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Zed CondorousisW RNt% /~ a nr>'>~ ~~S m 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. Condorousis Zed NAME OF LOBBYIST: (Last) (First) (M.I.) Boucher Brothers Management 420 Lincoln Road, # 265 Miami Beach, FL 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 535-8177 (305) 538-3288 Zcon@boucherbrothers. com TELEPHONE NUMBER: FAX NUMBER: EMAIL: LOBBYIST RETAINED BY: 1100 West Properties, LLC NAME OF PRINCIPAUCLIENT: c/o Morgans Hotel Group 475 10~h Avenue New York NY 10018 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305-) 674-4848 N/A agalbut@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: ~°J N See Exhibit "A" attached. .~ ~ ,.~.~ `~ ~ .. -_ ~ n II. SPECIFIC LOBBY ISSUE: ~~ ~- ~, -~ „~ Miami Beach Marine Authority Board Approval for Wave Runners ~ Issue to be lobbied (Describe in detail): "~ t°> 'c- .,., O III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: (Pursuant to City Code Section 2-482(8) include a statement of the extent of any business, financial, familial, professional or other relationship, giving rise 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 MIADOCS 3366795 1 IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) ~8~'I t B) PRINCIPAL'j~~ISCLOSURE (OF LOBBYIST COMPENSATION): (Required). /~ o-i~t-e.-- 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": ^Yss 6a No• Are you lobbvina 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": ^Yes ba No• Are you lobbvina on a osndina application for a Development Agreement with the Citv or application for chance of zoning map designation or chance 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 anot-for-profit corporation or entity without special compensation or reimbursement for the appearance, whether direct, or indirect, to express support of or opposifion to any item, shall register with the clerk as required by this section but, shall not be required to pay any registration fees.. DYes ®No• Are you representing a not for profit corporation or entity without special compensation or reimbursement. V. SIGNATURE UNDER OATH: I do solemnly swear that all of the provisions contained in Section 2-4 Signature of Lobbyist: ~ Signature of PrincipaUClient: id' correct and that 1 have read or am familiar with the Code and all reporting requirements. Produced ID r / ~ ~ ^ Produced ID Form of Identification Form of Identification ® Personally known (Lobbyist) VII. SIGNATURE AND STAMP OF NOTARY: ^ Personally known (Principal) State of Florida, ounty of Miami-Dade Sworr~ cribed afore me This fir!;! State oI Florida :4etcerNlay 17, 2009 Assn. Form received aed verlflad bbvist Registration Form 3271 State of Florida, County of Miami-Dade Swom to and subscribed before me This _ day of , 2009 Signature of Public Notary -State of Florida Notarization of Principal's signature MIADOCS 33667951 Abraham AI. Galbut, President of 1100 West Moldings, LLC, Manager of 1100 West Properties, LLC VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER}: A) LO'B`BYIST DISCLOSURE: (Required} !v $~ 2 B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). ~ Uyt_.~.. The following information must be answered: 1) Pursuant to Miami Beach City Code Section 2-488 Entitled "i'rohibited Campaign Contributions By Lobbyists On Procurement Issues": ^Yes ~ No: Are you lobbying 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 "ProhG:~lted Campaign Contributions By Lobbyists On Real Estate Development Issues": ^Yes ®No: Are you lobbying 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.. ^Yes ~ No: Are you representing anot-for-profit comoration or entity without special compensation or reimbursement. V. SIGNATURE UNDER OATH: PERIOD. Signature of Lobbyist -Zed Condorousis 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 2-482 of the Miami Beach City Code aid all reporting requirements. Signature of Lobbyist: Signature of Principal/Client: West Properties, LLC VI. LOBBYIST IDENTIFICATION: ^ Produced ID Form of Identification ® Personally known (Lobbyist) VIl. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade Sworn to and subscribed before me This ,day of , 2009 Signature of Public Notary -State of Florida Notarization of Lobbyist's signature 00 West Holdings, LLC, Manager of 1100 PRINCIPAL IDENTIFICATION: ^ Produced ID Form of Identification ..•••••••~ ~'~ Personally known (Principal) 8 ;'Qe-,-'~ ~`~ ~•S . ~ 9 State of Florida, County of Miami-Dade Swo t and subs ribed before me ~~ n y o• ~ "i ~zoas is ~. ~ ~ ~ ~ ~~,G~~ p Signatur ub N ary - ate f or a ~ c ~ ~ ;; ion of Principal's signature q ~, u, nov Y TO BE COMPLETED BY CITY CLERF: S USE ONLY Annual Registration fee: j ]Yes [ ] No Amount Pald; MCR ~ S Date Paid Lobbyist Registration Form received and verKled by: F:\CLERILOBBYISIIIobbyist Re~tration Form 32708.doc Revised 03/27 008 MIADOCS 3366795 1 m MIAMIBEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, F-orida 33139, www.miamibeachfl.gov CITY CLERK office Tel: 305.673.7411, Fax: 305.673.7254 CityC Jerk@m iami beachfl. qov LOBBYIST NAME: Zed Condorousis t understand that no later than ~gber 1" of eac~i vgar, 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 registe lobby on has been resolved, I am n3quired to immediately notify the City Clerk's Office for lobbyist withdra n writing. 3 /K /D~! ~: MIADOCS 33667951 1100 WEST PROPERTIES ,LLC OWNERSHIP STRUCTURE 1100 WEST PROPERTIES, LLC 1100 West Holdings, LLC 100% (Sole Member of 1100 West Properties, LLC) 475 10`h Avenue c/o Morgans Hotel Group New York, New York 10018 1100 WEST HOLDINGS. LLC Mondrian Miami Investment, LLC 50% 475 10(h 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 10"' Avenue New York, New York 10018 MORGANS GROUP LLC Morgans Hotel Group Co. 97.1 475 10`h Avenue New York, New York 10018 Residual Hotel Interest LLC 2.9% {See attached c/o 475 10"' Avenue flow chart) New York, New York 10018 MORGANS HOTEL GROUP CO. Morgans Hotel Group Co. is a publicly held corporation M[ADO(.'S 2884089 1 SANCTUARY WEST AVENUE, LLC Sanctuary West Holdings, LLC 100% (Sole Owner of Sanctuary West Avenue, L]~C) 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, h.is 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 tit~nnocs zas~os~> > N N C Q a v w N 0 0 y N fD N 0 ~ C ~ ~ t~lf Q _ ~ O/~ \V ~~ O ~, C ~ r r n C7 0 CO 0 Z ~_ 1 '~ .~ ~ C? CD Q. ~_ ~• /Z~ \^^J `J N '~ U1 D m~ r~ ~ ~- `. N r :v .~ ~v _~ v~ 0 v ~~ ro ~ m ~ _ ~, J m ro 0 D _z CQQ$ N ~ 3 72' v ~D ~ w ~ o ~ flj 'O ..+ wJ T T N S ~a 0 3_ mz a~ d o ~~ ~~ N m J N n ~~' ~. ~_ ~Da ~ ~~ m Q ~ ~a cn ~ 9 O ~ y a V~ 3 ~ J ~. ~T• T °o obi a a° ~ fD y .~.. r n c ~ ~ C '' ~ m ~~ r. Z y ~~Fr7~. m °} ~ ~ co m~ ~~ ~, cN~ 3 ~ ~ !D c~D dK ~ Nm -~~t cac~2 ~ ~_ CQ •G O ~_ _~ [~~] ~• ~M U} ~ ~ C ~ "S r* ~ r r