Harold Rosen (2)J8~ ( ~'o ~i~ rv1 ,.~~~~ o i ~
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City of Miami Beach Office of the City Clerk ~ ~ ~ ~ ~ ~~ r~-, C
1700 Convention Center Drive, Miami Beach, FL 3313~jpg JAN ! 6 p~ 4.29
LOBBYIST REGISTRATION FORM
CfTY C~.~;`;~;
Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage`th~~ ~ I~[w
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.
Rosen Harold
NAME OF LOBBYIST: (Last) (First) (M.I.)
c/o Rosen Switkes & Entin P.L. 407 Lincoln Road, PH SE Miami Beach FL 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 534-4757 (305) 538-5504 hrosen@rosenandswitkes.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
LOBBYIST RETAINED BY:
IC, LLC
NAME OF PRINCIPAL/CLIENT:
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)
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 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
SPECIFIC LOBBY ISSUE:
Certificate of Appropriateness for the construction of a new robotic parking garage at 1826 Collins Avenue,
including an accessory commercial space containing a restaurant, which will replace an existing surface parking
lot.
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 IndividuaUTitle B) An Financial, Familial or Professional Relationship
City of Miami Beach Historic Preservation Board None
City of Miami Beach Planning Staff None
City of Miami Beach Mayor/Commissioners None
City of Miami Beach Committees None
/c~~
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER
HOURLY, FLAT RATE OR OTHER):
LOBBYIST DISCLOSURE: (Required) $
B) PRINCIPALaS DI CLOSURE (OF LOBBYIST COMPENSATION):
(Required). $ f ~~
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 lobbying on a Wresent or pending bid for goods, eauipment or services, or on a
present or pending award for Goods, eauipment 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 lobbying on a Wending 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 MaW?
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 6d No: Are you representing anot-for-profit corWOration or entity without special compensation or
reimbursement.
V. SIGNATURE UNDER OATH:
Signature of Lobbyist:
Signature of Principal/Client:
R se
VI. LOBBYIST IDENTIFICATION:
^ Produced ID
Form of Identification
Q~ 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 ~{W~J , 200$q
g Member of IC, LLC
PRINCIPAL IDENTIFICATION:
^ Produced ID
Form of Identification
~] Personally known (Principal)
State of Florida, County of Miami-Dade
Sworn to and su scribed before me
T day of ~ ~
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'•- Notary Public -State of Fbrida
Sig ature f Public ,g pion Expires Mar t6, 2011
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BY CITY CLERK'S USE ONLY
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Form 32708.doc
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 MiamyBg>d(i Cityfyode and all reporting requirements.
m !V~'~'~"~'IBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, wvuw miamibeachfl oav
CITY CLERK office CityClerk(a~miamibeachfl qov
Tel: 305.673.7411, Fax: 305.673.7254
LOBBYIST NAME:
Harold Rosen
I understand that no later than October 1gt 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 issue I have registered to lobby on has been resolved, I am required to immediately notify the
City Clerk's Office for lobbyist withdrawal in writing.
Signature: Harold Rosen
Date: