Kricket Snow - Russell W Galbut •••
V 4 II)
City of Miami Beach Office of the City Clerk )..„ 1040
1700 Convention Center Drive, Miami Beach, FL 33139 � \ �jo
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•
1
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.
Fran-+�Gn Faso n
NAME OF LOBBYIST: (Last) (First) (M.I)
14 or zoq * de_ r e_Li-on R he-inscinctn a e Iv 4056 Swi+aerl cr)d
BUSINESSAAOIE AND ADDRESS (Number and Street) (City) (State) (Zip Code)
J(0)3a558 8 I -+ 41613855 758 . .Frgnt acne hex-a09de.rme Yn .Cory)
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes:address,phone, or e-mail address.
I. LOBBYIST RETAINED BY:
M Lko&) L. L L P
NAME OF PRINCIPAL/CLIENT:
lut Lincoln Rood 5-1-e..-260 t1I Grn, l3eachh F L 3313
USIN 5S NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 5S8-93c),),
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: Robert- Werl")z.-+
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE 0 NERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: _�f
ii.SPECIFIC LOBBY ISSUE:
I
lanA r ; toni�t v v41S r ardi, trF /oca+� 1W Avc o i'ancolri Rd, Vb A l+ Rd
P � � ppro e� ,� �� y �o� � � I �S d� t
Issue to eilobbied(Describe in detail):
' M:G0,; ate,
iv.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
Plcinnin' cr,d 7zn;n5 Deport-c»c,•1- - 5-tei c c a(q >'C
toad F Adjvs en-r nlfq k
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.
Sec 2-482(g)Any Financial, Familial or Professional Relationship • •
f't RY £e a
F:\CLER\$ALLIaFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
' r ,
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required)..I0
B) PRINCIPALS DISCLOSURE(OF LOBBYIST COMPENSATION):
(REQUIRED).4O
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":
_
YesNo: 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 Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
_Ye$ 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 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.
_YeNo: Are you 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 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
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/Cli
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced ID Produced ID
—
Form of Identification Form of Identification
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 Sworn and subscribed before me
This c,.?-74/--day of L € ' ,201
COINISSOIORf This c,Z,Zday sieve Mhz
EXPIRES: Sgt. 3, 4011 R CRISS26
= wwwAA OulCtatr- —ice ! -. Ex/MIEb 81St &2018
Signature of Public Notaryyter'lorida • Signature of Public Notary— =ta e o :i ' inavAillalleMeom
Notarization of Lobbyist s signa ure Notarization of Princi•al'- sis nat - •
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: cYes[ J No Amount P...1.,.$5 85c' MCR# 362.30 Date Paid I? 2/2p/GI
Lobbyist Registration Form received and verified by:
F:\CLER\SALL\aFORMS\LOBBYIST FORMS\Lobbyist Annual R tration Form.doc Revised 01/22/2014
MBEACH1, LLLP a Delaware limited liability
F:\CLER1$ALL1aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc limited partnership By: MBEACH1 GP, LLC,
its General Partner, By: Urban Investments
Advisors, LLC, its Sole Member, By:
Wellspring Investments Management I, LLC,
dy: its Managing Member
A I A I\ A P ,„r: A L
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: Ct
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$50.00 a day shall be assessed for all
Statement(s) filed after the due date. The City Clerk shall notify the Miami-Dade
County Commission on Ethics and Public Trust of the failure of a lobbyist(or principal)
to file the Statement or pay the assessed fines after notification.
Any lobbyist, who fails to file the required Statement by April 30th of each year, shall be
automatically suspended from lobbying until all fines are paid, unless the fine has been
appealed to the Miami-Dade County Commission on Ethics and Public Trust.
Ac_. oz �i Y
-
Sign. ‘>01111.1.---
• Date:
•
A.
