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Wilson Herrera - Marisa Galbut 66'3 AttOI1L . DocuSign Envelope ID:D532BDF3-A86C-4484-89F6-D97D956516FD RECEIVED MIAMI BEACH MAR212023 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"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: Herrera Wilson NAME OF LOBBYIST (Last) (First) (Middle Name) oGateked 1r IL (See 4+ ) Built Form,LLC 935 W. Chestnut Street,#520 Chicago - ari - 60642 LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-902-8629 wherrera@built-form.net LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS Il. PRINCIPAL INFORMATION: Galbut Marisa NAME OF PRINCIPAL (Last) (First) (Middle Name) South Beach Heights II, LLC 2200 Biscayne Blvd. 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 pursuant to City Code Section 2-482(h)(1)(a): a principal of any corporation, partnership,or other entity who appears as a lobbyist on behalf of that entity,d iL.,g bv'•Ati pen8ation -Y- W .1.�, leF=Y .-,(2MIN. indire'Ct,CB 4 '` ti�°(:1:{°T-F1,4Claw:AM°�O°tOSitiOntfl fan item shall register 'th the Clerk as required by this subsection but shall not be required to pay any registration fees. C If the principal is a Corporation, Partnership or Trust, the following information MUST be provided pursuant to City Code Section 2-482(c): s • 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 0 CORPORATION,PARTNERSHIP OR TRUST(if none,write N/A): Please see the attached. O o , Page 1 of 5 DocVerify ID:3CE08DDC-3409-49EC-8646-64D17031C2CB Page 27 of 39 2764017031C2CB I IN•.{' Kai III A, www docvenfy.com u DocuSign Envelope ID:D5328DF3-A86C-4484-89F6-D97D956516FD 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 property located at 663 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 N/A): None ❑ V. DISCLOSE RATE AND AMOUNT OF LOBBYIST COMPENSATION —Be Specific. (Note that a W contingency fee is prohibited pursuant to City Code Sec. 2-485.3): $ .00 per hour ❑ Page 2 of 5 wwww do f elnty comOBDDC-3409-49 EC-8646-64D17031C2C8 I Page 28 of 39 I 28641317031 C2C8 J ')HI I DocuSign Envelope ID:D532BDF3-A86C-4484-89F6-D97D956516FD • 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: Areyou 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 2482(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: f yes. has it been less than 12 months since the elected official(s)whom you provided campaign consulting seice was sworn infirm 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. _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: CV m O a _Yes XNo: If yes, ware you promised or gigvocq receive economic consideration i r xchange( �cam p in consulting senvJcsr e io Co TO BE COMPLETED BY CITY CLERK'S STAFF ONLY o • Annual Registration fee: ( )Yes( )No Amount Paid$ MCR# Date Paid Lobbyist Registration Form received and verified by: • F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 09-20-18 REG.doc Revised 09/20/2018 Page 3 of 5 Docverify ID:3CE08DDC-3409-49EC-8646-64D17031C2C8 Page 29 of 39 j 29641:117031C2CB ,II 1M11III www docverify.com DocuSign Envelope ID:D532BDF3-A86C-4484-89F6-D97D956516FD 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.' Signature of Lobbyist: R sow th.wtva Date 03/20/2023 AbfUe9111-4aee4wv... 