Don Washburn/TBS REalty, LLC Tudor South Beachm MIAMIBEACH
City of Miami Beach 4f6ce of the City Glerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION FORM
Lobbyist means a~ persons employed or retained, whether paid or not, by a prirxipal who seeks b encourage the
passage, defeat or modificatior- of any orntnance, resolution, action or decision of any aorrKrMSS~rrer; any action,
decision, neaornmer~dation of the City Manager or any aty board or oornmittee; or any action, decision or
recomrrrendation of any city personnel dur~ the time period of the ent9re decision-making process on such action,
decision or reoorrunrendation that wig be heard or renewed by the ~ aorrrrrisston, or a city bond or
corrsniElee. The term specificaly includes the principal as well as any err~byee engaged m lobbying ac:tivides. The
term "LObbyylStS" has Specific lXCl~srons. @ refer tD Ordinance 2~4-~J.
WeShbum Don
NAME OF LOBBYIST: (Last) (First) (M.1.)
c!o The Audio Bug, Inc. 3800 Hillcrest Drive, Unit 102 Hollywood, FL 33021
(NESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(954) 983-2788 (954) 983-2789 audiobugl a~aol.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
LOBBYIST RETAINED BY:
TBS Realty, LLC; Tudor South Beach Resort Coridominssri, Inc.: and Tudor South Beach Resart-North
Corufominium, Inc-
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NAME OF PRINCIPAL/CLIENT:
1111 & 1119 Gollins Avenue Miami Beach, FL 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(212) 474-9865 N/A jstein@hh-r.com
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
FiY out this section if pririclpal ~ a Corporation, ParMership or Tnnst
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Rabinder Pal Singh and .lay Stein
IDENTIFY ALL PERSONS HOLDING, DIRECTLY CR INDIRECTLY, A 5% OR MORE
OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST:
See Exhibit "A' attached.
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11. SPECIFIC LOBBY ISSUE: c-> ~ '~'-
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Conditional Use Pem~t ry
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Issue to be lobbied (Describe in detail): '". ""
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111. CITY AGENCIES/INDIVIDUAt.S TO BE LOBBIED: (Pursuant to City Code Section 2-482~j, irx~ie a '~
statement of the extent of any bi~ess, fnanc:~, fmri~l, professiortel or other relatiansh~, girirt,~txe~r-"
~ of an lrripropriety, with any City persoru~el sough b be lobbied; turttier, pixsi~it tiD City Codes 2-
482(ax4} iridude a statement of any ~ relntioristap (paMd or unpaid) from 12 nwriths pr~edirg the
of service of City personnel to be lobbied.)
FuN Nave of bdirldtraltTitls B Firgriciel, Faniliad or Pno~ssional
City of Miami Beach Planning Board None
City of Mimi Beach MayodCommissioners None
City of Miami Beadi Comirattees None '~
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER
HOURLY, FLAT RATE OR OTHER}:
A) LOBBYIST DISCLOSURE: (Required)
$4.500.00
B) PRfNCiPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
(Required}.
The following information must be answered:
1) Pursuant to Miami Beadr City Code Section 2488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues°:
^Yes ®No• Are you lobbvina 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 ®No• Are you lobbvina on a pending application for a Development Agreement with the City or
application for chance of zoning map designation or chance to the Citv's Future Land Use Map?
3) Pursuant to Miami Beach Gity Code 2-484 (h) Arty person (except those exempt fran the definition of
'lobbrst' as set forth ~ Section 2-481 above) who orgy appears as a representative of anot-for-profit
corporation or entity without special compensation ~ reimbrusernertt for the ~, whether direct, or
indirect, to ex#xess support of a opposition to any item, shall nester with the cleric as required by this
section but, shall not be required to pay any registration fees..
_^Yes ®No• Are you representing snot-for-profit corporation or entity without special compensation or
reimbursement.
V. SIGNATURE UNDER OATH:
Signature of Lobbyist: ,~~,(~' f Y d°
Signature of PrincipaUCfient:
Vi. LOBBYIST IDENTIFICATION:
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w ~ ~ N ~ ^ Produced ID
c Form of Identification
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~ Personally known (Lobbyist)
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VII. SIGNATURE AND STAMP OF NOTARY:
~ ~ ~°~ ~ i~ State of Florida, County of Mianu-Dade
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~ Sworn ~ and subscxi before me
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~ ~2Q08
This ~ day of
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Sign ire of Pubic N ry - State a orida
N rrzation of Lobb s s ne
TO BE COMPLETI
,teK~~Ys~>No I~s_
Fay reo.iwa ~d »esaa cnr• -
F_ won Form 32708.doc
PRINCIPAL IDENTIFICATION:
^ Produced ID
Form of Identification
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^ Personally known (Principal) ~ m
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State of New York, County of New York ~ ; N
Sworn to and subscribed before me w ---
This _ day of ,2008 ~.~ y„ ~
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Signature of Public Notary -Stale of New Yorit ~.
Notarization of PriirraTipal's signat«re ~^ pa
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BY CITY CLERK'S USE ONLY . r 1 _ ,c, / _ ~ 7
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1 do soterr>nly swear that alt of the fads a and that 1 have r+e~ ~ am familiar with the
provisions contained in Sec~on 282 of Miamil~~~ y C9de ar-cf at~~e~orhng re~remerrts'
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION ~ISCL~~(al ER
HOURLY, FLAT RATE OR OTHER): Q(f~s, " ' 4<f ~,~
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A) LOBBYIST DISCLOSURE: (Required) 23 ''
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.~it* 8
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): t~~ ~`~~~'~'~~, ~ 4
(Required). `~ fil,'"r-
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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":
I-iYes ®No• Are you lobbvina on a present or pandlna bid for aoods. equipment or services. or on a
present or pending award for Gooda. sautpment or service?
