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Graham C. Penn - Marisa Galbut a DocuSign Envelope ID:DBA5D3B5-F63B-4E59-A994-60FBFB8C7F3C p� RECEIVE t\/\I AM I B EAC H Office of the City Clerk MAR 23 2023 1700 Convention Center Drive Miami Beach, FL 33139 CITY FF C oFf AN EACH 305.673.7411 ,CLERK 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 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: Penn Graham C. NAME OF LOBBYIST (Last) (First) (Middle Name) Bercow Radell Fernandez Larkin&Tapanes,PLLC 200 S.Biscayne Blvd.,#300,Miami,FL 33131 LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-374-5300 gpenn@brzoninglaw.com LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS II. PRINCIPAL INFORMATION: Galbut Marisa NAME OF PRINCIPAL (Last) (First) (Middle Name) 740 Alton Road,LLC 4770 Biscayne Blvd.,Suite 1100 Miami Florida 33137 PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-374-5700 mgalbut@crescentheights.com PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER - EMAIL ADDRESS Pursoan to eit code Section Qx')(1)(ai) G,1 principa of any corporation, partnership, or other eni ty W a ap.ears as a lobbyist on be al o t at en i`+a witt out special compensation 07 reimb rsement fo -ppea an`e whethe di ect nel ,Cf con ingen ib ex.iess suppor (91 o opposition to ~qrt ite hat egiste "ithf he1Blt as ,equiredtbrliis suesection but shall nottbe required to pay an, registration fees, n If the principal is a Corporation, Partnership or Trust, the following information MUST be provided pursuant to City Code Section 2-482(c): • • NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY(if none,write N/A): M. Galbut z • 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 F, N ch Page 1 of 5 ^^^"^•'@m!^m-^6. 20A-832D-47A3-92A2-A7907956A18D Page 1 of 35_-____I- 1A7907956A18D_, ,III n 'I III I f DocuSign Envelope ID:DBA5D3B5-F63B-4E59-A994-60FBFB8C7F3C 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 Commission, and any City Workshops or Committees,if necessary,relating to the properties located at 710-720-740 Alton Road 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 NIA): None • 0 s 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): $750.00 per hour LL Page 2 of 5 Dwww dower com 220A-832D-47A3-92A2-A7907956A18D � ge 2 of 2A7907956A18D I ,III p(q�p' g, ,l II I Pa e 2 of 35 ___— 03f1'T'�f�b 1 4 DocuSign Envelope ID:DBA5D3B5-F63B-4E59-A994-60FBFB8C7F3C 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 XNo: 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 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 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 XNo: 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 XNo: 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 requestip_g 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 249.1 for more information. —Yes XNo: 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 XNo: If yes, has it been less than 12 months since the elected official(s)w om you provided campaign consul ing ervices was sworn irn 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 o 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. _Yes XNo: 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: 0 M n O n o _Yes XNo: If yes, were you p Lomised or did you receive ec•nomic consideration in exchange for campa'gn, m consulting ser t cesr 88 a R TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: "[ ]Yes[ ]No Amount Paid$ MCR# Date Paid d n c Lobbyist Registration Form received and verified by: ti F:\GLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 09-20-18 REG.doc Revised 09/20/2018 n , M ui Page 3 of 5 Docverify ID:1E3F220A-832D-47A3-92A2-A7987956A78D ,III 11 III I www docveriry com Page 3 of 35 �__3A7907956A18D t '' DocuSign Envelope ID:DBA5D3B5-F63B-4E59-A994-60FBFB8C7F3C 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 COMPANSA,TIQNyDURING THE REPORTING PERIOD.' aretium Signature of Lobbyist: yob G� .' Date 03/22/2023 ' 83... 