Todd Tragash - David Dushey 'MIAMI BEACH
City f Miami Beach Office of the City Clerk
Y Y 3s (�
1700 Convention Center Drive, Miami Beach, FL 33139 7
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.
Tragash, Todd,
NAME OF LOBBYIST: (Last) (First) (M.1)
Sta Architectural Group, 3526 North Miami Avenue, Miami, FL 33127
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 571-1811 (305) 571-1821 todd(ustaarchitecturalaroua.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
. _. ...__ ._ __.
1014.
lease notify this.office if your contact information changes:address,phone, or e-mail address.
I. LOBBYIST RETAINED BY:
David Dushey
NAME OF PRINCIPAUCLIENT:
735 Collins, LLC, a Delaware Company 275 Madison Ave., Suite 702, New York, NY 10016
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(212)889-6405 (212)889-6922
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:David Dushey
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST:see attached Exhibit A
II SPECIFIC A®i
Development Approvals for renovations to the Lynmar Hotel at 735 Collins Avenue
Issue to be lobbied(Describe in detail):
nl.CIT'1(_.ACEFNCIES/INDIVIDUALS-T®,BE LOBBIED:
Pursuant to City Code Section 2-482(a)(4) include the commissioner or personnel sought to be lobbied,and whether the lobbyist has entered
into any 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 2-482(a)(4) Full Name of Individual and Contractual Relationship(Explain) YES NO
title of person to be lobbied
Planning Department and Building Department Staff one X
B, HPB, BOA, City Commission, as necessary* 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
'N — t
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Formrevised 5-30-2012.doc
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required)
$250
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION):
(REQUIRED). $250
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,eguipment or se rvices.or on a present or
ggpdjag award for good%eguipment or service?
2) Pursuant to Miami Beach City Code Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
_Yes X No: Are you lobbying on a pendina application for a Development Agreement with the City or application
f4I change of zoning map designation or change to the City's Future Land Use Map?
3) Pursuant to Miami Beach City Code Section 2-482 (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 reoresentina 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 Aj % IQbj RECEIVED. IN THE CITY OF MIAMI BEACH
FQE THE PRECEDING CALENDAR YEAR, A SIAIEMEN L ERE HAVE agEN bQ
EXPENDITURES OR
/ /7�
Signature of Lobby t
I do solemnly swear that all a foregoing fa a true and correct an that I have rea o fami Farwith the provisions contained
in Section 2-482 of the Mi i B Ci de and II r orting requirements.
Signature of Lobbyist-
Signature of Principal/Clien : '
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4
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced ID o Produced ID
Form of Identification " o Form of Identification=>°- ?:.c4� TWO O m�
r/Personally known(Lobbyist) 'A N Personally known(Principal) ?�y
CL
35 E VII. SIGNATURE AND STAMP OF NOTARY: °• n� 9 O m O �CO
t, too. a<- tL�
f Florida, County of Mia ade Z ` State ofN-Reridw, Count of�e •�
State o o da, Co ty y o �
Sworn to and subscri d b f e m '°'°4 Sworn and subscribed before me Q a
This o , 2012 `'3 This 1 day of , 2012 Z�Z
jNotari na ublic No —St of or a Signature of blic Notary—State of44efi tmN U
9 rY '�
ion of Lobbyist's signa a Notarization of Principal's signature
o
T MPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ ]Yes[ ]No Amount Paid$ _ D-' MCR# / Date Paid ZZZ/ Z
Lobbyist Registration Form received and veri ed by:
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F:\CAE. istration Form.doc Revised 04/27/2012
MIAN�IBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach. Florida 33139, www.miamibeachfl.gov
CITY CLERK Office
Rafael E. Granado, City Clerk CityClerk(u;miamibeachtl.gov
Tel: 305.673.7411 , Fax: 305.673.7254
LOBBYIST NAME: Todd Tragash
I understand that no later than February 28 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 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, or I am no longer
lobbying on that issue or for that principal, I am required to immediately notify the City Clerk's
Office of lobbyist withdrawal in writing.
Pursuant to Section 2-485 (d), the City Clerk shall notify any lobbyist (or principal) who
fails to timely file a Statement and in addition to any other penalties which may be
imposed as provided in Section 2-485.1, a fine of $50.00 a day shall be assessed for all
Statement(s) filed after the due date. The City Clerk shall notify the Miami-Dade
County Commission on Ethics and Public Trust of the failure of a lobbyist (or principal)
to file the Statement or pay the assessed fines after notification.
Any lobbyist, who fails to file the required Statement by April 30th, 2012, shall be
automatically suspended from lobbying until all fines are paid, unless the fine has been
appeale to the Mi Dade County Commission on Ethics and Public Trust.
/2-
Sig at Date:
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Exhibit A: Corporate Disclosure
735 Collins, LLC
c/o Joseph Dusheu, Jenel Management Corp.,
275 Madison Ave Suite 702, New York, NY 10018
NAME, ADDRESS, AND OFFICE % OF STOCK
Joseph Dusheg 20%
275 Madison Ave Suite 702
New York NY 10018
David Dusheg 24%
275 Madison Ave Suite 702
New York NY 10018
Sam J. Dusheg 16%
275 Madison Ave Suite 702
New York NY 10018
Sam A. Dusheg 20%
275 Madison Ave Suite 702
New York NY 10018
Blue Collins 20%
140 Fulton Street, 5th Floor
New York NY 10038
Blue Collins, LLC- 140 Fulton Street, 5th Floor, New York, NY 10038
NAME, ADDRESS, AND OFFICE % OF STOCK
Rcu mond Gindi 25%
140 Fulton Street, 5th Floor
New York NY 10038
Isaac A. Gindi 25%
140 Fulton Street, 5th Floor
New York NY 10038
Isaac S. Gindi 16.667916
140 Fulton Street, 5th Floor
New York NY 10038
Jack Gindi 16.666%
140 Fulton Street, 5th Floor
New York NY 10038
Eddie Gindi 16.667916
140 Fulton Street, 5th Floor
New York NY 10038