•
F:ICLERI$ALL1aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
. i
CITY OF MAIMI BEACH
DEVELOPMENT REVIEW BOARD APPLICATION •
DISCLOSURE OF INTEREST
1. CORPORATION
If the property which is the subject of the application is owned or leased by a CORPORATION, list the
principal stockholders and the percentage of stock owned by each. Where the principal officers or
stockholders consist of another corporation(s), trustee(s), partnership(s) or other similar entity, further
disclosure shall be required which disclosed the identity of the individual9s) (natural persons) having the
ultimate ownership interest in the entity).*
•
MBEACHI GP, LLC, a Delaware limited liability company
CORPORATION NAME
NAME,ADDRESS,AND OFFICE %OF STOCK
URBAN INVESTMENTS ADVISORS, LLC, a Delaware limited liability company, 100%
the Sole Member of MBeachl GP, LLC, a Delaware limited liability company
1111 Lincoln Road,Suite 760
Miami Beach, Florida 33139
MBEACHI INVESTORS GP, LLC. a Delaware limited liability company
CORPORATION NAME
NAME,ADDRESS,AND OFFICE %/o OF STOCK
URBAN INVESTMENTS ADVISORS, LLC. a Delaware limited liability company, 100%
the Sole Member of MBeachl Investors GP. LLC.
a Delaware limited liability company
1111 Lincoln Road, Suite 760
Miami Beach, Florida 33139
URBAN INVESTMENTS ADVISORS, LLC, a Delaware limited liability company
CORPORATION NAME
NAME,ADDRESS,AND OFFICE %OF STOCK
WELLSPRING INVESTMENTS MANAGEMENT I, LLC. a Delaware limited liability 1%
company, the Managing Member of Urban Investments Advisors, LLC, a Delaware
limited liability company
1111 Lincoln Road. Suite 760
Miami Beach, Florida 33139
WELLSPRING INVESTMENTS MANAGEMENT II, LLC, a Delaware limited liability 99%
company, the Managing Member of Urban Investments Advisors, LLC, a Delaware
limited liability company -
1111 Lincoln Road, Suite 760
Miami Beach, Florida 33139
MIAMI 963391.1 7613422013 9
09/23/2014
•
WELLSPRING INVESTMENTS MANAGEMENT I. LLC,a Delaware limited liability company
CORPORATION NAME
NAME,ADDRESS,AND OFFICE %OF STOCK
ROBERT S.WENNE I I,TOD ROBERT S.WENNETT REVOCABLE TRUST, 0.5%
the Managing Member of Wellspring Investments Management I, LLC,
a Delaware limited liability company
1111 Lincoln Road, Suite 760
Miami Beach, Florida 33139
ROBERT S.WENNETT REVOCABLE TRUST, the Managing Member of 99.00%
Wellspring Investments Management I, LLC, a Delaware limited liability company
1111 Lincoln Road, Suite 760
Miami Beach, Florida 33139
MARIO CADER-FRECH REVOCABLE TRUST, a Member of 0.5%
Wellspring Investments Management I, LLC, a Delaware limited liability company
1111 Lincoln Road, Suite 760
Miami Beach, Florida 33139
WELLSPRING INVESTMENTS MANAGEMENT il, LLC, a Delaware limited liability company
CORPORATION NAME
NAME,ADDRESS,AND OFFICE %OF STOCK
ROBERT S.WENNETT,TOD ROBERT S.WENNETT REVOCABLE TRUST, 0.5%
the Managing Member of Wellspring Investments Management I, LLC.
a Delaware limited liability company
1111 Lincoln Road,Suite 760
Miami Beach, Florida 33139
ROBERT S. WENNETT REVOCABLE TRUST,the Managing Member of 99.00%
Wellspring Investments Management I, LLC, a Delaware limited liability company
1111 Lincoln Road, Suite 760
Miami Beach, Florida 33139
MARIO CADER-FRECH REVOCABLE TRUST, a Member of 0.5%
Wellspring Investments Management I, LLC, a Delaware limited liability company
1111 Lincoln Road. Suite 760
Miami Beach, Florida 33139
IF THERE ARE ADDITIONAL CORPORATIONS, LIST OTHERS, INCLUDING CORP. NAME(S)AND
EACH INDIVIDUAL'S NAME,ADDRESS, OFFICE AND PERCENTAGE OF STOCK, ON A SEPARATE
PAGE.
NOTE:Notarized signature required on page 13
MIAMI 963391.1 76 1 3422013 10
09/23/2014
•
CITY OF MAIMI BEACH
DEVELOPMENT REVIEW BOARD APPLICATON
DISCLOSURE OF INTEREST
2. TRUSTEE
If the property which is the subject of the applications owned or leased by a TRUSTEE, list the
beneficiaries of the trust and the percentage of interest held by each. Where the beneficiary/beneficiaries
consist of corporation(s), another trust(s), partnership(s)or other similar entity, further disclosure shall be
required which discloses the identity of the individuals) (natural person) having the ultimate ownership
interest in the entity.*
ROBERT S.WENNETT REVOCABLE TRUST
TRUST NAME
NAME,ADDRESS AND OFFICE %OF STOCK
ROBERT S.WENNETT TRUSTEE 76.30711%
1111 LINCOLN ROAD,SUITE 760,MIAMI BEACH, FL 33139
MARIO CADER-FRECH REVOCABLE TRUST
TRUST NAME
NAME,ADDRESS AND OFFICE %OF STOCK
MARIO CADER-FRECH TRUSTEE 15.46193%
1111 LINCOLN ROAD,SUITE 760,MIAMI BEACH. FL 33139
3. PARTNERSHIP/LIMITED PARTNERSHIP -
If the property which is the subject of the application is owned or leased by a PARTNERSHIP or LIMITED
PARTNERESHIP, list the principals of the partnership, including general and limited partners. Where the
partner(s) consist of another partnership(s), corporation(s), trust(s) or other similar entity, further
disclosure shall be required which discloses the identity of the individuals) (natural persons) having the
ultimate ownership interest in the entity.*
•
MBEACHI, LLLP, a Delaware limited liability limited partnership
PARTNERSHIP or LIMITED PARTNERSHHP NAME
NAME, ADDRESS, AND OFFICE % OF STOCK
MBEACH1 GP, LLC, a Delaware limited liability company. the General Partner 0.5%
of MBeachl, LLLP, a Delaware limited liability limited partnership.
1111 Lincoln Road, Suite 760
Miami Beach, Florida 33139 •
MBEACHI INVESTORS, LP, a Delaware limited partnership, a Partner. 99.5%
of MBeachl, LLLP, a Delaware limited liability limited partnership
1111 Lincoln Road, Suite 760
Miami Beach,Florida 33139
MIAMI 96339 4.1 7613422013 11
09/23/2014
MBEACHI INVESTORS, LP, a Delaware limited partnership
PARTNERSHIP or LIMITED PARTNERSIHP NAME
NAME,ADDRESS, AND OFF(CE % OF STOCK
MBEACHI Investors GP, LLC, a Delaware limited liability company, 0.5%
the General Partner of MBeachl Investors, LP, a Delaware limited partnership
ROBERT S.WENNETT REVOCABLE TRUST, a Limited Partner
of MBeachl Investors, LP, a Delaware limited partnership 76.30711%
1111 Lincoln Road, Suite 760
Miami Beach, Florida 33139
MARIO CADER-FRECH REVOCABLE TRUST,a Limited Partner
of MBeachl Investors, LP, a Delaware limited partnership 15.46193%
1111 Lincoln Road, Suite 760
Miami Beach. Florida 33139
CLAUDE CHANDONNET, a Limited Partner of MBeachl Investors. LP, 7.73096%
a Delaware limited partnership
1111 Lincoln Road, Suite 760
Miami Beach, Florida 33139
NOTE: Notarized signature required on page 13
4.
