Harold Rosen - Shelborne Associates~~~/ ~o CCi n~
m ,~11Ar~t~iBEACH
City of I'~lliami .Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION FORM
Lobbyist means all persons employecl or retained, whether paid or not, by a principal who seeks to encourage the
passage, defeat or modification of arty 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 forE:seeably 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 excluisions. 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:
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: f=AX 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
~. s..~_
~~ ~ ~~
.IDENTIFY ALL f~ERSONS .HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE
„~ c~.. €'~ OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST:
~~.:: ~~~
--- ~. See attached Disclosures of Interest.
~•--
III. ~ S~R~ECIFIC LOBBY ISSUE:
"`-
Cei icat 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 m<~in 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 det~~il):
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 arty 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) Any 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
IV. DISCLOSURE OF TERMS i~ND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER
HOURLY, FLAT RATE OR OTHER):
LOBBYIST DISCLOSURE: (Required) $ ~w~~ I ~(~,~`~~
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
(Required). $ ~( ~ ~ ~'1(;l 7~P.
The following information must be answered:
1) Pursuant to Miami Beach Cityr Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
^Yes ®No: Are you lobbvinq oin 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 Ciity Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On
Real Estate Development Issues":
^Yes. ~ No: Are you lobbvinq 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 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:
sHaLL s
E PRECEDING
BE FFLED EVEN. IF THERE WAVE BEEN NO EXPENDITURES OR.COMPEN.SQTION DURING THE REPORTING
of Lobbyist -Harold Rosen
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,Be~eh'Ci~y,Code and all reporting requirements.
Signature of Lobbyist:
Signature of Principal/Client:
Russell a eh o elborne Associates, Costello Investments, Inc.,
Shellborne Ocean Beach Hotel Corp., and Beach Group 111, LLC.
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced ID
Form of Identiification
[~ Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dadle
Sworn to and subscribed before me
Th~ il- day of ~, 2010
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AnnuakRegistration fe~p] Yes [ ] No Amount Paid
Lobbyist Registration .Form received and verified by: ,
F:\CLER\LOBBYIST1Lobbyist Registration Form 32708.dE
^ Produced ID
Form of Identification
Personally 'known {Principal)
State of Florida, County of e
Swor to and su ribe .b ore~,,,,~ DAYAMIAtaUTAR
s day of ~'-, Notary Pyblic -State of Florida
• ? Mtr Comndss~n Ex~res Mar 16, 2011:
` d`•~ Commission # 00 644032
- Si natu of Public o ry Sf~ `~IOI~~ed Through Nada~ai Notary Assn,
No riz on of Principal'
CI CLERK'S USE
MCR # $ Date Paid
I
(, ~ Revised 03/27/2008
-~~ _ .
City of Miami Beach, 1700 Convention Center Drive, Miami Beach,. Florida 33139, .miamibeachfl.e~ov
CITY CLERK office CifiiClerlc@rniamibeachfl.Qav
Tel: 305.673.7411, Fax: 305.673.7254
LOBBYIST NAME:
Harold Rosen
I understand that no later than October 1St of each near, I must frle 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 regiistered to lobby on has been resolved, I am required to immediately notify the
City Clerk's Office for lobbyist withdracv`~I,in~vriting.
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Signature: Harold Rosen Date:
1