Don Washburn/1100 West Properties, LLCm MIAMIBEACH
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REt~STRATION FORM
Lobb~y~st means ant persons employed or gained, wtgh~r paid ~ rat, by a prindpai who seeks fio encourage the
passage, defeat or mo~fication of arty ordinance. reso)v#ion, action or decision of any commissioner; arty action,
decision, reoomrrierxfa~ion of the City Mager' or any cih- board or committee; or any action, deas~n or
reoomme~ion of any ~Y P ~R4 ~ tkrrre P~ of the errtire vision-making Prnaess on such action.
deasion or reaommerrdaton ttrat to-Iy wiA be heard or reviewed by the aty oorrrrnissnon, or a cdy bond or
committee. The Perm speaft~dly inc~des the prinapal as well as any employee engaged ~ krbbying ac~ivitres. The
term ~.La~l~., has specific ems. Please refer to Ordit~srnoe 2004-3435.
Washburn Don
NAME OF LOBBYIST: (Last) (First) (M.1.)
c% The Audio Bug Inc 38~ Hilkxest Drive, Unit 102 Hollywood, FL 33021
BUSINESS NAME AND ADDRESS (Number and 5tr+g) (City) (State) (Zrp Code)
(954) 983-2788 (954} 983-2789 audiobugl@aol.com __
TELEPHONE NUMBER: FAX NUMBER: EMAIL
LOBBYIST RETAINED BY:
1100 West Properties, LLC
NAME OF PRINCIPAUCLIENT:
c/o Morgans Hotel Group 47510"' Avenue New York NY 10018
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zrp Code)
(305} 674-4848 WA agalbut~twdcap.oom
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
Fdl art ti>iss section if principal is a Corporation, Partrterstap or Tnrst [Ser:tion 2.482 (c)]
NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Rabinder Pal Singh ark Jay Stein
+. IDENTIFY Ali PERSONS HOLDING, DIRECTLY CR INDIRECTLY, A 5% OR MORE
OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST:
See Exhibk "A attached.
q. SPEgFIC LOBBY ISSUE:
Conditional Use Permit
Issue to be lobbied (Describe in detaiq:
~ qN A TO BE LOBBIED: (Pursuant to City Code Section 2-482(9) ~indude a
statement of the extent of arty bersiness, finaru~, tam~al, p~ or other gationshiP, 9mn9 rise to an
a~ppearanoe of ~ impropriety, with any City per'soruret sought to be bbbied; fwther, Ptirsuarrt to City Code Section 2-
482(a)(4) irtc~de a statement of any oontracbuai reap (paid or unpaid) from 12 months preceding the
oommerrceg of service of City per'sorxg to be .) .
A r-uM Madre df trldividnaYTlfie B t=~nilW dr Prdessiottal Relationafri
City of Miarr4 Beach Planr>Mg Board Noce
City ~ Miarrri Beach Gomm~ees None ~ ~ ! _? ."~ ~ s , ~'; ~; ~ ~ ~ ~, '~' I ~
t_E ~1 Nd LZ
MI/4DOCS 31137071 ~~~ :„"1 /~ 1 ~ ~ ~ _'~
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER
HOURLY, FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
B} PRINCIPAL'S. DISCLOSURE (OF LOBBYIST COMPENSATION}:
(Required). 3~ y ~~T Oo
The following information must be answered:
1) Pursuant to Mlaml Beach Clty Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues':
nYes ®No• Are you lobbvlna on a present or pending bid for goods eauipment or services or on a
present or pending award for Goods, equipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On
Real Estate Development Issues":
^Yes ~ No• Are you lobbyina on a pending~applicatlon for a Development Agreement with the City or
application for chance of zoninsl map designation or chance to the Cltv's Future Land Use Map?
3) Pursuant to Miami Beach City Cade 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 gnat-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 ~ No• Are you representing snot-for-profit corporation or entity without special compensation or
reimbursement.
E
Signature of Lobbyist -Don Washburn
I do solemnly swear that all of the foregoing facts are true and correct and that 1 have read or am familiar with the
provisions contained in Section 2-482 of the Miami Beach City Code and all reporting requirements.
Signature of Lobbyist:
Signature of Principal/Client:
graham AI. Galbut, F
West Properties, LLC
VI. LOBBYIST IDENTIFICATION:
^ Produced ID
Form of Identification
^ Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Swam to and subscribed before me
This __,_ day of , 2008
Signature of Public Notary -State of Florida
Notarization of Lobbvlst's signature
E
of 1100 West Holdings, LLC, Manager of 1100
PRINCIPAL IDENTIFICATION:
^ Produced ID
Form f Identification
^ Personally known (Principal)
NOTARY PUBLIC - STATE OF FLORIDA
State of ~~ o'""o
ounty_ 'MdA~aistian
Swam to and subscribed bL i+Cotlunission #DD651416
This ~ day of by~ • , 20 •••'~ F~P~s: MAR. 23, 2011
_ p , ~ ~ t BONDED THRU ATLANTfC BONDING CO., INC.
