Graham C. Penn - Russell Galbut Soo 441� Q-oc
MIAMI BEACH t'�� � Si-e4-4,1-
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, Q( 331,39 1 °' 10
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 _ C.
NAME OF LOBBYIST: (Last) (First) (M.I)
Bercow Radell&Fernandez 200 South Biscayne Blvd., Suite 850 Miami, Florida 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-374-5300
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 Galbut
NAME OF PRINCIPAL/CLIENT:
500 Alton Road Ventures, LLC and 1220 Sixth, LLC c/o Crescent Heights 2200 Biscayne Blvd. Miami, FL 33137
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-374-5700
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:
LDevelopment Approvals and=Permitting Issues]including, but not limited to the Design Review Board, Planning Board, Board of
Adjustment,-"Land-Use Development-Committee, City Commission, and any City Workshops or Committees, if necessary,
'relating to the oronertu located at 500 Alton Road and-1220-Sixth'Street,-Miami Beach,-Florida\
Issue to be lobbied(Describe in detail): —
In. 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
• Staff for the Planning Department, Building Department, None. X
Public Works and City administration, PB, HPB, BOA, None. • X
City Commission, and Mayor 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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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)$490 per hour
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): $490 per hour
(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 XNo: Are you Iobbvina on a present or oendina bid for aoods.eauipment or services.or on a present or pending
award for aoods.ea ioment or service?
2) Pursuant to Miami Beach City Code Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
—Yes XNo: Are you Iobbvina on a oendina application for a Development Agreement with the City or application for
change of zonina 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.
_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 S-ALL SU=MIT TO THE CITY CLERK A SIGNED STATEMENT UNDER
OATH. LISTING LOBBYING EXPENDITURES. AS WE AS CO •ENSATIO RECEIVED. IN THE CITY OF MIAMI BEACI{
EQR THE PRECEDING CALENDAR YEAR. A S EME SHALL B7 FILED EVEN IF THERE HAVE BEEN NO
EXPENDITURES OR •u • . _ • ► I : ► •• : ∎. •. : •
riV /C
_� //'
Signature of Lr yi
I do solemnly swear that all of the foregoi'g fact are true -•. corre -nd that I have read or am familiar with the provisions contained
in Section 2-482 of the Miami Beach Cit ,Co•- and - •, -quirements.
Signature of Lobbyist:
Signature of Principal/Client: //j % �
�
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced ID Produced ID
Form of Identification �`AbA.4� ,--
o z „,1,0%44, DAYAMI AGUIAR
ii m �. ^� =. Notary Public-State of Florida
_Personally known(Lobbyist) ✓Personally kn't O[[[4����'''.```II• tl) Commission#FF 196144
3 w Q --;,.e--6.;,-del My Comm.Expires Mar 16,2019
VII. SIGNATURE AND STAMP OF NOTARY: g gag S ,,°, , Bonded tfvough National NotaryAssn.”
�, a
State of Florida, Cou'hty of Miami-Dade m T ^ State of Florida, County of Miarr D�ds d _
6 N a. - ...d5..�.-
Sworn n subscribe efore me G T Sworn and subscri.'ed befo`rg,me
DAYAMI AG0,1;-
This ay o IinQ, , 2016 –, _ - his 023 day •f �� , `_°�' Of��tary Public
I ,r i :, 1 ., Comm ,. , r
.., RA,, 1 ylia Mai 16,2019
Signature of Pub' otary–State of Florida Signature of blic Not. , "taf:• orida ;,;,,,gh National Notary Assn.
Notarization of Lbbvist's signature Notarization principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ ]Yes[x]No Amount Paid$ 7 cO ,,o MCR# 9 if) )Q 7 Date Paid r/Z-m.
Lobbyist Registration Form received and verified by: isteppviest 41
•
MIAMI BEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office
Rafael E. Granado, City Clerk CityClerknmiamibeachfl.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
automatic-. ly suspended from lobbying until all fines are paid, unless the fine has been
appeale 6 to "e Miami-Dade County Commission on Ethics and Public Trust.
44‘00/
ature: Date:
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Formrevised 5-30-2012.doc
.
SUPPLEMENTARY DISCLOSURE OF INTEREST
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
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
0
City of Miami Beach
,1 City Hall
[-t_ . -a 1700 Convention Center Dr.
I - • > Miami Beach , FL 33139
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