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Jeniifer McConney-Gayoso - Galbut Russell tic 00 CA 11164S DocuSign Envelope ID:0897C753-BF47-4D8A-A4B6-FBAFC7DFD26A RECEIVED MAMBEACH OCT 18 2022 Office of the City Clerk 1700 Convention Center Drive CITY OF MIAMI BEACH Miami Beach, FL 33139 OFFICE OF THE CITY CLERK 305.673,7411 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 "Lobbyist"has specific exclusions. Please refer to City Code Chapter 2, Article VII, Division 3,entitled"Lobbyists," for additional information. Instructions: Please complete all sections of this form and submit the completed form,with the applicable fee,to the Office of the City Clerk. If you need more space to complete an answer, use a separate sheet(s)of paper. If you have nothing to report in a particular section, you must write "none" or "n/a" in that section. Any change to any information originally filed, or any additional City Commissioner or personnel who are also sought to be lobbied shall require that the lobbyist file an amendment to the registration form. The lobbyist has a continuing duty to supply information and amend the forms filed throughout the period that the lobbying occurs. Separate registration forms shall be required for each principal represented on each specific issue. I. LOBBYIST INFORMATION: • McConney-Gayoso Jennifer NAME OF LOBBYIST (Last) (First) (Middle Name) Studio Mc+G Architecture 7500 NE 4 Court,Studio 102 Miami Florida 33138 LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-573-2728 jennifer@studio-mcg.com LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS II. PRINCIPAL INFORMATION: Russell Galbut NAME OF PRINCIPAL (Last) (First) (Middle Name) Collins Hotel Associates, LLC 2200 Biscayne Blvd. Miami Florida 33137 PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-374-5700 rgalbut@crescentheights.com PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS N Pursuant in Eitl @hift)&NEED 2 82(h Mg Q principal CO M)ae .a , s ._ m • . CPC2iit;FG5M7 EGO du*-, eg)p lobbyist WhE GQfi'M e b netritmeatyer:.tIticmja fr:ftter.tCpreimburse ant hrmes,,xrurec•is,C'J te11 ,indirect,& o e' t�a3C kattwi Offfg:BICYCIIMDCEMIIItl an item shall register with the C*.lerk as required b this subsec ion but shall not be required to pay any registrm'ion tees. 0 If the principal is a Corporation, Partnership or Trust, the following information MUST be provided pursuant to City Code Section 2-482(c): (0 • NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY(if none,write N/A): R.Galbut • NAME OF ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST(if none,write N/A): Please see the attached. 0 L9 [+1 C9 Page 1 of 5 I vnvw er r:895 5341-B52C-48FD-96E0-863840F5E426 yrryg L .Page 1 of 7 r 1663640F5E426__j 1111 11 III DocuSign Envelope ID:0897C753-BF47-4D8A-A4B6-FBAFC7DFD26A III. ISSUE TO BE LOBBIED: Describe with as much detail as is practical, including but not limited to a specific description where applicable of a pending request for proposal, invitation to bid, or public hearing number. Development Approvals&Permitting Issues,including but not limited to the Historic Preservation Board,Design Review Board, Planning Board, Board of Adjustment,Land Use Development,City Commissin,and any City Workshops or Committees,if necessary,relating to the property located at 1690 Collins Avenue in Miami Beach,Florida. IV. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: Pursuant to City Code Section 2-482(a)(4), list the City Commissioner or City personnel sought to be lobbied, and whether the lobbyist has entered into any contractual relationship (paid or unpaid) with said City Commissioner or City personnel from 12 months preceding such commencement of service with the City to the present date, stating the general nature of the subject contractual relationship. Full Name of Individual and Contractual Relationship(If yes,explain) YES NO Title of Person to be Lobbied Staff for the Planning&Building Department None X Public Works&City Administration, PB,HPB, BOA None X DRB,City Commission,and Mayor as necessary None X Land Use&Sustainability Committee 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. List any Business, Financial, Familial or Professional Relationship, or other relationship giving rise to an appearance of impropriety(if