Don Washburn - Philips So Beach
aty of Miami Beach Office of the aty aerk
1700 Convention Center Drive, Miami Beach, FL 33139
Email: dtyderk@d.miami-beach.ft.us
LOBBYIST REGISTRATION FORM
RECE\VED
03 AUG 26 PM 12: 02
CITY CLERK'S OFF ICE
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(aty of Miami Beach, Oty Code Olapter 2, Division 3, Section 2-481)
a Check Box if an Amendment
VVashburn ])on
NAME OF LOBBYIST: (Last) (First) (M.!) DATE QUAllFIED AS LOBBYIST
1180 N.E. 165 Street, North Miami Beach, FL 33162-3847
BUSINESS ADDRESS: (Number and Street) (aty) (State) (Zip Code)
305-945-6313 305-945-0992 Audiobug l@ao1.com
laEPHONE NUMBER: FAX NUMBER: EMAIL:
L LOBBYIST RETAINED BY:
Philips South Beach LLC d/b/a The Shore Club
NAME OF PRINOPALlCUENT:
1901 Collins Avenue, Miami Beach, FL 33139
BUSINESS ADDRESS: (Number and Street) (aty) (State) (Zip Code)
305-695-3236 305-695-3255 matt.pargament@ianschragerhotels.com
TElEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
Fill out this section If prIndplll Is e CorporetIon, Partnership or Trust [SectIon 2-482 (e)]
. NAME OF CHIEF OFFICER, PMTNER, OR BENEFIOARY:
See attached.
. UST ALL PERSONS HOLDING, DIREcny OR INDIREcny, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR lRUST:
See attached.
D. SPECIFIC LOBBY ISSUE:
SkyBar
Issue to be lobbied (Desaibe in detail):
m. arY AGENCES/INDIVIDUALS TO BE LOBBIED:
A) Full Neme or lndIvIduel/11tle B) Relationship
City Administration, City Attorney's Office, Mayor & City None
Commission, City Boards and Committees, if permissible
~v. II~~_ ur II:KI"I::I ANII Al"lUUNI::I ur LUDDY.&::II "UI'I_N~ I ~U" \II~LU::II: wnl: I nl:K nuu,u..',
FLATRATEOR OTHER):
A) LOBBYIST DISCl.OSURE: _1-1 J tl (l. ( y
FEE
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~T"'tJ
B) PRINCIPAL'S DISCl.OSURE (Of LOBBYIST COMPENSATION):
UOG{{Ll Y' iEt:
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1)
pu~nt to Ordinance No. 2003-3393 Amendina Miami Beach Otv Code Chaoter 2. Article vn. DMsion 5
The f Entitled "Camoaian Finance Reform" Via The Addition Of Code SectIon 2-488 Entitled "Prohibited
Camoaian Contributions BY Lobbvists On Procurement Issues":
:::e O:::i~Gb=:,O;;': ==~~i='::~:~~:UI~nt or sentices. or on a Dn!S8nt
2)
i~r:nt to ~inance No. 2003-3395 Amendina Miami Beach CitY Code Chaoter 2. Article VII DMsion 5
___{ Entitl_ "Camoaian Finance Reform". Via The Addition Of Code Section 2-490 Entitled "Prohibited
Camoaian Contributions BY Lobbvists On Real Estate Develooment Issues":
A:revo~u 10~nG on a _ndinG aDDllcation for a DeveloDment AGreement with the Citv or
~_ I_Nr chanae of zonina maD desiGnation or chanae to the CitY's Future Land Use MaD?
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V. SIGNATURE UNDER OATH:
ON OCTOBER 151 OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, USTlNG LOBBYING EXPENDITURES IN THE CITY OF MIAMI BEAOI FOR
THE PRECEDING CALENDAR YEAR.
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
){ Produced Ioft.~~.. KlJ./ b -/Cjb-4~ -ltt1f - D 0 Personally Known
Form of Identification
Signature
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OF f\.O MAY 8,2006 FORCLERK'S USE ONLY
_, [)f ACCEPTID [ ] REJECTED ""TE' ~ - 'li, - ~ '7
If rejected, staJ r:a~: - 9/- ., 31 LL
Registration fee paid:Wes _ [ ] No [ ] Cash [~ Check M~Y; I
DATA ENTRY DATE: ~ 2003 ENTERED BY:
2nd Revision 3/18/03 F:' \HAll\lobbyi5ts\registrationa03.doc
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