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Don Washburn- 1100 West Properties, LLC vi p, ,, Q t. ..i 1 i e ., • ., ,-- i ,, , 0 v maw AAIAMIBE ,C11 4 151 1 1 City 0 , Miami Beach Office of the City Clerk ()(° 1700 Conve ition Center Drive Miami Beach, FL 33139 1 LOBBYIST REGISTRATION FORM I Lobbyist means all persons employed or retest ed , whether paid or not, by a principal who seeks to encourage the passage, defeat or modification of any ordinance, resolution, act i l i n or decision of any commissioner; any action, decision, recommendation of the City Manager or any city board or committee; or an ' action, decision or recommendation of any city personnel during the time period of the entire decision-making process on such actio , decision or recommendation that foreseeably will be heard or reviewed by the city commission, or a city board or committee. Th term specifically include, s the principal as well as any employee engaged in lobbying activities. The term "Lobbyists" has specific lexclusions. Please refer to Ordinance 20044435. Washburn' Don NAME OF LOBBYIST: (Last) i (First), (M.1) 1 . iv TheAudiQaug MWORkm4D = • 1 • A, as _ BUSINESS NAME AND ADDRESS uN( andm • I , Street) (City) ' (State) (Zip Code) 954 954 au.diobugl ®aol.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: - , Pleisemitifythit &tibia ff your conterat pfonnation .ohanges: address, phone, or eghall addiess. I. LOBBYIST RETAINED BY: 1100 West Properties, LLC MINEMINMINIMMINIMMININNOMINNMININIMMIL NAME OF PRINCIPAUCLIENT: c/o Morgans Hotel Group 475 100 Avenue New York NY 10018 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-674-4848 14/A —, TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) 1 . '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 OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: 1 I . . . , y; l° ,4 -403 i , Conditional Use Permit 1 ill ertwi,,m11040000000010141,0 .,..„... Issue to be lobbied (Describe In detail): .. ... Pursuant to City Code Section 2.482(aX4) include the commissioner or personnel sought to be lobbied, and whether the lobbyist has entered into any contractual relationship (paid or unp with said city commissioner or personnel from 12 months preceding such person's commencement of service with the city to the p ' ent date, stating the general nature of the sublect contractual relationship. Sec 2.482(aX4) Full Maine of IndIvIWaI and Contractual Relationship (Explain) YES NO title of person to be IobbieI City of Miami Beach Planning ard X - . City of Miami Beach Mayor/Co • . loners X , , City of Miami Beach Commi ri- - s X Pursuant to City Code Section 2.482(g) Every mill, , nt shallbe required to state the extent of any business, financial, familial or professional relationship, or other relationship giving rise to eh, appearance of an impropriety, with any current city commissioner or cfty personnel who is sought to be lobbied as identified on the lobbyist iftistration form filed. Sec 2482 • An Financial Familial. or PrOfeisional itelationshi • , s — ,-- - ,-.1 1 4 L None _ . . c 2 6:1 tiz NvNYE' 1 loz _ , _ _ (GA i 3 1 :i) a d , , I 1 1 IV. DISCLOSURE OF TERMS AND AMOUN OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): I 1 A) LOBBYIST DISCLOSURE: (Required) f $1 500 .00 f B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). The following information must be answered: 1) Pursuant to Miami Beach City Code S 2488 Entitled "Prohibited Campaign Contributions By Lobbyists On Procurement Issues": 0 Yes El No Are You lobbvina on a pres or pendina bid for poods. eauipment or services. or on a Present or pending award for poods. eauiornent!or service ? 2) Pursuant to Miami Beach City Code 2494 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues ": _______ n Yes © No: Are you tobbvina on a pepdina application for a pevglopment Aareement with the City or application for ch =n• - •fz•ni • ma• 4,.