Donald J. Washburn - 2228 Park Avenue, LLC i
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. .0_ MIAMIBEACH
O City. of Mia i Beach Office of the City Clerk
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170 Conventio Center Drive, Miami Beach, FL 33139 .
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LOB MIST 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, acticn or decision of any commissioner; any action, decision, recommendation of the
City . Manager or any city board or committee; or any action, deacon 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 he or reviewed
by the city commission, or a city board or committee. The term specifically indudes the principal 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)
The Audio Bug, Inc. 3800 Hillcrest Drive,' #102 Hollywood ;Florida 33021
BUSINESS NAME AND ADDRESS (Number and Street) (City} (State) (Zip Code)
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(954 ) 2E3-2788 (9541983 -2789 audiobuai(aaoi.com
TELEPHONE NUMBER: FAX FAX NUMBER: EMAIL:
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I. LOBBYIST RETAINED BY:
2228 Park Avenue, LLC, contact: Todd Glaser, Managing Member
NAME OF PRINCIPAL/CLIENT:
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,2228 Park Avenue. LLC P.O. Box 02249 Miami Beach Ronda 1 ! 33140
BUSINESS NAME AND ADDRESS (Number' and Street) (City) (State) I (Zip Code)
(786) 208 -2113 (305) 538 -4302 tmgeng64 @aoi.com
• TELEPHONE NUMBER: I FAX NUMBER: (Optional) EMAIL: (Optional)
Fill out this section if principal is a Corpo on, Partnership or Trust [Section 2-482 (c)]
• NAME OF CHIEF OFFICER, PARTNER, 0 BENEFICIARY: Todd Glaser, Managing Member
• . IDENTIFY ALL PERSONS ,HOLDING, DI ECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRU See Exhibit A
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II. SPECIFIC LOBBY ISSUE: j
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Development approvals for conversion of two 4-story townhouses to a restaurant and entertainment establishment located at 2228
Park Avenue !I
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES /INDIVIDUALS TO BE LOBBIED: C'°) rV
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A) Full Name of Individual /Title B) Any. Financial, Familial or Professional Relatihip� fri
Planning Department Staff, HPB, BOA, Planning Board and .z;
Oty Commission* None cr; .,,
• * Unless an i ssue is legislative In nature, HPB, BOA, Planning Board, and Oty Commission members are not lobbied outside of a public hearing setting.
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IV. DISCLOSURE OF TERMS AND AMO NTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) 4,000.00
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B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST CO PENSATION): (Required). S 1 Z 2 2 a U
• T he following information must be an ered:
1) Pursuant to Miami Beach City Code Section 2 -488 Entitled "Prohibited Campaign Contributions 'By Lobbyists
On Procurement Issues ":
❑ Yes X No: Are you lobbvina on a present or pending bid f or g eq uigment 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 X No: Are you lobbvino on a pend`ir a applicat fora Development Agreement with' he City or
application for change of zoning mar 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 th i definition o
"lobbyist" as set forth in Section 2-481 above) who only appears as a representative of a not - for - profi t
corporation or entity without special compensation or reimbursement for the appearance, whether direct, o
indirect, to express support of or opposition to any item, shall register with the clerk as required by thi
section but, shall not be required to pay any registration fees..
O Y es X Jim jirs you representinm a not - for -profit c orporation or e ntity without special compensation
or reimbursement. I
V. SIGNATURE UNDER OATH:
ON OCTOBER 1 OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY .CLERIX A SIGNED
STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION
• RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALEN AR YEAR. A STATEMENT
SHALL BE FILED .EVEN IF THERE HAVE BEEN NO PENDITUR - - R PENSA ON DURING THE
REPORTING PERIOD. / /
4..—/A1 LfA r . `�..i/
•' re of Lobbyist
I do solemnly swear that all of the fo egoing facts are true and ! correct and that I have read or :arn
familiar with the provisio , ontained i , Section 2 '82 of the Miami Beach City Code and all reporting
requirements.
Signature of Lobbyist: ..o. / 14 4 / ,,i 4 1 �r..,t
Signature of Principal /Client: /�
:; ; : •. ; ; {. VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: 1
f � Prod uced ID W 1 q tl'7 944--C)
._ a • Produced ID
s Q a F orm of Identifi • - lion .. L
Form of Id • R. :..�.: - � �.
�
4;17.` ,Ii DAM
8 x "" Personally known (Lobbyist) P ersonally known (Princi . �� Notary Pew - BM of tea
,• r t - My Comm. E plros *u910. 2014
A . VII. SIGNATURE AND STAMP OF N • TARY: Commission di 00 097266
i1
.: ,∎ . State of Florida, County of Miami -Dade State of Horida, County of Miami-Dade {
P , Sworn to and subscribed e me Sworn and subscribed be re e 1
This .. y o f �o fir►
` --:
-�.,,* �, s �� f 20 � This � f ��.day of � f v Z•� 1;k0 1 G
�- . 111111* .
