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Donald J. Washburn - HHG Holding I, LLLP 6o L 0ca114(1.4 d MIAMI BEACH 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 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 Donald J. NAME OF LOBBYIST: (Last) (First) (M.I) The Audio Bug, Inc. 3800 Hillcrest Drive, Unit 102, Hollywood, FL 33021 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 954-983-2788 954-983-2789 audiobua 1aaol.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: Please notify this office if your contact information changes:address,phone, or e-mail address. I. LOBBYIST RETAINED BY: Michael Wilkinas NAME OF PRINCIPAUCLIENT: HHG Holding I, LLLP 1111 Lincoln Road, 4th Floor Miami Beach FL 33139 BUSINESS NAME AND ADDRESS (Number and street) (Ulty) (State) (zip code) 416-889-3977 michael(a?wilkinas.com TELEPHONE NUMBER: FAX NUMBER:(Optional) EMAIL:(Optional) Fill out this section if principal is a Corporation,Partnership or Trust[Section 2-482(c)] crs • NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY: Michael Wilkinas(President of the General Partner) • IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST:See Attached Exhibit II.SPECIFIC LOBBY ISSUE:. �. Development Approvals and Permitting Issues, including, but not limited to Historic Preservation Board,Pleinnin and Board of Adjustment approvals for the property located at 605 Lincoln Road. '. rs..) Issue to be lobbied(Describe in detail): ' lll. CITY AGENCIES/INDIVIDUALS 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 Planning Department and Building Department Staff None. X PB, DRB, HPB, BOA, FP, City Commission, LUDC, and None. X Commission Committees, as necessary None. X 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 Alone. Alone. Alone. C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required)$4000.00 Flat fee B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): $4000.00 Flat fee (REQUIRED). 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)CNo: Are you lobbvina on a present or pendina bid for goods.eauioment or services.or on a present or pending award for aoods.eauipment or service? 2) Pursuant to Miami Beach City Code Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": Yes)CNo: Are you lobbvina on a pending application for a Development Aareement with the City or application for change of zonina map desianation or chanae to the City's Future Land Use Mao? 3) Pursuant to Miami Beach City Code Section 2-482(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 XNo: Are you reoresentina a not-for-profit corporation or entity without special compensation or reimbursements V. SIGNATURE UNDER OATH: ON FEBRUARY 28 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 EQB THE PRECEDING CALENDAR YEAR. A STATEAI T SHALL BE FILED •VEN IF THERE HAVE BEEN NO. EXPENDITURES OR •1/ - ►. _ • ► • : k • : -0::fa.. : •i /A" / /_ / / " /___e■ Signature of Lobbyist ir I do solemnly swear that all of t'- �•regoing facts are true an• correct and that I have read or am familiar with the provisions contained in Section 2-482 of the Miami - City Cod-- Ind al epo.tin! requi -m- .s. f �� Signature of Lobbyist: / L '-,rte - f - ......- Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: _ PRINCIPAL IDENTIFICATION: /Produced ID 1105= le'''1'"— Produced ID Form of Identification Form of Identification Personally known(Lobbyist) Personally known(Principal) VII. SIGNATURE AND STAMP OF NOTARY: State of • ida, County of Miami-D 044 Christine A.Brace State of Florida, County of Miami-Dade S •r • d sub cribed before 4�r, Sworn and subscribed before me T i r State of Florida .