David J. CovielloGv ~-v~ ~urvw en. 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 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.
Coviello David J.
--
NAME OF LOBBYIST: (Last) (First) (M.I.)
c/o Shutts & Bowen LLP 201 South Biscayne Boulevard, Suite 1500, Miami, FL 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 415-9437 (305) 415-9837 dcoviello@shutts.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
LOBBYIST RETAINED BY:
1100 West Properties, LLC
NAME OF PRINCIPAL/CLIENT:
c/o Morgans Hotel Group 475 10th 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 principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY CR INDIRECTLY, A 5% ~9R I1~!~RE
OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: ~ ~
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See Exhibit "A" attached. A ,. ~
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Miami Beach Marine Authority Board Approval for Wave Runners `: ,~..
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 IndividualITitle 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 3366724 1
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER
HOURLY, FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
Hourly - $275.00
B) PRINCIPAL'S DISCLOSURE {OF LOBBYIST COMPENSATION}:
(Required). Hourly-$275.00
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 lobbying on a present or pending bid for goods. eaufpment or services, or on a
present or pending award for Goods, eouipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohit~lted Campaign Contributions By Lobbyists On
Real Estate Development Issues":
^Yes ~ No: Are you lobbying on a pending appiicatlon for a Development Agreement with the Cltv or
appiicatlon for chance of zoning map designation or chance to the City's Future Land Use Map?
3) Pursuant to Miami Seach 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 i~ppears 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,.
rlYes 6a No: Are you rgpresenting anot-for-profit corporation or entity without special compensation or
reimbursement.
V. SIGNATURE UNDER OATH:
ON OCTOBER 1`~ OF EACH YEAR. EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH. LISTING LOBBYING EXPENDITURES, AS WELL AS f~OMPENSATION
RECEIVED IN THE CITY OF MIAMI BEACH FOR THE PRECEDINI3 CALENDAR YEAR. A STATEMENT SHALL
BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING
PEWOD. ~^-~ n .. n
Signature of Lobbyist -David J. Coviello
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: f ` ,
Abra am . Galbut, President of 11 0 est Holdings, LLC, Manager of 1100 ~C
West Properties, LLC
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: m ~..~~~~., ~
^ Produced ID
Form of Identification
x;'~ ' ~
^ Produced ID ~~'`•.; ~''•~
.~ ..•°
Form of Identification c F;' ~ y~
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® Personally know~~~}sy'(I~dC-STATE OF FLORIDA Personally known (Principal) ~ ~ 9 ~ "
' ~• 9
VII. SIGNATURE AEI„ ~,,,,,• o~~~~651416 n a ~ ~
State of Florida, County of. `-~~s~ MA~~ 23, 2011
5wom to ands ribs Tiif~ nxt~wnC aoarouvG ca, tNC,
This .day of , X008 C
t t s r-.,
re of Public Notary -State of Florida
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0
State of Florida, County of Miami-Dade ~ ~ v "'
Swo 4and subscribed before me A (~
kiay of „~~~~2009 c
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Sign to of Pub c Nota - Sta of o da
of Lobbyist^s signature :itlon of rincipat's signature
MPLETED
Lobbyfat Registration Form received and verl(led by: _
F:ICLER\LOBBYISlILobbyist Repistralion Form 32708.doc
MIADOCS 3366724 1
m MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.aov
CITY CLERK office CityClerkCa~miamibeachfl.gov
Tel: 305.673.7411, Fax: 305.673.7254
LOBBYIST NAME: David J. Coviello
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
City Clerk's Office for lobbyist withdrawal in writing.
Signature:
.3 C~ p
Date:
MIADOCS 3366724 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 10`h 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 10`h Avenue
New York, New York 10018
MORGANS GROUP LLC
Morgans Hotel Group Co. 97.1
475 10`h 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
M[ADOC.'S 2884089 ]
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, Florida 33137
Gladys Brownstein 2.5
Honey Waldman 2. S
SANCTUARY WEST MANAGEMENT, LLC
Abraham Galbut & Nancy K. Galbut, his wife 28%
4770 Biscayne Blvd., Suite 400
Miami, Florida 33137
Keith Mersin 18%
c/o 4770 Biscayne Blvd., Suite 400
Miami, Florida 33137
Daniel Galbut 16%
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
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