`nati•n • c .n• = • t= Ci,'sF1 re _ . • U =e La.? 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 a not -for -profit corporation or entity without special compensation or reimbursement for a appearance, whether direct, or indirect, to express support of or opposition to any item, shall register with the clerk as ' uired by this section but, shall not be required to pay any registration fees. D Yes 5 No Are you represen�tina a not- ' r -profit corporation or entity without special compensation or reimbursement, . V. SIGNATURE UNDER OATH: Ohl FEBRUARY 28th OF EACH YEAR, EACH LOBBYIST SIjALL SUBMIT TO THE CITY CLERK A. SIGNED STATEN NT UNDER OATH. WSTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SH ' , i, BE FILED EVEN IF T RE H . VE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPQRTINGI PERIOD. 1 i ° / / 1 Signature of Lobbyist if I do solemnly swear that all of 1 -- foregoing fa , are true nd correct and that I h , read or am familiar with the provisions contained in Section 2-482 of the Miami = = City Co e d II repo 'ng require , ents. Signature of Lobbyist `. ' ,- s.--e.......--- Signature of PrincipaVClient: X VI. LOBBYIST IDENTIFICATION: i PRINCIPAL IDENTIFICATION: )( I ❑ Produced ID D„ Produced ID Form of Identification Form of Identification 0 Personally known (Lobbyist) C ❑Personally known (Principal) VII. SI ., ATURE AND STAMP OF NOT 1 Y: . D 1 s State = tort, a, Coun of . State of Florida, County of Miami -Dade S ' � subsc 'f d before me ' ; m and subscribed before me T f • day 0 � - ,. 1 . 4 - CHRISTINE A. BRACE Th ► da of , 2011 • 1 Notary Public .State of Florida Agi ......r ; � .� �.�.[ , *, r . � _ � A' � . _- - ri ff MyComm.Exp1resMiar91.,'flt4 o ignature of Public Notary — Sta = of Fl. Commission dE - ublic No #pry -State of Florida i■ Notarization of Lobtyigt's signature ! Notarizatio of Principal', signature I TO BE COMPL D BY CITY CLERK'S STAFF OPNY •- 1 Annual Registration tee: [ ]Yes [ 1 No Amount $ --NCR # ' Date Paid / -)--- 7 i Lobbyist Registration Form received and verMed y e i . i• - - - -_ - � `' • - - ' : - 'a ,� : .. , ., , �, nual Registration Form.doc ,,, L_ � Revised 1/11/2D11 �.,; CHRISTINE A. BRACE 1 I ,�,� , : Notary Public - State of Florida 4 , f �. ,� My Comm. Expires Mar 28, 2014 ,'�..;�o,�;�'', Commission # DD 975727 1 1 1 i i I I , IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) ;f B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): _ (Required). 1, 51)0 r 0 0 11 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 ": . 0 Yes S No: Are vou lobbying I o being on a ores nt or pending bid for goods, equipment or services, or on a present or pending award for goods, eauipmen 1 or service? 2) Pursuant to Miami Beach City Code 2 90 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues ": '1 ,:I Yes o No: Are vou lobbying on a pent ina application for a Development Agreement with the City or application for change of zoning map des! nation or chance to the City's Future Land Use Mao? 3) Pursuant to Miami Beach City Code 2 i 84 (h) Any person (except those exempt from the definition of "lobbyist" P as set forth in Section 2-481 above) who only appears as a representative of a not - for - profit corporation or entity without special compensation or reimbursement for the appearance, whether direct or indirect express to ex ss support of or opposition to any item, shall register with the clerk as re wired by this section but, shall not be re ured to a ' q p y any registration fees. D Yes 12 No: Are you representing a not -f' r- profit corporation or entity without ithout special compensation or reimbursement. . V. SIGNATURE UNDER OATH: ON FEBRUARY 28th 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 p I do solemnly swear that all of the foregoing fa are true and correct and that I have read or am familiar with the provisions containe d in Section 2-482 of the Miami Beach City Code ; nd all