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Jonathan W. Cardello/South Beach Heights I, LLC (3) ~x~ ~ F, 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. CARDELLO, JONATHAN W. NAME OF LOBBYIST: (Last) (First) (M.I) ONE BISCAYNE TOWER, SUITE 1670, TWO SOUTH BISCAYNE BLVD., MIAMI, FLORIDA 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-482-8705 305-482-8770 JCARDELLO@ADDINC.COM TELEPHONE NUMBER: FAX NUMBER: EMAIL: LOBBYIST RETAINED BY: SOUTH BEACH HEIGHTS I, LLC NAME OF PRINCIPAL/CLIENT: 2200 BISCAYNE BOULEVARD MIAMI, FLORIDA 33137 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-374-5700 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 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: LAND DEVELOPMENT REGULATION AMENDMENT TO CHANGE THE ACTUAL ZONING MAP DESIGNATION OF PARCEL(S) OF LAND FOR THE PROPERTY LOCATED AT 630 ALTON ROAD (SOMETIMES REFERRED TO AS 600 ALTON ROAD) Issue to be lobbied (Describe in detail): III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: (Pursuant to city code section 2-48z(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 PLANNING BOARD NO CITY COMMISSION NO ,~~~ _, -,~ : E',,.~~.-,+ ,{11;1 ~~ =~~ ~w~ ~~ ~~}~ BoaZ ..,, -..3 ~~ Y ..,d r' ry IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHERJ: A) LOBBYIST DISCLOSURE: (Required) ~t7S . [~J~ . ~ PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): quired). /- 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": present or Dendina award for aoods equipment or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": application for chance of zoning map designation or chance to the Citv's Future Land Use MaD? 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 sect~n but, shall not be required to pay any registration fees. reimbursement. . V. SIGNATURE UNDER OATH: n~~ nrrno~o SST ,~,r ~,,,.,,, ~„ I do solemnly swear tha all of th foregoing facts are true and Corr t and that I have read or am familiar with the provisions contained in ection 2-4 of the Miami Beach City Code a d all reporting requirements. Signature of Lobbyist: , r_-''--_ Signature of Principal/Client: VI. LOBBYIST IDENTIFICATI N: PRINCIPAL IDENTIFICATION: ^ Produced ID ^ Produced ID Form of Identification Form of Identification Pe rs on all y known (Lobbyist) ~] Personally known (Principal) ` 7Z ~~ ~~ ~~AA V~ COMM~5S10N~'dd'lt~41~N STAMP OF NOTARY: ( EXPIRES: August 2 2011 8atetemt,Fbor~dau~t~o iami-Dade -~'~i"a~ p~e~. DAYAMIAGUTAR State of Florida, C u acybtary Pubtic - Stat fore me This day o ~~Q , 2008 e of Fioryda Swo nd subscri • .. MyC ~da of ~0A Ex~~ Ma-1ti, 2ptt his 8 ~- , Y 11„ ~ Commission # DD 644032 'Bonded Through National Nogr Signature of Public Nota Sta a of Florida y ~. St ature Public No ry fate of Florida Notarization of Lobbvis s signature No rizati n of Principal's signature TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Anr-ual Registration fee: [. ]Yes [ ) No Amount P Id ' .~~~" ' MCR # Date Paid Lobbyist Registration Form received and verified b~~# F:\CLER\LOBBYIST\Lobbyist Registration Form 327D8, oe.,:~ea ne r~~i~nnn m MAMIBEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov CITY CLERK Office CityClerk@miamibeachfl.gov Tel: 305,673.741 1 ,Fax: 305.673.7254 LOBBYIST NAME: ~ 1G~ C~~~.~~.~ 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) 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 Citv Clerk's Office of 1o66vist withdrawal in writing. ~ - 22- O$ Date: F:ICLERILOBBYIST1Lobbyist Registration Form 32708.dac - CITY OE 1VlIAMI BEACH DEVELOPIV[ENT REVIEUV BOARD APi'L~CATlON 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 corporations}, trustee(s), partnerships} 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.