2) Pursuant b Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On
Real Estate Development Issues":
^Yes 6d No• Are you lobbvina on a pendlng apnlicatlon fora 1]evelopment Agreement with the City or
~pfication for chance of zoning map destination or chanc to the Citv'a Future Land Use Map?
3) Pursuant tp 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 anot-for-profit
corporation or entity without special compensation or reimbursement for the appearance, whether direct, or
Indirect, to express support of or opposltlon to any item, shalt register with the clerk as required by this
section but, shall not be required to pay any registration fees..
I-IYes 64 No: Are you rspresentina a not for profit corooration or entity without apeclal compensation or
reimbunsem~
V. SIGNATURE UNDER OATii:
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 Cfty Code and ail reporting requirements.
Signature of Lobbyist:
Signature of PrincipaUClient: ___ _ _ __ '~
Rabinder Pal Singh on behaff of TBS Realty, LLC
VI. LO86YIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
^ Produced ID ^ Produced 10
Form of identification Form of Identification
® Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, Couniy of Miami-Dade
Sworn to and subscribed before me
This _ day of , 2008
Signature of Public Notary -State of Forida
Notarization of Lobbyist's signature
~ Personally known (Principal) M U N I R~ N~ E
• Notary Public 9tife ei Naw York
State of New York, Coun of New No. 011~H8tiG38'953
ty ~~+mission Ezpitas March 20,10
Sworn to and subscribed before me
This r S day of S E A 2008
~~~ ~~~~ ~
Signature of Public Notary -State of New York
Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S USE ONLY
Annual Registration tes: [ ]Yes (] No Amount Pald i MCR # Date Paid
Lobbyist Reptatratlon Form racalvad and verified by:
F:ICLERILOBBYIS71Lobbyist Registration Form 32708.doc Revised 03@7!2008
MIADOCS 2972884 1
Signature of Lobbyist '
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N. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISC~(~~IVHETH~~ ~~.~~,
HOURLY, FLAT RATE OR OTHER): ~~ fP~3 ~")
A) LOBBYIST DISCLOSURE: (Required) T
wired).
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The following Information must be answered:
t) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
^Yes IRI Na• Are you lobbvina on a present or pending bid for goods equipment or services. or on_a
present or Dendina award for Goods. eauloment or ser I
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On
Real Estate Development Issues':
^Yes ®No• Are you lobbvina on a pending application for a Development Aareenwnt with the Cltv or
a Iicati n for h nce of ma deaf nation chance o the C ure Land Use Ma ?
3) Pursuant to Miami Beach City Cade 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 snot-for-profit
corporation or entity without special compensafan 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 ®No: Are vou_representina snot-for-profit corporation or entity without special compensation or
reimbursement.
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 PrlnclpaUCiient
J ein half th each Resort Condominium Association, Ina and Tudor
uth ach Resort-North Condominium Assoaation, Inc.
Vi. LOBBYIST 1DENTIFICAT PRINCIPAL IDENTIFICATION:
^ Produced ID ^ Produced ID
Form of Identification Form of Identification
® Personally known {Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This _ day of , 2008
Signature of Public Notary -State of Florida
Notarization of Lobbyist's signature
(~{ Personally known (Principal}
MUNIR AHME`0
State of New York, County of NewrlRlA(y Public State of New York
Swom to and subscribed beforE me No. 01AH8@38953
This 1S dayof'___\~2008 Commission Expires Marcn 20,10
\ ~v.-~
Signature of ublio Notary -State of New York
Notarization of Principals signature
TO BE COMPLETED BY CITY CLERK'S USE ONLY
Annual Registration fee: [ ]Yes [ ] No Amount Pald S MCR # S Date Paid
Lobbyist Registration Form received and verifted Hy:
F:ICLERILOBBYIS71Lobb st Re istratlon Form 32TOB.doc Revised 03!2712008
LOBBYIST
~~~~~
MIADOCS 2973020 1
V. SIGNATURE UNDER OATH:
m MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.oov
CITY CLERK office
Tel: 305.673.7411, Fax: 305.673.7254
LOBBYIST NAME:
Don Washburn
CityClerk(a2miamibeachfl.gov
I understand that no later than October 1'~ of each veer, i must file the following forms, pursuant to Sedion 2-485 of
the Miami Beach City Code, with the City C~ric's Office for all alive lobbying issues.
1) Lobbyist Expenditure Form
2) Disclosure Form
Failure to file these forms on a timely basis wifi result ~ my name being transmitted to the MiamhDade County
Commission on Ethics and for code violation evaluation.
In addition, once an issue 1 have rimed tD bbby on has been res~ved, 1 am required to irrvnediately notify the
City Clerk's Office for lobbyist withdrawal in writing.
Signature:
Mianocs 3o1mo5 1
pate: SePtern6er 16 ,21108
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OWNERSHIP STRUCTURE CHART -TBS REALTY, LLC
PARDAMAN K. VIVEK VIKRAM
CHATWAL CHATWAL CHATWAL
Member Member Member
50°/\ 25% I 25%/
Chatwal Family, LLC
(NY Limited Liability Company)
Sant Chatwal -Sole Manager
100%
Channel Properties, LLC
(N1' Limited Liability Company)
Pardaman K Chatwal -Sole Manager
100% owner
TBS Hotel Management Corp.
(FL Corporation)
Rabinder Pal Singh -Vice President
of the Corp.
Manager Member
1 % interest 99% interest
TBS Realty, LLC `~
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FL Limited Liability Company -t cn
Rabinder Pal Singh -Vice President of the ~ ~ '- ~
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MIADOCS 3009786 1