Harold Rosen/1100 West Properties, LLC
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City of Miami Beach Office.of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION FORM
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TELEPHONE NUMBER:
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 ant city personnel defined in any
manner in this section, 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. .
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(Last) (First)
t (;,,,rnN '?L. &.{D1 t...''''''''c..."
(Number and Street) (City)
3d S ~3K' S SO "f
FAX NUMBER:
NAME OF LOBBYIST:
f2,.o ~ ~ ,J S ~ tl K.i"S
BUSINESS NAME AND ADDRESS
4757
(M.!)
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(State) (Zip Code)
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I. LOBBYIST RETAINED BY:
Jj 00 WG"t;r .p~'c(l.rl Ci-S J LJ-C.
NAME OF PRINCIPAl./CUENT:
y 75 IO'pt Alle,Nc.t~ '( 10 fY\ O~A"'S
i
BUSINESS NAME AND ADDRESS (Number and Street) (City)
~~ (,(Zo"lP j\J 'i:w 1~'f,. AJ i IrPlf
(State) (Zip Code)
--1fJ .)774177
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 BENEFIOARY: s.t If f<< 0 ttLu.. tf
.
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: S.~ -+TT4c...H1;10
II.
SPECIFIC LOBBY ISSUE:
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Issue to be lobbied (Describe in detail):
'A-PP(\'oV-1( fotL DF)(bAJ OF /1-€'.Nall'+"i'OIVS.+,
I , 0 0 wesT 4101 e AJ ",,{;
III. CITY AGENCIES/INDIVIDUALS TO. BE LOBBIED:
A) Full Name of IndividualfTitle" B) Any Financial, Familial,or Professional Relati~nship
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,'
FLA T RATE OR OTHER).
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B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required), fI,!~ IV. p..o r #If,;r;v-
o Yes ~: Are ,",ou reoresentinc a not-for-orofit corooratiori or entity without soecial comJensation or
. reimbursement. Pursuant to Ordinance No. 2004-3435.
A) LOBBYIST DISCLOSURE: (Required)
1)
o Yes ~:
2)
DYes ~:
.'
Pursuant to Ordinance No. 2003-3393 AmendinG Miami Beach Citv Code Chapter 2, Article VII, Division 5
Thereof Entitled "Campaion Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited
CampaiGn Contributions By LobbYists On Procurement Issues":
Are YOU lobbYina on a oresent" or oendina bid for coods. ecuioment or services. or on a present
or oendinc award for aoods. ecuiomerit or service?
Pursuant to Ordinance No. 2003-3395 AmendinG Miami Beach Citv Code Chapter 2, Article VII Division 5
thereof Entitled "Campaion Finance Reform", Via The Addition Of Code Section 2-490 Entitled "Prohibited
CampaiGn Contributions By Lobbyists O"n Real Estate Development Issues";. '.
Are YOU lobbyinc on a oendina aoolication for a Develooment Aareement with the City or
aoolication for chance of zonina mao desicnation'or chance to the,'City's Future Land Use Mao?
V. SIGNATURE UNDER OATH:
.
O"N OctOBER 1ST 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 BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE
REPORTING PERIOD. _ ~ . ~
'" S;g",tu,~
I do'solem'nly swear'that all nlth'e'foregoing facts are true 'and -correct and that I ha~e rea~' or am
familiar with the provisions cciht~ine in Section 2- 82 f the Miami Beach City Code and all.reporting
reql,.lirements. I },
'.
Signature of Lobbyist:
VI.
LOBBYIST IDENTIFICATION~ ;'
PRINCIPAL IDENTIFICATION:'
o Produced ID
o Produced ID
Form of Identification
~rSOnallY known (Lobbyi~t) , I'
Form of Identification
J Personally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
.State of Florida, County of Miami-Dade
Sworn to and subscribed before me '.