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 Cod eilillifilliatting requirements. Signature of Lobbyist: Wm, tiLVYLNa oocuslanedby: Date 03/20/2023 ADMCOOr46:DOcA... Signature of Principal: Mavtsa 44/0 Date 03/20/2023 7FAB78686F9342A... 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 0 online notarization, or 0 online notarization, this day of nwr4/n93 . 20 , by this—day of n3/2n/2n23 .20_,by Wilson Herrera Marisa Galbut NAME OF LOBBYIST NAME OF PRINCIPAL _Produced ID _Produced ID FORM OF IDENTIFICATION FORM OF IDENTIFICATION "- :1'�•' ]wn _Personally Kno —• 0 b amwonmaaimm+o-o.em ser.d.era +a:m Signature of Notary Public Signature of Notary Public Diana Ramos Diana Ramos M .'J N Name of Notary,Typed,Printed or Stamped Name of Notary,Typed,Printed or Stamped 1 Jana Ramos _ 71 1 gym Ramos 1 Commission#GG 308355 1 4 mmIssion#GG 308355 ANotary Public-State of Florida 1 1 Ktotary Public-State of Florida 4 Icy Commission Expires Apr 10,2023 th 1 Thl CI Commission Expires Apr 10,2023 tng persons: 1 T T `T T T_ T_ W Exp ^—^t•r ^'s ^—^"*^"-'t^ al or other speciaiizeaTriTorma rOn or tesnmony in puouc 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 g not-for-profit community based organization for the purpose of requesting a grant without special compensation or reimbursement for W the appearance. 0 Page 4of6 DocVeriiy ID:3CE08DDC-3409-49EC-8646-64D17031 C2CB L.Page 30 of39 ji 3064D17031C2CB J III ,I nI www.docverity.corn fa N DocuSign Envelope ID:D532BDF3-A86C-4484-89F6-D97D956516FD MIAMIBEACH 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: Wilson Herrera 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 $500.00 pursuant to Section 2-482 of the Miami Beach City Code. Dom:Signed by: Nitstm, thin" 03/20/2023 AD70C90F4:fD4AA... Signature of Lobbyist Date U 0 F:\CLERL$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 03-11-20 REG.doc Page 5 of 5 Si DocVerify ID:3CEO8DDC-3409-49EC-8646-64D17031C2CB Page 31 of 39 I_3164D17031C2C6 fb�i I 11 m www.docventy.com - DocuSign Envelope ID:D532BDF3-A86C-4484-89F6-D97D956516FD SUPPLEMENTARY DISCLOSURE OF INTEREST Interests in South Beach Heights II,LLC Percentage of Interest SBH Holdings II, LLC 99% 2200 Biscayne Blvd. Miami FL 33137 SBH Management Company, LLC 1% 2200 Biscayne Blvd. Miami FL 33137 Interests in SBH Holdings II. LLC Percentage of Interest CH Investment Holdings, LLC 89.89% 2200 Biscayne Blvd. Miami FL 33137 David Galbut and Gita Galbut 10.11% 2200 Biscayne Blvd. Miami FL 33137 Interests in SBH Management Company. LLC Percentage of Interest CH Investment Holdings, LLC 100% 2200 Biscayne Blvd. Miami FL 33137 Interests in CH Investment Holdings. LLC Percentage of Interest N S Kahn CH Investments, LLLP 18.685% 2200 Biscayne Blvd. Miami FL 33137 S Kahn CH Holdings, LLLP 18.351% 2200 Biscayne Blvd. Miami FL 33137 W DocVerify ID:3CE08DDC-3409-49 EC-8646-64D17031 C2C6 r— „I ,I'II Doc erify I :3CE L_Page 32 of 39 3264D17031C2CB_� u DocuSign Envelope ID:D532BDF3-A86C-4484-89F6-D97D956516FD Galbut CH Investments, LLLP • 18.685% 2200 Biscayne Blvd. Miami FL 33137 Galbut CH Holdings, LLLP 18.351% 2200 Biscayne Blvd. Miami FL 33137 Menin CH-BT Co, LLLP 19.56% 2200 Biscayne Blvd. Miami FL 33137 Menin CH Holdings, LLLP 6.435% 2200 Biscayne Blvd. Miami FL 33137 Interests in S Kahn CH Investments.LLLP Percentage of Interest S Kahn CH Investments 1, LLC 1% 2200 Biscayne Blvd. Miami FL 33137 SK Business Trust 99% 2200 