Ari Milstein/~ z~ Cal(~ivs ~~~
m MIAMIBEACH
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 aty 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.
Milstein Ari
NAME OF LOBBYIST: (Last) (First) (M.I.)
Go Automotion Parking Systems, LCC 411 West Hempstead Turnpike Hempstead, New York 11552
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(516) 656-5600 (516) 908-4411 grim@agdorg.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
LOBBYIST RETAINED BY:
IC, LLC
NAME OF PRINCIPAUCLIENT:
IC, 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@crescentheights.com
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
this section if principal is a Corporation, Partnership or Trust
NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Russell W. Galbut and Irving
Cowan
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE
OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST:
Russell W. Galbut (50%), Managing Member
Irving Cowan (50%), Managing Member
II. SPECIFIC LOBBY ISSUE:
Conditional Use Approval (1) to permit the use of a robotic parking system in a commercial main use parking
garage at 1826 Collins Avenue, which inGudes a restaurant within the commercial space; and (2) to operate the
garage after midnight.
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: (Pursuant to City Code Section 2-482(8) inGude 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) inGude 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 IndividuaUTitle B An Financial, Famlllal or Professional Relatlonshi
City of Miami Beach Planning Board None
City of Miami Beach Planning Staff None
City of Miami Beach Mayor/Commissioners None
City of Miami Beach Committees None
/y~
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER
HOURLY, FLAT RATE OR OTHER):
LOBBYIST DISCLOSURE (Required) $0.
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
(Required). $0.
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 ®No• Are you lobbvina on a present or pendina bid for aoods equipment or services. or on a
present or pendina award for aoods, equipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On
Real Estate Development Issues":
^Yes 6a No• Are you lobbvina on a pendina application for a Development Agreement with the City or
application for chance of zoning map designation or change to the City's Future Land Use Map?
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 ~ No• Are you representing anot-for-profit corporation or entity without special compensation or
reimbursement.
V. SIGNATURE UNDER OATH:
PERIOD.
Signature of Lobbyist - Ari Milstein
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: _~~~~
;e
VI. LOBBYIST IDENTIFICATION:
^ Produced ID
Form of Identification
^ Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This _ day of , 2008
Signature of Public Notary -State of Florida
Notarization of Lobbyist's sjgnature
as Managing Member of IC, LLC
PRINCIPAL IDENTIFICATION:
^ Produced ID
Form of Identification
Personally known (Principal)
State of Florida, County of Miami-D DAYAMIAGUTAR
Swor to and su scribed b f¢i~~~~~ ~~e~% Notary Public -State o1 Fbrida
T day of Commission Expires Mar 16, 2011
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Sign tur of Pubic otary BQ"~Tr1f01~'N~101sN°gry''ase^•
Notariza on of Principal's signature
TO BE COMPLETED BY CITY CLERK'S SE ONLY
Annual Registration fee: [ Yes [ ] No Amount Pald S MCR # Paid
Lobbyist Registration Form received and verified by:
F:\CLER\LOBBYIS11Lobbvist Registration Form 32708.doc Revised
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER
HOURLY, FLAT RATE OR OTHER):
LOBBYIST DISCLOSURE: (Required) $0.
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
(Required). $0.
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 ~ No: Are you lobbvina on a present or gendina bid for goods. equipment or services. or on a
present or pending award for goods, eguilnment 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 lobbying on a pending application for a Develoament Agreement with the Citv or
acnlication for change of zoning mae designation or change to the City's Future Land Use Mao?
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 snot-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 ~ No: Are you representing snot-for-arofit coraoration or entity without special compensation or
reimbursement.
V. SIGNATURE UNDER OATH:
I do solemnly swear that all of the foregoing facts ar true and correct and that 1 have read or am familiar with the
provisions contained in Section 2 of the m' B ' ch City Code and all reporting requirements.
Signature of Lobbyist: `C
Signature of Principal/Client:
Russell W. Galbut, as Managing Member of IC, LLC
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
^ Produced ID
Form of Identification
Personally known (Lobbyist)
^ Produced ID
Form of Identification
^ Personally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Swom o and subscribe before e
This ,(~ y of , 2009'
natur f Pub ' Notary -State of Florida
otarization of Lobbyist's signature
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This _ day of , 2008
Signature of Public Notary -State of Florida
Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S USE NLY
Annual Registration fee: [ ]Yes [ ] No Amount Pald; CR ~; PaW
Lobbyist Reglstratlon Form received and verlfled by:
F:\CLER\LOBBYISlILobb ist R istration Form 32708.doc Revised 03/27/2008
JO LYNN GRILL
Notary Public, State of New York
No. 01 GR6108467
Qualified in Nassau County
Commission Expires April 19, 20 L~'"
ON OCTOBER 1sr OF EACH YEAR. EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH LISTING LOBBYING EXPENDITURES AS WELL AS COMPENSATION
m MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.aov
CITY CLERK office CityClerk miamibeachfl.gov
Tel: 305.673.7411, Fax: 305.673.7254
Ari Milstein
LOBBYIST NAME:
I understand that no later than October 1" 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 addition, once an i sue I ha registered to lobby on has been resolved, I am required to immediately notify the
City Clerk's Office fo obbyist ' hdrawal in writing.
~„ ~ ~ ~ ~ ~
Signature: An Milstein D