none,write N/A): None LL V. DISCLOSE RATE AND AMOUNT OF LOBBYIST COMPENSATION — Be Specific. (Note that a contingency fee is prohibited pursuant to City Code Sec. 2-485.3): 250 0 $ .00 per hour M Page 2 of 5 DocVerify ID�89535341-B52C-48FD•96E0-863640F5E426 ' Page 2 of 7 T 2863640F5E426 1 1111 ptgg 'I II I www docveri com C'.yf� DocuSign Envelope ID:0897C753-BF47-4D8A-A4B6-FBAFC7DFD26A The following six(6)questions MUST be answered: 1) Pursuant to City Code Section 2-488,entitled"Prohibited Campaign Contributions By Lobbyists On Procurement Issues": —Yes ,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 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 change of zoning map designation or change to the City's Future Land Use Map? 3) Pursuant to City Code Section 2-482(h), any person (except those exempt from the definition of"lobbyist" as set forth in Section 2-481)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 city 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? 4) Pursuant to City Code Section 2-481, the term "lobbyist' specifically excludes the following persons: Expert witnesses who provide only scientific, technical or other specialized information or testimony in public meetings;any person who only appears as a representative of a neighborhood association without compensation or reimbursement for the appearance,whether direct, indirect or contingent,to express support of or opposition to any item;and any person who only appears as a representative of not-for-profit community based organization for the purpose of requesting a grant without special compensation or reimbursement for.the appearance. _Yes x No: Are you providing only scientific, technical or other specialized information; appearing as a representative of a neighborhood association without special compensation or reimbursement or representing a not-for-profit based organization for the purpose of requesting a grant without special compensation or reimbursement? 5) Pursuant to City Code Section 2-491(1), no campaign consultant shall lobby the City Commission for a period of 12 months following the swearing in of any elected official(s)for whom the campaign consultant provided campaign consulting services within the past election cycle.See Section 2-491 for more information. —Yes x No: Have you provided campaign consulting services to an incumbent member of the City Commission within the past election cycle?If yes,please list the incumbent member(s)of the City Commission: _Yes x No. if y�"esihas7 t1lbe'-1.1e' s7th"n1;2 ths'TsiTiMITlectWdTofficial(s°1Trihom you provided campaign consulting services was sworn inr 6) Pursuant to City Code Section 2-482(a)(4)a., a lobbyist who has within the past election cycle provided campaign consulting services to an incumbent member of the City Commission(which lobbying activity is not otherwise prohibited by Code section 2-491) shall disclose such particular service on his/her lobbyist registration form and shall orally disclose such particular service before lobbying the City Commission at a public meeting. N Yes x No: Have you provided campaign consulting services to an incumbent member of the City Commission 8 within the past election cycle?If yes,please list the incumbent member(s)of the City Commission: - a N O Yes x No: If yes, were you promised or did you receive economic consideration in exchange for campaig co"ns'Uttii Is ri�tccs?) 111 TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: [ ]Yes[ No. Amount Paid$ ��' MCR# V 0`7 ( � Date Paid Lt)--(15'Z2 N a.J Lobbyist Registration Form received and verified by: F;\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 03-11-20 REG.doc Revised 03/11/2020 Page 3 of 5 Docverify ID:69535347-B52C-48FD-96E0-863640F5E426 L_page 3 of 7 ,j 3863640F5E426 ,III®ECt6n'yti34E'I III www docverity.com II ILh14�c3Fvr�E VI. SIGNATURES UNDER OATH: ON FEBRUARY 28 OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE OFFICE OF THE CITY CLERK A SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION RECEIVED, FOR THE PRECEDING CALENDAR YEAR WITH REGARD TO THE SPECIFIC ISSUE ON WHICH THE LOBBYIST HAS BEEN ENGAGED TO LOBBY. A STATEMENT SHALL BE FILED EVEN IF THERE HAS BEEN NO EXPENDITURE OR COMPENSATION DURING THE REPORTING PERIOD.1 Signature of Lobbyist: Date I do