Jonathan W. Cardello Shelborne Associatesm MIAMIBEACH
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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 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.
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 ~ jcardello@addinc.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
LOBBYIST RETAINED BY:
Shelborne Associates, Costello Investments, Inc., Shelbome 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@crescenthei hts.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:
Application for Modification of a Conditional Use Permit for an existing Neighborhood Impact Establishment, including a Cafe
and Outdoor Cafe restaurant wi'~ioutF dan"bing and entertainment, Brasserie restaurant with entertainment, Lounge bar with
entertainment, Lobby Bar and Restaurant without dancing and entertainment, Nightclub space with dancing an entertainment,
and Taqueria pool bar and outdoor cafe without dancing and entertainment. ~~ ~~d/ ~-o~%y /~rl~
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 Relationshi
City of Miami Beach Planning Board None
City of Miami Beach Planning Staff None _~ ~ ~ .~ { ~ ~ . ~,I ~ti ~ `~ ~~ ,~,, l ~ ~
City of Miami Beach Mayor/Commissioners None
City of Miami Beach Committees None
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER
HOURLY, FLAT RATE OR OTHER):
~} LOBBYIST DISCLOSURE: {Required} $ y~STgb2 ~ F ~k~ F~
B) PRINCIPAL'S DISCLOSURE {OF LOBBYIST COMPENSATION):
(Required}. $ y Q$ , Q~2 ~- Ft. A-T ~~
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":
C1Yes 6~1 No: Are you lobbying on a present or pending bid for goods. equipment or services. or on a
present or p®ndina 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 ~ No: Are you lobbying on a pending aaplication for a Development Agreement with the City or
application for chancre of zoning map designation or chanoe 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 specie! 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..
I]Yes ®No: Are you representing anot-for-profit corporation or entity without special compensation or
reimbursement.
V. SIGNATURE UNDER OATH:
ON OCTOBER 'ist OF EACH YEAR. EACH LOBBYIST SHALL SUBMIT TO THE C TY CLERK A SIGNED
PERIOD.
Signature Lobbyist -Jonathan w. Cardello
I do solemnly swear that all of the fo goi fads are true and Corr t and that I have read or am familiar with the
provisions contained in Section 2-4 of th Miami Beach Ci#y Code nd all reporting requirements.
Signature of Lobbyist:
Signature of Principal/Client: '~~ '""~
Russ . Ga bu , o a helborne Associates, Costello Investments, Inc.,,
Sheiborne Ocean Beach Hotel Corp., and Beach Group tl[, LLC.
Vl. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
^ Produced ID ^ Produced ID
Form of Identification Form of lden#ification
~ ~ Personally known (Lobbyist)
_ '~
o ~ g ll. SIGNATURE AND STAMP OF NOTARY:
° ~ ? State of Florida, County of Miami-Dade
~ H
~ $ ~ z Sworn to and subscribed before me
~ ~ w z This day of , 2010
2
C~~~
~ m Signature of lic Notary - tats of Florida
_,,,,L„~,,,_ Notarizatio f Lobb ist' gnature
~( Personally known {Principal)
State of Florida, County of Miami-Dade
Swom to and sub ri d befo .
Tit ~ ,~ day o~ , 20 ,..~t`~"~i
1 ~ ~~'i~ 1
of Pclblic Notary -
on of Principal's.s
DAl-AfdiAGUlAR
Notasy P+tDiio • State of fiorlda
D9y Corranission Expires Mar 16, 40t1
Commlaslor~ # DD 844032
~ondeQThrough National NotaryAsan,
TO BE COMPLETED BY CITY CLERK'S US ONLY
Annual Registration fee: j Yes [ j No Amount Paid $ MCR # $ Date Pald
Lobbyist Registration Form reaelved and verified by: ~
F:ICLERILCBBYIST1Lobbylst Registration Form 32708.do~ ~ at~v~_aart A3~2Ti~nnr~
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER
HOURLY, FLAT RATE OR OTHER):
A~ LOBBYIST DISCLOSURE: (Required) $ ~~ 1 ~ (O °Z F~~ i F~
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
(Required). $ y'~<d I a b ~ - 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 ~ No: Are you lobbying on a present or pending bid for Qoods, equipment or services, or on a
present or pending award for Qoods, equipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On
Real Estate Development Issues":
^Yes ®No: Are you lobbying on a pending application for a Development Agreement with the Citv 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:
ON OCTOBER 18t OF_ EACH YEAR. EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH. LISTING LOBBYING EXPENDITURES. AS WELL AS COMPENSATION
RECEIVED. IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL
BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING
PERIOD.
