David Coviello - 1100 West Properties, LLC MIAMI BEACH f IA:h
City of Miami Beach Office of the City Clark= r,r- I V
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION FORM 2013 APR —3 AMl 10: 56
Lobbyist means all persons employed or retained, whether paid or not, by a principal wl rLol jegkE LoLencdu,:ragg(h �jiassage, 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.
Coviello David
NAME OF LOBBYIST: (Last) (First) (M.I)
Shutts&Bowen LLP 201 S.Biscayne Blvd.,Suite 1500 Miami FL 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-415-9437 305-415-9837 DCoviello @shutts.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes: address,phone, or e-mail address.
I. LOBBYIST RETAINED BY:
1100 West Properties,LLC
NAME OF PRINCIPAUCLIENT:
c/o Morgans Hotel Group 475 10th Avenue NY NY 10018
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
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:
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: See attached.
ii.SPECIFIC LOBBY ISSUE:
Proposed legislation affecting West Avenue
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 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 eneral 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
City of Miami Beach Committees and Boards None ✓
City of Miami Beach Attorneys Office and Administration None ✓
City of Miami Beach Mayors/Commissioners None ✓
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
MIADOCS:7443920 1 7
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Rgfg3 r d)
S
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION):
(REQUIRED). )n art 4 3 319°
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2.488 Entitled"Prohibited Campaign Contributions By Lobbyists On Procurement
Isues":
_Yes V_No: Are You lobbying on a present or aendina bid for goods.equipment or services,or on a aresent or pending
award for-goods,equipment or service?
2) Pursuant to Miami Beach City Code Section 2.490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
gevelopment Issues":
_Yes_-No: Are you lobbvina on a pending application for a Development Agreement with the City or application for
chance of zoning map desianation or change to the CIWs 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.
YesJ 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 YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD. w ^
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 'ty od and all reporting requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
N
_Produced ID W _Produced ID ,
Form of Identification a E Z Form of Identification
O LU
T,in o w .
_Personally known(Lobbyist) W V/Personally known(Principal) Z
VII. SIGNATURE AND STAMP OF NOTARY: 3 W
State of Florida, County of Miami-Dade ate;,. yO'c� State of Florida,County of Miami-Dade n
Sworn to and subscribed before me }: Sworn and subscribeo before me ,
This _day of 2013 y FOP This_VLday of 1i4. 2013
Signature of Public Notary—State of Florida Signature of Public Notary—State of Florida
Notarization of Lobbyist's 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: f✓.
C:\Users\clerhati\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration
Formrevised 5-30-2012.doc
IM MIAMIBEACH
City of Miami Beath, 1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.gov
CITY CLERK Office
Rafael E. Granada, City Clerk CityClerk @miamibeachfl.gov
Tel: 305.673.7411 ,Fax: 305.673.7254
LOBBYIST NAME: David Coviello
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, 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.
V /3 // 3
Signature: Date:
MIADOCS:7443920 1
1100 WEST PROPERTIES, LLC
OWNERSHIP STRUCTURE
1100 WEST PROPERTIES, LLC
1100 West Holdings, LLC 100%
(Sole Member of 1100 West Properties, LLC)
475 10"'Avenue
c/o Morgans Hotel Group
New York, New York 10018
1100 WEST HOLDINGS, LLC
Mondrian Miami Investment, LLC 50%
475 l Ot" Avenue
c/o Morgans Group, LLC
New York, New York 10018
Sanctuary West Avenue, LLC . 50%
c/o Hudson Capital
4770 Biscayne Blvd., Suite 400
Miami, Florida 33137
MONDRUN MIAMI INVESTMENT,LLC
Morgans Group, LLC 100%
475 10"'Avenue
New York, New York 10018
MORGANS GROUP LLC
Morgans Hotel Group Co. 97.1%
475 10"' Avenue
New York, New York 10018
Residual Hotel Interest LLC 2.9% (See attached
c/o 475 10"'Avenue flow chart)
New York, New York 10018
MORGANS HOTEL GROUP CO.
Morgans Hotel Group Co. is a publicly held corporation
MIADOCS 2884089 1 t'
SANCTUARY WEST AVENUE,LLC
Sanctuary West Holdings, LLC 100%
(Sole Owner of Sanctuary West Avenue, LLC)
4770 Biscayne Blvd., Suite 400
Miami,Florida 33137
SANCTUARY WEST HOLDINGS, LLC
Sanctuary West Management, LLC 95%
4770 Biscayne Blvd., Suite 400
Miami, Florida 33137
Gladys Brownstein 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 33137
Keith Menin 18%
c/o 4770 Biscayne Blvd., Suite 400
Miami, Florida 33137
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 33137
David Galbut and Geta Galbut, his wife 10%
c/o 4770 Biscayne Blvd., Suite 400
Miami,Florida 33137
Joan Brent 10%
c/o 4770 Biscayne Blvd., Suite 400
Miami, Florida 33137
MIADOCS 2884089 1
o, CD
CD D
o -
rn z D �
N O 0
O
3 CD
a
CD -,
a T _
m
n�
CA) 0 CCDD d
_ :r O d co:-4 d @
N :3 -0 m
O 0 (L� r CD (D ,
z
n -D
Q Cl)
D
z
CD
o
CD (D V Q. 7�
N CD \ j � o
CD Ey 0
Q v (D
O �
(a r- =
v CD
D
cn O
cn
2 CD :3- O
m o � D '�•
cn 3
CD 10 CD
-o r v -c � C CD
r C7 ;L cy Ci Z co r-+-
m -n
N s CD C N rn
co co CL CD
j co r
CD D
� T
m
CL
T o `°-
0 D o CD (D a)
o N m cQ
cD �001 r v CD
m 0O n CD
r �
� (
r � w CD
3 3
CO
i
c cn �C
m`< 3 �-0 m
cn CL � D @ m
C) U o CD CL
CD m o N m -t
3 co Co c
to n co 3
CD _
co
r co
r co
0