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J.J. Wood - South Beach Heights I, LLC M I AM I BEACH 5oobookW a& City of Miami Beach Office of the City Clerk Z�� Y y °F 1700 Convention Center Drive, Miami Beach, FL 33139 r l 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. Wood J.J. NAME OF LOBBYIST: (Last) (First) (M.I) Urban Robot Associates 420 Lincoln Road, #406 Miami Beach Florida 33140 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (786) 246-4857 (305) 766-0071 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 raalbutt crescentheiahts.corn 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 C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration n l� Formrevised 5-30-2012.doc V IV. DISCLOSURE OF TERMS"AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) U POD 1 kr B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): G OQ oo tie (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 orpendina bid for aoods.eauinment or services.or on a present or pending award for aoods.eauipment or service? 2) Pursuant to Miami Beach City Code Section 2490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": _Yes X No: Are you lobbvina on a oendina application fora Development Aareement with the City or application for chanae of zoning man 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.vou representina-a not-for-profit corporation or entitv without special compensation or reimbursement, V. SIGNATURE UNDER OATH: ON FEBRUARY 28 OF EACH YEAR,EACH LOBBYIST SHAI I SUBMIT TO TI-IF CITY ci FRK A$IGNFP,STATFMFNT UNDER OATH. LISTING LOBBYING _EXPENDITURES. AS WELL AS COMPENSATION RECEIVED. IN_THE CITY OF MIAMI BEACH i EO$ THE PRECEDING CALENDAR YEAR A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO, EXPENDITURES OR MIRING THE REPORTING PERIOD iv f ati i.IL frAl A Cow. S g n-'u of Lobbyist v' I do solemnlyswear that all of the foregoing fac s 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 - d al repo ing requirements. Signature of Lobbyist: 4 �:► ;' mod_— Signature of Principal/Client: ii�e�� '_j • VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: Produced ID 7._, e? Produced ID Form of Identification 'ba.1' / Form of Identification a�vo _ / Personally known(Lobbyist) - d V Y ( Yi ) � o �,.z Personally known(Principal) VII. SIGNATURE AND STAMP OF NOTARY: ;y al Q Oy G ff- G g s Ol • State of Fl•n•a,County of Miami-Dade w m . State,of Florida,Coun y o ,I-ease orn -,. subscribe./bef• e me o DAYAMI AGUIAR -,°. Swod -,ubscri , hi- ►e day of /II el 2015 a " This_ .. mow PUbUC-State of Florida Y of �r1`�, r COmarls=Ion i FI:186144 A;1�4 11 t Aar i '.,?.0. - /Ay Comm.Expires Mar 16,2019 Sig'attire • -ublic Notary-State of Florida Signa' re slJ Public L. ,. . ry-St'- �_- - Notary Ass<r.° No .jization of Lobbyist's signature Notari•ation of Principal's signature qo BE COMPLE D BY CITY CLERK'S STAFF O Annual Registration fee: [ I Yes,[ o Amount Paid 5O °r' MCR# Date Paid //, / Lobbyist Registration Form receive nd verified by: C:1Userslclerhatl\AppData\LocallMicrosoft\W indowsvTemporary ternet Files\Content.Outlook183LGQDDHILobbyist Registration Formrevised 5-30-2012.doc F:\CLE istration Form.doc Revised 04/27/2012 MIAMH '; EACH City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139, www.miamibeach8.gov CITY CLERK Office Rafael E.Granado, City Clerk CityClerk@miamibeachfl.gov Tel: 305.673.741 l , Fax: 30.5.673.7254 LOBBYIST NAME J.J. Wood 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. r Aid Ala IId O �� 1 c Signature: / Date: C:\Users\clerhati\AppData\Local\Microsoft\Windows\Temporary Internet.Files\Content.Outlook183LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc .,-,:.,„---L-sr-=.71::Tgf.:::::!:,,..3:::i. 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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 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