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 with the
provisions contained in Section 2-482 of the Miami Beach City Code and all reporting requirements.
Signature of Lobbyist:
Signature of Principal/Client:
Russell W. Gafbuf, on~S~helborne Associates, Costello Investments, Inc.,
Shelbome Ocean Beach Hotel Corp., and Beach Group III, LLC.
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
^ Produced ID ^ Produced ID
Form of Identification
^ 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 , 2010
Signature of Public Notary -State of Florida
Notarization of Lobbyist's signature
Form of Identification
Personally known (Principal)
State of Florida, County of Miam
Sworn to and sub ri d befo
T~i s ~ day o , 20D
of P~iblic Notary -
on of Principal's
DAYAMI ACUWR
Notary Pt~lic -State of Florida
Ml- Can Expires iMar 16, 2011
Commission # OD 644032.
Banded Tlnouph N~ionaf Notary Assn
TO BE COMPLETED BY CITY CLERK'S USE ONLY
Annual Registration fee: [ Yes [ ] No Amount Paid $ MCR # $ Date Paid
Lobbyist Registration Form received and verified by: ~ .,
F:\CLER\LOBBYIST\Lobb ist Re istration Form 32708.doc Revised 03/27/2008
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
[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
lMZ INVESTMENTS, LLC
Irving Cowan ~ 100
3725 South Ocean Drive, #718
Hollywood, Florida 33137
Page 2 of 2
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City of Miami Beath, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLEl7K Office
Tel: 305.673.7411 ,Fax: 305.673,7254
CityClerk@miamibeachfl.gov
Acknowledgement of fines/suspension from lobbying for failure to
comply with City of Miami Beach lobbying Laws
LOBBYIST NAME: ~/?Jf1~V L'.~~~~
I understand that no lafier than October 1st of each veer, lobbyists subject to lobbyist
registration requirements shall submit to the city clerk a signed statement under oath
listing all lobbying expenditures, as well as compensation received, for the preceding
calendar year with regard to the specific issue on which the lobbyist has been engaged
to lobby. A statement shall be filed even if there have been no expenditures or
compensation during the reporting period. The statement shall fist, in detail, each
expenditure by category, including Food and beverage, entertainment, research,
communication, media advertising, publications, travel, lodging and special events.
FAILURE TO TIMELY FILE THE EXPENDITURE AND FEE DISCLOSURE REPORT
WILL RESULT IN A FINE OF $50.00 PER DAY. ANY LOBBYIST WHO FAILS
TO FILE THE REQUIRED EXPENDITURE REPORT BY DECEMBER 1, SHALL
AUTOMATICALLY BE SUSPENDED FROM LOBBYING UNTIL ALL FINES ARE
PAID, UNLESS THE FINE HAS BEEN APPEALED TO THE MIAMI=DADS COUNTY
COMMISSION ON ETHICS AND PUBLIC TRUST. In the event a lobbyist fails to
either file the report and/or pay the assessed fines, the Clerk shall notify the Miami-Dade
County Commission on Ethics and Public Trust.
IN ADDITION, ONCE AN ISSUE 1 HAVE REGISTERED TO LOBBY ON HAS
BEEN RESOLVED, I AM REQUIRED TO IMMEDIATELY NOTIFY THE CITY
CLERK'S OFF~~OF LOBBYIST WITHDRAWAL IN WRITING.
o~l~ .~~ • ~ O~0
Signature: Date: