Don Washburn/1100 West Properties LLC
lD
MIAMI BEACH
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRA nON 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.
NAME OF LOBBYIST:
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(Last)
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(First)
(M.!)
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TELEPHONE NUMBER:
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EMAIL:
I. LOBBYIST RETAINED BY:
JJ 00 we~t (J'(7)fe{ tles
NAME OF PRINCIPAL/CLIENT:
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BUSINESS NAME AND ADDRESS (Number and Street)
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TELEPHONE NUMBER:
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(City)
'P.Jll/IJ.
J..I. ;aMi
(State)
FL :'3137
(Zip Code)
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:
~ '0 at 'Ao. "'" Pr . b<t.l \odr
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A S% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
~ A~cMt:d
II. SPECIFIC LOBBY ISSUE:
review a
Issue to b lobbied (Describe in de i :
a
00 UAt
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/Title
B) Any Financial, Familial or Professional Relationship
lYI\e.
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLA T RA TE OR OTHER):
The following information must be answered:
A) LOBBYIST DISCLOSURE: (Required)
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required).
1)
Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
~: Are you 10bbvinQ on a oresent or oendinQ bid for Qoods. eQuioment or services. or on a
oresent or oendinQ award for Qoods. eauioment or service?
DYes
2)
Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
~:
Are yOU 10bbvinQ on a oendinQ aoolication for a Develooment AQreement with the City or
aoolication for chanQe of zoninQ mao desiQnation or chanQe to the City's Future Land Use
Mao?
DYes
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
se .on but, shall not be required to pay any registration fees..
DYes
V. SIGNATURE UNDER OATH:
ON OCTOBER 1 Sf 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 FOR THE PRECEDING CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EX ITURES R COMPENSATION DURING THE
REPORTING PERIOD.
I do solemnly swear that all of the foregoing acts are true and correct and that I have read or am
familiar with the provisions c a ed in Sectio 2-482 of the Miami Beach City Code and all reporting
requirements. ~
Signature of Lobby~~
r...... . ure of Principal/Client:
i ~I 'i
. III ,. LOBBYIST IDENTIFICATION:
:~ ~ .;:
:l/C ~ r;; i ",,:
f918J:I i if D Produced ID
f~ 1 If D Personally known (Lobbyist)
:cr :
-w ~\_I""", .
f.... ~~,~p. SIGNATURE AND STAMP OF NOTARY:
. ."....~~.:-.
: ""~~;~~,""Siate of Florida, County of Miami-Dade
.................$vorn to and sub rib d bef e me
~O of , e1
PRINCIPAL IDENTIFICATION:
D Produced ID
Form of Identification
Form of Identification
D Personally known (Principal)
.............. .....1..... ..... ................
: JERI DEE GOODKIN :
S I.~;l,~ Comml 000475441 i
: I ~ ~~ Expira lII271200t !
State of Florida, County of Miami-Dap~~~ 80ndecIlhN (800)4~S
Sworn and ubscribed before me i....:~..:~~:.......FIoricIa..... Nolary A...... Inc .:
This 7 VI Y of 20Ci ......................
/"" FOR LE
Annual Registration fee: [ -....rYes [ ] No Amoun Pa.
Lobbyist Registration Form received and verified by'
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM 5 oc
ic otary - State of Florida
n of Principal's signature
Date Paid
Revised 12/08/04
CITY OF MIAMI BEACH
DEVELOPMENT REVIEW BOARD APPLICATION
DISCLOSURE OF INTEREST
1. LIMITED LIABILITY COMPANY
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 disclosures shall which discloses ~he
identity of the individual(s) (natural persons) having the ultimate ownership interest in the
entity).*
1100 WEST PROPERTIES, LLC
LIMITED LIABILITY COMPANY NAME
Name, Address, and Office
% OF STOCK
1 ] 00 West Holdings, LLC
(Sole Member of I ] 00 West Properties, LLC)
475 loth Avenue
c/o Morgans Hotel Group
New York, New York 10018
]00%
IF THERE ARE ADDITIONAL CORPORATIONS, LIST OTHERS, INCLUDING CORP.
NAME(S) AND EACH INDIVIDUAL'S NAME, ADDRESS, OFFICE AND PERCENT AGE
OF STOCK, ON A SEPARATE PAGE.
NOTE: Notarized signature required on page 8
6
CITY OF MIAMI BEACH
DEVELOPMENT REVIEW BOARD APPLICATION
DISCLOSURE OF INTEREST
1. LIMITED LIABILITY COMPANY
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 disclosures shall which discloses the
identity of the individual(s) (natural persons) having the ultimate ownership interest in the
entity).*
1100 WEST HOLDINGS. LLC
LIMITED LIABILITY COMPANY NAME
Name, Address, and Office
% OF STOCK
Mondrian Miami Investment, LLC
475 10th Avenue
c/o Morgans Group, LLC
New York, New York 10018
50%
Sanctuary West Avenue, LLC
c/o Hudson Capital
4770 Biscayne Blvd.
Suite 400
Miami, Florida 33137
50%
IF THERE ARE ADDITIONAL CORPORATIONS, LIST OTHERS, INCLUDING CORP.
NAME(S) AND EACH INDIVIDUAL'S NAME, ADDRESS, OFFICE AND PERCENTAGE
OF STOCK, ON A SEP ARA TE PAGE.
