Betancourt Orestes MIAMI BEACH v� AOL
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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 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.
Orestes Betancourt
NAME OF LOBBYIST: (Last) (First) (M.1)
Coastal Systems International, Inc. 464 South Dixie HWY Coral Gables Florida 33146
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305)661-3655 (305) 661-1914 obetancourt&coastalsystemsint.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes:address,phone, or e-mail address.
I. LOBBYIST RETAINED BY:
Chaim Elkoby
NAME OF PRINCIPAUCLIENT:
Crescent Heights 2200 Biscayne Blvd. Miami Florida 33137
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 374-5700 (305) 573-8489 celkoby@crescentheights.com
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL:(Optional)
Fill out this section if principal is a Corporation,Partnership or Trust[Section 2482(c)]
• NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY:
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST:
II.SPECIFIC LOBBY ISSUE:
Development Board ADarovals for 600 Alton Road
Issue to be lobbied(Describe in detail):
Ill. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
Pursuant to City Code Section 2-482(a)(4) include the commissioner or personnel sought to be lobbied,and whether the lobbyist has entered
into any contractual relationship (paid or unpaid) with said city commissioner or personnel from 12 months -preceding such
person's commencement of service with the city to the present date,stating the general nature of the subject contractual relationship.
Sec 2-482(a)(4) Full Name of Individual and Contractual Relationship(Explain) YES NO
title of person to be lobbied
Planning Department and Building Department Staff None X
B, HPB, BOA, City Commission, as necessary* None X
Pursuant to City Code Section 2-482(g)Every registrant shall be required to state the extent of any business,financial,familial or professional
relationship,or other relationship giving rise to an appearance of an impropriety,with any current city commissioner or city personnel who is
sought to be lobbied as identified on the lobbyist registration form filed.
71 n
Sec 2-482(8)Any Financial, Familial or Professional Relationship
91 d 2
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE-(Required) $
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): /1
(REQUIRED). 0 °
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 X No: Are Xou lobbying on a present or pending bid for goods.equipment or services,or on a present or
ggndjpg award for goods,eauioment or service?
2) Pursuant to Miami Beach City Code Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
_Yes X No: Are you lobbying on a pending application for a Development Agreement with the CitX or application
fs[change of zoning map designation or change to the City's Future Land Use Map?
3) Pursuant to Miami Beach City Code Section 2-482 (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 a not-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 X Now Are Xou representing a not-for-profit corporation or entity without special compensation or reimbursement.
V. SIGNATURE UNDER OATH:
ON FEBRUARY 28 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
EM
EXPENDITURES OR COMEENSATION DUftWG IHE a -
Si u of Lob Et
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 ity ode and all r porting requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: .
Produced ID Produced ID
Form of Identification -worm of Identific
.trot �, ..' '�utary Public State of Florida
Personally known(Lobbyist) I? aria krv� ,nl{� tay 21,2
• >;
�_' Commission # EE 59123
VII. SIGNATURE AND STAMP OF NOTARY: Bonded Through Nalionai Notary assn.
State of Florida,County of Miami-Dade State of Florida, County of Miami-Dade
Sworn to and subscribed before me Sworn and subscribed before me
This 15 day of AAO ,201 �' T•is ''day of . C ,20
..... DARLENE SANCHEZ-0SPINA 1i.V119 aLek A� -
_ MY COMMISSION#EE 220699
Signature of Pub is N tary—State of FI EXPIRES:July 31,2016 Si ture of Publl 1Nota', —State of Florida.
Notarization of Lobb iy st's signature 20 F, "'��` Banded Thru Notary Public Undervrti rization of signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ Yes[ ]No Amount Paid$ 430 0 MCR# Date Paid
Lobbyist Registration Form received and verified by:
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+ s
F:�CLE istration Form.doc Revised 04/27/2012
t I MI
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office
Rafael E. Granado, City Clerk CityClerk @miamibeachfl.gov
Tel: 305.673.7411 ,Fax: 305.673.7254
LOBBYIST NAME: Orestes Betancourt
I understand that no later than February 28 of each year, I must file the following form,
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 AND COMPENSATION 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, or I am no longer
lobbying on that issue or for that principal, I am required to immediately notify the City Clerk's
Office of lobbyist withdrawal in writing.
Pursuant to Section 2-485 (d), the City Clerk shall notify any lobbyist (or principal) who
fails to timely file a Statement and in addition to any other penalties which may be
imposed as provided in Section 2-485.1, a fine of $50.00 a day shall be assessed for all
Statement(s) filed after the due date. The City Clerk shall notify the Miami-Dade
County Commission on Ethics and Public Trust of the failure of a lobbyist (or principal)
to file the Statement or pay the assessed fines after notification.
Any lobbyist, who fails to file the required Statement by April 30th, 2012, shall be
automatically suspended from lobbying until all fines are paid, unless the fine has been
appealed to the Miami-Dade County Commission on Ethics and Public Trust.
