Florencia Gariboldi - 1100 West Properties, LLC 0./ Cfr
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City of Miami Beach Office of the City Clerk
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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.
Gariboldi Florencia
NAME OF LOBBYIST: _ (Last) (First) (M.i)
Mondrian South Beach 1100 West Avenue Miami Beach FL 33119 - -_
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305 - 627 - 2662 n/a florencia. gariboldi ®morganshotelgroup.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this = office if your contact information changes address, phone, or e-mail address,
1. LOBBYIST RETAINED BY:
1100 West Properties, LLC
NAME OF PRINCIPAUCLIENT:
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 i
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 OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST:
E Px)2Re .1t J §�'9 1 C tv � 6 l >a j �' C^C C C C .' - i '.
r �.
11.. PE IFI tAki ISSUE
Conditional Use Permit
Issue to be lobbied (Describe in detail):
111. 01,TY?A OtritelEtriN,DIVIDUALtItt a •
>tE L OBBIED.
Pursuant to City Code Section 2- 482(a)(4) include the commissioner or personnel sought to be lobbied, and whether the lobbyist has entered
into any contractual relationship (paid or unpaid) with said city commissioner or personnel from 12 months preceding such person's
commencement of service with the city to the present date, stating the general nature of the subject contractual relationship.
Sec 2- 482(a)(4) Full Name of Individual and Contractual Relationship (Explain) YES NO
title of person to be lobbied
City of Miami Beach Planning Board X
City of Miami Beach Mayor /Commissioners X
City of Miami Beach Committees X
Pursuant to City Code Section 2- 482(g) Every registrant shall be required to state the extant of any business, financial, familial or professional
relationship, or other relationship giving rise to an appearance of an impropriety, with any current city commissioner or city personnel who is
sought to be lobbied as identified on the lobbyist registration form filed.
Sec 2- 482(g) Any Financial, Familial or Professional Relationship 3 1
None 331i cti:z pro
C1-31\1-3J:38
q J (
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR
OTHER):
A) LOBBYIST DISCLOSURE: (Required)
Normal compensation
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
(Required). Normal compensation
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 ":
JJ Yes 0 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 2-4 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues ":
Yes ig No: Are you lobbying on a pending application for a Development Agreement with the City or application for
change of zoning map desionation or change to the City's Future Lpind Use Map?
2-484 3) Pursuant to Miami Beach City Code (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 a not - 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, ahall not be required to pay any registration fees.
� E
D Yes 12 No: Are you representing a not - for - profit corporation or entity without special compensation or reimbursement. .
V. SIGNATURE UNDER OATH:
ON FEBRUARY 28th OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER
OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPEN TION RECEIVED, IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE F ED Ati IF THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
i
Signature of Lobbyist
I do solemnly swear that all of the foregoing fa - true and correct and that I have read or am familiar with the rovisions contained
City •req uir ements
in Section 2-482 of the Miami Beach Cit Co.. Co . = and - p
. Alid,"01114
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICA ' I • N: PRINCIPAL IDENTIFICATION:
0 Produced ID
• ID
Form of Identification Form of Identification
Personally known (Lobbyist) • { Personally k • _ a z -, indi hIJ3 COLLADO
C. B. COLLADO 1 MY COMMISSION # DD864622
VII. SIGNATURE AND STAMP OF MY COMMISSION # DD864622 ,
• EXPIRES: February 25, 2013
• �' ' EXPIRES: February 25, 2013'
n. Notary Discount Assoc. Co.
