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David Martin - Marisa Galbut RECEIVED • ,:D,ocuSim Envelope ID:DBA5D3B5-F63B-4E59-A994-60FBFB8C7F3C APR 04.2023 CITY OF MIAMI BEACH I V'I LAM I EAR H' Office of the City Clerk OFFICE OF THE CITY CLERK 1700 Convention Center Drive Miami Beach, FL 33139 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"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: Martin David NAME OF LOBBYIST (Last) (First) (Middle Name) TCH 500 Alton,LLC 3310 Mary Street, #302 Coconut Grove Florida 33133 LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-416-4556 DMartin@terragroup.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 PlimaZIm(i c. -@tam 2-482 h)1)(a): a oliAbrall c fir/ _ b.a ,ca pa nership,OTS —c2t appears CID p lobbyist CE belief d inEE N . •r special compensa on CG reimburse ent tplikD.•.:x a=,whether lei indirect,COcontfngen 117 .. loaf.... . tE gjAitrg@kij]rofffigpeatilrafteahratgar OM subsection bit ffi 11 p Lb :2 (i)(i 7ge/re.istration f , 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 • 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. f") w Page 1 of 5 V4I �DwwocVerify w do ID E3F220A-832D-47A3-92A2-A7907956A18D Page 22 of 35 22A7907956A18D ���1 EMU 1111 • ;.DocuSig;1 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 in 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 ih appearance of impropriety(if none,write N/A): None cn 0 rn 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): $0.00 per hour Page 2 of 5 DocVerify ID:1 E3F220A-832D-47A3-92A2-A7907956A18D I page 23 of 35 23A7907956A18D 1111111212111111 www docverify:com 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 Cities 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 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 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)whom you provided campaign consulting services was sworn ini 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 0 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. M 0. _Yes XNo: Have you provided campaign consulting services to an incumbent member of the City Commission n within the past election cycle?If yes,please list the incumbent member(s)of the City Commission: 0 N O N ci Yes XNo: If es,. were you promised or did you receiv• economic consideration in exchange for campaign consulting services 0 a 2 TO BE COMPLETED.BY CITY CLERK'S STAFF ONLY M a Annual Registration fee: [ ]Yes[ ]No Amount Paid$ MCR# Date Paid d N 00 Lobbyist Registration Form received and verified by: N F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 09-20-18 REG.doc Revised 09/20/2018 N M Page 3 of 5 DocVerify ID:1 E3F220A-832D-47A3-92A2-A7907956A18D r Page 24 of 35 1 24A7907956A18D 1 ,III p[q+iC.NEST II coin docvenfy co • . 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 COMP DURING THE REPORTING PERIOD.1 Signature of Lobbyist: Date 03/22/2023 g y `-49C93F0507F5444... 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 regtArort edby: Signature of Lobbyist: Docusignedby: / '' � Date 03/22/2023 —49C93F03D7F5444... itt Signature of Principal: aViSa Date 03/22/2023 7FA1370600Fe5e2A... 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 R online notarization, or E online notarization, this day of n-Ai99i9071 , 20 , by this_day of n-4i99/9mq , 20_, by David Martin Marisa Galbut NAME OF LOBBYIST NAME OF PRINCIPAL _Produced ID _Produced ID FORM OF IDENTIFICATION FORM OF IDENTIFICATION _Personally Kn � _Personally Kno Signa re of to Public Signature of Notary Public Tana arms Diana Ramos CV lh Name of Notary,Typed, Printed or Stamped Name of Notary, Typed, Printed or Stamped Diana RamosDana Ramos 4ommission#GG 308355 mmission#GG 308355 Notary Public-State of Florida Notary Public-State of Florida 2 1 Th IclY Commission Expires Apr 10,2023 persons: My Commission Expires Apr 10,2023 Expe '111.17 MMITP inl'IrrtvThrWrITIv"fintorfbrtFrma I or other specialize nT *X.1 "*^R;1^*:.xi ^RVgg ny 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 u. the appearance. Page 4 of 5 IDocVerify ID:1 E3F220A-832D-47A3-92A2-A7907956A78D Page 25 of 35 I 25A7907956A18D J. ,III a'�- 1I III l www docverify corn DocuSiji Envelope ID:DBA5D3B5-F63B-4E59-A994-60FBFB8C7F3C MIAMt 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: David Martin 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. 0 0 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 $500.00 pursuant to Section 2-482 of the Miami Beach City Code. DocuSignedby: 0 1ocoaro6o7 1... 03/22/2023 Signature of Lobbyist Date 0 M F:\CLER1$ALLIaFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 03-11-20 REG.doc LL CS Page 5 of 5 DocVerify ID:www do er comF220A-832D-47A3-92A2•A7907956A18D Page 26 of 35 26A7907956A18D I ,III p� m Sdf�"rikyh"SJE 'III I -- ----- r DocuSigp 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 O Interests in Marisa Galbut, LLLP Percentage Interest N Russell Galbut 1.0% Marisa Galbut 99.0% 6 Ih LL DocVerify ID: r cE3F220A-632D-47A3-92A2-A7907956A18D I Page 27 of 35 I 27A7907956A18D ,III p(9i RV S.Tr'I III I • ,. DocuSicn Envelope ID:DBA5D3B5-F63B-4E59-A994-60FBFB8C7F3C 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 Y7 C1 Abraham A. Galbut& Nancy K. Galbut 33.3% Eric Galbut & Sarit Galbut 33.3% Daniel Galbut &Jillian Galbut 33.3% co rn r c rn ci 6 M W O N LT W loc docverify E3F220A-832D-47A3-92A2•A7907956A18D Page 28 of 35 I-28A7907956A18D j ,III I �t II I 1, • / b D `�� a �. � „ D r PaBF . • -,: z o o n. r c City Hall ' s © 1700 ,Convention Center Dr. k N ;,rn a �.`. ° "��>, .< 3'. Oar lD o z z k,?, y` r� �, Miami Seach , FL 33139 '� "_ g 'o O 30 Welcome 5-b73-7420 o �� � o` t� m �� 04/04/2023 03:55PM Carmen V. 4 . - i-, O ;;" ` ( :. � V,v s 0Refere0045 zm C a n �` t N a s MISCELLANEOUS �, Reference 1: MCR431435 ' '� MCR OPEN (MCR) ;� �. 2023 Item: NCR O 1 Q $850,0000 $850.00 }.. ,`a � _ ` MCR OPEN (MCR) $850.00 m : a t � ; Subtotal $850.00 � t /� $850.00 o V Total .Y N :A e �. ., :� �.' CHECK $850.00 ,� Check Number000500871 \ o Change due $0.00 z M � . � �� � TCH 500 71 • �� ,�, ' �, , . Paid by: ALTON LLC °, f w ems �",s} `� '�� {- s s�� etc � ? , a •,3a� , s,' ,�, � � - ' �-� w IIIIIIIIIII 'Y'''E/9e— r ——I.: III NMI! I III 11111111111111111111011 11111110111111111 l ' �`u _ ; 3 `� '� ei F fS4b Ct. , .�A f y tc�wMLYawa �rfsaia � �Q 1 a y, }op� • clan MUHPRsa)ii'if axa 00/IOb COLlh/9 C177 a)MINK sY?a,1 7 • mn 1700 GC7VA7cioq C8{iil9 Cd[YC ,� a §. up YLOb0. a �;s� v .!"�� P 1 17" 06{0i1.W 79159 Thank you for your payment CUSTOMER COPY