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Steven V. Boucherwa-~~~ xu~.v~~s m MIAMIBEACH 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 aty personnel during the time period of the entire decision-making pnycess on such action, decision or recommendation that foreseeably will be heard or reviewed by the aty commission, or a aty bond or committee. The term specifically inGudes the prinapal as well as any employee engaged in lobbying adivifies. The term "Lobbyists" has specific exclusions. Please ref®r to Ordinance 2004-3435. Boucher Steven V. NAME OF LOBBYIST: (Last) (First) (M.I.) Boucher Brothers Management 420 Lincoln Road, # 265 Miami Beach, FL 33139 BUSINES~AM AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 535-8177 (305) 538-3288 svboucher~boucherbrothers. com TELEPHONE NUMBER: FAX NUMBER: EMAIL: LOBBYIST RETAINED BY: 1100 West Properties, LLC NAME OF PRINCIPAUCLIENT: Go Morgans Hotel Group 475 10"' Avenue ~ New York NY 10018 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) _(305-) 674-4848 N/A agalbut@hudcap.com TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) Fill out this section if prinapal is a Corporation, Partnership or Trust [Section 2.482 (c)] • NAME OF CWIEF OFFICER, PARTNER, OR BENEFICIARY: • IDENTIFY ALL PERSONS HOLDING, DIRECTLY CR INDIRECTLY, A 5% OR MORE OWNERSWIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: ~ a See Exhibit "A" attached. ~ ~. _,~, ~ ,~ ~- .-{ ~-' ~ ~ ~~ 11. SPECIFIC LOBBY ISSUE: =~ ;~ -o ~,~, Miami Beach Marine Authority Board Approval for Wave Runners ~ ~ .-~~ Issue to be lobbied (Describe in detail): -,-; ~ ~ ~..~ c= ~ '~' 111. CITY AGENCIESlINDIVIDUALS TO BE LOBBIED: (Pursuant to City Code Section 2-482(gj in~de 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) inducts 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 IndhrWuaUTitle B An Financial, Familial or Professional Relationshi City of Miami Beach Planning Board None City of Miami Beach Mayor/Commissioners None City of Miami Beach Committees None MIADOCS 3368783 1 IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER . HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) Ni7-)t -s? B) PRINCIPAL' DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). / ~ 4~t r2-- 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 6d No• Are you lobbvlna on a present or gendina bid for aoods eauipment or services or on a gn3sent 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 lobbvinn on a pending application for a Development Agreement with the City or application for chance of zoning map designation or chance 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 dark as required by this section but, shah not be required to pay any registration fees.. C]Yss ®No• Are you repnasentina anot-for-profit corporation or entity without special compensation or reimbursement. V. SIGNATURE UNDER OATH: Signature of Lobbyist: Signature of PrindpaUClient: Abraham Al. Galbut, President West Properties, LLC VI. LOBBYIST IDENTIFICATION: ^ Produced ID Form of Identification ® Personally known (Lobbyist) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade Swom a su before me This ~ of_; 2009 of TO BE Fomr rncalvoed and vetMad by: V. Boucher 1100 West Holdings, LLC, Manager of 1 PRINCIPAL IDENTIFICATION: ^ Produced ID Form of Identification ^ Personally known (Principal) State of~F-lo''ri~d~'a', ~C~o~~un~ty o~f MiamaDade '~aY P,~~~Y Of MI~JJI'ItN'1 C.} ~~-. No'f$'f~P~D11tr'Sta~te oi' bride • EMy Commissbn Expires May 17, 2009 Df Pu P I ~I da ~„ ,,.. MIADOCS 33667831 1 do solemnly swear that all of the foregoing facts are true and correct and that 1 have read or am familiar with the provisions contained in Section 2-482 of the Miami Beach City Code ancj.