Sign ure: Date:
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SUPPLEMENTARY DISCLOSURE OF INTEREST
Interests in South Beach Heights I, LLC
Percentage of Interest
SBH Holdings I, LLC 99%
2200 Biscayne Blvd.
Miami FL 33137
SBH Management Company, LLC 1%
2200 Biscayne Blvd.
Miami FL 33137
Interests in SBH Holdings I, LLC
Percentage of Interest
CH Investment Holdings, LLC 89.89%
2200 Biscayne Blvd.
Miami FL 33137 '
David Galbut and Gita Galbut 10.11%
2200 Biscayne Blvd.
Miami FL 33137
Interests in SBH Management Company, LLC
Percentage of Interest
CH Investment Holdings, LLC 100%
2200 Biscayne Blvd.
Miami FL 33137
Interests in 500 Alton Road Ventures, LLC
Percentage of Interest
500 Alton Road Holdings, LLC 100%
2200 Biscayne Blvd.
Miami FL 33137
Interests in 500 Alton Road Holdings, LLC
Percentage of Interest
CH Investment Holdings, LLC 100%
2200 Biscayne Blvd.
Miami FL 33137
Interests in 1220 Sixth, LLC
Percentage of Interest
500 Alton Road Holdings, LLC 100%
2200 Biscayne Blvd.
Miami FL 33137
Interests in CH Investment Holdings, LLC
Percentage of Interest
S Kahn CH Investments, LLLP 18.685%
2200 Biscayne Blvd.
Miami FL 33137
S Kahn CH Holdings, LLLP . 18.351%
2200 Biscayne Blvd.
Miami FL 33137
Galbut CH Investments, LLLP 18.685%
2200 Biscayne Blvd.
Miami FL 33137
Galbut CH Holdings, LLLP 18.351%
2200 Biscayne Blvd.
Miami FL 33137
Menin CH-BT Co, LLLP 19.56%
2200 Biscayne Blvd.
Miami FL 33137
Menin CH Holdings, LLLP 6.435%
2200 Biscayne Blvd.
Miami FL 33137
Interests in S Kahn CH Investments, LLLP
Percentage of Interest
S Kahn CH Investments 1, LLC 1%
2200 Biscayne Blvd.
Miami FL 33137
SK Business Trust 99%
2200 Biscayne Blvd.
Miami FL 33137
Interests in S Kahn CH Investments 1, LLC
Percentage of Interest
SK Business Trust 100%
2200 Biscayne Blvd.
Miami FL 33137
Interests in SK Business Trust
Percentage of Interest
Sonny Kahn 100%
2200 Biscayne Blvd.
Miami FL 33137
Interests in S Kahn CH Holdings, LLLP
Percentage of Interest
S Kahn CH Management, LLC 1%
2200 Biscayne Blvd.
Miami FL 33137
Kahn 2009 Investments Irrevocable Trust 99%
2200 Biscayne Blvd. .
Miami FL 33137
i
Interests in S Kahn Management, LLC
Percentage of Interest
Kahn Management Trust 100%
2200 Biscayne Blvd.
Miami FL 33.137
Interests in Kahn Management Trust
Percentage of Interest
Sonny Kahn 100%
2200 Biscayne Blvd.
Miami FL 33137
Interests in Kahn 2009 Investments Irrevocable Trust
Percentage of Interest
Sonny Kahn 100%
2200 Biscayne Blvd.
Miami FL 33137
Interests in Galbut CH Investments, LLLP
Percentage of Interest
Galbut CH Investments 1, LLC 1%
2200 Biscayne Blvd.
Miami FL 33137
RF Business Trust 99%
2200 Biscayne Blvd.
Miami FL 33137
Interests in Galbut CH Investments 1, LLC
Percentage of Interest
RF Business Trust 100%
2200 Biscayne Blvd.
Miami FL 33137
Interests in RI= Business Trust
Percentage of Interest
Russell W. Galbut 100%
2200 Biscayne Blvd.
Miami FL 33137
Interests in Galbut CH Holdings, LLLP
Percentage of Interest
Galbut CH Management, LLC 1%
2200 Biscayne Blvd.
Miami FL 33137
Galbut 2009 Investments Irrevocable Trust 99%
2200 Biscayne Blvd.
Miami FL 33137
Interests in Galbut CH Management, LLC
Percentage of Interest
Galbut Management Trust 100%
2200 Biscayne Blvd.
Miami FL 33137
Interests in Galbut Management Trust
Percentage of Interest
Russell W. Galbut 100%
2200 Biscayne Blvd.
Miami FL 33137
Interests in Galbut 2009 Investments Irrevocable Trust
Percentage of Interest
Russell W. Galbut 100%
2200 Biscayne Blvd.
Miami FL 33137
Interests in Menin CH-BT Co., LLLP
Percentage of Interest
Menin CH-BT Co., LLC 1%
2200 Biscayne Blvd.
Miami FL 33137
Menin 1998 Business Trust 99%
2200 Biscayne Blvd.
Miami FL 33137
Interests in Menin CH-BT Co., LLC
Percentage of Interest
Menin 1998 Business Trust 100%
2200 Biscayne Blvd.
Miami FL 33137
Interests in Menin 1998 Business Trust
Percentage of Interest
Bruce Menin 100%
2200 Biscayne Blvd.
Miami FL 33137
Interests in Menin CH Holdings, LLLP
Percentage of Interest
Menin CH Management, LLC 1%
2200 Biscayne Blvd.
Miami FL 33137
Menin CH Holdings, LLC 99%
2200 Biscayne Blvd.
Miami FL 33137
Interests in Menin CH Management, LLC
Percentage of Interest
Menin Management Trust 100%
2200 Biscayne Blvd.
Miami FL 33137
Interests in Menin Management Trust
Percentage of Interest
Bruce Menin 100%
2200 Biscayne Blvd.
Miami FL 33137
Interests in Menin CH Holdings, LLC
Percentage of Interest
Menin 2009 Investments Irrevocable Trust 100%
2200 Biscayne Blvd.
Miami FL 33137
Interests in Menin 2009 Investments Irrevocable Trust
Percentage of Interest
Bruce Menin 100%
2200 Biscayne Blvd.
Miami FL 33137