Eric B. Jassin/Collins Hotel Associates, LLCm M.IA.MIBEACH
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.
NAME OF LOBBYIST: (Last) (First) (M.I.)
Jassin Eric B.
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
Adache Group Architects, Inc. 550 S. Federal Hwy., Ft. Lauderdale, FL 33301
TELEPHONE NUMBER: FAX NUMBER: EMAIL
(954) 525-8133 (954) 728-8159 ejassin@adache.com
I. LOBBYIST RETAINED BY:
NAME OF PRINCIPAL/CLIENT:
Collins Hotel Associates, LLC
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
c/o Morgans Hotel Group Co. 1685 Collins Avenue, Miami Beach, FL 33139
Mark Tamis, Area Vice President
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
(305) 674-6182
Fill out this section if principal is a Corporation, Partnership or Trust [Section 282 (c)]
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Fred J. KleiSner, Interim President and Chief Executive
Officer
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: See Attached
II. sPECIFIC LOBBY IssuE: Flood Plain Management Board application for property located at 1690
Collins Avenue and 1685 James Avenue
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship
Mayor None
Commissioners
City Administration None
Cit Attorne 's Office
City Boards None
Cit Committees
MIADOCS 2384862 1
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHERf
A) LOBBYIST DISCLOSURE: (Required) ~ ~~~' ~~ ~f ~ f7U~
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). ~ ~~~• ~V ~ef ~) DU /
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 0~'No• Are you lobbvina on a present or cendina bid for goods equipment or services, or on a
present or cendina award for goods eauiument or service
2) Pursuant to Miami Beach City Code 2-490 Entitled ~~Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
^Yes ~IVo• Are you lobbvina on a cendina aoolication for a Development Agreement with the City or
~~~~~ation for chance of zoning map designation or change to the Citv'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 snot-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
sectipn but, shall not be required to pay any registration fees..
or reimbursement. .
V. SIGNATURE UNDER OATH:
ON OCTOBER 1~ 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 EXP NDIZU COMPENSATIO~1 DURING THE
REPORTING PERIOD.
Signatu obbyist
I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am
familiar with the provisions contained in S~ction -482 of the Miami Beach City Code and all reporting
requirements. ~~ ~ ~ w /~
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
^ Prod ed ID
Form of Identification
Personally known (Lobbyist)
PRINCIPAL IDENTIFICATION:
^ Produced ID
Form of Identification
^ Personally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of
This N~3L_~"""u~iav of
State of Florida, County of Miami-Dade
Sworn and subscribed before me
This day of . 20_
'e'.~' leuda-S Signature of Public Notary -State of Florida
signature Notarization of Principal's signature
Annual Registration fee: [ Yes [ ] No F LR C E~NMCR l~~ Date Paid
Lobbyist Registration Form received and verified b .
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM .do Revised 12/08/04
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHERt
A) LOBBYIST DISCLOSURE: (Required) ~ ~~~' D0 if~f ~ dUf
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). ~ 1$ ~• ~ V ~ef y r7U /
The following information must be answered:
1) Pursuant to Miami Beach Gty Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
^ Yes S'h'o Are you lobbvina on a Dresent or Dendina bid for goods eauioment or services or on a
Dream°nt or Dendina award for goods eauloment or ~rvice?
2) Pursuant to Miami Beach Gty Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
^Yes ~lo• Are you lobbvino on a Dendina aoDlication for a Development Agreement with the City or
a_nDlication for chance of zoning maD designation or chance to the C'ite's Future Land Use
MaD?
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 anot-for-profit
corporation or entity without special wmpensation 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
sectipn but, shall not be required to pay any registration fees..
or reimbursement. .
V. SIGNATURE UNDER OATH:
ON OCTOBER 1~ OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, LISTING LOBBYING IXPENDITURES, 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 IXP ND1iZU COMPENSATIO~1 DURING THE
REPORTING PERIOD.
Signatu ob 'st
I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am
familiar with the provisions contained in Section -48~ 2 of the Miami Beach City Code and all reporting
requirements. /~ ~ ~ ~"~~~ w ~1
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
^ Prad ed ID
Form of Identification
Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State'of
This 1-ll,~"'""4rJ,av of
signature
~
.
PRINCIPAL IDENTIFICATION:
~ •a+ i~
^ Produced ID ~~
/~ Form of Identification
f~Personally known (Principal)
~' v/j '+y
~
lA
~~00
State of Florida, County of Miami-Dade
Sworn subscri re me 8 ~
This day of v
~ N O
~
~
~
Signature of Pu lic No S e o Florida
Notarization of Principal's signature
FOR CLERK'S USE ONLY
Annual Registration fee: [ ]Yes [ ] No Amount Paid MCR # Date Paid
Lobbyist Registration Form received and verified by:
F:\CLER\$ALL\MAR]A-M\Lobbyist\LOBBYIST fORM 05.doc Revised 12/08/04
CITY OF MIAMI BEACH
Lobbyist Registration
- Disclosure of Interest for Collins Hotel Associates, LLC -
ENTITY
OF STOCK
*Morgans Group, LLC 100% of Collins Hotel Associates, LLC
*Morgans Group, LLC's managing member is Morgans Hotel Group Co., a publicly traded
company, which holds a 97.1 % interest in Morgans Group, LLC
MIADOCS 2384417 1