Russell W. Galbut/1801 Collins Avenuea? MIAMIBEACH
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION FORM
I8°~ ~"~G~-e%
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.
Galbut Russell W.
NAME OF LOBBYIST: (Last) (First) (M:I.)
2200 Biscayne Boulevard Miami FL 33137
BUSINESS .NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 374-5700 (305) 847-3354 rgalbut@crescentheights.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
LOBBYIST RETAINED BY:
Shelborne Associates, Costello Investments, Inc., Shelborne Ocean Beach Hotel Corp., and Beach Group III, LLC
NAME OF PRINCIPAUCLIENT:
Shelborne Hotel 1801 Collins Avenue Miami Beach FL 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305).531-1271 (305) 531.-2206 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
• IDENTIFY ALL 'PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE
OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST:
See attached Disclosures of Interest.
II. SPECIFIC LOBBY ISSUE:
Certificate of Appropriateness for the partial demolition, renovation and restoration of the existing 15-story, 8-story,
and 3-story buildings, including design modifications to the ground floor, including lobby, pool deck, and cabanas,
and the demolition of the existing main entrance facade and porte-cochere and construction of a .new entrance and
new porte-cochere, for the property located at 1801 Collins Avenue, Miami Beach, Florida 33139.
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 Individual/Title B) An Financial, Farriilial or"l?~ofessional,RelatiQ $hip
City of Miami Beach Historic Preservation Board
City of Miami Beach Planning Staff None
None
~',~ r ~ ~:ac~ ~ I ~~}~ ~ I QZ
City of Miami Beach'MayorlCommissioners None
City of Miami Beach Committees None ~ .,~ .!'1 ~ ~ 5
, ..4,:.A. \.r
F f,.
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER
HOURLY, FLAT RATE OR OTHER):
LOBBYIST DISCLOSURE: (Required) $0. No additional compensation for lobbying.
B) PRINCIPAL'S DISCLOSURE (OF .LOBBYIST COMPENSATION):
(Required). $0. No additional compensation for lobbying.
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 lobbvinq on a present or pendinq bid for goods equipment or services or on a
present or pendinq award for goods, 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 lobbvinq on a pendinq application for a Development Agreement with the City or
application for change of zoning map designation or change to the Citv'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 6~ No• Are you representing anot-for-profit corporation or entity without special compensation or
reimbursement.
V. SIGNATURE UNDER OATH:
Signature of Lobbyist:
Signature of Principal/Client:
Russell . Galbut, on behalf o Shelborne Associates, Costello Investments, Inc.,
Shelborne Ocean Beach Hotel Corp., and Beach Group III, LLC.
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
^ Produced ID
Form of Identification
'~, Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY;
State of Florida, County of Miami-Dade State of Florida, County of Miami-Dade
Sworn to and su gibed before me DAYAMIAGUTAR Sworn to and su rib d before me
;h' day of ~ .; 201Q Notary Public -State of Florida i day of , 2010.. ;
~~,' ' My Commission Expires Mar 1ti, 2011 - c r',~
'Commission # DO 644032 ~ ~~
Si nat of Public of - ,~;,~ teedf~d6fid~h NerionelNotaryAssrl. gnatu of Public No ary - Sta ""
N tariz ion of Lobb ' ,. otarization of Principal's sig atuPe!
TO BE COMPLETED BY CITY CLERK'S USE ONLY . ,
Registration Form received and verified by: _
~_OBBYIST\Lobbvist Registration Form 32708.doc
^ Produced ID
Form of Identification
Personally known (Principal)
' Revised
DAYAMI AGUTAR
9<i;-; Notary Public -State of Florida
. _ My Commission Expires Mar 16, 20'
Commission # DD 644032
~~`~ Bonded Through National Notary Ash
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 ~mi Be~j,~Cj~Zar~,all reporting requirements.
a? MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, wa~rr.miamibeach8.gov
CITY CLERK office CityClerkC~miamibeachfl.gov
Tel: 305.673.7411, Fax: 305.673.7254
Russell W. Galbut
LOBBYIST NAME:
I understand that no later than October 1st of each year, 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.
Si el albut
~ -8'-0/0
Date:
' ~ C9TY ®F fV11A{l~I ~EAC~I
. DEVELOPN1Ei~T REVfEW ~~AR® APPLICATION
. k DISCLOSURE OF INTEREST
' :. 1: CORPORr4TlOfd
~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),- 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 INVESTORS. INC:
C.ORPO;RATLON NAME ,
NAME AND' ADDRESS % OF STOCK
- ° .Russel VV: Galbut ~ ~ 50%
. ~ 2220 Biscayne Blvd. -
-~- Miami; FL 33137... '
Abraham A. Galbut, and Nancy K. Galbut; his wife 50%
4770 Biscayne B1vd., St. -1400 .
. ~ Miami, FL' ,33137
' IF THERE ARE ADDITIONAL C®RPORATIONS, LIST ®THERS, INCLU®lNG CORP.