S U e of Public Notary'-- Sts^yte of N~eraN F~C~d>~-
Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S USE ONLY
Annual Registration fee: [ ]Yes (] No Amount paid $ MCR # $ Date Faid
Lobbyist Registration Form received and verified by:
F~ICLERILOBBYIST1Lobbyist Registration Form 32708.doc Revised 03127!2008
MIADOCS 3113707 1
V. SIGNATURE UNDER OATH:
iiy rrf A?9iami BsacY~, 9704 :Unvr ntian Gentesr ~rrve, tvliarr~i ir3earJi, Ftorufa 33139,
fit,., .., ; !?~ t~i~f~L9.
.~ ~ ~ ~ l3. ~ ~' 1. Fa.z: ~5_~ 7.72.54
LC)E~8"f;Sl' NAME.
t..'QC? V~aSh~}Ilt`t1
i undErstarxi That n~ later thar9 t3c~o#rt3r 4"` csf each veer !mint ;lie ttft~ foliuwir9g forms, pursuant t~s 5ection 2-4$~ of
the F~iami Beach Cif' Ccxie, with the City CterKs C+#fice fir all a~~v~; iobt~~iag issue.
~} t_cbbyi5t Ex~endit,:re ~t~rr~i
~) ()~~,c.'c~.>r9rE9 Farrr9
~aiiur=~ to tilt thYast~ ft~rms can a tim~:iy basis will result in y carne be(nc~ transmitted ht tF~e Miami°Dade~Gounty
~~rnmiSSipn tin i<thics and for code viola6at~ ev~usiiono
ire ~:~ #it~:~n ~n<;e ar9 issue t hr~v~ registered to r t»'r Fins Fay reaitv~t, atn required t4 itntnediately notif~t the
C ~ ~ ~.: Ir>ri;'fi t~ffice for lobbyist withtSrawat in writitttj,
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Signature: ,.
~~~
(~ct~ber 23, ~t$
Date:
MiAt7~X:S ~1137t)7 1
1100 WEST PROPERTIES, LLC
OWNERSHIP STRUCTURE
1100 WEST PROPERTIES, LLC
1100 West Holdings, LLC 100%
(Sole Member of 1100 West Properties, LLC)
475 10th Avenue
c/o Morgans Hotel Group
New York, New York 10018
1100 WEST HOLDINGS, LLC
Mondrian Miami Investment, LLC 50%
475 10th Avenue
c/o Morgans Group, LLC
New York, New York 10018
Sanctuary West Avenue, LLC 50%
c/o Hudson Capital
4770 Biscayne Blvd., Suite 400
Miami, Florida 33137
MONDRIAN MIAMI INVESTMENT, LLC
Morgans Group, LLC 100%
475 10th Avenue
New York, New York 10018
MORGANS GROUP LLC
Morgans Hotel Group Co.
475 10th Avenue
New York, New York 10018
Residual Hotel Interest LLC
c/o 475 10th Avenue
New York, New York 10018
MORGANS HOTEL GROUP CO.
Morgans Hotel Group Co. is a publicly held corporation
97.1
2.9% (See attached
flow chart)
MIADOCS 2884089 1
SANCTUARY WEST AVENUE, LLC
Sanctuary West Holdings, LLC 100%
(Sole Owner of Sanctuary West Avenue, LLC)
4770 Biscayne Blvd., Suite 400
Miami, Florida 33137
SANCTUARY WEST HOLDINGS, LLC
Sanctuary West Management, LLC 95%
4770 Biscayne Blvd., Suite 400
Miami, Florida 33137
Gladys Brownstein 2.5%
Honey Waldman 2.5%
SANCTUARY WEST MANAGEMENT, LLC
Abraham Galbut & Nancy K. Galbut, his wife 28%
4770 Biscayne Blvd., Suite 400
Miami, Florida 33137
Keith Menin 18%
c/o 4770 Biscayne Blvd., Suite 400
Miami, Florida 33137
Daniel Galbut 16%
c/o 4770 Biscayne Blvd., Suite 400
Miami, Florida 33137
Seth Frohlich & Kimberly Frohlich, his wife 8%
c/o 4770 Biscayne Blvd., Suite 400
Miami, Florida 33137
Robert N. Galbut and Rita Galbut, his wife 10%
c/o 4770 Biscayne Blvd., Suite 400
Miami, Florida 33137
David Galbut and Geta Galbut, his wife 10%
c/o 4770 Biscayne Blvd., Suite 400
Miami, Florida 33137
Joan Brent 10%
c/o 4770 Biscayne Blvd., Suite 400
Miami, Florida 33137
MIADOCS 2884089 I
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