Donald J. Washburn (3)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 prinripal who seeks to encourage the
passage, defeat or modification of any ordinance, resolution, action or decision of any commissioner; any action,
derision, recommendation of the City Manager or any city board or committee; or any action, derision or
recommendation of any rity personnel during the time period of the entire derision-making process on such action,
derision or recommendation that foreseeably will be heard or reviewed by the city commission, or a dty bond or
committee. The term specifically includes the prinripal as well as any employee engaged in lobbying activities. The
term "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435.
Washburn Donald J.
NAME OF LOBBYIST: (Last) (First) (M.I.)
Go 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:
LOBBYIST RETAINED BY:
South Beach Resort Development, LLC
NAME OF PRINCIPAUCLIENT:
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 gene southbeachrd.com
TELEPHONE NUMBER: ~ FAX NUMBER: (Optional) EMAIL: (Optional)
Fill out this section if prinripal 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 Conditional Use Permit for Neighborhood Impact Establishment 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 2-482(8) include a
statement of the extent of any business, Fnanrial, 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 IndividuaVTlUe B An Financial, iqa r Professional Relationshi
City of Miami Beach Planning Board None -' -~ ~=~ n ~ ,' ~~;`~ `~, ,
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City of Miami Beach Planning Staff
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City of Miami Beach Land Use & Development None 6{~Qz
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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 6ZI 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":
I-lYes 15a No: Are you lobbying on a pending application for a Development Agreement with the City or
application for chance 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..
I-IYes 6a No: Are you representing anot-for-profit corporation or entity without special compensation or
reimbursement.
V. SIGNATURE UNDER OATH:
ON OCTOBER 15t 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 EXPENDITURES OR COMPENSATION DURING THE REPORTING
PERIOD.
Signature of Lobbyist -Donald J. Washburn
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 2-482 of the iami Beach City Code and all reporting requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI.
Louis Taic, ~ '"~ A~anager of So. Beach Hotel, LLC, on behalf of and as
Managing Memoer of South Beach Resort Development, LLC
LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
^ Produced ID
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 of Florida, C ~~Wiei -
Sworn t and sub ril~dY ogre meMARIA V. ERRICKSON
This ~o da ~gg Notary Public -State of Fbrida
• eMY Commission Expires Apr 10, 2010
=,~,~ `~~:' Commission # DD 526009
Signature of Publi ' nal Notary Assn.
Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S USE ONLY
Annual Registration fee: ]Yes [ ] No Amount Paid $ ._ R # $ Date Paid
Lobbyist Registration Form received and verified by:
F:\CLER\LOBBYIS11Lobb ist Re istration Form 32708.doc Revised 03/27/2008
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°:
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On
Real Estate Development Issues":
^Yes ®No• Are you lobbvina on a pendinct application for a Development Agreement with the City or
application for change of zoning map desiranation or change to the C~tv'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-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 Gerk 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:
Signature of Lobbyist:
Signature of PrincipaUClient:
Louis Taic, as aA
a ~ v~ a Managing Member of
ENTIFICATION
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VI. LOBBYIST ID
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~ ~ ~ ~ ~ ^ Produced ID
Form of Identification
~ N H ~' ~] Personally known (Lobbyist)
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VII. SIGNATURE AND STAMP OF NOTARY:
~
a
State of Florida, County of Miami-Dade
b Swom to and subscribed before me
z ~ 2009
This ~ day of
1
Si ture of Pu is Notary -State lorida
N tarization of Lobbyist's sig ure
TO BE COMPLETED
Annual Registration fee: [ ]Yes [ ] No Amount Paid ~
Lobbyist Registration Form n3ceived and verified by:
F~\CLERILOBBYISlILobbvist Registration Form 32708.doc
pal~of So. Beach Hotel, LLC, on
Beach Resort Development, LLC
PRINCIPAL IDENTIFICATION:
as
^ Produced ID
Form of Identification
^ Personally known (Principal)
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 Principal's signature
BY CITY CLERK'S USE ONLY
YP`Q ~ t
1 do solemnly swear that all of the foregoi facts are true and correct and that I have read or am familiar with the
provisions contained in Section 2-482 of a iami Beacl~City~ode end all reporting requirements.
m MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, vvww.miamibeachfl.pov
CITY CLERK office CityClerk(a~.miamibeachfl.pov
Tel: 305.673.7411, Fax: 305.673.7254
LOBBYIST NAME:
Donald J. Washburn
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: Donald ashbum Date: Apri120, 2009
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 % OF MEMBERSHIP INTEREST
SO. BEACH HOTEL, LLC
58 East 79th Street
New York, New York 10075
Managing Member
66 2/3%
GENE GRABARNICK 25%
& 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
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
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(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, L1ST 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
Z. 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
OF INTEREST
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