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Eric Bass/1200 West Avenue Lessee, LLCm MIAMIBEACH 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 bond 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. Bass Eric NAME OF LOBBYIST: (Last) (First) (M.L) c/o Morgans Hotel Group 475 10th Avenue New York N.Y. 10018 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (646) 229-2260 N/A eric.bass@morganshotelgroup.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: LOBBYIST RETAINED BY: 1200 West Avenue Lessee, LLC NAME OF PRINCIPAUCLIENT: 4770 Biscayne Boulevard, Suite 400 Miami Florida 33137 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305-) 674-4848 N/A sfrohlich@hudcap.com TELEPHONE NUMBER: 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: • IDENTIFY ALL PERSONS HOLDING, DIRECTLY CR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: See Exhibit "A" attached. ~..~ 0 "`t ca ~ co ~-~ b II. SPECIFIC LOBBY ISSUE: ~ i ~~ ~; W ,~„i Variance from Section 142-247 of the City Code ~., Issue to be lobbied (Describe in detail): -,., ,~ -.,., .~. III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: (Pursuant to City Code Section 2-48~(g) lude`~"a statement of the extent of any business, financial, familial, professional or other relationship, giving r to an appearance of an impropriety, with any City personnel sought to be lobbied; further, pursuant to City Code Section 2- 482(a)(4) include a statement of any contractual relationship (paid or unpaid) from 12 months preceding the commencement of service of City personnel to be lobbied.) A Full Name of Individual/Title B) An Financial, Familial or Professional Relationshi City of Miami Beach Planning Board None City of Miami Beach Mayor/Commissioners None City of Miami Beach Committees None 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 (Required). /? O~ jn a.~ ~1.~~.R.(S The following information must be answered: NSATION): 1). Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists On Procurement Issues°: ^Yes 6~ No• Are you lobbvinq on a present or pending bid for goods equipment 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": C1Yes ®No• Are you lobbvinq on a pending application for a Development Agreement with the City or application for chance of zoning map designation or chance to the City'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 anot-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.. nYes ®No• Are you representing anot-for-profit corporation or entity without special compensation or reimbursement. V. SIGNATURE UNDER OATH: Signature of Lobbyist: ~ ~~ E' Signature of Principal/Client: ~ F Seth Frolich, Vice-President of 1100 West Holdings, LLC, Managing Member 1100 West Properties, LLC, sole member of 1200 West Avenue Lessee, LLC VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: ^ Produced ID Form of Identification ® Personally known (Lobbyist) ~~~~\tuiitt/////~ VII. SIGNATURE AND STAMP OF It~~A~RaFNIFEq~,~~i~'% ~~pR (7~~`~y"•~~~ State of Florida, County of Miami-Dade ~: •• P ' SaQ~.: Sworn to and subscrib d before me ? ~ ; ~ ®~ This 2 day of , 2008 ®x; ' ~'~~DSS ® ~ TI ti • °a9 993 ~~' •' ]~ gnatu u N - _tate of Florid~?;:~ ~Tg7E OF F~-~~\~~``~ No nzati fist's signature ~~6°~//i!il1111~\~~`\ N ^ Produced ID Form of Identification personally known (Principal) ~\~~tuiuur/u~~ `~~~~`~ ~FER t^ag0 i~~i~4 ~~ ` ~ ' of Florida, County of Miami-Dade ~~c ~ GO~MtsstoN . q9 ~•~ t and sub cnb d fore me ~ ~ ~ QP 05, 20 ~~,• O~ ~ ~' 2008 day of ~ ?~, : P J~ . ~ 7rDD659913 °• \ •~ fg ure otary -State of Flori~p'v~,, •.?~, ~,,.>S ~° o~ ~ • Q " iza°fi f Pri 'al's signature „ ~ t s? Sta. i P- , . ~9 ~ E~ ` o~~`.` _5 '''~~ ~~ e ~ 1A1 ~ i~. TO BE COMPLETED BY CITY CLERK'S U5E ONLY ""'~~~" Annual Registration fee: [ ]Yes [ ] No Amount Paid $ MCR # $ Date Paid Lobbyist Registration Form received and verified by: F:\CLER\LOBBYIS'T~Lobbyist Registration Form 32708.doc Revised 03/27/2008 fie I do solemnly swear that all of the fore is are true and correct and that I have read or am familiar with the provisions contained in Section 2-482 t ~ Beach City Code and all reporting requirements. City of Miiami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov CITY CLERK office CityClerkCa~miamibeachfl.gov Tel: 305.673.7411, Fax: 305.673.7254 LOBBYIST NAME: Eric Bass I .understand that no later than October 1$` of each vear, I must file the following forms, 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 Form 2) Disclosure 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, I am required to immediately notify the City Clerk's Office for lobbyist withdrawal in writing. ~~ Signature: P Eric Bass Date: F.vhihit uA» 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. 97.1 475 10th Avenue New York, New York 10018 Residual Hotel Interest LLC 2.9% (See attached c/o 475 10th Avenue flow chart) New York, New York 10018 MORGANS HOTEL GROUP CO. Morgans Hotel Group Co. is a publicly held corporation MIADOCS 3029930 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 3029930 1