...,
NA11alE($) AND -EACH /NDl1!IDUAL'S NAME, ADDRESS, . ®FFICE AND
= PERCENTAGE'.OF STOCK, ®N A SEPARATE PAGE.
NOTE: Notarized signature required ®n page ~
~: ~ 6-A~
- ~I,TI( ®F .Il~IAIViI BEACH
®EVELOPIVIEIl1T REVIEW ~OAR® APPLICATIORI
. DISCLOSURE OF INTEREST .
1,. C®RPORATION .
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 inferest in the entity.*.
s - MAR IRV investment Inc '
CORPORATION NAM'E~
' - ~ NAME AND ADDRESS , ~ % OF STOCK
Irving Cowan 100% -
- 3725 South Ocean Drive, Suite 718
Hollywood; FL 33019 -
OITY OF IVII~NII ~EACF1 _ a
DEVEL®P~fiEN`T REVIEW BOARD APPLICAI°ION
DISCLOSURE OF INTEREST
7.'C®RP®RATION
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.*
- SHELBORNE OCEAN BEACH.. HOTEL CORP.
CORPORATION NAME .
NAME AND ADDRESS - % OF STOCK
Russell W: Galbut S0%
2200 Biscayne. Blvd. ~ _
Miami, FL 33137 .
Abraham A: Galbut, and Nancy K. Galbut, his wife 50%~
4770LLBiscayne Blvd., St. 1400. - .~
Miami, FL 33137
~° ~ ~ - . r .
lF THERE ARE ADDITIOIlIAL -CORPORATIONS,-LIST OTHERS, INCLUDING CORP,
NAME(S) AND EACH. INDIVIDUAL'S NAME, A®DRESS, OFFICE AND
PERCENTAGE OF STOC6C, ON A SEPARATE PAGE, '
NOTE: Notarized signature required ®n page ~
6-C
. _ CITY ®F 1011IA11~~1 BEACI~
.- DEVELOPMEIVI' REVIEW B®AR® APPLICA°~ION
DISCLOSURE OF tN~EREST~ .
1.~ CORPORATION . ' ; .
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 owried by each. Where the principal
- officers or stockholders consist- of another corporation(s), trustee(s), partnership(s) or other
similar entity; further disclosureshall.be required which .discloses the identity of-.the individual(s)
` ~ (natural persons) having.. the ultimate ownership interest in the entity.*
. COSTELLO 1NVES1 MENTS, tNC. •
. CORPORATION NAME
NAME AND ADDRESS %. OF STOCK
• Russell W. Galbut ~ ~ 50%
2200 Biscayne Blvd.
Miami, FL 33-137. .
Abraham A. Galbut,.and Nancy K. Galbut, his wife 50%
4770 BiscayneBlvd., St. 1400 .
Miami, F:L 33137.
-. ~ .
• IF THERE ARE ADDITIONAL CORPORATIONS, LIST OTHERS, INCLUDING CORP..
:.101AlUfE(S) AND EACH /NDIVIDUAL'-S NAi1elE, ADDRESS, OFFICE ~ AND .
PERCENTAGE OP STOCK, ON.A SEPARATE PAGE.
! ..
-NOTE: •N®tarized signature required ®n page 8 .
6~®
~~ ~. ~ ~ CITY ®F IVIIAI~11 BEACH
- ~ .REVEL®PMENT RE~VIEIN BOAR® APPLICATI®RI .
- -DISCLOSURE OF INTEREST ~ .
- 1. LIilfiITED LIABILITY COI-lIPAIdY
If the property which is the'subject of an application is owned or leased by a LIMITED LIABILITY
COMPANY, 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.' -
_ `..BEACH GROUP Iil, LLC ~ .
LIMITED.LIABILITY COMPANY NAME .
NAME AND ADDRESS % OF MEMBERSHIP LNTERESTS
ARC Investors, LLC 50%
,.
2200 Biscayne Blvd. `
Miami, FL 33137.
Russell W. Galbut, as Manager ~ . . 0%
2200 Biscayne Blvd. ,
- Miami, FL 33137
Irving Cowan, as Manager 0%
,~ 3725 S. Ocean Drive, #707
_ Hollywood, FL 33019 - .
. IMZ Investments, LLC 50%
3725 S. -Ocean Drive, #707 -
Hollywood, FL 33019 ~ '
,,
. 7F THERE ARE ADDITIONAL C®RPORATIONS, LIST ®THERS, INCLUDING CORP.
NAME(S) AND EACH INDIVIDUAL'S NAlI01E, ADDRESS, ®FFICE AND
PERCENTAGE OF STOCK, ~ON A SEPARATE PAGE.