~U reporting requirements. IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOtlRLY, FLAT RATE OR OTHER): A) LO/B~B/YIST DISCLOSURE: (Required} /V OI'I~ B) PRINCIPALS 91SCLOSURE {OF LOBBYIST COMPENSATION): (Required). ~/~l~- The following information must be answered: 1) Pursuant to Miami Beach City Code Section 2-488 Entitled "F~rohibited Campaign Contributions By Lobbyists On Procurement Issues": I-7Yes ~ No: Are you lobbying on a present or pending bid for [roods. eauipment or services. or on a present ar pending award for Goods. eaulpment or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohlt~ited Campaign Contributions By Lobbyists On Real Estate Development Issues": ^Yes ba No: Are you lobbying on a pending application for a Development Agreement with the City or application for chance of zoning map designation or chance to the Cltv'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.. ^Yes ~ No: Are you representing anot-for-profit corporation or entity without special compensation or reimbursement. Signature of Lobbyist -Steven V. Boucher 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 atl reporting requirements. Signature of Lobbyist: Signature of Principal/Client: West Properties, LLC VI. LOBBY1S71DENTIFICATION: V. 8ouche of 1100 West Holdings, Manager PRINCIPAL IDENTIFICATION: ^ Produced ID Form of Identification ® Personally known (Lobbyist) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade Swom to and subscribed before me This _ day of , 2009 Signature of Public Notary -State of Florida Notarization of Lobbyist's signature ^ Produced ID ~ ,.~~~~•.,, ~ Form of Identification s.i F~ersonally known (Pr~nctpal} ~~ .;;'~`~ ~,~ n State of Florida, County of Miami-Dade n a <3 n and subscribe before me $ cis ~ ~ ~ Thi _ of( 2009 ~~~~ ~~~;~~ Signa o tary - tate o ~ ~~ NotaFiz~ati Principal's signature ~' a`~ TO BE COMPLETED BY CITY CLERIC'S USE ONLY Annual Registration fea: [ ]Yes [ ] No Amount Paid S MCR de ~ Date Paid Lobbyist Registration Form received and verified by: F:ICLER\LOBBYiST\Lobbylst Registration Form 32708.doc Revlaed 09 7!2008 MIADOCS 3366783 1 V. SIGNATURE UNDER OATH: m MIAMIBEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.oov CITY CLERK office Tel: 305.673.7411, Fax: 305.673.7254 CityClerk@miamibeachfl.gov LOBBYIST NAME: Steven V. Boudier t understand that no later than October 1" 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 alive lobbying issues. 1) Lobbyist F_xpenditure 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 for lobbyist withdrawal in writing. l`~ ~, 6~ Signature: n V. Boucher Date: MIADOCS 3366783 1 1100 WEST PROPERTIES, LLC OWNERSHIP STRUC7,URE 1100 WEST PROPERTIES, LLC 1100 West Holdings, LLC 100% (Sole Member of 1100 West Properties, LLC) 475 10th Avenue c/o Morgans Hotel Group New York, New York 10018 1100 WEST HOLDINGS. LLC Mondrian Miami Investment, LLC 50% 475 10"' Avenue c/o Morgans Group, LLC New York, New York 10018 Sanctuary West Avenue, LLC 50% c/o Hudson Capital 4770 Biscayne Blvd., Suite 400 Miami, Florida 33137 MONDRIAN MIAMI INVESTMENT, LLC Morgans Group, LLC 100% 475 10th Avenue New York, New York 10018 MORGANS GROUP LLC Morgans Hotel Group Co. 97.1 475 10th Avenue New York, New York 10018 Residual Hotel Interest LLC 2.9% (See attached c/o 475 10`'' Avenue flow chart) New York, New York 10018 MORGANS HOTEL GROUP CO. Morgans Hotel Group Co. is a publicly held corporation MfADO(.'S 28R4089 1 SANCTUARY WEST AVENUE, LLC Sanctuary West Holdings, LLC 100% {Sole Owner of Sanctuary West Avenue, L]~C) 4770 Biscayne Blvd., Suite 400 Miami, Florida 33137 SANCTUARY WEST HOLDINGS, LLC Sanctuary West Management, LLC 95% 4770 Biscayne Blvd., Suite 400 Miami, FIorida 33137 Gladys Brownstein 2.5 Honey Waldman 2.5 SANCTUARY WEST MANAGEMENT. LLC Abraham Galbut & Nancy K. Galbut, his wife 28% 4770 Biscayne Blvd., Suite 400 Miami, Florida 33 i 37 Keith Mersin 18% c/o 4770 Biscayne Blvd., Suite 400 Miami, Florida 33137 Daniel Galbut 1 G% c/o 4770 Biscayne Blvd., Suite 400 Miami, Florida 33137 Seth Frohlich & Kimberly Frohlich, his wife 8% c/o 4770 Biscayne Blvd., Suite 400 Miami, Florida 33137 Robert N. Galbut and Rita Galbut, his wife 10% c/o 4770 Biscayne Blvd., Suite 400 Miami, Florida 33137 David Galbut and Geta Galbut, his wife 10% c/o 4770 Biscayne Blvd., Suite 400 Miami, Florida 33137 Joan Brent 10% c/o 4770 Biscayne Blvd., Suite 400 Miami, Florida 33137 Nt~nnocs zss~+oa~> > ~• A N D _~ Z ~° o ~~ C ~ Q ~ a 'l7 N .-. ~ ~ a w n ~ m ~ ~ Q 3 w _ ~, d 6~ O _ . ~ ~ ~ O ~ ~ ~ .~ v Z ~ o / Q. ~ ~, z ~ ~~ ~ 3 ~ ~ ~ ~ . V N ~ J °~ J f D ca p ~ ~' v o ~ ~ = v cn O 2 ~? T \V S ~ c~ ~a ~ rr ° ~' 0 ~ ° ~ Q ~ r"' ~ o ~ ~ n ~ N J ``~ O` '^ D ~' T i ~ ~ ~/1 D N ~ c ~ 1~ o O ~ ~~ v . N m~ r r n r ~,' ~. N ~ ~ 3~ ~ _. ~x ° ~° a o a° n i ~ to ~~.. r n c ~ m C ~ s .~'+Dco~ N a -{ -+ IO y ~ ~ ~~~~. 7 ~' f~D v ~~~°~ gnu ~ N ~ ~ ~ ~~~3 (CQQ ~ _ CO ~ /~ O C ~ ~ N = ~ ~ C ~ C N ~ t~ ~ r r