Biscayne Blvd. Miami FL 33137 Interests in S Kahn CH Investments 1. LLC Percentage of Interest 8 0 SK Business Trust 100% 2200 Biscayne Blvd. Miami FL 33137 Interests in SK Business Trust Percentage of Interest s Sonny Kahn 100% 2200 Biscayne Blvd. Miami FL 33137 I U ❑ 0 U U M DocVerify ID:3CE08DDC-3409-49EC-8646-64D17031C2CB Page 33 o9 3364D17031C2C8 III I II HI www.docveriN com 13 t DocuSign Envelope ID:D532BDF3-A86C-4484-89F6-D97D956516FD Interests in S Kahn CH Holdings. LLLP Percentage of Interest S Kahn CH Management, LLC 1% 2200 Biscayne Blvd. Miami FL 33137 Kahn 2009 Investments Irrevocable Trust 99% 2200 Biscayne Blvd. Miami FL 33137 Interests in S Kahn Management. LLC • Percentage of Interest Kahn Management Trust 100% 2200 Biscayne Blvd. Miami FL 33137 Interests in Kahn Management Trust Percentage of Interest Sonny Kahn 100% 2200 Biscayne Blvd. Miami FL 33137 Interests in Kahn 2009 Investments irrevocable Trust Percentage of Interest 0 0 Sonny Kahn 100% 2200 Biscayne Blvd. Miami FL 33137 Interests in Galbut CH Investments, LLLP 0 Percentage of Interest Galbut CH Investments 1, LLC 1% 2200 Biscayne Blvd. Miami FL 33137 LL M • DocVerify ID:3CEOBDDC-3409-49EC-8646-64D17031C2CB 1 Page 34 of 39 j 3464D17031C2C8 III ~IiS�'I III www.docverify.com +� DocuSign Envelope ID:D532BDF3-A86C-4484-89F6-D97D956516FD RF Business Trust 99% 2200 Biscayne Blvd. Miami FL 33137 Interests in Galbut CH Investments 1. LLC Percentage of Interest RF Business Trust 100% 2200 Biscayne Blvd. Miami FL 33137 Interests in RF Business Trust Percentage of Interest Russell W. Galbut 100% 2200 Biscayne Blvd. Miami FL 33137 Interests in Galbut CH Holdings. LLLP Percentage of Interest Galbut CH Management, LLC 1% 2200 Biscayne Blvd. Miami FL 33137 Galbut 2009 Investments Irrevocable Trust 99% 2200 Biscayne Blvd. Miami FL 33137 Interests in Galbut CH Management. LLC Percentage of Interest ' Galbut Management Trust 100% • 2200 Biscayne Blvd. Miami FL 33137 0 CD CD CD 0 W T O C, U O 0 O W 0 n mi 1���� DocVerify ID:3CEO8DDC-3409-49EC-8646-64D17031C2CB Page 35 of 39 3564D17031 C2C8 www.docvenfy.com DocuSign Envelope ID:D532BDF3-A86C-4484-89F6-D97D956516FD Interests in Galbut Management Trust Percentage of Interest Russell W. Galbut 100% 2200 Biscayne Blvd. Miami FL 33137 Interests in Galbut 2009 Investments Irrevocable Trust Percentage of Interest Russell W. Galbut 100% 2200 Biscayne Blvd. Miami FL 33137 Interests in Menin CH-BT Co., LLLP Percentage of Interest Menin CH-BT Co., LLC 1% 2200 Biscayne Blvd. Miami FL 33137 Menin 1998 Business Trust 99% 2200 Biscayne Blvd. Miami FL 33137 Interests in Menin CH-BT Co., LLC Percentage of Interest Menin 1998 Business Trust 100% 2200 Biscayne Blvd. Miami FL 33137 Interests in Menin 1998 Business Trust • 0 Percentage of Interest th Bruce Menin 100% 2200 Biscayne Blvd. Miami FL 33137 DwocVerify ID:ww.doenfycomOBDDC-3409-49EC-6646-64D17031C2CB (_Page 36 of 39 1 3664D17031C2CB J 1111 •. 