NOTE; Notarized signature required on pagre ~
. 6-E
:Ci.TY OF f11111~41~11 BEACH
DEVLOPIViENT R~VI~V11 ~OAR® APPLICATION.
.DISCLOSURE OF Ff~TEREST
1. LIMITED LIABILITY COMPANY
. _ If the property-which is the subject of an application is.owned or leased by a LIMITED LIABILITY .
COMPANY,- 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.'
ARC tNVESTORS. LLC
LIMITED LIABILITY COMPANY NAME
.NAME ANO ADDRESS % OF MEMBERSHIP INTERESTS
'Russell W. Galbut 50%
2200:Biscayae Blvd.
Miami; FL 33137.` .
Abraham A. Galbut 50%"
4270 Biscayne Blvd., St. 1400
Miami, FL 3 313 7
lF THERE ARE ADDITI®NAL CDRPORATIQNS, LIST ®THERS, INCLUDING C®RP.~
NAME(S): BIND EACH INDIVIDUAL'S ~ :NAME, ADDRESS, ®FFICE AND
PERCENTAGE OF ST®Cd~, ON A SEPARATE PAGE.
- - N®TE: N®tari~ed signature..required ®n page ~
.M1 6-F -
CITY OF tV1lAtVtl DEATH ' ~ '
DEVELOt'NiE~JI° F?EVIEVU t30ARD APPLI~ATtOtV
DISCLOSURE ®F INTEREST
. _ .. 1.'LiMITED LIABILITY COI411PAPdY
,~ If the property-which is the subject of an application is owned or leased by a LIMITED LIABILITY
COMPANY, 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.
- lMZ INVESTMENTS;. LLC - -
- . , LIM1TED LlAB1LITY COMPANY NAME
NAME AND AIDDRESS ~ % OF MEMBE'RSH'IP INTERESTS
Irving. Cowan 100%
. ~ - 3725 South Oceari Drive, Suite 718
Hollywood, FL 33019 ~ .
~v~~ ®~' Ill ~l~il ~~A~H ~-
- ®~V~L®Pi~IERI~° R~VIEV~/ ~OAR~ APPLI~AT1®IV
. ,- DISCLOSURE OF INTEREST
1: CORPOF2ATI®N
If the property which is the subject of an application is owned or leased by a CORPORATION;
listahe 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:*
' SHEtBORNE OCEAN. BEACH HOTEL.CONDOMWIUMASSOClATION INC.' ~ `
"CORPORATION NAME
NAME AND ADDRESS % OF STOCK
.. Adam, Gruber 0%
1801 Collins Avenue ~ .
• Miami Beach, FL 33139
Title: President
Keith Menin ~ 0% .
1801 Collins Avenue -
.Miami Beach,. FL 33139
'`Title:. -Vice. President -
,.
.Rochelle Morse p%
' 1.801.Collns Avenue
.. .. Miami Beach; FL 33139
- Title: Secretary - .
. "pisclosure of the individual owners of Shelborne Ocean Beach Hotel Condominium
.. Association, Inc. is' not required because no one person or entity holds more than a total of 5% of
.the. ownership interests in the entity.
` ~ lF THERE ARE ADDITIONAL CORPORATIONS, LIST OTHERS, INCLUDING CORP.
NAME(SJ AND '. EACH INDIVIDUAL'S ,NAME, .ADDRESS, .OFFICE AND
. PERCENTAGE OF STOCK, ON A SEPARATE PAGE.
NOTE; Notarized signature required on page 8
- ,. 6-H
CITY ®F MIAI~iI ~~ACH
®EVEL®PMEN°i REVlEVlJ S®AR® APPLICATL®N ~.
DISCL®SURE ®F 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/berieficiary consist of corporation(s), another trust(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.*
. ~ 'Not Applicable -
TRUST NAME ,
NAME,"ADDRESS, AND OFFICE % OF IN`I EREST .
3. PARTNERSHIP/LIMITED PARTN€RSH'IP '
` . if the property which is the subject of the application is ~owhed or eased by a PARTNERSHIP or
LIMITED PARTNERSHIP, list the principals of the partnership, including ejeneral and limited partners.
Where: the partner(s) consist of other partnership(s), corporation(s), trust(s) or other similar entity,
further disclosure shall be required which discloses the identity of the individual(s)- (natura! persons)
having the ultirriate ownership interest in the entity ~ .
. SHELB~RNE ASSOCIATES A FLORIDA GENERAL PARTNERSHIP
PHRTNERSHIP
NAME AND ADDRESS % OF-STOCK
MAR IRV Investment, Inc. ~ ~ 50%
3725 South Oceari Drive,. X718 ~~
Hollywood, Florida 33019
' CRI-d In~ioctnrc Ind
" - ~ - - 5v%
2200 Biscayne Boulevard ~ '
_ Miami, Florida.33137