Donald Washburn/Royal Palm Hotel Property, LLC Robert D. Falor, Mgr
ceo tvdAfyl\! BEACH
~.
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.
NAME OF LOBBYIsr:
Washburn
(Last)
Donald
(Rrst)
J
(M.I)
The Audio Bug, Inc.
BUSINESS NAME AND ADDRESS
3800 Hillcrest Drive, #102
(Number and Street)
Hollywood
(City)
Rorida
(State)
33021
(Zip Code)
(954) 983-2788
TELEPHONE NUMBER:
(954) 983-2789
FAX NUMBER:
audiobug 1@aol.com
EMAIL:
I. LOBBYIST RETAINED BY:
Royal Palm Hotel Property, LLC, c/o Robert D. Falor, Manager
NAME OF PRINCIPAL/CUENT:
Roval Palm Hotel Prooertv. LLC
BUSINESS NAME AND ADDRESS
1545 Collins Avenue
(Number and Street)
Miami Beach
(City)
FL
(State)
33139
(Zip Code)
(305) 604-5700
TELEPHONE NUMBER:
(305) 604-2059
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 BENEFIOARY: Robert D. Falor, Manager
· IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUsr: See Exhibit "B"
II. SPECIFIC LOBBY ISSUE:
Application to the Planning Board for Conditional Use Approval for a Neighborhood Impact Establishment*
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship
Jorge Gomez None
Richard Lorber None
Mercy Lamazares None
* As the action by the Planning Board is a quasi-judicial proceeding, the lobbyist will NOT lobby any member of the Planning Board.
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLA T RA TE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) $ 6.000.00 ftc/+- l2.t::tk
B) PRINCIPAL'S DISCLOSURE (OFLOBBYIST COMPENSATION): (Required). $ (, J UQJ, 00 "P"lq..f- Rqdc-
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":
D 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":
DYes X No: Are you lobbying on a pending application for a Deyelopment Agreement with the City or
application for change of zoning map designation or change to the City'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..
o Yes X No: Are you representing a not-for-profit corporation or entity without special comoensation
or reimbursement.
V. SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, USTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDrrYEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO PENDITURES 0 COMPE SATION DURING THE
REPORTING PERIOD. ' /
'IV I (/
'Yl. I v ! 1--'
of Lobbyist
I do solemnly swear that all of the foregoing fa cts~re. ue and orrect and that I have read or am
familiar with the provisions c ined in Section -482 of he Miami Beach City Code and all reporting
requirements. 7 :
Signature of Lobbyist: '{l.
Signature of Principal/Client:
VI.
LOBBYIST IDENTIFICATION:
PRINCIPAL IDENTIFICATION:
D Produced ID
D Produced ID
Form of Identification
~ersonallY known (Lobbyist)
Form of Identification
D Personally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Swom and subscribed before me
This _day of . 20_
Signature of Public Notary - State of Florida
Notarization of Principal's signature
Date Paid
€A
.....
MIAMI BEACH
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRA nON 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.
NAME OF LOBBYIST:
Washburn
( Last)
Donald
(First)
J
(M.!)
The Audio Bug, Inc.
BUSINESS NAME AND ADDRESS
3800 Hillcrest Drive, #102
(Number and Street)
Hollywood
(City)
Florida
(State)
33021
(Zip Code)
(954) 983-2788
TELEPHONE NUMBER:
(954) 983-2789
FAX NUMBER:
audiobug1@aol.com
EMAIL:
1. lOBBYIST RETAINED BY:
Royal Palm Hotel Property, LLC, c/o Robert D. Falor, Manager
NAME OF PRINCIPAL/CliENT:
Roval Palm Hotel Property. LLC
BUSINESS NAME AND ADDRESS
1545 Collins Avenue
(Number and Street)
Miami Beach
(City)
FL
(State)
33139
(Zip Code)
(305) 604-5700
TELEPHONE NUMBER:
(305) 604-2059
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: Robert D. Falor, Manager
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: See Exhibit "B"
II. SPECIFIC lOBBY ISSUE:
Application to the Planning Board for Conditional Use Approval for a Neighborhood Impact Establishment*
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship
Jorge Gomez None
Richard Lorber None
Mercy Lamazares None
* As the action by the Planning Board is a quasi-judicial proceeding, the lobbyist will NOT lobby any member of the Planning Board.
IV. DISCLOSURE OF TERMS AND AMOUNTS OF lOBBYIST COMPENSATION (DISCLOSE WH ETHER HOURL Y,
FLAT RAtE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) $
aJcx-U(W
F{ak ~;Je,
~ J (XX). 00
,
'F{ak- p.qJG
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (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":
n Yes X No: Are yOU 10bbvinQ on a present or pendinQ bid for Qoods. equipment or services. or on a
present or pendinQ award for Qoods. equipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
nYes X No: Are yOU 10bbvinQ on a pendinQ application for a Development AQreement with the City or
application for chanQe of zoninQ map desicmation or chanQe to the City'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..
n Yes X No: Are yOU representinQ a not-for-profit corporation or entity without special compensation
or reimbursement.
V. SIGNATURE UNDER OATH:
ON OCTOBER 1sT 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
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: t---
PRINCIPAL IDENTIFICATION:
o Produced ID
o Produced ID
Form of Idenfification,
Form of Identification
VII.
SIGNATURE AND STAMP OF NOTARY:
\\ ~E)tSOnaIlY known (PrinciPa~e.'. '..
/---.1
o Personally known (Lobbyist)
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State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This day of , 20_
State of Florida, County of Miami-Dade
s,^:or~d SUb.~cJi d ~f ,e me
ThiS c;ley:off', , '. ,20_
: ) ;
Ii, I .
Uf
Signature of lPubli<; Notary - State of Florida
Notarization of fJrincipal's signature
Annual Registration fee:
Lobbyist Registration Form received and verified by:
, ~~JN;iR#2r71'6/4
Date Paid
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Signature of Public Notary - State of Florida
Notarization of Lobbyist's signature
Entered By: