Donald J. Washburnl~Z(o ~'4(I'~ru_f ~''pGaoilC
City of Miami Beach Office of the City Clerk 700q
1700 Convention Center Drive, Miami Beach, FL 3313~~~ 2a AM ~~~ 32
LOBBYIST REGISTRATION FORM ~'r ~' L ~" c. ~°L ~ ~~ ll ~ r' ~ v .~.
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 bond 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.
Washburn Donald J.
NAME OF LOBBYIST: (Last) (First) (M.I.)
c/o The Audio Bug, Inc. 3800 Hillcrest Drive Hollywood FL 33021-7937
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(954) 983-2788 (954) 083-2789 audiobug1@aol.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
LOBBYIST RETAINED BY:
IC, LLC
NAME OF PRINCIPAL/CLIENT:
IC, LLC 2200 Biscayne Boulevard Miami FL 33137
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 374-5700 (305) 847-3354 mkramer@crescentheights.com
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
Fill out this section if principal is a
rship or Trust
NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Russell W. Galbut and Irving
Cowan
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE
OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST:
Russell W. Galbut (50%), Managing Member
Irving Cowan (50%), Managing Member
II. SPECIFIC LOBBY ISSUE:
Certificate of Appropriateness for the construction of a new robotic parking garage at 1826 Collins Avenue,
including an accessory commercial space containing a restaurant, which will replace an existing surface parking
lot.
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: (Pursuant to City Code Section 2-482(g) include a
statement of the extent of any business, financial, familial, professional or other relationship, giving rise 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) An Financial, Familial or Professional Relationship
City of Miami Beach Historic Preservation Board None
City of Miami Beach Planning Staff None
City of Miami Beach Mayor/Commissioners None
City of Miami Beach Committees None
~yf
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER
HOURLY, FLAT RATE OR OTHER):
LOBBYIST DISCLOSURE: (Required) $3 000 Flat Rate.
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
(Required). $3,000 Flat Rate.
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 ®No• Are you lobbvina on a present or pendina bid for aoods equipment or services or on a
present or pendin4 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":
^Yes 6a No• Are you lobbvin4 on a pendina application for a Development Agreement with the Citv or
application for change of zoning map designation or chance to the City'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 snot-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..
^Yes ~ No• Are you representing anot-for-profit corporation or entity without special compensation or
reimbursement.
Signature of Lobbyist -Donald J. Washburn
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 the Miami Beach City Code and all reporting requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
^ Produced ID
Form of Identification
^ Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This _ day of , 2008
Signature of Public Notary -State of Florida
Notarization of Lobbyist's signature
TO BE COMP
Annual Registration fee: f 1 Yes t 1 No Amount Pa
Fonn received and verified by: _
>bvist Registration Form 32708.doc
PRINCIPAL IDENTIFICATION:
^ Produced ID
Form of Identification
Personally known (Principal)
State of Florida, County of Miami-Dade
Sworn to ands scribed before me
T ' day of ~I
~ DAYAMI AGUTAR
t ~
~ •- Notary Public -State of Fbrida
Sig ture f Public o a ;'r MbIiCl9nnrssian Expires Mar t8, 201t
Notarization of Princi a ~ Commission ~ DD 64032
'o,, of F~ ,.•` Bonded Th N
„~~~,~• rough ationalNotaryASSn.
ITY CLERK'S USE ONLY
V. SIGNATURE UNDER OATH:
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER
HOURtY, FLAT RATE OR OTHER:
LOBBYIST DISCLOSURE (Required) $3 000 Flat Rate.
B} PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
(Required). $3,000 Flat Rate.
The following infom~ration must be answered:
1 } Pursuant to Miami Beach City Code Section 2-488 Entitled °Prohibded Campaign Contributions By Lobbyists
On Procurement Issues":
^Yes 6a No• 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 Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On
Real Estate Development Issues":
^Yes ®No• Are you lobbying on a pending application for a Development Agreement with the City or
application for chance of zoning m~ designation or change to the City's Future Land Use Map?
3) Pursuant to Miami Beach City Code 2-484 (h) Any person (except those exempt from the definition of
"IobbyisY 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 Berk as required by this
section but, shall not be required to pay any registration fees..
^Yes ®No• Are you representing a not for-profit corporation or entity without special compensation or
reimbursement.
V. SIGNATURE UNDER OATH:
Signature of Lobbyist:
Signature of PrincipaUClient
Russell W. Galbut, as Managing Member of IC, LLC
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
~ ~ ~~ ~
q ~ ao a
~ ~ N ., Produced ID
c., c Form of Identification
~rs,~ AN o0
p ~ A w G ~ Personally known (Lobbyist)
~ ~~ o
~ ° `~ VII. SIGNATURE AND STAMP OF NOTARY:
~ y .~ y G
3;~ ~ ~ .~ State of Florida, County of Miami-Dade
~ ~ ~ r~a Sworn to and subscribed before me
a ~ This ~ day of 1a„ 2008
b
~ ~ ~~
z ~, Sig ure of Public otary - Stat Florida
Notarization of Lobbyist's sig ure
^ Produced ID
Form of Identification
^ Personally known (Principal)
State of Florida, County of Miami-Dade
Swom to and subscribed before me
This _ day of .2008
Signature of Public Notary -State of Florida
Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S USE ONLY
Annual Registration fee: [ ]Yes [ ] No Amount Paid f MCR !! i Date Paid
Lobbyist Registration Form received and verified by:
F:\CLERU.OBBYIST\Lobbyist Registration Form 32708.doc Revised 03/27/2008
I do solemnly swear that all of the for ng facts are true and c rrect and that I have read or am familiar with the
provisions contained in Section 2-482 o tF~e Miami B~ea~' C~ C~o`d~ and a~r~porting requirements.
m nniq,~;1iBEACH
City of Miami Beach. 1700 Convention Center Drive, Miami Beach. Florida 33139, :,
CITY CLERK office
Tel: 305.673.7411. Fax: 305.673.7254
LOBBYIST NAME:
Donald J. Washburn
I understand that no later than October 1e of each veer, 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 ewaluation_
In addition, once an issue 1 have registered to lobby on has been resolved, I am required to immediately notify the
City Clerk's Office for lobbyist withdrawal in writing.
~~ ~~~ January 12, 2009
Signature: Donal ashburn Date: