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David H. Nevel 1747 Bay Road Propertiesm MIAMIBEACH City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 . LOBBYIST REGISTRATION FORM fl ~ ~ ~~Y ~ ~. ~ . ~ , ,G/~ ~ ~~o ~ G . ~v~~ .Pik ' 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 board 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. Nevel David H. NAME OF LOBBYIST: (Last) (First) (M.I.) c/o David H. Nevel, P.A. 950 S. Pine Island Road, Suite A-150 Plantation, Florida 33324 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (954) 423-4348 (954) 727-8250 law@dnevel.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: LOBBYIST RETAINED BY: 1747 Bay Road Properties, LLC NAME OF PRINCIPAUCLIENT: 1747 Bay Road Properties, LLC 2200 Biscayne Blvd. Miami Beach FL 33137 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 374-5700 (305) 84.7-3354 mkramer@crescenthei his 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, as President of Ronruss Corporation, General Partner of Ronruss Partners, Ltd., Managing Member of 1747 Investments; LLC, Managing Member of 1747 Bav Road Properties I I c: IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR ~ INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: See attached Disclosures of Interest. .11, SPECIFIC LOBBY ISSUE: Application for Conditional Use Approval to permit the use of a robotic parking system in a parking garage, which includes restaurant and/or retail uses within the commercial space, and to operate the parking .garage after midnight, for the property located at 1747-1759 Bay Road, 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 said City Personnel' commencement of service with the City to the present date, stating the general nature of the subject contractual relationship. A) Full Name of Individual/Title - B) An Financial, Fam ~~ s nah ~lati ip City of Miami Beach Planning Board None . . , City of Miami Beach Planning Staff City of Miami Beach Ma or/Com i i e None ~ £ ; ~ d ~ ~ ~~ j ~ ~ ~ y m ss on rs None Z City of Miami Beach Committees None ....~ . . /, 6 ..,,,k . `~ ` ~.. ~ s~ IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): LOBBYIST DISCLOSURE: (Required) $ 275 per hour. B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $ 275 per hour. 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 ®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 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.. ^Yes 6a No: Are you representing snot-for-profit corporation or entity without special compensation or reimbursement. V. SIGNATURE UNDER OATH: ON OCTOBER 1St 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 PRECEDI ~ r_ni ~NDAR YEAR A STATEMENT SHALL PERIOD. Signature of Lo~David Nevel I do solemnly swear that all of the foregoing f and correct and that I have read or am familiar with the provisions contained in. Section 2-482 of the i y Cede-all reporting requirements. Signature of Lobbyist: ~~~~ Signature of Principal/Client: Rus of Ronruss Corporation, General Partner of Ro s artners, Ltd., Managing Member of 1747 Investments, LLC, Managing Member of 1747 Bay Road Properties, LLC VI. LOBBYIST IDENTIFICATION: ,,~,/ ~ 'n L~ Produced I D l ~`~'~ ~~~s l ~' Form of Identification ~ ~ ^ Personally known (Lobbyist) VII. SIGNATURE AND STAMP OF NOTARY: m ~ ~ State of Florida, County of Miami-Dade $~ ~ ~ ~ ~ a Sworn to nd subscr' a before me This ay ~ , 2010 m ,~ ~ ~.• ~ ~••. ~ S gnature of Public Notary -State of Florida Notarization of Lobbyist s signature .~! ~~N * TO BE COMPLETE Annual Registration fee: [ Yes [ j No Amount Paid $ ~ Lobbyist Registration Form received and verified by: F:\CLER\LOBBYIS11Lobb ist Registration Form 32708.doc PRINCIPAL IDENTIFICATION: ~~ ~ Produced ID -~ ` ~ rsr--,,~ ~ -~~ Form of Identification ^ Personally known (Principal) ~~ ~ ,,~ .~ ~ -< 'gyp ~~ a State of Florida, County of Miami-Dade ~' Sworn to and subscr'be before me Thi~~'day 10 ~ ~ ~~ ~ Signatur o Public Notary -State of Florida Notarization of Principal's si nature ~~ ~ ~ g g ~, N !p ~ CLERK'S USE ONLY ~ ~ ~ ~ MCR # $ Date Paid Revised 03/27/2008 EXHIBIT «g~, DISCLOSURE OF INTEREST NAME AND ADDRESS % OF INTEREST 1747 BAY ROAD PROPERTIES, LLC , 1747 Investments, LLC 32 2200 Biscayne Boulevard .Miami, Florida 33132 Managing Member MJK Group, LLC 2200 Biscayne Boulevard Miami, Florida 33137 Member Sharon Mirmelli 1210 Michigan Avenue Miami Beach, i=lorida 33139 Managing Member Philip Mirmelli 6500 North Bay Road Miami Beach, Florida 33141 Member Sean Mirmelli 1415 20th .Street, #103 Miami Beach, Florida 33139 Member 1747 INVESTMENTS, LLC Ronruss Partners, Ltd., a Florida Limited Partnership 2200 Biscayne Boulevard Miami, Florida 33137 Managing Member RONRUSS PARTNERS, LTD. Ronruss Corporation, as General Partner 2200 Biscayne Boulevard Miami, Florida 33137 Russell Galbut, as a Limited Partner 2200 Biscayne. Boulevard Miami, Florida 33137 Ronalee Galbut, as a Limited Partner 2200 Biscayne Boulevard Miami, Florida 33137 Jenna Beth Galbut, as a Limited Partner 2200 Biscayne Boulevard Miami, Florida 33137 18% 30 10% 10% 100 1% 43.72 43.72 5.65 [CONTINUED TO NEXT PAGE) Page 1 of 2 Marisa Ann Galbut, as a Limited Partner 2200 Biscayne Boulevard Miami, Florida 33137 RONRUSS CORPORATION Russell W. Galbut, as a Director; President and Shareholder 2200 Biscayne Boulevard Miami, Florida 33137 . Ronalee Galbut, as a Shareholder 2200 Biscayne Boulevard Miami, Florida 33137 Abraham A. Galbut, as a Shareholder 4770 Biscayne Bivd., Suite 1400 Miami, Florida 33137 MJK GROUP, LLC Keith Menin 2200 Biscayne Boulevard Miami, Fiorida 33137 Manager Jenna Beth Galbut 2200 Biscayne Boulevard Miami, Florida 33137 Member Marisa Ann Galbut 2200 Biscayne Boulevard Miami, Florida 33137 Member 5.91 49.5 49.5 1% 33.33 33.33 33.34 m MIANIIBEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov CITY CLERK Office CityClerk@miamibeachfl.gov Tel: 305.673.7411 ,Fax: 305.673.7254 Acknowledgement of fines/suspension from lobbying for failure to comply with City of Miami Beach lobbying Laws LOBBYIST NAME: // ~ ~ I ~ f-t ~ ~/1= ~ G ~ I understand that no later than October 1st of each ve~ar., 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 list, 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, 1 AM REQUIRED TO IMMEDIATELY NOTIFY ~ THE CITY CLERK'S OFFICE OF LOBBYIST WITHDRAWAL IN WRITING. ~ ~S ~ C/O Signature: ~ Date: