Graham Penn - South Beach Heights I, LLC o c7o AI-1-6-Y, L''
MIAMI BEACH
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.
Penn Graham .
NAME OF LOBBYIST: (Last) (First) (M.I)
Bercow Radell & Fernandez, PA 200 South Biscayne Blvd., Suite 850 Miami, Florida 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 374-5300 (305) 377-6222 apenntbrzoninalaw.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:
Russell W. Galbut
NAME OF PRINCIPAUCLIENT:
South Beach Heights I, LLC, 500 Alton Road Ventures, LLC, and 1220 Sixth, LLC
2200 Biscayne Blvd Miami Florida 33137
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 573-4127 raalbutncrescentheiahts.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 GALBUT
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: SEE ATTACHED
II.SPECIFIC LOBBY ISSUE:
Development Board Approvals for 500-600 Alton Road. Miami Beach—Parkina Lot
Issue to be lobbied(Describe in detail):
III. 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, City Commission, Development Boards None X
Land Use Development Committee and Commission None X
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.
Sec 2-482(g)Any Financial, Familial or Professional Relationship
None
None
None
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required) $475.00
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): $475.00
(REQUIRED).
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 Iobbvina on a present or'oendina bid for aoods.eauinment or services.or on a present or°ending
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 lobbying on a pending application for a Development Aareen ent with the City or application for
change of zonina map.desiangtion 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 coro_oration or entity without special compensation or reimbursement.
V. SIGNATURE UNDER OATH:
- - • ___: _I ; - •
- _ _ WELL AS COW__.► , !v RECEIVE. IN THE _! _ _hi ■ ► :
OATH. L.ISTII�Lf� LOBBYING EXPENQITURE& AS 1z 'CITY OF MIAMI BEACF(
1,
EXPENDITURES OR •ii _i , • -•► • . : . . :. • 1 I ' dr _ _ ._-
Signature of
I do solemnly swear that all oft .- •regoi is are true and correct and that I have read or am familiar with the provisions contained
in Section 2-482 of the Mia :-. -. d all reporting requirements.
Signature of Lobbyist:
�I
Signature of Principal/Client:/j /
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced ID a0 M� Produced ID
Form of Identification 7Z
rn3OZ Form of Identification
%a Ile
A.
Personally known(Lobbyist) . Personally known(Principal)
VII. SIGNATURE STAMP OF NOTARY: N
o i.3 i
State of Florida,County.of Miami-Dade o g N ( State of Florida,Cou - -
Swo I • -A+ S •scribe efo a me co-n in Sworn .n• subscrib.:`b e -
,2015 This day of `� '` OAYAf81 A6UTAR__
Thi . Id. of o a, �.
.., y �t d�� :• '.1 ►pogo-oleo of Flora
Ai Ai co d 1 , , w ` w ='qr.I.. CommN=Ion FF 18811+
Signatu if blic Notary "�� it:Col – a Comm.Expires
ry–State of Florida Sig atu - of Publ. ota State'of;;\fda a Mar tar 2019 `
Notari 'ation •f Lobbyist's signature No�=riza'ion of principal's si � '
TO BE COMPL ED BY CI- 'C ERK'S S •FF •NL a
Annual Registration fee [ ]Yes[ ~'o Amount Paid$ _ a•'�` MCR# i 9C't Date Paid
��
Lvbbyist.Registration Form receiv=,. and verified by:_
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City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139, www.miamibeachfl:gov
CITY CLERK Office
Rafael E. Granado, City Clerk CityClerkQmiamibeachfl.gov
Tel:305.673.7411 , Fax: 305.673..7254
LOBBYIST NAME Graham Penn
•
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
a -aled:t•: the Miami-Dade County Commission on Ethics and Public Trust.
Cam !
Sig re: Date:
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SUPPLEMENTARY DISCLOSURE OF INTEREST
Interests in South Beach Heights I, LLC
Percentage of Interest
KGM Equities, LLC 100%
2200 Biscayne Blvd.
Miami FL 33137
Interests in 500 Alton Road Ventures, LLC
Percentage of Interest
KGM Equities, LLC 100%
2200 Biscayne Blvd.
Miami FL 33137
Interests in 1220 Sixth, LLC
Percentage of Interest
KGM Equities, LLC 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
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interests in Sonny Kahn 2004 Irrevocable Trust
ry.. -� Percentage of-Interest
, r '_4. L
" Sonny •Kahn 100% u�
M
00/a
2200 Biscayne Blvd.
Miami FL 33137
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Interests in Russell W. Galbut 2004 Irrevocable Trust
' Percentage of Interest
t
Russell W. Galbut = :_+ 100%�
2200 Biscayne Blvd. rr
Miami FL 33137 F
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Interests in Bruce A. Menin 2004 Irrevocable Trust s
Percentage:of,I nteresf+
Bruce Menin 100% 1 `
2200 Biscayne Blvd.
Miami FL 33137 ,,
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