Derek Sanders/Southpointe Heights, LLCm ;;J',Iv^.~11BEACH
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
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 Ordinance 2004-3435.
SANDERS, DEREK
NAME OF LOBBYIST: (Last) (First) (M.I)
203 LAFAYETTE STREET, 4C NEW YORK, NEW YORK 10012
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
212-625-3750
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
LOBBYIST RETAINED BY:
SOUTHPOINTE HEIGHTS, LLC
NAME OF PRINCIPAUCLIENT:
2200 BISCAYNE BLVD. MIAMI, FL 33137
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-374-5700 305-847-3354
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482
NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: RUSSELL W. GALBUT
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST: SEE ATTACHED
II.SPECIFIC LOBBY ISSUE:
DESIGN REVIEW APPROVAL FOR THE PARTIAL DEMOLITION, RENOVATION AND FACADE MODIFICATIONS TO AN
EXISTING BUILDING AT 42 COLLINS AVENUE.
Issue to be lobbied (Describe in detail):
ill. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: (Pursuant to city code section 2-4s2(g)
include a statement of the extent of any business, financial, familial, professional or other relationship, giving raise to an
appearance of an impropriety, with any City personnel sought to be lobbied; further, pursuant to City Code Section 2-
482(a)(4) include a statement of any contractual relationship (paid or unpaid) from 12 months preceding the
commencement of service of City personnel to be lobbied.}
A Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship
DESIGN REVIEW BOARD NO
~4 'D ~tf Oj"~ ~tt~ ~~UL
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) `N'b ~ D °
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): ~ 0- do
(Required).
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
^ Yes L'~ No: Are you lobbvina on a aresent or aendina bid for goods, eaulament or services, or on a
present or pending award for Bloods. equipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On
,R..,ea~l Estate Development Issues":
^ Yes Cl No: Are you lobbvina on a pending application for a Development Agreement with the Cltv or
application for change of zoning map designation or change to the Citv's Future Land Use
Map?
3) Pursuant to Miami Beach City Code 2-484 (h) Any person (except those exempt from the definition of
"lobbyist" as set forth in Section 2-481 above) who only appears as a representative of anot-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 clerk as required by this
section but, shall not be required to pay any registration fees.
reimbursement. .
V. SIGNATURE UNDER OATH:
Signature of Lobbyist: Vi}-~'
~ ~ ignature of Principal/Client: ~
r
~
~ c ~ ~ ~ LOBBYIST IDENTIFICATION:
g ~ Produced IDN`/DL ~ g~ ~8~ ~' ~~
°C ~ Form of Identification
E
3 ^ Personally known (Lobbyist)
I. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
~Swom to and subscribed before me
This r~ day of C~~, 2008
Signature of Public Notary -State of Florida
Notarization of Lobbyist's signature
PRINCIPAL IDENTIFICATION:
Produced ID ~~~"~~~., DAYAMIAGUTAR
Form F ~ 1 ~ n Notary Put-IIc -State of Fbrida
• ; •'_ My Commis~on Expires Mar 16, 2011
%~~' O~~ Commission # DD 644032
Personally known (P n~' , ;;~'' BondedThrauphNationalNotaryAsen.
State of Florida, County of Miami-Dade
Swom and subscri d before me
T~s2~day of • , 2008
Sig afar of Public Notaryy -State of Florida
No riza on of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ ]Yes [ ] No Amount Paid S MCR # Date Paid
Lobbyist Registration Form received and verified by:
F:\CLER\LOBBYIST\Lobbvist Registration Form 32708.doc /9` ~ Revised 03/27/2008
I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am familiar with the
provisions contained in Section 2-482 of th~ Miam_~x~~~4' y Code and all reporting requirements.
d~ l'4 /f~1~s, ~ ~Atit~l ~ ~ Ems., ,~ ~..~
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachH.gov
CITY CLERK Office Ci1yClerkC~miamibeachfl.gov
Tel: 305.673.7411 ,Fax: 305.673.7254
LOBBYIST NAME: 1._J~~1~ ~'°~^'~S
I understand that no later than October 1st of each year,. I must file the following
forms, pursuant to Section 2-485 of the Miami Beach City Code, with the City Clerk's
Office for all active lobbying issues.
1 j Lobbyist Expenditure Form
2) Disclosure Form
Failure to file these forms on a timely basis will result in my name being transmitted to the
Miami-Dade County Commission on Ethics and for code violation evaluation.
In addition, once an issue I have registered to lobby on has been resolved, I am required
to immediately notify the City Clerk's Office of lobbyist withdrawal in writing.
~ /5 / a-~
Signature: Date:
F:\CLERILOBBYIST1Lobbyist Registration Form 32708.doc
CITY OF MIAMI BEACH
DEVELOPMENT REVIEW BOARD APPLICATION
DISCLOSURE OF INTEREST
1. LIMITED LIABILITY COMPANY
If the property which is the subject of an 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 discloses the identity of the individual(s)
(natural persons) having the ultimate ownership interest in the entity.*
SOUTHPOINTE HEIGHTS, LLC
LIMITED LIABILITY COMPANY NAME
NAME, ADDRESS, AND OFFICE % OF MEMERSHIP INTEREST
SOUTHPOINTE HEIGHTS HOLDINGS, LLC 100%
2200 Biscayne Boulevard
Miami, Florida 33137
Member and Manager
OFFICERS:
SONNY KAHN
2200 Biscayne Boulevard
Miami, Florida 33137
Chairman
RUSSELL W. GALBUT
2200 Biscayne Boulevard
Miami, Florida 33137
President
BRUCE A. MENIN
2200 Biscayne Boulevard
Miami, Florida 33137
Sr. Vice President
SHARON CHRISTENBURY
2200 Biscayne Boulevard
Miami, Florida 33137
Vice President
SHLOMO DACHOH
2200 Biscayne Boulevard
Miami, Florida 33137
Secretary
JOSEPH ZDON
2200 Biscayne Boulevard
Miami, Florida 33137
Treasurer
PABLO DE ALMAGRO
2200 Biscayne Boulevard
Miami, Florida 33137
Asst. Treasurer
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 S
,~.
