Donald Washburn - Grestone Terra Firma, LLC MI.AM.1 BEACH
City f Miami Beach Office of the Ci r ��o �
Y � �" V ;9�� A l0: 0 7 1700 Convention.Center Drive, Miami Beac
LOBBYIST REGISTRATION FORM C l I Y L="'` 5 0
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 asany.employee engaged in
lobbying activities:.The term"Lobbyists"has specific exclusions. Please refer to Ordinance 2004-3435.
Washburn Donald
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 audiobugl@aol.com
TELEPHONE NUMBER: FAX NUMBER:: EMAIL:
Please notify this office if your contact:information changes:address,phone,ore-mail address.
I. LOBBYIST RETAINED BY:
Greystone Terra Firma, LLC
NAME.OF PRINCIPALICLIENT.
The Greystone.Hotel c/o Trans Inns.Management 31525 W. 12 Mile Road, Farmington Hills,MI 48334
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(248)489-4333 James.vosotas @transinns.com
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:James D.Vosotas as a Managing:Member of Greystone Hospitality, LLC, a
Managing Member Company.of Greystone Terra Firma,LLC
IDENTIFY.ALL PERSONS HOLDING,.DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR:TRUS'f: See attached Exhibit.
n.SPECIFIC LOBBY-ISSUE;
Development Approvals and Permitting Issues,including,,but not limited to Certificate of Appropriateness from Historic Preservation Board and
Conditional Use Permit from Planning.Board.for the Greystone Hotel at 1920.Collins Ave., Miami Beach,FL
Issue to be lobbied(Describe In detail):
ul. CITY AGENCIE.81 NDIVIDUALS TO B-E LOSSIED:.
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
arson's commencement of service with the cit .to the resent-date,stating the general nature of the'subject contractual nship.
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 None
% HPB,BOA, City'Cornmission, as necessary None
Pursuant to City Code Section 2-482(g)Every registrant shall be required to state.the dxtent of any business,financial,familial or professional
.relationship,or otherrelationship 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 Aled.
Sec 2-482(g),Any Financial,Familial or Professional Relationship
None
I
F:ICLER\$ALL1aF0RMSIL0BBYIST FORMSUbbyist Registration Form: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) $5,500.00
�t
B) PRINCIPAL'S DISCLOSURE,(OF LOBBYISZ COMPENSATION):
(Required). $5,500.00 tupv SaA
The following information must be answered:
1) Pursuant to Miami Beach City-Code Section 2=488 Entitled"'Prohibited Campaign.Contributions By Lobbyists On.Procurement
r Issues
Yes.X No: Are Vou lobbying on a present or pending bid for goods.eauioment or services.or on a present or pending
award for good s.eauioment or service?
2) Pursuant.to Miami:Beach.City Code 2A..90 Entitled"Prohibited Campaign Contributions.By Lobbyists On.Real Estate.
Development Issues":,
Yes X No: Are you lobbying-on a pending ag,plication fora Development Agreement with the Clty or apBlication for
change.of zoning map designation or change to the City's Future Land Use Ma l2?
3) Pursuant to Miami.Beach City Code 2484(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.
Ye
s.&No: Are you representing a not-for-profit corporation or entity without 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.
LQR THE PRECEDING CALENDAR YEAR, A STATE LL BE FI Q EVEN I THERE HAVE BEEN NO
EXPENDITURES OR goMPENSATION DURING THE REPORTING PERIOD.
Signature of Lpbbyist
I do solemnly swear that all of th regoing facts are.true an correct and that I have read or rn familiar with the provisions contained
in Section 2-482 of the Miami=dj rep rti g requir Is.
