Don Washburn - Seville Acquisition, LLC MIAMIBEACH
4 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 board 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.
Washburn Don
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)
954 - 983 -2788 954 - 983 -2789
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes: address, phone, or e-mail address.
I. LOBBYIST RETAINED BY:
Seville Acquisition, LLC
NAME OF PRINCIPAL /CLIENT:
10400 Fernwood Road Bethesda Maryland 20817
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(301) 380 -7972
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2 -482 (c)]
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• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Publicly traded on the NYSE under the symbol MAR. ---i
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• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH fi N 0
CORPORATION, PARTNERSHIP OR TRUST: Publicly traded on the NYSE under the symbol MAR. Y tV
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II. SPECIFIC LOBBY ISSUE: - ..–
Redevelopment of the properties located at 2901 Collins Avenue and 2901 -2912 Collins Ave., 201 -265 29 St., & 2901 -2911 Inn au* Drive
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES /INDIVIDUALS TO BE LOBBIED:
Pursuant to City Code Section 2- 482(a)(4) include the commissioner of personnel sought to be lobbied, and whether the lobbyist
has entered into contractual relationship (paid or unpaid) with said city commissioner or personnel from 12 months preceding
such person's commencement of service with the city to the present date, stating the general nature of the subject contractual
relationship.
Sec 2482(a)(4) Full Name of Individual and Contractual Relationship (Explain) YES NO
title of person to be lobbied
Planning Staff, Public Works Staff, Parking Dept. None X
Staff
HPB, BOA, Planning Board, City Commission None X
Pursuant to City Code Section 2- 482(g) Every registrant shall be required to state the extent of any business, financial, familial or
professional relationship, or other relationship giving rise to an appearance of an impropriety, with any current city commissioner
or city personnel who is sought to be lobbied as identified on the lobbyist registration form filed.
Sec 2- 482(g) Any Financial, Familial or Professional Relationship
None.
• IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR
OTHER)i
Ay LOBBYIST DISCLOSURE: (Required) 'U , V ,I,e4J
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). r ")
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 X 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 ":
Yes 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 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 a not - 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 X No: Are you representing a not - for - profit corporation or entity without special compensation or
reimbursement. .
V. SIGNATURE UNDER OATH:
ON FEBRUARY 28 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 YEA A STATEMENT SHAL E FILED EVEN IF THERE HAVE BEEN
NO EXPENDITURES OR COMPENSATION DURING THE PORTING D.
Signature of Lob yi
I do solemnly swear that all of t foregoing facts are tr a and corre and that I have read or am familiar with the
provisions contained in Section 2 412 of the i m( ea ity Co d all reporting requirements.
Signature of Lobbyist: / t
Signature of Principal /Client: ---� —
LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced ID Produced ID
i R Form of Identification Form of Identification co
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Personally known (Lobbyist) Personally known Principal) .2 A.
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i x • if 7[ SIGNATURE AND STAMP OF NOTARY: c o o (°
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Sta , if Florida, County of Miami -Dade State of.glefida, County of i L �,Q
• r • • a subscribe befor me Sworn a d subscribed before me °
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Sig .tur:.wr bl' rotary - State of Florida Signature of lic Notary - St a of leriele M 4hy IQ Rd .. E
Nota • of Lobbyist's signature Notarization of Principal's signature ca 0
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FOR C RK'S O Y 93
Annual Registration fee: [ ] Yes [ ] No Amount Paid MCR # 0 v ate aid ? A ! 11
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Lobbyist Registration Form received and verified by: 7 Entered By: , j ' � ' �
Revised 1/11/2011
I P\AIMAIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office CityClerk @miamibeachfl.gov
Tel: 305.673.7411 , Fax: 305.673.7254
LOBBYIST NAME: D D /1 cis)IL r ,t)
I understand that no later than February 28th of each year, 1 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 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 of lobbyist withdrawal in writing.
1
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Signature: Date: