Jonathan W. Cardello - Shelborne Associateso ~ _ i?~
~ NI I Ah~l I B EA~~H ~ ~
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 o'r 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 jcardelloC~3addinc.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. 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 `~ mkramerC~crescentheights.com
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) ~
out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)j
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Russell W. Galbut
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR
OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST:
See attached Disclosures of Interest. c-~
--i
H. SPECIFIC L088Y ISSUE: `~~-. ~ .^~-~'i
f°r:
Application for variances for the property located at 1801 Collins Avenue, Miami Beach 33139. =~ r '° -'
to
Issue to be lobbied (Describe in detail): {,.; ~ ~~,
o ~
`~•
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: (Pursuant to City Code Section 2-4$2(g~cluti~f a
statement of the extent of any business, financial, familial, 'professional or other relationship, grying~~-~y'se to-~~n
appearance of an impropriety, with any City personnel sought to be lobbied; further, pursuant to City"Cod~ection 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.) ~
City of Miami Beach Board of Adjustment 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 AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER
HOURLY, FLAT RATE OR OTHEF17: ,,.
LOBBYIST DISCLOSURE: (Required) $ ?, ~~ ay~ ./
+ ~~
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
(Required). $ ,2 0? ooD
The following information must be answered:
i) 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 aresent or aendina bid for aoods, eauiament or services. or on a
present or aendina award for aoods. eauiament or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On
Real Estate Development Issues":
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 Eby this
section but, shall not be required to pay any registration fees..
V. SIGNATURE UNDER OATH:
AAI AnTA~rn ~ St ~r l•' ~ A,., yr ~ n r ~ w• • • ~•~r•~i•w~ w• • ~ • • w.
Signature of L yist - Joni w. Cardello
I do solemnly swear that all oft going facts are true and correct a that I have read or am familiar w ith the
provisions contained in Sectio -482 o the Miami Beach City Code and a reporting requirements.
Signature of Lobbyist:
Signature of Principal/Client:
Russell . Galbut, on behalf of Shelborne Associates, Costello Investments, I nc.,
Shelborne Ocean Beach Hotel Corp., and Beach Group III, LLC.
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
^ Produced ID ^ Produced ID
Form of Identification Form of Identification
~
~~~ ~ Personally known (Lobbyist] ^ Personally known (Prfncfpal)
N ~ VII. SIGNATURE AND STAMP OF NOTARY:
o~~
Z ~ ~
State of Florida, County of Miami-Dade
State of Florida, County of Miami-Dade
~ 4 ~ z Sworn o and subscribed before me Sworn to and subscribed before me
~ ~ Z
~ ~ 2 This day of A , 2010 This ~ day of , 2010
~-~`
OUW-~,,
.
~ ~ Signature of P lic Nota State of Florida Signature of Public Notary -State of Florida
~k°~d~ Notarization Lobbvis s signature Notarization of Principal's signature
-s
~=
•
~• ~~ TO BE COMPLETE BY CITY CLERK'S USE O LY
Annual Registration fee: ]Yes [ ] No Amount Paid $ MCR # $ Date Paid
Lobbyist Registration Form received and verified by:
F:\CLER\LOBBYIS11Lobb ist Re istration Form 32708.doc _ ,Jy~,~ i Revised 03 7/20 8
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
(Required). $
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":
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On
Real Estate Development Issues":
3) Pursuant to Miami Beach City Code 2-484 (h) Any person (except those exempt from the definition of
"IobbyisY' 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..
reimbursement.
V. SIGNATURE UNDER OATH:
A~~ AATA!\!-!1 JHt A!- r ~ A~ ~ \/r ~ !\ r ~ A~ ~ ~ A!-!~\/SAT e\~ ~ ~ ~ ~ A~ ~w~~~~ ~A ~~ ~~ A~~\/ w• ~w~J ~ A.w-.~w
Signature of Lobbyist -Jonathan w. Cardello
I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am familiar
provisions contained in Section 2-482 of the Miami Beach City Code and all reporting requirements.
Signature of Lobbyist:
Signature of Principal/Client:
Russel W. Ga u , on beh of Shelborne Associates, Costello Investments
Shelbome Ocean Beach Hotel Corp., and Beach Group III, LLC.
