Greg Waldron/1100 West Properties, LLCm MIAMIBEACH
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 bond or
committee. The term specifically includes the principal as well as any employee engaged to lobbying activities. The
term "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435.
Waldron Greg
NAME OF LOBBYIST: (Last) (First) (M.1.)
China Grill Management 235 Lincoln Road, Suite 207 Miami Beach FL 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) {State} {Zip Code)~~
_(305) 672-0046 (305} 672-9126 greg.waldronQchina rillmgt.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL: ~~~
LOBBYIST RETAINED BY:
1100 West Properties, LLC
NAME OF PRINCIPAUCLIENT:
c/o Morgans Hotel Group 475 10~h Avenue New York NY 10018
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
_ {305-) 674-4848 N/A agalbut@hudcap.com
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) ~~
Fill out this section 1f principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY CR INDIRECTLY, A 5% OR MORE
OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST:
See Exhibit "A" attached.
II. SPECIFIC LOBBY ISSUE:
Conditional Use Permit
Issue to be lobbied (Describe in detail):
III. CITY ACyENCIES/INDIVIDUALS TO BE LOBBIED: (Pursuant to City Code Section 2-482(g) include a
statement of the extent of any business, financial, familial, professional or other relationship, giving rise to an
appearance of an impropriety, with any Clty personnel sought to be lobbied; further, pursuant to City Code Section 2-
482(a)(4) include a statement of any contractual relationship (paid or unpaid) from 12 months preceding the
commencement of service of City personnel to be lobbied.)
A Full Name of Indlvldual/Title B An Financial, Familial or Professional Relationshl
City of Miami Beach Planning Board None
City of Miami Beach Mayor/Commissioners None
City of Miami Beach Committees None
MIADOCS 3124333 1
~~
s
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION {DISCLOSE WHETHER
HOURLY, FLAT RATE OR OTHER}:
A) LOBBYIST DISCLOSURE: (Required)
No extra compensation for lobbying
B} PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION}:
(Required). No extra compensation for lobbying
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-lYes 6a No: Are you lobbv[ng on a present or pending bid for 9aods, eauipment or services, or on a
present or pending award for Goods, equipment ar servic®?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On
Real Estate Development Issues":
f-lYes ®No: Are you lobbvina on a p~ndina application for a Development Agreement with the City or
application for chance of zoning man designation or chance 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 anot-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..
I-IYes ®No: Are you representing a not-for-profit corporation_ Qr entity without special compensation or
reimbursement.
V. SIGNATURE UNDER OATH:
E
S of Lobbyis Greg Waldron
1 do solemnly swear that all of the ~-f~~o'r~e~~ ~ facts are true and correct and that I have read or am familiar with the
provisions contained in Section 2-4~-- i Ci nd all reporting requirements.
Signature of Lobbyist: .~.---- - - F
Signature of Principal/Client: E ~ ~
VI. LOBBYIST IDENTIFIGATION: PRINCIPAL IDENTIFICATION:
^ Produced ID ~~ OQ. L\~~ W ~3~'Z~~ ~~' ~~~/j,y Produced ID CO-..b-ec-tic~fi~. ~~#- !?766sz21 y /
Form of Ident~cation Form of Identification
® Personally known {Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of - uB Notary Public State of
Sworn~p and sub cri ed be r~ ~,
This L`6 d f ~(e~ Alejandro Romero
' 2 0$ ` o My Commission DD6i
/ ~ I ''+'or f~°a Expires 06/1512011
^ Personally known (Princl
of Florida, County of Miami-d'!
i and subscribed before me
2_ day of (~;.T~~ 2008
9
Signature of Public Notary -State of F
Notarization of Principal's signature
~`c ~~~
~ 9Fsss~O~~'°ti
~? "'o
TO BE GOMPLETED BY CITY CLERK'S USE ONLY
Annual Registration fee: [ Yes [ ] No Amount Paid S MCR ti Date Paid
Lobbyist Registration Form received and verified by:
F:~CLER\LOBBYIS11Lobbylst Registration Form 32708. Revised 0312 12008
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m MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.aov
CITY CLERK office CitvClerkCDmiamibeachfl.gov
Tel: 305.673.7411, Fax: 305.673.7254
LOBBYIST NAME: Greg Waldron
I understand that no later than October 1't of each veer, I must file the following forms, 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 Form
2) Disclosure 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.
(n addition, once an issue i have registered to lobby on has been resolved, I am required to immediately notify the
City Clerk's Office for lobbyist withdrawal in writing.
gnature: g Waldron Dates-~
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