Rafael E. Andrade - KGM Equities, LLC AP
MIAMIBEACH 1° OIJ
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City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
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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.
Andrade Rafael E.
•
NAME OF LOBBYIST: (Last) (First) (M.I)
Law Offices of Rafael E. Andrade, P.A., 1111 Lincoln Road, Suite 400, Miami Beach, Florida 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 531-9511 (305) 673-5734 ralph(a,randradelaw.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:
KGM Equities, LLC
NAME OF PRINCIPAL/CLIENT:
Same 2200 Biscayne Boulevard Miami Florida 33137
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 573-4127
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: David Smith, Manager
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: f '44-lcici/e ,. 7
II.SPECIFIC LOBBY ISSUE:
Development Board approvals for 709 Alton Road and related matters •
Issue to be lobbied(Describe in detail):
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
Mayor and City Commission, City Manager and Staff, X
City Attorney and Staff, Planning Director and Staff, and X
all City Boards and Committees 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 dity 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 1-7- '
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)
$500 per hour
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION):
(REQUIRED). $500 per hour
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 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":
_Yes X_No: Are you lobbying on a pending application for a Development Agreement with the City or application for
chan•e of zonin• ma• desic nation or chan•e to the Cit 's Future Land Use Ma.?
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.
YesXNo: 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. —
i
Signature •�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 C...-4. .--. porting requirem OW
Signature of Lobbyist: ,,
Signature of Princi al/Client
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
-, Produced ID • `4 N = Produced ID
Form of Identification `v��o do Form of Identification
ersonally known(Lobbyist) yQ y`�Q�� /Personally known(Principal)
VII. SIGNATURE AND STAMP OF NOTARI�:;,�y ��a�*°
F r
State of Florida, County of Miami-Dade o oo0 F0 State of Flori.a, . o,nt, of ii mjaDi e.. ..
Sworn to a ubscribed before I co IP Sworn and s ;,•scrl•,.• •e ore me
This /.•a ,of - - , .'20L .- ',,`r ca- This da gro, s!.!<'. , 20 AMl AGUIAR
m� '! n -VI c Notary u lic-State of Flonda '
_, - *,*•b�? - M Comm.E Mar 16,2015�, `c ,G ' •- y Expires
Signature of ,'ublic Nota —State of Florida:;* '1F84. l 17 :ry;' �'of Fl. emission # EE 70292
,,, t�,, Si•natu - of Pu• N.,�. ►€„.: .� a
Notarizatio of Lobbyist's signature '�••S��■��' .-� No ariz:tion of Princ1'-• ' ,.. :,. --
( ,.
TO BE C MPLETED BYITY CLERK'S STAFF ONLY
Annual Registration fee: [ ]Yes[V]No Amount Paid$ ?i
MCR# 3 (2,3.4-0 Date Paid )7- /r/v
Lobbyist Registration Form received and verified by: G fai.2-- Co�4----
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Annual Registration Form.doc Revised 11/18/2013
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
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MAM B
City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachH.gov
CITY CLERK Office
Rafael E. Granado, City Clerk CityClerk @miamibeachfl.gov
Tel: 305.673.7411 ,Fax: 305.673.7254
LOBBYIST NAME: Rafael E. Andrade
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 30, 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.
/ fir/
ignature Date
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
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WORSZPIMPEMINNEMEANEWF
City of Miami Beach-Florida
Finance Department
1 City Hall
1434920-1 12/15/2014 BR1 T113
Mon Dec15,2014 12:09PM Trans#33-33
33 $350.00 MCRCLERK - MCR-City Clerk
* MCR#: 36250
1 ITEM(S): TOTAL: $350,00
Check (00045) PAID $350.00
Have a nice day!
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Miscellaneous Cash Receipt c s .00
CITY OF MIAMI BEACH s
36250
_ No.
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(THIS INFORMATION MUST BE COMPLETED) - 4\=' Offl,e,of Finance Director
Account Number: Dili` = .tip!, . _ ;�;
Prcparer: _ Dept: - �_=j� EXT:'•
•
SUPPLEMENTARY DISCLOSURE OF INTEREST
Interests in ARRP Miami III, LLC
Percentage of Interest
KGM Equities 2, LLC 95%
2200 Biscayne Blvd.
Miami FL 33137
Beach R Holdings, LLC 5%
_ ---2200-BLscayne-Blvd. - — - - — --- - -
Miami FL 33137
Interests in KGM Equities 2, LLC
Percentage of Interest
Sonny Kahn 2004 Irrevocable Trust 45%
2200 Biscayne Blvd.
Miami FL 33137
Russell W. Galbut 2004 Irrevocable Trust 45%
2200 Biscayne Blvd.
Miami FL 33137
Bruce A. Menin 2004 Irrevocable Trust 10%
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
Interests in Beach R Holdings, LLC
Percentage of Interest
Tomer Bitton 100%
2200 Biscayne Blvd.
Miami FL 33137