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Don Washburn - 1600 Collins Avenue LLC II MIAMI BEACH City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 3;Q�1��ES 19 API 11. i LOBBYIST REGISTRATION FORM C r fY I.,L� Fe S OF F I C F 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. Washburn Don NAME OF LOBBYIST: (Last) (First) (M.I) The Audio Bug 3800 Hillcrest Drive, Unit 102 Hollywood FL 33021-7937 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 954-983-2788 954-983-2789 audlobugl _-aol.com TE Please notify this office if your contact information changes:address,phone, or e-mail address. I. LOBBYIST RETAINED BY: 1600 Collins Avenue, LLC NAME OF PRINCIPAL/CLIENT: 1065 Kane Concourse, Suite 201 Bay Harbor Islands FL ) 33154 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305)866-7555 (305)866-7515 :robert(a-finvarb.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: Robert Finvarb • IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,PARTNERSHIP OR TRUST: III.SPECIFIC LOBBY ISSUE: Development aggrovals and Dermittina issues for one hotel 12roiect located at 1600.Collins Avenue, Miami Beach. Issue to be lobbied (Describe in detail): nl.CITY AGENCIEWINDIVIDUALS TO BE LOBBIED: 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 Tanning Department, Building Department and Public None Works Staff B, DRB, HPB, BOA, FP, City Commission, as None necessary* Pursuant to City Code Section 2-482(g)Every registrant shall be required to state the extent 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 None. F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required)$5,000.00 B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): (Required). $5.000.00 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 X No: Are You lobbying on a present or pendina bid for goods.equipment or services,or on a present or pending award for 929115,equipment or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": ❑Yes X N2: Are You lOUAM9 on a pendina application for a Development Agreement with the City or application for change of z2nina map 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"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,shall not be required to pay any registration fees. ❑Yes X 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 COMPENSATION RECEIVED, IN THE CITY OF MIAMI BEACH EXPENDITURES OR // G� Signature of Lobbyist I do solemnly swear that all of the foregoing facts are true an"grr rect and that I have read am familiar with the provisions contained in Section 2-482 of the Miami Beach City Code and all repo quizt Signature of Lobbyist: Signature of Principal/Client: VI. LOBBYIST ID NTIFICATI PRINCIPAL IDENTIFICATION: Produced ID ,�-L—4-) ❑ Produced ID Form of Identification Form of Identification \ILIII ❑ Personall known(Lobbyist) Personally knownL6 MAN \\61111/, (Principal)VI =oaY P a�;� GEORG:1ANA :olFlori]da SIGNATURE AND STAMP OF E-'�, \ r * Notary Pub ' NOTARY: ? ; � My Comm.ECommiss i,OF FL` State of Florid Co of Mi State of Florida, County of Miami-Dade �. Sworn to ad subscribed b fore me Sworn nd subscribed before me + This day f ,203 This da of a re of Publ –State of Florida Sin re of u ' Nota o g ry–State of Florida Nota ization of Lobbyist's signature Notarization o signature w TO BE COMPLETED BY CITY CLERK'S STAFF O/NLLY/ a Annual Registration fee: [ ]Yes[ o Amount Paid$ CR# ° Y'4e Date Paid ! �� Lobbyist Registration Form received and verified by: • P- ® NAIAMI BEACH City of Miami Beach, 1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.gov CITY CLERK Office CityClerk@miamibeachfl.gov Tel: 305.673.7411 ,Fax: 305.673.7254 LOBBYIST NAME: Don Washburn I understand that no later than February 28th ®f each year, I must file the following form, 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 