Donald J. Washburn (2)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,
deasion or recommendation that foreseeably will be heard or reviewed by the city commission, or a aty bond or
committee. The term specifically inGudes the princpal as well as any employee engaged in lobbying activities. The
term "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435.
Washbum Donald J.
NAME OF LOBBYIST: (Last) (First) (M.I.)
c/o The Audio Bug Inc. 3800 Hillcrest Drive Hollywood FL 33021-7937
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(954) 983-2788 (954) 983-2789 audiobug1@aol.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
South Beach Resort Development, LLC
NAME OF PRINCIPAL/CLIENT:
South Beach Resort Development LLC 420 Lincoln Road, Suite 357 Miami Beach Florida 33139
BUSINESS NAME AND ADDRESS .(Number and Street) (City) (State) (Zip Code)
(305) 672-4554 (305) 672-4553 genera southbeachrd.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: Louis Taic
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE
OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST:
See attached.
SPECIFIC LOBBY ISSUE:
Application for Variance to exceed allowable hours of operation of an outdoor bar counter through 2:OOam at 1458
Ocean Drive (a/k/a 1437 Collins Avenue), Miami Beach, Florida 33139.
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: (Pursuant to City Code Section 2~82(g) 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 IrtdividuaUTitle B An Financial, Familial or Professional Relationshi
City of Miami Beach Zoning Board of Adjustment None ~ .a ~ ~ ~ ~ 4 k# .i, ~ ~' ~
` ~
~ I
City of Miami Beach Planning Staff None ~ -
„
.
City of Miami Beach Mayor/Commissioners
City of Miami Beach Land Use & Development None
None $ ~ ' ~ ~ i ~ ~
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Committee
City of Miami Beach Committees None i..~ ~~ t,, ~ ~ µ,~ ~ ~~~
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER
HOURLY, FLAT RATE OR OTHER):
LOBBYIST DISCLOSURE: (Required) $5,000 flat fee.
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
(Required). $5,000 flat fee.
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 6a 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 "Prohibited Campaign Contributions By Lobbyists On
Real Estate Development Issues":
ayes ~ No: Are you lobbying on a pending application for a Development Agreement with the City or
application for change of zoning map designation or change 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 corporation or entity without special compensation or
reimbursement.
V. SIGNATURE UNDER OATH:
ON OCTOBER 1St OF EACH YEAR EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
PERIOD.
Signature of Lobbyist -Donald J. Washburn
I do solemnly swear that all of the foregoi
provisions contained in Section 2-482 gf'[ri
Signature of Lobbyist:
Signature of Principal/Client: \ ~
Managing
VI. LOBBYIST IDENTIFICATION:
^ Produced ID
facts are true and correct and that I have read or am familiar with the
liami Beach City Code and all reporting requirements.
Manager.. of So. Beach Hotel, LLC, on behalf of and as
k1~r of South Beach Resort Development, LLC
PRINCIPAL IDENTIFICATION:
Form of Identification
^ Personally known (Lobbyist)
VII. 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
^ Produced ID
Form of Identification
Personally known (Principal)
State i)f Florida, County of 'a i- a ~ _ _ _ _ _
Sworry~o and subsc ibed b re [r+s,,, MARIA V. ERRICKSON
This/ da of ~~'"~""~°--
Y ~.: Notary Public _ State of Fbrba
" ~ •My Commission Expires Apr 10, 2010
` -+ ~` Commission # OD 526008
Signature of Public Notary t ~ e~~ loi8deied By National Notary Assn.
Notarization of Principal' s n
/ TO BE COMPLETED BY CITY CLERK'S
Annual Registration fee: Yes r 1 No Amount Paid S ~S _MCRit A'.
Registration FoFm received and verified by: _
_OBBYIS71Lobbyist Registration Form 32708.doc
Revised 03/27/2008
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER
HOURtY, FLAT RATE OR OTHER):
LOBBYIST DISCLOSURE (Required) $5 000 flat fee
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B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
(Required). $5,000 flat fee.
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 ®No• Are you lobbyina on a present or pendina bid for aoods eauipment or services, or on a
present or pendina award for aoods, eauipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On
Real Estate Development Issues":
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 281 above) who only appears as a representative of snot-for-profd
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 representina anot-for-profit corporation or entity without special compensation or
reimbursement.
V. SIGNATURE UNDER OATH:
Signature of Lobbyist:
Signature of Principal/Client:
Louis Taic, as of So. Beach Hotel, LLC, on behalf of and as
Managing Member of South Beach Resort Development, LLC
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
^ Produced ID
Form of Identification
^ Produced ID
Form of Identification
[~ Personally known (Lobbyist)
^ Personally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Swom to and subscribed before me
This ~ day of ~:/ , 2009
State of Florida, County of Miami-Dade
Swom to and subscribed before me
This _ day of , 2009
S~fiature of Public Notary -State Florida
otarization of Lobbyist's sig turB
y,.