. This .l..\ ' dayof~. 200:1 - "
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Signature of Public Notary - State of Florida
NOr~il:"tlQn..o.t.~t.i&t.'&O&j~ature
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FOR
Annual Registration fee:. [ ] Yes [ ] No Amoun
Lobbyist Registration Form received and verified by:
Revised 02/10/04 F: C R AL
ARlA-M\LOBBYIST\LOBBYIST FORM 04
CITY OF MIAMI BEACH
DEVELOPMENT REVIEW BOARD APPLICATION
DISCLOSURE OF INTEREST
1. LIMITED LIABILITY COMPANY
If the property which is the subject of the application is owned or leased by a CORPORATION,
list the principal stockholders and the percentage of stock owned by each. Where the principal
officers or stockholders consist of another corporation(s), trustee(s), partnership(s) or other
similar entity, further disclosure shall be required which disclosures shall which discloses the
identity of the individual(s) (natural persons) having the ultimate ownership interest in the
entity).*
SANCTUARY WEST HOLDINGS. LLC
LIMITED LIABILITY COMPANY NAME
Name, Address, and Office
% OF STOCK
Sanctuary West Management, LLC
4770Bisca)'Ile Blvd.
Suite 400
Miami, Florida 33137
95%
Gladys Brownstein
2.5%
Honey Waldman
2,5%
IF THERE ARE ADDITIONAL CORPORATIONS, LIST OTHERS, INCLUDING CORP.
NAME(S) AND EACH INDIVIDUAL'S NAME, ADDRESS, OFFICE AND PERCENT AGE
OF STOCK, ON A SEPARATE PAGE.
NOTE: Notarized signature required on page 8
6
CITY OF MIAMI BEACH
DEVELOPMENT REVIEW BOARD APPLICATION
DISCLOSURE OF INTEREST
1. LIMITED LIABILITY COMPANY
If the property which is the subject of the application is owned or leased by a CORPORATION,
list the principal stockholders and the percentage of stock owned by each. Where the principal
officers or stockholders consist of another corporation(s), trustee(s), partnership(s) or other
similar entity, further disclosure shall be required which disclosures shall which discloses the
identity of the individual( s) (natural persons) having the ultimate ownership interest in the
entity). *
SANCTUARY WEST MANAGEMENT. LLC
LIMITED LIABILITY COMPANY NAME
Name, Address, and Office
% OF STOCK
Abraham Galbut & Nancy K. Galb1it, his wife
4770 Biscayne Blvd.
Suite 400
Miami, Florida 33137
28%
. Keith Menin
c/o 4770 Biscayne Blvd.
Suite 400
Miami, Florida 33137
18%
Daniel Galbut
c/o 4770 Biscayne Blvd.
Suite 400
Miami, Florida 33137
16%
Seth Frohlich & Kimberly Frolich, his wife
c/o 4770 Biscayne Blvd.
Suite 400
Miami, Florida 33137 .
8%
(continued to a second page)
IF THERE ARE ADDITIONAL CORPORATIONS, LIST OTHERS, INCLUDING CORP.
NAME(S) AND EACH INDIVIDUAL'S NAME, ADDRESS, OFFICE AND PERCENT AGE
OF STOCK, ON A SEPARATE PAGE.
NOTE: Notarized signature required on page 8
6
Robert N. Galbut and Rita Galbut, his wife
c/o 4770 Biscayne Blvd.
Suite 400
Miami, Florida 33137
10%
David Galbut and Geta Galbut, his wife
c/o 4770 Biscayne Blvd.
Suite 400
Miami, Florida 33137
10%
Joan Brent
c/o 4770 Biscayne Blvd.
Suite 400 .
Miami, Florida 33137
10%
IF THERE ARE ADDITIONAL CORPORATIONS, LIST OTHERS, INCLUDING CORP.
NAME(S) AND EACH INDIVIDUAL'S NAME, ADDRESS, OFFICE AND PERCENTAGE.
OF STOCK, ON A SEPARATE PAGE.
NOTE: Notarized signature required on page 8
6