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
^ Produced ID ^ Produced ID
Form of Identification Form of Identification
the
Inc.,
^ Personally known (Lobbyist) ~ Personally known (Principal) ',
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade State of Florida, County of Miami-Dade
Sworn to and subscribed before me
Thi
d
f
2 Swor and su c ' ed before me
~
s _
ay o
,
010 i day of , 2010
Signature of Public Notary -State of Florida Sig to of Pubh N ry -State of Florida
Notarization of Lobbyist's signature Notariz ion of Princiaal's signature
TO BE COMPLETED BY CITY CLERK'S USE ONLY ~I
Annual Reglstratlon fee: [ ]Yes [ ] No Amount Pald $ MCR # $ Date Pald
Lobbyist ReglstreUon Form received and verlfled by:
F:\CLER\LOBBYISTLobbYist RestisVation Form 32708.doc Rp~i~ed n~n~nnnn i
c~~~ PCB` ~/ DAYAtiN AGUTAR `
? ,¢., Notary PubNc -State of Plaids
o ~ Com~safon E><W-es Mar 16, 2011
"~} ~`' p~~C~o~m~ymission # DD 044032
OF fl~~\\, ~w,Y01J 111~y~ h
111111 ~~ '~~O N~y~/~~
m MIAMIBEACH
City of Miami Beach, f 700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.aov
CITY CLERK office CityClerkC~miamibeachfl.gov
Tel: 305.673.7411, Fax: 305.673.7254
Jonathan W. Cardello
LOBBYIST NAME:
I understand that no later than October 1st of each vear; I must file the following forms, pursuant to Section 21485 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 nce an issue I have registered to lobby on has been resolved, I am required to immediately notify the
City 's O 'ce for lobbyist withdrawal in writing.
Signature:
`~' -?~ l 0
- EXHIBIT "B"
DISCLOSURE OF INTEREST
NAME AND ADDRESS % OF INTEREST
SHELBORNE ASSOCIATES, A FLORIDA GENERAL_PARTNERSHIP
Mar Irv Investment, Inc. 50
3725 South Ocean Drive, #718
Hollywood, Florida 33137
SBH Investors, Inc. 50
2200 Biscayne Boulevard
Miami, Florida 33137
MAR IRV INVESTMENT. INC.
Irving Cowan 100
3725 South Ocean Drive, #718
Hollywood, Florida 33137
SBH INVESTORS, INC.
Russel! W. Galbut 50
2200 Biscayne Boulevard
Miami, Florida 33137
Abraham A. Galbut, and Nancy K. Galbut, his wife 50
4770 Biscayne Blvd., Suite 1400
Miami, Florida 33137
COSTELLO INVESTMENTS, INC.
Russell W. Galbut 50
2200 Biscayne Boulevard
Miami, Florida 33137
Abraham A. Galbut, and Nancy K. Galbut, his wife 50
4770 Biscayne Blvd., Suite 1400
Miami, Florida 33137
SHELBORNE OCEAN BEACH HOTEL CORP.
Russell W. Galbut 50
2200 Biscayne Boulevard
Miami, Florida 33137
Abraham A. Galbut, and Nancy K. Galbut, his wife 50
4770 Biscayne Blvd., Suite 1400
Miami, Florida 33137
[CONTINUED TO NEXT PAGE]
Page 1 of 2
BEACH GROUP III, LLC
ARC Investors, LLC
.2200 Biscayne Boulevard
Miami, Florida 33137
Russell W. Galbut, as Manager
2200 Biscayne Boulevard
Miami, Florida 33137
Irving Cowan, as Manager
3725 South Ocean Drive, #718
Hollywood, Florida 33137
IMZ Investments, LLC
3725 South Ocean Drive, #718
Hollywood, Florida 33137
ARC INVESTORS. LLC
Russell W. Galbut
2200 Biscayne Boulevard
Miami, Florida 33137
50
0%
0%
50
50
Abraham A. Galbut, and Nancy K. Galbut, his wife 50
4770 Biscayne Blvd., Suite 1400
Miami, Florida 33137
IMZ INVESTMENTS. LLC
Irving Cowan 100
3725 South Ocean Drive, #718
Hollywood, Florida 33137
Page 2 of 2