reporting requirements. Signature of Lobbyist: Ai • Signature of Principal /Client: i X VI. LOBBYIST IDENT ' ATION: PRINCIPAL IDENTIFICATION: )C ❑ Produced ID i a Produced ID Form of identification Form of Identification r- O Personally known (Lobbyist) EI Pe rsonally know • - - . . - C. B. COLLADO ViI. SIGNATURE AND STAMP OF NOTARY: , MY COMMISSION # DD864622 ; , EXPIRES: February 25, 2013 State of Florida, County of Miami -Dade State of Florida, Co , ;4 ' . r • • , °UuY °i 00t"I �. Co. Sworn to and subscribed before me S om - d subs b �, This day of , 2011 subscribed e me T ' � d . � � c of , 2011 1 I► Signature of Public Notary — State of Florida Signature of Publi Notary State of Florida Notarization of Lobbyist's signature Notarization of Principal's signature 1 TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: [ j Yes [ j No _ Amount Paid $ ' MCR # , Date Paid Lobbyist Registration Form received and verified by�l F :`CLERWALLtaFORMS‘LOBRYIST FORMS‘Lobbyist An ua1 Registration Form.doc Revised 1/11/2011 � I 1 TA wir M City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeochfl.gov CITY CLERK Office CityClerk@miamibeachH.gov Tel: 305.673.7411 , Fax: 305.6737254 LOBBYIST NAME: Don Washburn 1 understand that no later than Nitbe 28th of each year, I must file the following form, 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 and Compensation Form Failure to file these forms on a timel, basis will result in my name being transmitted to the Miami-Dade County Commission on Ethics and f l i r code violation evaluation. In addition, once an issue 1 hay registered to lobby on has been resolved, I am required to immediately notify the City Clerk's I fFice of lobbyist withdrawal in writing. .461 . r / 9a. Wit . _ __ . l a �1,d' Signature: � at e: i i 1 1 1 1100 WEST PROPERTIES, LLC OWNERSHIP STRUCTURE 1100 WEST PROPERTIES LLC 1100 West Holdi gs, LLC 100% (Sole Member of 1100 West Properties, LLC) 475 10 Avenue c/o Morgans Hot 1 Group New York, New York 10018 1100 WEST HOLDINGS LL ► Mondrian Miami' LLC 50% 475 10 Avenue c/o Morgans Gro p, LLC New York, New ork 10018 Sanctuary West ., venue, LLC 50% c/o Hudson Ca pi al p 4770 Biscayne B vd., Suite 400 Miami, Florida 3 137 MONDRIAN MIAMI INVES MENT LLC Morgans Group, ► LC 100% 475 10 Avenue New York, New ork 10018 MORGANS GROUP LLC Morgans Hotel G oup Co. 97.1% 475 10 Avenue New York, New ork 10018 Residual Hotel In erest LLC 2.9% (See attached c/o 475 10 Ave ue flow chart) New York, New 'ork 10018 MORGANS HOTEL GROUP O. Morgans Hotel Group Co. is a publicly held corporation SANCTUARY WEST AVENUE LLC Sanctuary West oldings, LLC 100% ( Sole Owner of Sanctu ary West Avenue, LLC) , • 4770 Biscayne B vd., Suite 400 Miami, F orida 331.37 - SANCTUARY WEST HOLDINGS, LLC Sanctuary West 1 ,4anagement, LLC 95% 4770 Biscayne B vd., Suite 400 Miami, Florida 3 1,37 Gladys Brownstejn 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 3 137 Keith Menin • • • 18% c/o 4770 Biscayne Blvd., Suite 400 Miami Florida 3 313 7 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 33,137, • David Galbut and; Geta Galbut, his wife 10% . • c/o 4770 Biscayne Blvd., Suite 400 Miami, Florida 33;137 Joan Brent ? o 10% c/o 4770 Biscayne Blvd., Suite 400 •- . Miami, Florida 33137 . ' ■ 0 0) , -J .,..i ., 0) i. . 1 > ....... , a) . • • ! ..., „ ,--- , . C . 0 cu 3 0) 0) Li. • it CU N , '5 co ' 0 0 L.. ,, - 0 i 0- 9 d 5 L M -0 O (I) CU < la - 0) a , • (1) v 0.... ca . E ..... •-- . co -., a) 0 ..... , ..-i co ca. a) , co zi . u_ ....... GO i co co en ,..... — 0 _ 6 --1 , . 0 u j ...--, , ,.. , s lu" ! :1 ' CO 10 • ! / w ua 4 o . • < 6 El. 2 • H c c 6 • .c . :5 -t cs) 5) • I C co "D CU, •- : . CO 0 0 0 07) _I ., CV a w co • 2. . Ll. 2 to oi 0 __I "` lime 1.- I-- "0 CV ■11...0 0 • CD - I --I I . . --Ne 't _J 0. +a la co • CD o .c cr) D AD) : 1 - = L... v". ›- a- 4-. a) L. 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