NOTE: Notarized signature required 011 page 8
6
CITY OF MIAMI BEACH
DEVELOPMENT REVIEW BOARD APPLICATION
DISCLOSURE OF INTEREST
1. LIMITED LIABILITY COMPANY
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, fmiher disclosure shall be required which disclosures shall which discloses the
identity of the individual(s) (natural persons) having the ultimate ownership interest in the
entity). *
MONDRIAN MIAMI INVESTMENT, LLC
LIMITED LIABILITY COMPANY NAME
Name, Address, and Office
% OF STOCK
Morgans Group, LLC
475 10th Avenue
New York, New York 10018
100%
IF THERE ARE ADDITIONAL 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
CITY OF MIAMI BEACH
DEVELOPMENT REVIEW BOARD APPLICATION
DISCLOSURE OF INTEREST
1. LIMITED LIABILITY COMPANY
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 disclosures shall which discloses the
identity of the individual(s) (natural persons) having the ultimate ownership interest in the
entity).*
MORGANS GROUP LLC
LIMITED LIABILITY COMPANY NAME
Name, Address, and Office
% OF STOCK
Morgans Hotel Group Co.
475 10th Avenue
New York, New York 10018
97.1%
Residual Hotel Interest LLC
c/o 475 10th Avenue
New York, New York 10018
2.9%
IF THERE ARE ADDITIONAL 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 Oil page 8
6
CITY OF MIAMI BEACH
DEVELOPMENT REVIEW BOARD APPLICATION
DISCLOSURE OF INTEREST
1. COMPANY
Ifthe 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), pminership(s) or other
similar entity, further disclosure shall be required which disclosures shall which discloses the
identity o[the individual(s) (natural persons) having the ultimate ownership interest in the
entity).*
MORGANS HOTEL GROUP CO.
COMP ANY NAME
Morgans Hotel Group Co. is a publicly held corporation.
IF THERE ARE ADDITIONAL CORPORATIONS, LIST OTHERS, INCLUDING CORP.
NAME(S) AND EACH INDIVIDUAL'S NAME, ADDRESS, OFFICE AND PERCENT AGE
OF STOCK, ON A SEP ARA TE PAGE.
NOTE: Notarized signature required on page 8
6
CITY OF MIAMI BEACH
DEVELOPMENT REVIEW BOARD APPLICATION
DISCLOSURE OF INTEREST
1. LIMITED LIABILITY COMPANY
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 disclosures shall which discloses the
identity of the individual(s) (natural persons) having the ultimate ownership interest in the
entity).*
SANCTUARY WEST A VENUE, LLC
LIMITED LIABILITY COMP ANY NAME
Name, Address, and Office
% OF STOCK
Sanctuary West Holdings, LLC
(Sole Owner of Sanctuary West A venue, LLC)
4770 Biscayne Blvd.
Suite 400
Miami, Florida 33137
100%
IF THERE ARE ADDITIONAL CORPORATIONS, LIST OTHERS, INCLUDING CORP.
NAME(S) AND EACH INDIVIDUAL'S NAME, ADDRESS, OFFICE AND PERCENT AGE
OF STOCK, ON A SEPARATE PAGE.
NOTE: Notarized signature required on page 8
6
CITY OF MIAMI BEACH
DEVELOPMENT REVIEW BOARD APPLICATION
DISCLOSURE OF INTEREST
1. LIMITED LIABILITY COMPANY
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 disclosures shall which discloses the
identity of the individual(s) (natural persons) having the ultimate ownership interest in the
entity).*
SANCTUARY WEST HOLDINGS, LLC
LIMITED LIABILITY COMPANY NAME
Name, Address, and Office
% OF STOCK
Sanctuary West Management, LLC
4770 Biscayne Blvd.
Suite 400
Miami, Florida 33137
95%
Gladys Brownstein
2.5%
Honey Waldman
2.5%
IF THERE ARE ADDITIONAL CORPORATIONS, LIST OTHERS, INCLUDING CORP.
NAME(S) AND EACH INDIVIDUAL'S NAME, ADDRESS, OFFICE AND PERCENTAGE
OF STOCK, ON A SEP ARA TE PAGE.
NOTE: Notarized signature required on page 8
6
CITY OF MIAMI BEACH
DEVELOPMENT REVIEW BOARD APPLICATION
DISCLOSURE OF INTEREST
1. LIMITED LIABILITY COMPANY
If the property which is the subject of the application is owned or leased bya 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 disclosures shall which discloses the
identity of the individual(s) (natural persons) having the ultimate ownership interest in the
entity). *
SANCTUARY WEST MANAGEMENT, LLC
LIMITED LIABILITY COMPANY NAME
Name, Address, and Office
% OF STOCK
Abraham Galbut & Nancy K. Galbut, his wife
4770 Biscayne Blvd.
Suite 400
Miami, Florida 33137
28%
Keith Menin
c/o 4770 Biscayne Blvd.
Suite 400
Miami, Florida 33137
18%
Daniel Galbut
c/o 4770 Biscayne Blvd.
Suite 400
Miami, Florida 33137
16%
Seth Frohlich & Kimberly Frolich, his wife
c/o 4770 Biscayne Blvd.
Suite 400
Miami, Florida 33137 .
8%
(continued to a second page)
IF THERE ARE ADDITIONAL CORPORATIONS, LIST OTHERS, INCLUDING CORP.
NAME(S) AND EACH INDIVIDUAL'S NAME, ADDRESS, OFFICE AND PERCENT AGE
OF STOCK, ON A SEPARATE PAGE.
NOTE: Notarized signature required on page 8
6
Robert N. Ga]but and Rita Ga]but, his wife
c/o 4770 Biscayne Blvd.
Suite 400
Miami, F]orida 33137
David Ga]but and Geta Ga]but, his wife
c/o 4770 Biscayne Blvd.
Suite 400
Miami, Florida 33137
Joan Brent
c/o 4770 Biscayne B]vd.
Suite 400
Miami, F]orida 33137
10%
]0%
10%
IF THERE ARE ADDITIONAL CORPORA TrONS, 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