Signature of Lobbyist:
Signature.of Principal/Client. G L
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced ID F ,V eis � - Produced ID
Form of,Identification'.•;d►•M Form of Identification
Personally known(Lobbyist) ,• Personally known
(Principal)VII. SIGNATURE AND'.STAMP OF
NOTARY: =3 r
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State.of Florida,Countyof Miami-,Dade 3 State of.Florida,County of Miami-Dade z
Sworn QQ a id subscribed be.gre me ^ �• Sworn and.subscribed,before me o
This �b day of 2012: m Y. This AAday of bc-om 061W-,2012
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fin Signature of Public Notary-State of Florida: --& Signature of Public Notary ate Florid.
Notarization of Lobbyist's signature o Notarization of Principal's signature.
TO BE.COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee. [ ]Yes f% No Amount Paid$ •Vv MCR# I 1 Date Paid
Lobbyist Registration Form received and verified by:. rn
t
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR
OTHER):
A) LOBBYIST DISCLOSURE: (Required)
B) PRINCIPAL'S DISCLOSURE(OF LOBBY IjP�TION):
(Required).
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,eauipment or services.or on a present or ep ndina
award for goods,eguipment 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 City's Future Land Use Man?
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.
Ye§_&No: Are you representing a not-for-profit corporation or entity without 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
ME 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
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 Miami Beach City Code.and all reporting requirements.
Signature of Lobbyist:
Signature of Principal/Client: �-
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced ID Produced ID
Form of Identification Form of Identification I lot##
Personally known (Lobbyist) Personally known �..
(Principal)VII. SIGNATURE AND STAMP OF
=:_
NOTARY:
SES
State of Florida, County of Miami-Dade State of Florida, County of Miami-Dade a z v
Sworn to and subscribed before me Sworn and subscribed before me N v
This day of , 2012 This l44-day of oc,,m FSV4, 2012 a
A
Signature of Public Notary-State of Florida Signature of Public Notary- ate o Florid
Notarization of Lobby _signature Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ ]Yes[ ]No Amount Paid$ MCR# Date Paid
Lobbyist Registration Form received and verified by:
/\AIA M. 1 BEACH
City of Miami Beach, 1700 Convention Center Drive.Miami Beach,Florida 33139,www.miantibeaclifl.gov
CITY CLERK Office CityClerk @iniamibeachfl.gnv
Tel:305.673.7411 ,Fax:305.673.7254
LOBBYIST NAME: Donald Washbum
I understand that no later than February 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 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.
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
appealed to the Miami-Dade County Commission on Ethics and Public Trust.
Signature: Date:
FACLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
EXHIBIT
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DISCLOSURE OF INTEREST
Grejustone Terru AmuxLLC
.CIO Tram inas]Management.Inc..
150 Dauie Blvd.Ste 401.:Fort.Lauderdale,FL 33316
CORPORATION NAME and-ADDRESS
:NAME,ADDRESS,AND OFFICE. WOFSTOCK
Greustone Hospitality..LLC; Managing Member 50 010
4111 Andover Road. Suife 110-W
Bloomfield Hills.MI48302'
-BB_M_3,.LLC,Managing Member. 50%
235'West 4-Sm-Street:.Apt."37C
New York, NY J 00036
Grepstone Hospitalitu,.LAC
41.11 Andouer Road,Suite 110-.W Bloomfield Hills MI.48302:
CORPORATION NAME:-and ADDRESS
NAME,:ADDRESS,.AND`OFFICE. /o OF-STOCK
James_D. Vosotas:Managing Member
56°6
4111 Andover Road. Suite 110-W'
Bloomfield Hills MI 48302
Dan-Vosotas. Member 50 90
4111 And-over Road, Suite 110-W
Bloomfield Hills, M14.8302
BBM3,-LLC.
235 West 481h Street:.Apt.37C.New York,NY 1-00036
CORPORATION NAME•and,ADDRESS
NAME;ADDRESS,AND OFFICE 0/6 OF-STOCK
Branden Muhl.Managing Member 3396
235 West 48th Street.,Apt. 37C
New York.NY 100036'
Blaine B. Muhl..Member 33 96
24'02 West 11.4th Street
Leawood.KS 66211
Britain B. Muhl,'Member
2402'West-114th Street..
Leawood.KS 6621:1