TO BE COh
Signature of Public Notary -State of Florida
Notarization of Principal's signature
CLERK'S USE
Form received and verlfled by: _
bbvist Registration Forth 32708.doc
I do solemnly swear that all of the foregor facts are true and correct and that I have read or am familiar with the
provisions contained in Section 2-482 oft e~Aiami BeactyEity CAde and) all reporting requirements.
CITY OF MIAMI BEACH
DEVELOPMENT REVIEW BOARD APPLICATION
DISCLOSURE OF INTEREST
1. LIMITED LIABILITY COMPANY
If the property which is the subject of an 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 discloses the identity of the individual(s) (natural persons) having the
ultimate ownership interest in the entity.*
SOUTH BEACH RESORT DEVELOPMENT, LLC, a Florida Limited Liability Company
LIMITED LIABILITY COMPANY NAME
NAME, ADDRESS, AND OFFICE
SO. BEACH HOTEL, LLC
58 East 79th Street
New York, New York 10075
Managing Member
OF MEMBERSHIP INTEREST
66 2/3%
GENE GRABARNICK
& PAULINE GRABARNICK,
HIS WIFE, AS TENANTS BY THE ENTIRETY
6480 Allison Island
Miami Beach, Florida 33141
Members
GARETT GRABARNICK
5700 Collins Avenue, No. 5L
Miami Beach, Florida 33140
Member
25%
8 1 /3%
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.
Last page must be signed and notarized
Page A-5(1)
CITY OF MIAMI BEACH
DEVELOPMENT REVIEW BOARD APPLICATION
DISCLOSURE OF INTEREST
1. LIMITED LIABILITY COMPANY
If the property which is the subject of an 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 discloses the identity of the individual(s)
(natural persons) having the ultimate ownership interest in the entity.*
SO. BEACH HOTEL, LLC, a Delaware Limited Liability Company
LIMITED LIABILITY COMPANY NAME
NAME, ADDRESS, AND OFFICE % OF MEMBERSHIP INTEREST
TRUST F/B/O THE CHILDREN OF CHANTAL 50%
AND LOUIS TAIC U/A DATED APRIL 2, 1998
58 East 79th Street
New York, New York 10075
Member
OCEANFRONT EQUITIES CORP. 50%
58 East 79th Street
New York, New York 10075
Member
LOUIS TAIC 0%
58 East 79th Street
New York, New York 10075
Manager
lF 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.
Last page must be signed and notarized
Page A-5(2)
CITY OF MIAMI BEACH
DEVELOPMENT REVIEW BOARD APPLICATION
DISCLOSURE OF INTEREST
1. CORPORATION
If the property which is the subject of an 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 discloses the identity of the individual(s)
(natural persons) having the ultimate ownership interest in the entity.*
OCEANFRONT EQUITIES CORP., a Delaware Corporation
LIMITED LIABILITY COMPANY NAME
NAME, ADDRESS, AND OFFICE % OF STOCK
LOUIS TAIC
58 East 79th Street
New York, New York 10075
President and Secretary
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.
Last page must be signed and notarized
A-5(3)
CITY OF MIAMI BEACH
DEVELOPMENT REVIEW BOARD APPLICATION
DISCLOSURE OF INTEREST
2. TRUSTEE
If the property which is the subject of an application is owned or leased by a TRUSTEE, list the
beneficiaries of the trust and the percentage of interest held by each. Where the
beneficiaries/beneficiary consist of corporation(s), another trust(s), partnership(s) or other similar entity,
further disclosure shall be required which discloses the identity of the individual(s) (natural persons)
having the ultimate ownership interest in the entity.*
TRUST F/B/O THE CHILDREN OF CHANTAL AND LOUIS TAIC U/A DATED APRIL 2 1998
TRUST NAME
NAME, ADDRESS, AND OFFICE
JASON TAIC
58 East 79th Street
New York, New York 10075
Beneficiary
ALEXANDER TAIC
58 East 79th Street
New York, New York 10075
Beneficiary
STEFANIA TAIC
58 East 79th Street
New York, New York 10075
Beneficiary
LOUIS TAIC
58 East 79th Street
New York, New York 10075
Trustee
OFINTEREST
1/3
1/3
1/3
0%
3. PARTNERSHIP/LIMITED PARTNERSHIP
If the property which is the subject of the application is owned or leased by a PARTNERSHIP or
LIMITED PARTNERSHIP, list the principals of the partnership, including general and limited partners.
Where the partner(s) consist of other partnership(s), corporation(s), trust(s) or other similar entity,
further disclosure shall be required which discloses the identity of the individual(s) (natural persons)
having the ultimate ownership interest in the entity*
NOT APPLICABLE
PARTNERSHIP or LIMITED PARTNERSHIP
NAME, ADDRESS, AND OFFICE % OF STOCK
N/A N/A
Last page must be signed and notarized
A-6