CITY OF MIAMI BEACH
DEVELOPMENT REVIEW BOARD APPLICATION
DISCLOSURE OF INTEREST
1. LIMITED LIABILITY COMPANY
If the property which is the subject of an 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 discloses the identity of the individual(s)
(natural persons) having the ultimate ownership interest in the entity.*
SOUTHPOINTE HEIGHTS HOLDINGS LLC
LIMITED LIABILITY COMPANY NAME
NAME, ADDRESS, AND OFFICE % OF MEMERSHIP INTEREST
CH INVESTMENT HOLDINGS, LLC
2200 Biscayne Boulevard
Miami, Florida 33137
Member and Manager
100%
OFFICERS:
SONNY KAHN
2200 Biscayne Boulevard
Miami, Florida 33137
Chairman
RUSSELL w. GALBUT
2200 Biscayne Boulevard
Miami, Florida 33137
President
BRUCE A. MENIN
2200 Biscayne Boulevard
Miami, Florida 33137
Sr. Vice President
SHARON CHRISTENBURY
2200 Biscayne Boulevard
Miami, Florida 33137
Vice President
SHLOMO DACHOH
2200 Biscayne Boulevard
Miami, Florida 33137
Secretary
JOSEPH ZDON
2200 Biscayne Boulevard
Miami, Florida 33137
Treasurer
PABLO DEALMAGRO
2200 Biscayne Boulevard
Miami, Florida 33137
Asst. Treasurer
IF THERE ARE AD!?ITIONAL 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
CITY OF MIAMI BEACH
DEVELOPMENT REVIEW BOARD APPLICATION
DISCLOSURE OF {NTEREST
1. LIMITED LIABILITY COMPANY
If the property which is the subject of an 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 discloses the identity of the individual(s)
(natural persons) having the ultimate ownership interest in the entity."`
CH INVESTMENT HOLDINGS, LLC
LIMITED LIABILITY COMPANY NAME
NAME, ADDRESS, AND OFFICE % OF MEMERSHIP INTEREST
SK BUSINESS TRUST 37%
2200 Biscayne Boulevard
Miami, Florida 33137
Member
RF BUSINESS TRUST 37%
2200 Biscayne Boulevard
Miami, Florida 33137
Member
MENIN 1998 FAMILY TRUST 2g%
2200 Biscayne Boulevard
Miami, Florida 33137
Member
MANAGERS:
SONNY KAHN
2200 Biscayne Boulevard
Miami, Florida 33137
Manager
RUSSELL W. GALBUT
2200 Biscayne Boulevard
Miami, Florida 33137
Manager
BRUCE A. MENIN
2200 Biscayne Boulevard
Miami, Florida 33137
Manager
1F 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
CITY OF MIAMI BEACH
DEVELOPMENT REVIEW BOARD APPLICATION
DISCLOSURE OF INTEREST
2. TRUSTEE
If the property which is the subject of an application is owned or leased by a TRUSTEE, list the
beneficiaries of the trust and the percentage of interest held by each. Where the
beneficiaries/beneficiary consist of corporation(s), another trust(s), partnership(s) or other
similar entity, further disclosure shall be required which discloses the identity of the individual(s)
(natural persons) having the ultimate ownership interest in the entity.*
SK BUSINESS TRUST
TRUST NAME
NAME, ADDRESS, AND OFFICE
SONNY KAHN
2200 Biscayne Boulevard
Miami, Florida 33137
Beneficiary
OF INTEREST
100%
NOTE: Notarized signature required on page 8
7
CITY OF MIAMI BEACH
DEVELOPMENT REVIEW BOARD APPLICATION
DISCLOSURE OF INTEREST
2. TRUSTEE
if the property which is the subject of an application is owned or leased by a TRUSTEE, list the
beneficiaries of the trust and the percentage of interest held by each. Where the
beneficiaries/beneficiary consist of corporation(s), another trust(s), partnership(s) or other
similar entity, further disclosure shall be required which discloses the identity of the individual(s)
(natural persons) having the ultimate ownership interest in the entity.*
RF BUSINESS TRUST
TRUST NAME
NAME, ADDRESS, AND OFFICE
RUSSELL W. GALBUT
2200 Biscayne Boulevard
Miami, Florida 33137
Beneficiary
OF INTEREST
100%
NOTE: Notarized signature. required on page 8
7
CITY OF MIAMI BEACH
DEVELOPMENT REVIEW BOARD APPLICATION
DISCLOSURE OF INTEREST
2. TRUSTEE
If the property which is the subject of an application is owned or leased by a TRUSTEE, list the
beneficiaries of the trust and the percentage of interest held by each. Where the
beneficiaries/beneficiary consist of corporation(s), another trust(s), partnership(s) or other
similar entity, further disclosure shall be required which discloses the identity of the individual(s)
(natural persons) having the ultimate ownership interest in the entity."
MENIN 1998 FAMILY TRUST
TRUST NAME
NAME, ADDRESS, AND OFFICE
BRUCE A. MENIN
2200 Biscayne Boulevard
Miami, Florida 33137
Beneficiary
OF INTEREST
100%
NOTE: Notarized signature required on page 8
7