solemnly swear or affirm that all of the foregoing facts, statements, and disclosures in this form are true and correct, and that I have read or am familiar with the provisions contained in Chapter 2, Art. VII, Division 3, entitled "Lobbyists" of the Miami Beach City Code and all reporting requirements. Signature of Lobbyist: Date Signature of Principal: Date to\V D- .e, VII. NOTARY SIGNATURE AND SEAL: LOBBYIST: PRINCIPAL State of Florida State of Florida County of: Miami-Dade County of: Miami-Dade Sworn to (or affirmed)and subscribed before me, Sworn to (or affirmed) and subscribed before me, by means of❑ physical presence by means ofXphysical presence or®.online notarization, or El online notarization, this day of October , 20 22, by this 13 day of October , 20 22, by Jennifer McConney-Gayoso Russell Galbut NAME OF LOBBYIST NAME OF PRINCIPAL _Produced ID _Produced ID FORM OF IDENTIFICATION FORM OF IDENTIFICATION x Personally Known x rsonally Kn n 1 Signature of Notary Public S tur of Not ry blic ml , Name of Notary, Typed, Printed or Stamped Name of to ,Typed, rinted or Stamped YPu DAYAMIAGUTAR (NOTARY SEAL) (NOTARY SE • 1` Notary Public State of Florida 1 Is X `` Commission#GG 283448 of!. My Comm.Expires Mar 16,2023 i F Bonded through National Notary Assn. I I The term"lobbyist"specifically excludes the following persons: Expert witnesses who provide only scientific,technical or other specialized information or testimony in public meetings; any person who only appears as a representative of a neighborhood association without compensation or reimbursement for the appearance, whether direct, indirect or contingent, to express support of or opposition to any item; and any person who only appears as a representative of not-for-profit community based organization for the purpose of requesting a grant without special compensation or reimbursement for the appearance. Page 4 of 5 DocuSign Envelope ID:0897C753-BF47-4D8A-A4B6-FBAFC7DFD26A VI. SIGNATURES UNDER OATH: ON FEBRUARY 28 OF EACH YEAR. EACH LOBBYIST SHALL SUBMIT TO THE OFFICE OF THE CITY CLERK A SIGNED STATEMENT UNDER OATH. LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION RECEIVED, FOR THE PRECEDING CALENDAR YEAR WITH REGARD TO THE SPECIFIC ISSUE ON WHICH THE LOBBYIST HAS BEEN ENGAGED TO LOBBY. A STATEMENT SHALL BE FILED EVEN IF THERE HAS BEEN NO EXPENDITURE OR COMPINSA lONOURING THE REPORTING PERIOD.1 Signature of Lobbyist: �03''42 s5cas Date 10/17/2022 I do solemnly swear or affirm that all of the foregoing facts, statements, and disclosures in this form are true and correct, and that I have read or am familiar with the provisions contained in Chapter 2, Art. VII, Division 3, entitled "Lobbyists" of the Miami Beach City Codsande ifeptarting requirements. Signature of Lobbyist: Date 10/17/2022 UJ 141t6S1.6t0401... Signature of Principal: Date VII. NOTARY SIGNATURE AND SEAL: LOBBYIST: PRINCIPAL State of Florida State of Florida County of: Miami-Dade County of: Miami-Dade Sworn to(or affirmed)and subscribed before me, Sworn to(or affirmed)and subscribed before me, by means of❑ physical presence by means of❑ physical presence or El online notarization, or❑x online notarization, ,this 17 day of October , 20 22 by this day of October ,20 22 by Jennifer McConney-Gayoso Russell Galbut NAME OF LOBBYIST NAME OF PRINCIPAL _Produced ID _Produced ID FORM OF IDENTIFICATION FORM OF IDENTIFICATION x Personally Kno --- x Personally Known Signature of Notary Public Signature of Notary Public Diana Ramos Name of Notary,Typed, Printed or Stamped Name of Notary,Typed, Printed or Stamped NbYibA•I��JA.A°A At. A c.A* (NOTARY SEAL) 1 Diana Ramos 1 4ommission#GG 308355 44 notary Public-State of.Florida LL• ' The oy Commission Expires Apr 10,2023 persons: o Expert or other specialized information or testimony in public meetings;any person who 7 only appears as a representative of a neighborhood association without compensation or reimbursement for the appearance,whether m direct,indirect or contingent,to express support of or opposition to any item;and any person who only appears as a representative of • not-for-profit community based organization for the purpose of requesting a grant without special compensation or reimbursement for the appearance. Page 4 of 5 Iwww DocVer ify ID:er 899535341-B52C-48F0.96E0-863640F5E426 