State of Florida, County of Miami -Dade
1 -800.3- NOTARY F7. Notary Discount Assoc. Co. ' 800 -3 -NOTE
State of Florida, oun o iami -' ade
Sworn tp and subscribed ore me I Sworn and subscribed bef r me
This Wore d . �� of �A �
, 2011 • 1! This (q (day f , 2011
Sin - I}1,
g ature o ublic Notary — State of Florida Signature o_ b is Notary - State of Florida
Notarization of Lobbyist's signature Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ ] Yes [ ] No Amount Paid $ MCR # Date Paid
Lobbyist Registration Form received and verified by:
F: \CLER\$ALL\aFORMS \LOBBYIST FORMS \Lobbyist Annual Registration Form.doc ! Revised 1/11/2011
2011
•
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1:1 AA I AAA I BEACH
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City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida ;33139, www.miamibeachfigov
CITY CLERK Office ! cityClerk@miamibeachfl.gov
Tel: 305.673.7411 , Fax: 305.673.7254
Florencia Gariboldi
LOBBYIST NAME:
1 understand that no later than February 28th of each ear, I must file the following f
Y g orm, pursuant
to Section 2 -485 of the Miami Beach City Code, with the City Clerk's Office for all active ty act ve
issues.
1) Lobbyist Expenditure and Compensation Form
Failure to file these forms on a timely basis will result in l name Miami
-Dade
� m
�y ame .being transmitted to the Miami•Dade
County Commission on Ethics and for code violation evaluation.
In addition, once an issue 1 have registered to lobby, on has required to
g ; y, as been resolved, I am requi
immediately notify the City Clerk's Office of lobbyist :withtdrawal in writing.
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Signature: !
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1100 WEST PROPERTIES. ,ERTIES, LLC
OWNERSHIP STRUCTURE
1100 WEST PROPERTIES, LLC
1100 West Holdings, LLC • 100% .
Member of 11 0 West Properties, (Sole 0 LLC)
475 10 Avenue,:
c/o Morgans Hotel Group
New York, Newt York 10018
.1100 WEST HOLDINGS, LL'C
Mondrian Miami Investment LLC 50%
475 10 Avenue
c/o Morgans Grou , LLC
p ` •
New York, New, York 10018
Sanctuary West Avenue, ;LLC 50%
- c/o Hudson Ca
petal
4770 Biscayne Blvd., Suite 400
� a
Miami, Florida 33137
MONDRIAN MIAMI INVESTMENT.
Morgans Group, LLC ' 100%
475 10 Avenue
New York, New York 10018
MORGANS GROUP LLC
Morgans Hotel Group Co. j 97.1%
475 10 Avenue
New York, New York 10018
Residual Hotel Interest LLC 2.9% (See attached
� 2.9 /o
c/o 475 10 Avenue flow chart)
New York, New York 10018
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MORGANS HOTEL GROUP CO.
{
Morgans Hotel group Co. dis a ubiicl held corporation
p y rp
•
•
SANCTUARY WEST AVENUg, LLC •
Sanctuary West oldings LLC 100%
(Sole Owner of Sanctuary West Avenue, LLC)
4770 Biscayne Blvd., Suite 400 .
Miami, Florida 3 3 13 7
SANCTUARY WEST HOLDINGS, LLC
Sanctuary West 1VManagen ent, LLCM' 95%
4770 Biscayne Blvd., Suite 400
Miami, Florida 33137
Gladys Brownstein 2.5%
Honey Waldman
2.5% •
SANCTUARY WEST MANA LLC
•
Abraham Galbut :& Nancy K. Galbut, liswife 28%
4770 Biscayne Blvd.,• Suite 400
Miami, Florida 33137
Keith Menin 18%
c/o 4770 Biscayne Blvd., , Suite 400
Miami, Florida 33137
Daniel Galbut 16%
4770 Biscayne Blvd., Suite 400, •
Miami, Florida 33137
Seth Frohlich & Kimberl Frohlich his wife °
y s e 8 /o
• c/o 4770 Biscayne Blvd., 'Suite 400
• Miami, Florida 33137
Robert N. Galbut and Ri o
� d . to Galbut, his wife 10 /o
• c/o .4770 Biscayne Blvd., Suite 400'
Miami, Florida 33137
David Galbut and Geta Galbut, his wif 10%
c/o 4770 Biscayn,f 10 /o
e Blvd., Suite 400;
Miami, Florida 33137
Joan Brent 10%
i f
c/o 4770 Biscayne Blvd., Suite 400
Miami, Florida 33137
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