The URL can be used to link to this page

Michael W. Larkin - South Beach Heights I, LLC M I AM I BEAC H kkki," - 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. Larkin Michael W. 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 mlarkin ct' brzoninalaw.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) 573-41.27 raalbuttc'i_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: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): 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 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 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): CA) LOBBYIST DISCLOSURE:(Required): $525.00 A) LOBBYIST DISCLOSURE:(Required): •$525:00 B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION) $525.00 (REQUIRED). The following information must be answered: 1) Pursuant to Miami Beach City Code Section 2-488 Entitled"Prohibited Campaign Contributions By Lobbyists On Procurement Issues": _Yes.X No: Are you lobbvina on a present or aendina hid for goods.equipment or services.or on a present or pending award for aoods.eauioment or service? 2) Pursuant to Miami Beach City Code Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": _Yes X lop No: Are you lobbvina on a pending appiicatio■for a Devement Aareement with the City or application for change of zoning map desianation or chance to the City's Future Land Use Mao? 3) Pursuant to Miami Beach City Code Section 2-482(h)Any person(except those exempt from the definition of"lobbyist"as set forth in Section 2-481 above) who only appears as a representative of a not-for-profit corporation or entity without special compensation or reimbursement for the appearance, whether direct, or indirect, to express support of or opposition to any item,shall register with the clerk as required by this section but, shall not be required to pay any registration fees. _Yes X No: Are you reoresentina a.not-for-profit corporation or entity without special compensation or reimbursement, V. SIGNATURE UNDER OATH:. ON FEBRUARY 28 OF EACH YEAR. EACH LOBBYIST SHALL SUBMIT TO TI4E CITY CLERK A SIGNED STATEMENT UNDER OATH. LISTING LOBBYING. EXPENDITURES. AS WELL AS COMPENSATION RECEIVED—IN THE CITY OF MIAMI BEACH EQ$ THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR.COMPENSATION DURING THE REPORTING PERIOD. cy.N....i 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 require ents. • Signature of Lobbyist: Signature of Principal/Client: .1" ..'_e. .---- VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: ' • i °D Produced ID LL s Produced ID / Form of Identification. It o Form of Identification ✓ ig NON Personally known(Lobbyist) E S Personally known(Principal) a.rtge VII. SIGNATURE AND STAMP OF NOTARY: i i o g 2b2u7 t St- : of Florida,County of Miami-Dade _ • r State of Florida, Cou � .• w Svv�<or t- d s ,•scribe befor me �''` ` 'I - DAYAMI AGUIAR + Sworn a d subscri%- .., This ,�, I • y of C 1 ,2015 i< a This ''�''�� otar Pubt o-State ��'i ay of I,_'��,,t..�� y-1� 1 e of Florida 1 �, '"•�`` 1ALLd l Its ��■ ,/a,, -. My Comm.Expires Mar 16,2019 Sign:ture of 4ublic Notary—State of Florida Signat re Public ,:ra Sate dfTibrid trough INotaryAssn. Notar ation of Lobbyist's signature Notari -ti�of Principal's s Slate ——————— —• TO BE COMPLETED BY CITY CLERK'S STAFF 9 O LY Annual Registration fee: [ ]Yes[ o Amount Paid$ 2,Da OO MCR# L(Imo '{ Date Paid //, Lobbyist Registration Form receive and verified by: C:\Userslclerhatl\AppData\Local\Microsoft\Windows\Tempo ary Internet Files\Content.Outlook183LGQDDHILobbyist Registration Formrevised 5-30-2012.doc I F:\GLE. istration Form.doc Revised 04/27/2012 MIAMI i•i Ei City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachtgov CITY CLERK Office Rafael E.Granado,City Clerk CityClerk @m iamibeachfl.gov Tel: 305.673.7411 ,.Fax: 3 05.673:72.5 4 • LOBBYIST NAME Michael W. Larkin 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 2485.1, 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. i � Signature: Date: C:\Userslclerhatl\AppDatalLocal\MicrosofitWVindows\Temporary Internet Files\Content.Outlook183LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc 1 r i t .a r • E�_j i � � ,�5}. l 3 `°r t 1 � R -«S 1 _ aw Miscellaneous Cash Re eipt - ` � . i 4•�q� CITY OF MIAM 'Ph�?"•�'� � :E s - t.:. t S �a it f� _ c r 5.-�� Y.; .::Cash Credit Card Check - „. $ s it, .. . 20 . • ',',:;;...'-',','_;i',:::,...:....,: ::',..':',':';',.::.'::!:.;;:=-:,.-:,,81',..'''' ',.-;, ..''....,,,-,:'„::::=:;.:::.6:',:..:.'. .,;:;t:'.:--1:7:::::q Address d a . !-9 X1 e' t- t`� //Z2_6. ,X'�� s �- s c�� Park r � 1 1,;....,.,,L,,,,,„,..-.4-!_t-..-7..::..::r,,,:::.,,,,-..:.::.-,. ,,,: .E ,, �i t THIS'INFORMAT ION_MUST'EE COMPLETED) - e of,Finance Director 7.h.y. � G "3 � }yam � .x -�� . .: ' 7 '-d , (. �� , .Aunf�N ber:fi! ;�. 1� .. ..t. L - 1 1/j/? ',...7 f } /{//�q�'jam' ( ;c 1 11 �p/�■ (,{/ 1_ -i i Prepares.° � l�� ept �� r D :� 1:,, , , ,. „,I Y i -,J 21 b ,a -I. 1 11. .6.><iy b �� L i s /' > 1 1 .�•--�. :ter... r_, ., ..s..>:� .,r�l -t;.. c.,r..-T�.., ....,3.-...L-,.! ..4'.. .Z.rt. , „_ r ..i;.+%v.- is-t� «t ...... ........>r,,.,_ ...i. ....L�'r `,le_;•� .--< ,...rr�+ 1 _�6�' 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 • Interests in Sonny Kahn 2004 Irrevocable Trust Percentage of Interest Sonny Kahn 100% 2200 Biscayne Blvd. Miami FL 33137 Interests in Russell W, Galbut 2004 Irrevocable Trust Percentage of Interest Russell W. Galbut 100% 2200 Biscayne Blvd. Miami FL 33137 Interests in Bruce A. Menin 2004 Irrevocable Trust Percentage of Interest Bruce Menin 100% 2200 Biscayne Blvd. Miami FL 33137