5.
6.
7.
a.
MLAIvi I963391.17613422013 12
09/23/2014
1...101 122
Miscellaneous Cash Receipt 71,-:F:.-ci:::: :-..-.1-I-1 k :42:::0 42050.00
CITY OF MIAMI BEACH
No. 36230
0 Cash ,C*redit Card 0 Check# $ 2c7s7
• De.c . 2_ 20 /ci
Received of 1 ,e. c..1.1 L2 e--(---P
• Address
For ,,f-.) .--1 Z-i2-c) ' GI U ier AV 171-0 A c::1 — -•
(THIS INFORMATION MUST BE COMPLETED) Office of FInance Director
By
Account Number:011.E0 40 0.,3 6 ct. -i'l Li
Preparer7 S '"--- r-. Es.-,-, Dept: ( _.--1,-, i‹..._ DU:7c--7 I r
---,•:- 9 ff 17 0
b 3 5v
MIAM1BEACH
BEACH 6 kq
• 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.
Snow Kricket
NAME OF LOBBYIST: (Last) (First) (M.l)
Perkins +Will 806 Douglas Road, Suite 300 Coral Gables, Florida 33134
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 569-1347 Kricket.Snowa_perkinswill.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes: address,phone, ore-mail address.
I. LOBBYIST RETAINED BY:
Russell W. Galbut
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 rcialbut(a�crescentheiahts.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: a 1 GrnP0I,
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: P
II.SPE.CIFIC LOBBY ISSUE:
Development Board Approvals and related ordinances for 709 Alton Road
Issue to be lobbied(Describe in detail):
lll. 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 Staff, PB, HPB, BOA, DRB, Commission 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.
Sec 2-482(g)Any Financial, Familial or Professional Relationship "11117,,
NONE `
C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration
Formrevised 5-30-2012.doc
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required)
Z Sc' pe-i-
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATIO
(REQUIRED). s-'00 `°�✓' 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":
_Yes X No: Are you lobbvina on a present or pendina bid for aoods.eauioment or services.or on a present or pending
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 pendina application for a Development Aareement with the City or application for
chanae of zonina map desianation or chanae 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 No: Are you reoresentina 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 BEACI'-I
EQB, 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
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: z.47Signature of Principal/Client: /
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced ID Produced ID
Form of Identification Form of Identification
Personally known(Lobbyist) Personally known(Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade State of Florid i-@a — — —
Sworn to and subscribed before me Sworn and sub$cri c"Zfpre me DAYAMI AGUTAR
This day of 2014 This y €%�i;,. �,1
y � �'� �,�, `�: •o�a Oublic-State of Florida
� om My Comm.Expires Mar 16,2015
Oft er, Commission # EE 70292 P
Signature of Public Notary—State of Florida Sign tur f Publi of-tr..- _ .- e of Florida
F . .. .as�ter-v +cam�
Notarization of Lobbyist's signature Not riza on of Principal s signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ ]Yes[ ]No Amount Paid$ PSTO MCR#3(O.Z C Date Paid __ /
Lobbyist Registration Form received and verified by:
6
C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration
Formrevised 5-30-2012.doc
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
T fri)7,—0 1 h r.
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): . S.�
(REQUIRED). pe-r. �r
1
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 you lobbvina on a present or oendina bid for aoods.eauioment or services.or on a present or pending
award for aoods. eauipment 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 lobbvina on a oendina application for a Development Aareement with the City or application for,
chanae of zonina map desianation or chanae to the City's Future Land Use Mao?
