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James E. Rauh - Alma Mexicana, LLC ©f ,p L1( R M I A M I BEA CH P 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. Rauh James E. NAME OF LOBBYIST. (Last) (First) (M I) Terminello & Terminello, P.A 1111 Lincoln Road Miami Beach Florida 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (786) 276 -2343 (305) 448 -5566 jrauh @terminello.com TELEPHONE NUMBER. FAX NUMBER EMAIL. Please notify this office if your contact information changes: address, phone, or e-mail address. LOBBYIST RETAINED BY: Alma Mexicana, LLC NAME OF PRINCIPAL /CLIENT Alma Mexicana, LLC 1334 Washington Avenue Miami Beach Florida 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305)695 -0880 (305)695 -0881 AlmaMexicanaRestaurant (a� gmail.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: Jeffery Greenberg, Manager, Alama Mexicana, LLC • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: See Attached Exhibit "A" ['.SPECIFIC LOBBY ISSUE: Please See Attached Exhibit "B" Issue to be lobbied (Descnbe 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 Board of Adjustment None X City of Miami Beach Planning Director /Staff None X City of Miami Beach Mayor and Commissioners None X Pursuant to City Code Section 2- 482(9) 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 an y current city commissioner or city personnel who is sought to be lobbied as identified on the lobbyist registration form filed. ;3 i ! —I �` Sec 2 482(9) Any Financial, Familial or Professional Relationship 9s:z bid z— Nnrl1Ql None IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) $7,500 Flat Fee B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION) $7,500 Flat Fee (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 iNo: 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 ❑ Yes e 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 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 ❑ Yes '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 FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. ° "-- ) f 1 Sigma yr of ist I do solemnly swear that all of the foregoing facts are true+ ef5d correct and that I have read or am familiar with the provisions contained in Section 2-482 of the Miami Be. - - Co• - •d 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 L7 Nersonally known (Lobbyist) ❑ Personally known (Principal) VII, SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami -P.. - State of Florida, County of Miami -Dade Sworn o < id subscri. - , b -.o -..;; BRAD STEVEN FLEET Sworn and subscribed before me . . clay of 4.-,e �'���_ O$11 COMMISSION #DD616169 This day of 2011 All a - • , EXPIRES August 21, 2012 4 ¶4 .+.L��� �i � II ',.; - •T. 'Y FI. N"Y Di...unt AllW. Co. Signature of Public Notary �'�'� :': - g ry — 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 V Date Paid / LS'� r "' Annual Registration fee: [ ] Yes [ ] No Amount Paid $ ... .‘MCR # . Lobbyist Registration Form received and verified by: � � I . P' \CL RySALLvaFO €MS ", YI FORMS vLobbyistAnnsio Registration orar dot l i Revised 1 /11/2011 IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) $7,500 Flat Fee B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): $7,500 Flat Fee (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 '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': ❑ Yes Er 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 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. ❑ Yes I8'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 FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. , - — '~ �1 • Signat e of Lobbyist r do solemnly swear that all of the foregoing facts are true rSci cocorrect and that I have read or am familiar with the provisions contained in Section 2 -482 of the Miami Be. Co• - reporting requirements. Signature of Lobbyist l ,--- Signature of Principal /Client: r , VI. LOBBYIST IDENTIFICATIO PRINCIPAL IDENTIFICATION: ❑ Produced ID / � 0 Produced ID Form of Identification Form of Identification kl' ersonally known (Lobbyist) 5i( Personally known (Principal) VII. SIGNATURE AND STAMP OF NOTARY: THERE ( 'E - M`INGOS da State of Florida, County of apk-a - • - . .. _ State of Florida, Co Sworn o . ly [ 'i-D "'yPuUnc - State of Florida id subscn• b: BRAD STEVEN FLEET 4 "` C omm Expires Oct 25, 2014 • •��a o J„r ' Sworn a subscri d , • ► Commission # EE 16328 Y °1.11f COMMISSION N DD816769 This / day of _A_ , I \� r�a � EXPIRES: August 21, 2012 ^ � , eontletl 1hrn,u0` N hrnai Notary Assn Signature of Public Notary =': :'° : : : ' - Signature of Public Notary ry - State of Florida Notarization of Lobbyist's signature Notarization of Principal's signature TO BE COMPLETED BY CITY CLERK'S STAFF ONLY t � � � S �/� Annual Registratio m Aount Paid 5 S "- MCR # :it 2 X ?? ( Date Paid � Lobbyist Registration Form received and verified by: A 4 F: \Ct.CR \$ALL\a1'ORMS \LOBBYIST FORMS \ Lobbyist Annual Registration Forin.doc OW 61,1:e.-t Revised 1/11/2011 J • f e A . �Y ( 1 ' f % ,.. 9 City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Honda 33139, www miamibeachfl.gov CITY CLERK Office CityClerk @miamibeachfl.gov Tel 305 673 7411 , Fax 305 673.7254 James E. Rauh, Esq. LOBBYIST NAME: 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. Sign ture: Date: EXHIBIT "A" DISCLOSURE OF INTEREST ALMA MEXICANA, LLC Name and Address % of Ownership ALMA MEXICANA, LLC Kristopher Hinson 100% 5790 North Bay Road Miami Beach, Florida 33140 • EXHIBIT "B" SPECIFIC LOBBY ISSUE File No. 3509: Alma Mexicana, LLC 1344 Washington Avenue (a /k/a 1345 Drexel Avenue) The applicant is requesting a variance to waive the minimum required interior separation between a business that sells alcoholic beverages for consumption and an educational facility, Fisher - Feinberg Elementary School, in order to sell beer and wine for consumption on the premises and a variance to waive the minimum seat requirement for the restaurant to serve beer and wine for consumption on the premises.