* SOUTH BEACH HEIGHTS I LLC LIMITED LIABILITY COMPANY NAME NAME, ADDRESS, AND OFFICE SBH HOLDINGS I, LLC 2200 Biscayne Boulevard Miami, Florida 33137 Member SBH MANAGEMENT COMPANY, LLC 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 CHRlSTENBURY 2200 Biscayne Boulevard Miami, Florida 33137 Vice President SHLOMO DACHOH 2200 Biscayne Boulevard Miami, Florida 33137 Secretary JOSEPH ZDON 220D Biscayne Boulevard Miami, Florida 33137 Treasurer PABLO DE ALMAGRO 2200 Biscayne Boulevard Miami, Florida 33137 Asst. Treasurer OF MEMERSHIP INTEREST 99% 1% 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 G1TY Ot= NttAt111t DEACH DEVELOt'tV1ENT REVIEW DOARD APPLICATION DISCLOSURE OF INTEREST '(. LIMITED LIABILITY COMPANY If the property which is the subject of an application is owned or leased by a CORPORATION, fist the principal stockholders and the percentage of stack 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.* SBH MANAGEMENT COMPANY LLC LIMITED LIABILITY COMPANY NAME NAME, ADDRESS, APHID OFFICE CH INVESTMENT HOLDINGS, LLC 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 Bouievard Miami, Florida 33137 Treasurer PABLO DE ALMAGRO 2200 Biscayne Boulevard Miami, Florida 33137 Asst. Treasurer X00% IF THERE ARE ADDITIONAL CORPORATIONS, LIST OTHERS, 1NCLUD/NG 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 OF MEMERSHlP INTEREST 6 CITY OP MIAMI ~3EACH DEVELOPMENT REVIEW BOARD APPL1GAl"ION 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.* . SBH HOLDINGS f, LLC LIMITED LIABILITY COMPANY NAME NAME, ADDRESS, AND OFFICE CH INVESTMENT HOLDINGS, LLC 2200 Biscayne Boulevard Miami, Florida 33137 Member and Manager DAVID GALBUT 2200 Biscayne Boulevard Miami, Florida 33137 Member 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 OF MEMERSHIP INTEREST 89.89% 10.11% IF THERE ARE ADDITIONAL CORPORATIONS, LIST OTHERS, INCLUDING CORP, NAMF(S) AND EACH INDIVIDUAL'S NAME, ADDRESS, OFFICE AND PERCENTAGE OF STOCK, ON A SEPARATE PAGE. NOTE: Notarized signature required on gage 8 6 CITY OF MIA1V11 BEACH DEVELOPMENT REVIEVII BOARD APPLICATION DISCLOSURE OF ~NTERES~ 'I. 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 LlAB[LITY COMPANY NAME NAME, ADDRESS, AND OFFICE % OF MEMERSHlP 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 26% 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 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 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 corporations}, another trust(s), partnerships} or other similar entity, further disclosure shall be required which discloses the identity of the individua{(s) (natural persons) having the ultimate ownership interest in the entity.* SK BUSINESS TRUST TRUST NAME NAME, ADDRESS, ,4ND OFFICE SONNY KAHN 2200 Biscayne Boulevard Miami, Florida 33137 Beneficiary OF INTEREST 100% NOTE: Notarized signature required on page 8 7 CITY OF MIAMI REACH DEVELOPMENT REVIEVI! ~30ARD APPLICATION DISCLOSURE OF INTEREST 2. TRUSTEE If the property which is the subject of an application is owned or leased by a TRUSTEE, fist the beneficiaries of the trust and the percentage of interest held by each. 4Nhere 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 1Q0% NOTE: Notarized signature required on page S 7 CITY OF MIAMI BEACH DEVELOPMENT REVIEW BOARD APPLICATION DISCLOSURE OF INTEREST 2. TRUSTEE if the property which is the sub}ect 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 1898 FAMILY TRUST TRUST NAME NAME, ADDRESS, AND OFFICE % OF INTEREST BRUCE A. MENIN _ 100% 2200 Biscayne Boulevard Miami, Florida 33137 Beneficiary NOTE: Notarized signature required on page S 7 rn ai a 0 ~. :~ c~ a a~i a ~~ ng ~~ o~ ~- ~ ~' 30 -c 00 ~ n d _~ c~ n '~ -,_ -;' _ ~: ;~; - iii ~.. i' f' :~ f;i .,... iF :ii t . f! %'. ~'. O ~ _ ~~:; '4' h.~ N - ,= ~O -_~`- Cn ::_~ O~ V