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 No: Are you reoresentina 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
F_Qa 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
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 re orting requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced ID Produced ID
Form of Identification Form of Identification
LPersonally known (Lobbyist) Personally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
,;�':, Karen V31des
State of Florida, County of Miami-Dade
State of Florida, County of Miami-Dade ?: ;��:.COr�r�i�s 0:d EE?36524 y
Sworn to 1.rid subscribed before me '-
'-.-v,'. •F:':FxPTEs• RT. 11 2015 Sworn and subscribed before me
lit day of 1 ,.g1 •,l 2014 WWW.AARONNOTARY.com This day of , 2014
�y l
•
ure of Publi Notary—State of Florida Signature of Public Notary—State of Florida
Notarization of Lobbyist's signature Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ ]Yes[ ]No Amount Paid$ MCR# Date Paid
Lobbyist Registration Form received and verified by:
C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration
Formrevised 5-30-2012.doc
F:\CLE istration Form.doc Revised 04/27/2012
•
fvA\ ' , t A` IBECH'i 'S.
l ifv of S1i2mi Beach. 17!n) (()Ilk oltion (en1 r I)ritr Miami 14m± fk>ru3a 3'31:49 teN+tN.iniarruheat;iifl.go■
( IIV (1i:1tKOffice
kifhte! ( ."it)( ierlsamiarrubs:44.etif1.go
Tel: 305.673.7411 , Fax: 305.673.7254
LOBBYIST NAME: Kricket Snow
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.
Signature: ate:
C:\Users\clerhatIWppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration
Formrevised 5-30-2012.doc
SUPPLEMENTARY DISCLOSURE OF INTEREST
Interests in Alton Road Development, LLC
Percentage of Interest
Alton Road Holdings, LLC 100%
2200 Biscayne Blvd.
Miami FL 33137
• Interests in Alton Road Holdings, LLC
Percentage of Interest
South Beach Heights II, LLC 50%
2200 Biscayne Blvd.
Miami FL 33137
KGM Equities, LLC 50%
2200 Biscayne Blvd.
Miami FL 33137
Interests in South Beach Heights II, LLC
Percentage of Interest
SBH Holdings II, LLC 99%
2200 Biscayne Blvd.
Miami FL 33137
SBH Management Company, LLC 1%
2200 Biscayne Blvd.
Miami FL 33137
Interests in SBH Holdings II, 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 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
Interests in S Kahn Management, LLC
Percentage of Interest
Kahn Management Trust 100%
2200 Biscayne Blvd.
Miami FL 33137
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 RF 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
Interests in KGM Equities, LLC
Percentage of Interest
Sonny Kahn 2004 Irrevocable Trust 37%
2200 Biscayne Blvd.
Miami FL 33137
Russell W. Galbut 2004 Irrevocable Trust 37%
2200 Biscayne Blvd.
Miami FL 33137
Bruce A. Menin 2004 Irrevocable Trust 26%
2200 Biscayne Blvd.
Miami FL 33137
Beneficiaries of Sonny Kahn 2004 Irrevocable Trust
Percentage of Interest
Child of Sonny Kahn 20%
2200 Biscayne Blvd.
Miami FL 33137
Child of Sonny Kahn 20%
2200 Biscayne Blvd.
Miami FL 33137
Child of Sonny Kahn 20%
2200 Biscayne Blvd.
Miami FL 33137
Child of Sonny Kahn 20%
2200 Biscayne Blvd.
Miami FL 33137
Child of Sonny Kahn 20%
2200 Biscayne Blvd.
Miami FL 33137
Beneficiaries of Russell W. Galbut 2004 Irrevocable Trust
Percentage of Interest
Child of Russell Galbut 50%
2200 Biscayne Blvd.
Miami FL 33137
Child of Russell Galbut 50%
2200 Biscayne Blvd.
Miami FL 33137
Beneficiaries of Bruce A. Menin 2004 Irrevocable Trust
Percentage of Interest
Child of Bruce Menin 33.33%
2200 Biscayne Blvd.
Miami FL 33137
Child of Bruce Menin 33.33%
2200 Biscayne Blvd.
Miami FL 33137
Child of Bruce Menin 33.33%
2200 Biscayne Blvd.
Miami FL 33137
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