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 Cods 33P'ftfIFInfeVlarting requirements. �'alA GUM r A' oo�usianed by: Date 03/22/2023 Signature of Lobbyist: 2r10677Do3G1403... Cliutisa aatiolAt Signature of Principal: Date 03/22/2023 ,FrafebooF 2A.. - 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 0 physical presence by means of 0 physical presence or®online notarization, or NI online notarization, this day of nv on9-4 ,20 , by this_day of n-4n9i9m-4 ,20_, by Graham C. Penn Marisa Galbut NAME OF LOBBYIST NAME OF PRINCIPAL _Produced ID _Produced ID FORM OF IDENTIFICATION FORM OF IDENTIFICATION _Personally KnLt- _Personally Kn If- p am Signature of Notary Public Signature of Notary Public Diana Ramos Diana Ramos 0 Name of Notary, Typed, Printed or Stamped Name of Notary, Typed, Printed or Stamped N $ 1 Diana Ramos 0 1 Diana Ramos I Commission#GG 308355 0 I Commission#GG 308355 g I Notary Public-State of Florida 0 i I, otary Public-State of Florida a • —4 ItAy Commission Expires Apr 10,2023 * lily Commission Expires Apr 10,2023 2 ' Thq 0 pg persons: A o ...mmm Expert9.tnesseswho provide only scientific,technica l'or other specializwu aua n or Lcsunuurly of puuuc inccunys,any person who 7 only appears as a representative of a neighborhood association without compensation or reimbursement for the appearance,whether 2 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 I Doc doeveri fy comF220A-832D•47A3-92A2-A7907956A180 — [_Page 4 of 35 I 4A7907956A18D ,III KO 1� •�5G'I III 1 DocuSign Envelope ID:DBA5D3B5-F63B-4E59-A994-60FBFB8C7F3C MIAMIB.EACH 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: Graham C. Penn 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 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 $500.00 pursuant to Section 2-482 of the Miami Beach City Code. Q �Do-cu'Signed by; �^^�^"� f` , 03/22/2023 2 1 bI, U GIg83. Signature of LoDDylst Date F:\CLER1$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 03-11-20 REG.doc N LL Page 5 of 5 DocVerify do Irby.I 53F220A-832D-47A3-92A2-A7907956A18D Page 5 of 35---I 5A7907956A18D ,III p)L4Z L IS7e55c•'I III I DocuSign Envelope ID:DBA5D3B5-F63B-4E59-A994-60FBFB8C7F3C SUPPLEMENTARY DISCLOSURE OF INTEREST Interests in 740 Alton RD, LLC Percentage Interest Ronruss Nobe Creek, LLC 22.5% Alton M and J Investments LLC 50.0% Brack-Tel Alton, LLC 27.5% Interests in Ronruss Nobe Creek, LLC Percentage Interest Ronruss Partners, Ltd. 100% Interests in Ronruss Partners Ltd. Percentage Interest Ronruss Corporation 1.0% Russell Galbut 44.1% Ronalee Galbut • 44.1% Marisa Galbut, LLLP 5.52% Jenna Galbut, LLLP 5.28% Interests in Ronruss Corporation Percentage Interest Russell Galbut 49.5% Ronalee Galbut 49.5% Abraham A. Galbut 1.0% and Nancy K Galbut • 8 0 Interests in Marisa Galbut, LLLP .h. O Percentage Interest Russell Galbut 1.0% Marisa Galbut 99.0% a CJ LL CJ rwww docverDy co3F220A-832D-47A3-92A2-AT907958A'18D ,III • 1I II I j Page 6 of 356A7907956A160 DocuSign Envelope ID:DBA5D3B5-F63B-4E59-A994-6OFBFB8C7F3C Interests in Jenna Galbut, LLLP Percentage Interest Russell Galbut 1.0% Jenna Galbut 99.0% Interests in Alton M and J Investments LLC Percentage Interest Marisa Galbut, LLLP 37.5% Jenna Galbut, LLLP 37.5% R & R Family Grandchildren's Investment Trust#1 25.0% Interests in R & R Family Grandchildren's Investment Trust#1 Percentage Interest The Children born and yet to be born of 100% Marisa A. Galbut, Jenna B. Galbut, and Keith M. Menin. Interests in Brack-Tel Alton, LLC Percentage Interest Jefferson Brackin 36.35% Donald Wayne Brackin 36.35% NKW-EBG Prop 1, LLC 27.3% Interests in NKW-EBG Prop 1, LLC Percentage Interest Abraham A. Galbut & Nancy K. Galbut 33.3% N Eric Galbut & Sarit Galbut 33.3% Daniel Galbut & Jillian Galbut 33.3% to 0) m 0 0 m N CI M 0 0 O V L : W DwocVerify ID:ww do er ry comF220A-832D-47A3-92A2-A7907956A18D 1 Page 7 of 35 7A7907956A18D 1111 INS 21211111 MBF City Hall ° 1700 Convention Center 0r. fr Miami Beach , Fl. 33139 o 30a-673-7420 ° x Welcome r .N = W" a N `� 006013-0027 Ebani T. 03/22/2023 01:5�PM {'' co `r 15 MISCEU-ANEQUS o' Reference 1 ML'R_�31421 z, "', ,. o ,' ,4 MCR OPEN (NCR) `.. _ f 2023 Item; MCR 1 1,200,00 MCR OPEN (MCR) 1 200,00 1,200.00 a Subtotal 1,200.00 i W Total 1,900.00 �,.,.^ a CHECK 850.00 - -' : � Check Number001205 �,• �. ^ CHECK 350.00 �: a - '' W Check Number001209 ^ m H ��,p F= Change due 0.00 N ,.; cc:: �� `� � �. � ,,.. ^-" � � � ire; ; o Paid by: SMK ASSET MANAGEMENT LLC f. A IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII - lti .LL: �; y, # ".(n�( ., Z *' ,G7;: < ? ..+rsar�.»a.�s+:+vm a7 0. 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