MANAGERS: SONNY KAHN 2200 Biscayne Boulevard Miami, Florida 33137 Manager RUSSELL W. GALBUT 2200 Biscayne Boulevard Miami, Florida 33137 Manager BRUCE A. MENIN 2200 Biscayne Boulevard Miami, Florida 33137 Manager lF THERE ARE ADDITIONAL CORPORATIONS, LIST OTHERS, INCLUDING CORP. " NAME(S) AND EACH INDIVIDUAL'S NAME, ADDRESS, OFFICE - AND PERCENTAGE OF STOCK, ON A SEPARATE PAGE. NOTE: Nofarized signature required on page 8 6 CITY OF MIAMI BEACH DEVELOPMENT REVIEW BOARD APPLICATION DISCLOSURE OF INTEREST 2. TRUSTEE If the property which is the subject of an application is owned or leased by a TRUSTEE, list the beneficiaries of the trust and the percentage of interest held by each. Where the beneficiaries/beneficiary consist of corporation(s), another trust(s), partnership(s) or other similar enti#y, further disclosure shall be required which discloses the identity of the individual(s) (natural persons) having the ultimate ownership interest in the entity.* SK BUSINESS TRUST TRUST NAME NAME, ADDRESS, AND OFFICE % OF INTEREST SONNY KAHN 2200 Biscayne Boulevard Miami, Florida 33137 Beneficiary 100% NOTE: Notarized signature required on page 8 7 CITY OF MtAMt BEACH DEVELOPMENT REVIEW BOARD APPLICATION DISCLOSURE OF INTEREST 2. TRUSTEE If the property which is the subject of an application is owned ar leased by a TRUSTEE, list the beneficiaries of the trust and the percentage of interest held by each. Where the beneficiaries/beneficiary consist "of corporation(s), another trusts}, partnership(s) ar other similar entity, further disclosure shall be required which discloses the identity of the individual(s) (natural persons}having the ultimate ownership interest in the entity." RF BUSINESS TRUST TRUST NAME NAME, ADDRESS, AND OFFICE °!o OF INTEREST RUSSELL W. GALBUT 2200 Biscayne Boulevard Miami, Florida 33137 Beneficiary 100% NOTE: Notarized signature required on page 8 7 CITY OF MIAMI BEACH DEVELOPMENT REVIEW BOARD APPLICATION DISCLOSURE OF INTEREST 2. TRUSTEE If the property which is the subject of an application is awned or leased by a TRUSTEE, list the beneficiaries of the trust and the percentage of interest held by each. Where the beneficiaries/beneficiary consist of corporations}, another trusts}, partnerships} or other similar entity, further disclosure shall be required which discloses the identity of the individual(s) (natural persons) having the ultimate ownership interest in the entity.* MENIN 1998 FAMILY TRUST _ TRUST NAME NAME, ADDRESS, AND OFFICE °lo OF INTEREST BRUCE A. MENIN 2200 Biscayne Boulevard Miami, Florida 33137 Beneficiary 100% NOTE: Notarized signature required on page S 7