� d`�of A. 01-} This day of ,2014 irl _ `.4�My Commission Expires 04107/2010 Signature of Public Notary–State of Florida Commission No. FF 1 re of Public 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 Pald Lobbyist Registration Form received and verified by IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required)$4000.00 Flat fee B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): $4000.00 Flat fee (REQUIRED). . The following information must be answered: 1) Pursuant to Miami Beach City Code Section 2-488 Entitled"Prohibited Campaign Contributions By Lobbyists On Procurement Issues": _Yes XNo: Are you lobbying on a present or pending bid for goods.equipment or services.or on a present or pending ward_for goods.equipment or service?, 2) Pursuant to Miami Beach City Code Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": —Yes XNo: Are you lobbvina on a pendina application for a Development Agreement with the City or application for change of zoning man designation or chance to the City's Future Land Use Map? 3) Pursuant to Miami Beach City Code Section 2-482(h)Any person(except those exempt from the definition of"lobbyist"as set forth in Section 2-481 above) who only appears as a representative of a not-for-profit corporation or entity without special compensation or reimbursement for the appearance, whether direct, or indirect, to express support of or opposition to any item, shall register with the clerk as required by this section but,shall not be required to pay any registration fees. _Yes XNo: Are you representing a not-for-profit corporation or entity without special compensation or reimbursement, V. SIGNATURE UNDER OATH: - - OATH. LISTING LOBBYING EXPENDITURES. AS WELL AS COMPENSATION RECEIVED. IN THE CITY OF MIAMI BEACI-( EQa THE PRECEDING CALENDAR YEAR. A STATEL�,, T SHALL BE ILED EN IF THERE HAVE BEEN NO EXPENDITURES OR •li >, !► r ■ . 'e..� -' VfLIM$ . Signature of Lobbyist / I do solemnly swear that all of to 'oregoing facts are true an• correct and that I have read or am familiar with the provisions contained in Section 2-482 of the Miami :,-ach City Code=nd all eportin! requi -me 's. Signature of Lobbyist: .a r Signature of Principal/Client AL VI. LOBBYIST IDENTIFICATION: ` PRINCIPAL IDENTIFICATION: Produced ID J11/1/411"" ' l' `" Produced ID ONrke1 b c • Form of Identification Form of Identification ��° �►0 a he Personally known(Lobbyist) Personally known(Principal) ��� `1.(4 a VII. SIGNATURE AND STAMP OF NOTARY: 4,t7 c State of orida,County of Miami-D096 OMAN istii a A.Brain State of Florida,County of Miami-Dade o voF F��r Sworn and subscribed befo a me o�a , d sub cribed before _' , •,i �� state of Florida ! 2014' ? o i / :.1 it d-1 of •d. 4 01-': This_... da .a,(•,•1 , ,,,...�,.'.,,,� Ica `.:. . ,. _4.My Commission Expires 041071201: 1 ��► s;� o-/Ark Signature of Public Notary–State of Florida Commission fission N0.i'i=1 I;i4�1' re cif public Nota –State of Flgp6a °: �t/4 .: Notarization of j.obbvist's signature Notarization of principal's signature �'••,;, ���;.°••'� TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Reyistrativn fee; t ]Yes[ ]emu Arnuunt Pald$ MCR# Date Paid Lobbyist Registration Form received and verified by: M I AM I BEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov CITY CLERK Office Rafael E.Granado, City Clerk CityClerk @miamibeachfl.gov Tel: 305.673.7411 ,Fax: 305.673.7254 LOBBYIST NAME: Donald J. Washburn I understand that no later than February 28 of 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, or I am no longer lobbying on that issue or for that principal, 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. ‘0/ J1 April 27, 2015 Signature: f Date: C:\Users\clerhatRAppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc • • OWNERSHIP STRUCTURE • 60-:LiNCQ N'ROAD=UNITS DO0&2701 HttG Holding 1 lL1P ; :',. '' j - . . • HHG Developments Corp_ Howard Sitter HHG Management LLLP . gr l} Mel) . l's nerpd Partner ged Pormer • ie: 1FtT1 . ..� Howard Sitter W Capital Limited oward Sitt al 50%. 4 c9±6 49%. MIthaet-Will n gs Y lr . OWNERSHIP STRUCTURE 60 LINCOLN it O 1)-UNITS 800&270 - S 21kJt.1 ad, riir+il • • HI#iHg :llrgILLLP 1.311 Lincoln Road . tli1ri Floor • Miami Nadi,FL 33139 • . • .IHG�Managgitm r t:LLLla = H . .1111 tlrc&in FANO • 4thr Flcar - Miami Beach,;f,33139 HHIG e�perrerrelx Corp- - 111LncoInIRt4ad - . Lh Floor tt(tarrii Nr_cchr Ft.33139 VI Coital Limited • 14 Harkcitirm Street,3rtt 1 tY, Londe . '1S 1Y • Err nd . Harrafrd S1+i er 44a5 I gyoal F' n,A. 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