'j ,I 111 DocuSign Envelope ID:D532BDF3-A86C-4484-89F6-D97D956516FD Interests in Menin CH Holdings, LLLP Percentage of Interest Menin CH Management, LLC 1% 2200 Biscayne Blvd. Miami FL 33137 Menin CH Holdings, LLC 99% 2200 Biscayne Blvd. Miami FL 33137 Interests in Menin CH Management, LLC Percentage of Interest Menin Management Trust 100% 2200 Biscayne Blvd. Miami FL 33137 Interests in Menin Management Trust Percentage of Interest Bruce Menin 100% 2200 Biscayne Blvd. Miami FL 33137 Interests in Menin CH Holdings, LLC Percentage of Interest 0- Menin 2009 Investments Irrevocable Trust 100% 2200 Biscayne Blvd. Miami FL 33137 Interests in Menin 2009 Investments Irrevocable Trust 0 Percentage of interest Bruce Menin 100% 2200 Biscayne Blvd. Miami FL 33137 DocVerify ID:3CE08DDC-3409-49 EC-8646-64D17031 C2CB L—Page370139 3764D17031C2CB 11111111111611111 www-docveriry.corn DocuSign Envelope ID:D532BDF3-A86C-4484-89F6-D97D956516FD 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 Sonnv Kahn 2004 Irrevocable Trust Percentage of Interest Elliott Kahn 20% 2200 Biscayne Blvd. Miami FL 33137 Joshua Kahn 20% 2200 Biscayne Blvd. Miami FL 33137 Naomi Kahn 20% 2200 Biscayne Blvd. Miami FL 33137 • Rachel Kahn 20% 2200 Biscayne Blvd. Miami FL 33137 Avigail Kahn 20% 2200 Biscayne Blvd. Miami FL 33137 U u C) m U O O 0 W U M DocVerify ID:3CEO8DDC-3409-49 EC-8646-64D17031C2CB ( Page 380139 3864017031C2C8 „) •. m III www.docverify.com DocuSign Envelope ID:D5326DF3-A86C-4484-89F6-D97D956516FD Beneficiaries of Russell W. Galbut 2004 Irrevocable Trust Percentage of Interest Marisa Galbut 50% 2200 Biscayne Blvd. Miami FL 33137 Jenna Galbut 50% 2200 Biscayne Blvd. Miami FL 33137 Beneficiaries of Bruce A. Menin 2004 irrevocable Trust Percentage of Interest Maxwell Menin 33.33% 2200 Biscayne Blvd. Miami FL 33137 Mason Menin 33.33% 2200 Biscayne Blvd. Miami FL 33137 Lucas Menin 33.33% 2200 Biscayne Blvd. Miami FL 33137 O 0 0 O 0 N M O C' N N U O C7 Co O U W W O ❑ O O w U DDoc dower com08DDC-3409-49EC-8646-64D17031C2C6 r Page 39 of 39 3964D17031C2C8 iso II I 1 � � �k ° pia • �, ` ;Miscellaneous Cash Receipt' � i • s • CITY OAF MIAMI BEACH °` N'o 431417• P :i r�' x▪ "" �� `�� � oaf f ii ,.,.,,y�..�� ,w.S • ".. �, ❑Cash aQ Credit Card heck# ?.�u -, : r x 3 $' `,'1 ¢_� Received of C C � e ' .yam °J �, e a q - e 4 Y s z �,.�j Address d ' � V , , c' • . r-r For -- =� ,i c,�« {. � r c" i 17, �- '-'._.• ....�.;i ,✓'1 lam`t,.,....J c" .� "- ✓7. V m....i "I . °;� MssceQQaneous MCP 2023 x" ' a � • 00601t 0005�E8am Th"�03121f2023 52A ' 2�„ 3 t-fe , Payment Amount 2 050 00I, r ��/,(THIS INFORMATION�MUST BE-COMPLETED) . . Office of Finance Director Account num}�er ��, >� gBy b : p , Prepares is L v "Dept EXT.>� {� ' a ▪ �\ �saif .� ' �h �1�i i� • '^ r• .4iitiM, ,9.ti:‘,,Zi'-.1:.'"-D-.1.(ill'FlitIliXtc.'-',:l'igilic4-11-'.:,:, -;ta'''''''74-.7ii40,.;i14*E7,,, ,-,-,...'::''.-:',..:.-1.ii,-;,:.--2:!.,:;3;:w-,f.7, .,::,'.' 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THE NATURE OF OUR INDUSTRY HAS THE ADDED [ I • I j€ BENEFIT AND HONOR OF SHARING OUR PASSION WITH THE %+ ` ' [ It j# COMMUNITY; AND AS SUCH, WE TAKE GREAT STRIDES TO ENSURE THAT OUR PRODUCT PLAYS A POSITIVE ROLE i ,J f,.,...... ENVIRONMENTALLY, FISCALLY, AND AESTHETICALLY. ,,, '- IL t PARTNER R❑ BERT BISTRY B'BISTRY@BUILT-FORM.NET ARDEN FREEMAN AFREEMAN@BUILT-FORM.NET ASHLEY YOUNG AYOUNG@BUILT-FORM.NET OFFICE MANAGER LAURA SANTIAGO LSANTIAGO@BUILT-FORM.NET C N TA CT CHICAGO 93,5` ,W -GHES TNLLT-ST2_EE- 5>2`CI CHICAGO, IL 60642 31 2- 738-31335 M IAM I 305-902-8629 CHARLOTTE 81 3-340-2957 BUILT FORM IS ALWAYS OPEN TO NEW POSSIBILITIES, SO WHETHER YOU ARE A POTENTIAL CLIENT OR A TALENItU © 2022 BUILT FORM, LLC CONTACT US https://www.built-form.net/about 1/2