I page 4 of 7 4863640F5E426 ,III yg g�v'I III I • DocuSign Envelope ID:0897C753-BF47-4D8A-A4B6-FBAFC7DFD26A MIAMI BEACH City of Miami Beach,1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.gov Office of the City Clerk Rafael E.Granado, City Clerk CityClerk@miamibeachfl.gov Tel: 305.673.7411, Fax: 305.673.7254 NAME OF LOBBYIST: Jennifer McConney-Gayoso 1) LOBBYIST FEE EXPENDITURE AND COMPENSATION STATEMENT Pursuant to City Code Section 2-485(d), the City Clerk shall notify any lobbyist (or principal)who fails to file timely a Lobbyist Fee Expenditure and Compensation Statement (Statement). In addition to any other penalties that may be imposed as provided in Section 2-485.1, a fine of $50.00 a day shall be assessed for Statements 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 of each year, 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 hereby acknowledge that on February 28 of each year, I shall submit to the City Clerk a signed Statement under oath listing all lobbyist expenditures, as well as compensation received, for the preceding calendar year with regard to the specific issue on which I have been engaged to lobby. 2) LOBBYIST WITHDRAWAL Once an issue I have registered to lobby has concluded or I am no longer lobbying on that issue, I shall immediately file a Notice of Withdrawal with the Office of the City Clerk. 3) ANNUAL LOBBYIST REGISTRATION FEE I in understand annual registration of all lobbyists shall be required for each 12-month period commencing October 1 of each year, and the fee for such annual registration shall be $500.00 pursuant to Section 2-482 of the Miami Beach City Code. O DocuSigned by: 10/17/2022 3i E.e5 8E5g3,... -- Signature of Lobbyis) Date • LL C N t)1 F:ICLERISALL1aFORMS\LOBBYIST FORMS1Lobbyist Registration Form Revised 03-11-20 REG.doc Page 5 of 5 DocVerify ID: do r So5n 5341-B52C-46FD-96E0-863640FSE426 L Page 5 of 7 5663640F5E426 DocuSign Envelope ID:0897C753-BF47-4D8A-A4B6-FBAFC7DFD26A SUPPLEMENTARY DISCLOSURE OF INTEREST Interests in Collins Hotel Associates LLC Percentage Interest SU Gale Properties, LLC 100% 814 1st Street Miami Beach, Florida 33139 Interests in SU Gale Properties,LLC Percentage Interest Ronruss Partners, Ltd. 100% 814 1st Street Miami Beach, Florida 33139 Interests in Ronruss Partners, Ltd. Percentage Interest Ronruss Corporation 1.0% 814 15'Street Miami Beach, Florida 33139 Russell Galbut 44.1% 814 15t Street Miami Beach, Florida 33139 Ronalee Galbut 44.1% 814 1st Street Miami Beach, Florida 33139 ,s7 Marisa Galbut, LLLP 5.52% 814 1st Street Miami Beach, Florida 33139 Ui Ui LL Jenna Galbut, LLLP 5.28% 814 1 sf Street Miami Beach, Florida 33139 LL fV 4'J IDocVerify ID:89535341.852C-48FD-96E0-863640F5E426 page 6 of 7 f 6863640F5E426 j ,III q g ,I II I www docvonfy coin 0 !L'�tiA DocuSign Envelope ID:0897C753-BF47-4D8A-A4B6-FBAFC7DFD26A Interests in Ronruss Corporation Percentage Interest Russell Galbut 49.5% 814 15t Street Miami Beach, Florida 33139 Ronalee Galbut 49.5% 814 1st Street Miami Beach, Florida 33139 Abraham Galbut 1.0% 4770 Biscayne Boulevard, Suite 1400 Miami, Florida 33137 Interests in Marisa Galbut, LLLP Percentage Interest Russell Galbut 1.0% 814 1st Street Miami Beach, Florida 33139 Marisa Galbut 99.0% 814 1st Street Miami Beach, Florida 33139 Interests in Jenna Galbut, LLLP Percentage Interest Russell Galbut 1.0% 814 1°f Street . Miami Beach, Florida 33139 - Jenna Galbut 99.0% 814 15f Street Miami Beach, Florida 33139 LL Co 0 w Co rn 0 LL Co - N} •c 7 C: L'J m :corn www do er 89535347-852C-48F0.96E0-863640F5E426 I Page 7 of 7 j 7863640F5E426 1 ,Ill 'I II I ...„,.. ...,. ,,...,.•.. ,,,,••,,, ,•, ,,.,•„,,. Miscellaneous•Cash Rece•ipt No 430770 • , . ..,_,,,7_,,.-:.,,...:..9. .. . .,. "... ,. . .. .....,. _ ...,.. . ...........„ • ..,..... .. .... .. ..„„ . „..... . . ... , _ ..,„••.,.....,.,,,,„,„:„,:„.,..•.•:,••„.,..„,.:.,•„.,,,,.-. .„...„,...,.• ,....„..... . ..,....,,, CITYOF IVIIAMI=BEACH r r 0 Cash 0 CreditwC71.ard Check jr { rM [ Received=of �. t� 4 �� ` r 3 .�d """y t-��,:F � �� i °"i: '.s,., a ftf Address gy grimy T ,.w.1 • .'a .,� �, �'. et,> y;>° C; II d:f��+,.+k ,�r'as� -� ' s '\; For � _ � � °�. g �s �- ;;, v -."- y,' � :fi .� .S sF\\\ :▪"^s - ,` • ,::' s"�u k : t. 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