and Compensation 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 of lobbyist withdrawal in writing. Pursuant to Section 2-485 (d), the City Clerk shall notify any lobbyist (or principal) who fails to timely file a Statement and in addition to any other penalties which may be imposed as provided in Section 2-485.1, a fine of $50.00 a day shall be assessed for all Statement(s) filed after the due date. The City Clerk shall notify the Miami-Dade County Commission on Ethics and Public Trust of the failure of a lobbyist (or principal) to file the Statement or pay the assessed fines after notification. Any lobbyist, who fails to file the required Statement by April 30th, 2012, shall be automatically suspended from lobbying until all fines are paid, unless the fine has been appealed to the Miami-Dade County Commission on Ethics and Public Trust. 1 A f� Signature: ate: FACLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc r• 't CITY OF MIAMI BEACH DEVELOPMENT REVIEW BOARD APPLICATION DISCLOSURE OF INTEREST 1,CORPORATION If the property which is the subject of the 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).* 1600 Collins Avenue,LLC, a Delaware Company _1065 Kane Concourse,Suite 201,Ball Harbor Iglands,FL 33154 Refer to Composite Ex)tibit B CORPORATION NAME and ADDRESS NAME,ADDRESS,AND OFFICE %OF STOCK PqVid B. C.Martins,Managing Member 50% 1065 Kane Concourse,Suite 201 Bay Harbor Islands,FL 33154 Sobe 1600,LLC,Managing Member 50% 1065 Kane Concourse, Suite 201 Bay Harbor Islands,FL 33154 Sobe 1600,LLC 1065 Kane Concourse,Suite 201,Batt Harbor Islands FL 33154 CORPORATION NAME and ADDRESS NAME,ADDRESS,AND OFFICE %OF STOCK RIF 1600,LLC 50% 1065 Kane Concoursg,mite 201 Bau Harbor Islands,FL 33154 _ Juliette M.Kleunach as Trustee of 50% Juliette M.K revootte trust 5551d.E.18511,Street Miami,EL 33179 RIF 1600 LLC 1 065 Kane Concourse,Suite 201,Bau Harbor Islands FL 33154 Robert Finvarb Family Investments 100% 1065 Kane Concourse,Suite 201 Bari Harbor Islands,FL 33154 Robert Finvar•b Family Investments 1065 Kane Concourse,Suite 201,Bay Harbor Islands FL 33154 R_obert and Rochelle.Flnuarf,Managing Members 100%as 1065 Kane Concourse,Suite 201 tenants bu the entirety Barg Harbor Islands,FL 33154 IF THEREA RE A DD17TONAL 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 x Prieto, Silvia From: Betty Llerena [bllerena @brzoninglaw.com] Sent: Tuesday, February 19, 2013 12:30 PM To: Prieto, Silvia Subject: 1600 Collins Avenue, LLC Attachments: 1600 Collins Avenue- Dol.pdf Importance: High Dear Silvia: Please see the attached with regard to the lobbyist registration forms filed this morning for Don Washburn and Joaquin Vargas. Please let me know if this is not what you need. Thanks! Betty Llerena Assistant to B. Fernandez&M. Entin Bercow Radell& Fernandez, P.A. 200 S. Biscayne Blvd.,Suite 850 Miami, FL 33131 305-377-6224 office 305-377-6222 fax www.brzoninglaw.com RCOW, -AIDELL&FERNANOU The information contained in this electronic message is privileged and confidential and is intended only for the use of the individual named above and others who have been specifically authorized to receive such. If the recipient is not the intended recipient,you are hereby notified that any dissemination,distribution or duplication of the communication is strictly prohibited. If you have received this communication in error,or if any problems occur with transmission,please immediately notify us by telephone(305)374-5300. 1 Miscellaneous Cash Receipt ;gE a � oil Mil# 'N OV MIAMI BEACH a ie Na r{ 5 Cl Gash DCredit Card `®`Check'# �: { ; v - c ;A Idee For .71 � i ` _ - _ _ - ' -• '��----'�'' `� fie, - MtSBE CMPETED)THIS INFORMATION tflce o"f'F"yi�na`n c e t ` Director T ,. - f4Aj -. J 7 Zj t XLFS fi ;Account� �r '.r _. t + � - .