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Signature -. Public J & 6 State of Horida Signature of Public No' //-ta - o Florida
1111 Notariz .: on of Lobbyist's signature Notarization of Prin �: signa ure
I
l . t Paid :1 V.E( LY • -. _ �Date Paid J ] -
CR # �� . ' A � ( v
Annual Registration fee ] Yes [ ] No
Lobbyist Registration Form received and verified , 1.-- , . ,.... f I Entered By: I
F: ICLER 15ALL\MARIA- M\Lobbyist\loBBYIST CORM 05.da U All 'n� /I R 12/08/04
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
. . ' FLAT RATE OR OTHER)
A) LOBBYIST DISCLOSURE: (Required) $ t ( O� • CO
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST CO 1 PENSATION): (Required). $ / ( 0 • O
I
The following information must be ans ered:
I
I.
1) Pursuant to Miami Beach City Code 2 -488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues ": 1
i
■Yes No: A - • lob. in • • - - - n • • •i• for •••• - • i• -n •r' -rvil or • 1
present or pending award or goods, equipment or service?
2) Pursuant to Miami Beach City Code! -490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues ":
LYes X 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 i s not - for- profit
corporation or entity without specia compensation or reimbursement for the appearance, whether direct, or
indirect, to express support of or r pposition to any item, shall register with the clerk as required by this
section but, shall not be required to pay any registration fees..
n Yes X No: Are you representing a not- for - profit corporation or entity without special compensation
or reimbursement.
V. SIGNATURE UNDER OATH: 1
ON OCTOBER 1 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.
irbei 6) 4 s 64) P/1 J
Signature of Lobbyist 1
I do solemnly swear that all of the fo egoing facts are true and correct and that I have read or am
familiar with the provisions contained i Section 2 -482 of the Miami Beach City Code and all reporting
requirements. /
Signature of Lobbyist: al 1; / C7»'uj CJal1,b;
9 Principal/Client: i '
Signature of Princi al /Client: „Arlin
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
❑ Produced ID ❑ Produced ID i
Form of Identifica ion Form of Id ' * , I * I � / � - 1 i • N. ■
�rVi' fir. OA D
❑ Personally known (Lobbyist) ' Personally known (Princi • 40;:, ' Notir PN c • State of f ids ' ' My Cantu. Eiiphss Aug 10, 2014
VII. SIGNATURE AND STAMP OF NO ARY: Commission Al 00
7266
• "' l i ‘ 800ded National Notary Assn.
State of Florida, County of Miami -Dade State of Florida, County of Miari -Dade T — " —
Sworn to and subscribed before me Sworn and subscribed before e
This day of , 20 This 2f'I'.day of 0 by V —' O 10
i,Alla
Signature of Public Notary – State of Florida Signature of Public NOW/. - o Florida '
Notarization of Lobbyist's signature Notarization of Prin •1 ► iT signature
FOR CLERK'S USE ONLY
Annual Registration fee: [ ] Yes [ ] No A ount Paid MCR # Date Paid
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Lobbyist Registration Form received and verified by: Entered By: i
F: \CLER \$ ALL \MARIA -M \Lobbyist \LOBBYIST fORM 05.doc Revised 12/08/0
41)1201 I
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City of Miami Beach, 1700 Convention Cente Drive, Miami Beach, Florida 33139, www.miomibeachfl.gov
CITY CLERK Office CityClerlc@miornibeachil.gov
Tel: 305.673.7411 , Fax: 305.673.7254
LOBBYIST NAME: 111° 4 0 11q) 104.Sh
1 understand that no later than F - bruary 28th of each year, 1 must file the following
form, pursuant to Section 2-48 of the Miami Beach City Code, with the City Clerk's
Office for all active lobbying issu-s.
1) Lobbyist Expenditure and ompensation Form
Failure to File these forms on a ti ely 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 1 have registered to lobby on has been resolved, 1 am required
to irnmediately notify the City Cl-rk's Office of lobbyist withdrawal in writing.
y November 16, 2010
Signature: Date:
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Exhibit A
Disclosure of Interest
2228 Park Avenue. LLC
c/o Todd Glaser, Managing Member
P.O. Boa 402249
Miami Beach. Florida 33140
OWNERSHIP ENTITY % OF STOCK
1. Mitchell Rubinson & Edda Rubinson, tenants by the entireties 50'
3.525 Flamingo Drive, Miar.ii. Beach, FL 33140
2. The Glaser Children Irrevocable Trust (2/2/2005) 50
3681 Flamingo Drive, Miami Beach, FL 33140
Trustees: .Kim Glaser & Todd Glaser
Beneficiaries: Levi Cole Glaser
Chloe Pearl Glaser
Stone David Glaser
Coral Sky Glaser
Total 100
110
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