Harold Rosen - Shelborne Associates (2)m MIAMIBEACH
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION FORM
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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.
Rosen Harold
NAME OF LOBBYIST: (Last) (First) (M.l.)
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)
531-1271
TELEPHONE NUMBER
FAX N
R: (Optional)
EMAIL:
com
Fill out this section if principal is a
or Trust [Section 2-482
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.
SPECIFIC LOBBY ISSUE:
Application for variances for the property located at 1801 Collins Avenue, Miami Beach 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 Individualffitle B) An Financial, Familial or Professional Relationship
City of Miami Beach Board of Adjustment None
City of Miami Beach Planning Staff None # ~- ~ ' ~ r~ - ~ ~ °'~ -~~ ~
City of Miami Beach Mayor/Commissioners None
City of Miami Beach Committees None ~o :Q, ~~ o i ryn~ oioz
~
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION '(DfSCtOSE• WH
HER
HOURLY FLAT RATE OR OTHER
531
LOBBYIST DISCLOSURE: (Required) $ ~?jSQ ~ Q D c
' ) 2~^
/~
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
(Required). $ ~ ~ G • U
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 present or pending bid for goods. equipment or services, or on a
present or pending 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 lobbying 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 snot-for-profit corporation or entity without special compensation or
reimbursement.
V. SIGNATURE UNDER OATH:
PERIOD.
-Harold Rosen
I do solemnly swear that all of the foregoing facts are
provisions contained in Section 2-482 of the Miami Bea
Signature of Lobbyist:
~ect and that I have read or am familiar with the
and all reoortino requirements.
Signature of Principal/Client: ~,~'~~~/~~~~G`
del W. albut, on behalf of 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
^ Produced ID
Form of Identification
Personally known (Principal)
d 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 C' , 2010
State of Florida, County of Miami-Dade
Swor to and su scr'bed before me
TI}is~ day of ~, 2010
Signr~ture~f Public Notary -State of Florida
Note ization of Principal's signature
Form
by:
ti0tary Public -State Ot FloriAs
My Canrnhtion Expires Mar 16, 2011
Commission / 00 644032
Bonded Thraph Nalbnal Notary Apn,
m MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.pov
CITY CLERK office CityClerk@miamibeachfl.gov
Tel: 305.673.7411, Fax: 305.673.7254
Harold Rosen.
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 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.
~.. .~
~I t~l-~
Signatu .Harold Rosen Date:
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.
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
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
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BEACH GROUP III, LLC
ARC Investors, LLC 50
2200 Biscayne Boulevard
Miami, Florida 33137
Russell W. Galbut, as Manager 0
2200 Biscayne Boulevard
Miami, Florida 33137
Irving Cowan, as Manager 0
3725 South Ocean Drive, #718
Hollywood, Florida 33137
IMZ Investments, LLC 50
3725 South Ocean Drive, #718
Hollywood, Florida 33137
ARC INVESTORS. LLC
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
IMZ INVESTMENTS, LLC
Irving Cowan
3725 South Ocean Drive, #718
Hollywood, Florida 33137
100
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