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Sebastian Velez - 1747 Bay Road Properties, LLC ICE rp-ti 116ua City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 • Fn l' H 2' LOBBYIST REGISTRATION FORM `:I ` ` ' defeat�or.. Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the-passage, 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. Velez Sebastian NAME OF LOBBYIST: (Last) (First) (M.I) Urban Robot Associates 420 Lincoln Road, #406 Miami Beach Florida 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 786-246-4857 sebastian(a?urbanrobot.net 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: 1747 Bay Road Properties, LLC c/o Crescent Heights 2200 Biscayne Blvd. Miami Florida 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: �i, col.bot • IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,Q 5%,Q[t MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: LC 'C`E,14 (,(`�II n e II.SPECIFIC LOBBY ISSUE: VDev lopment Approvals_and Permitting_Issues,]including, but not limited to the Historic Preservation Board, Design Review Board, Planning Board, Board of Adjustment, Land Use Development Committee, City Commission, and any City Workshops or Committees. if necessaru. relatina to the nrooertu located atr1747 Bau Road. Miami Beach.-F_loridaV 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 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. C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration or! Formrevised 5-30-2012.doc ,1' IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required)$l0per hour B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): $`Ler hour (REQUIRED). The following information must be answered: 1) Pursuant to Miami Beach City Code Section 2-488 Entitled"Prohibited Campaign Contributions By Lobbyists On Procurement Issues": _Yes XNo: Are you lobbying on a present or pending bid for goods.eauipment or services.or on a present or pending award for goods.equipment or service? 2) Pursuant to Miami Beach City Code Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": _Yes XNo: Are you lobbying on a Pending application for a Development Agreement with the City or application for, change of zoning map designation or change to the City's Future Land Use Map? 3) Pursuant to Miami Beach City Code Section 2-482 (h)Any person (except those exempt from the definition of"lobbyist"as set forth in Section 2-481 above) who only appears as a representative of a not-for-profit corporation or entity without special compensation or. reimbursement for the appearance, whether direct, or indirect, to express support of or opposition to any item, shall register with the clerk as required by this section but, shall not be required to pay any registration fees. _Yes X No: Are you representing a not-for-profit corporation or entity without special compensation or reimbursement. V. SIGNATURE UNDER OATH: ON FEBRUARY 28 OF EACH YEAR. EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH. LISTING LOBBYING EXPENDITURES. AS WELL AS COMPENSATION RECEIVED. IN THE CITY OF MIAMI BEACI-i EQ$ THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR . •►i - ■ _ • ► 9 , : ► . : -• : ►,., -_I[S]9 Signature of Lobbyist I do solemnly swear that al: : the foregoin cts - - - ue and correct and that I have read or am familiar with the provisions contained in Section 2-482 of the Miami B--- -:•11,-4--_.,-4i -porting requirements. Signature of Lobbyist: , .. e i Signature of Principal/Client: ���/ ' VI. LOBBYIST IDENTIFICATI• : PRINCIPAL IDENTIFICATION: :%14.1 Produced ID Produced ID i' g 1 Form of Identification Form of Identificatio 23m a le Personally known(Lobbyist) Personally known(Principal) g H-II VII. SIGNATURE AND STAM P_OF IOTl4RY: a """ QAYItMI AGUIAR g State of Florida, County of Miami Ds : . r State of Flo da, County of Miami-Dade Sworn fi Notary Public•State of Florida , . s bscri d before me d subscrib- be •.e e. 1 i Cowl, salon'#�FF 1!8144 0 J Thi S day of ; ,,_ V t, ., F., � My Comm.Expires Mar 16,2019 ' T , d of '� ,2016 r/ f 80f ldedttl►OUg1 Mortal Notary Assn.'` Sign.:ure .I, 'ublic N.'�ry—State of Florida Signature of b c Notary—State of Florida Nota 'zati,n of Lobbyist's signature Notarization o rincipal's signature TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: [ ]Yes[IV No Amount Paid$ 5-3D• MCR# OQ Date Paid en 43-lb Lobbyist Registration Form received and verified by: ._ r M I AM I BEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov CITY CLERK Office Rafael E. Granado, City Clerk CityClerk @miamibeachfl.gov Tel: 305.673 7411 , Fax: 305.673 7254 LO B B Y IS T NAME Sebastian Velez 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, 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 the Miami-Dade County Commission on Ethics and Public Trust. ivie/2-57/42.40/y Signatur-. Date: C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc SUPPLEMENTARY DISCLOSURE OF INTEREST Interests in 1747 Bay Road Properties, LLC. Percentage of Interest 1747 Investments, LLC. 32% 2200 Biscayne Blvd. Miami FL 33137 Sharon Mirmelli 30% 2200 Biscayne Blvd. Miami FL 33137 MJK Group, LLC. 18% 2200 Biscayne Blvd. Miami FL 33137 Philip Mirmelli 10% 2200 Biscayne Blvd. Miami FL 33137 Sean Mirmelli 10% 2200 Biscayne Blvd. Miami FL 33137 Interests in 1747 Investments, LLC. Percentage of Interest Ronruss Partners, Ltd. 100% 2200 Biscayne Blvd. Miami FL 33137 Interests in Ronruss Partners, Ltd. Percentage of Interest Ronruss Corporation 1 2200 Biscayne Blvd. Miami FL 33137 Russell Galbut 44.1% 2200 Biscayne Blvd. Miami FL 33137 Ronalee Galbut 44.1% 2200 Biscayne Blvd. Miami FL 33137 Marisa Galbut 5.52% 2200 Biscayne Blvd. Miami FL 33137 Jenna Galbut 5.52% 2200 Biscayne Blvd. Miami FL 33137 Interests in Ronruss Corporation Percentage of Interest Russell Galbut 49.5% 2200 Biscayne Blvd. Miami FL 33137 Ronalee Galbut 49.5% 2200 Biscayne Blvd. Miami FL 33137 Abraham and Nancy Galbut 1% 2200 Biscayne Blvd. Miami FL 33137 Interests in MJK Group, LLC. Percentage of Interest Keith Menin 33.33% 2200 Biscayne Blvd. Miami FL 33137 Marisa Galbut 33.33% 2200 Biscayne Blvd. Miami FL 33137 Jared Galbut 33.33% 2200 Biscayne Blvd. Miami FL 33137 I Miscellaneous Cash Receipt CIlI`oF.M sue►-� `F TY J t Nor.::::::-,--;,:::,.;.--..„..,-,-:--,_ ,r, £ 4. Q Cash ❑Credit Card eck#. ,.fi ,; , .,, . . 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