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James E. Rauh - Sing Sing Karaoke, Inc. 1 •_ 21 ,�v-6 1—°1 ' %Is4 13:1 I tV\i 9 P -9 City of Miami Beach Office of the City Clerk '�%\\ S 1700 Convention Center Drive, Miami Beach, FL 33139,. R �: A r \ ��- 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: Sing Sing Karaoke, Inc. NAME OF PRINCIPAL /CLIENT: Sing Sing Karaoke 717 -721 Washington Avenue (a /k /a 719 Washington Ave.) Miami Beach, Florida 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (7in Code) (917)553 -6454 kelpbeach @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: Kellie Pilicer, Director, Sing Sing Karaoke, Inc. • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: See Attached Exhibit "B" II.SPECIFIC LOBBY ISSUE: Application for a Conditional Use Permit for a Neighborhood Impact Establishment with an occupant load of 200 or more _ persons also operating as an entertainment establishment. 41- � t.,../44 ,� .— A -6/4A 4)t, 4 - ) Issue to be lobbied (Describe in detail): J - ( 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 general 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 Planning Board 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(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 i IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) $375.00 per hour B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):$375.00 per hour (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 IL'1 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 re 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. 411111. Ce---I _ Signatur- of ..byist I do solemnly swear that all of the foregoing facts are true • d 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: ba-- Signature of Principal /Client: P/A1 1 .-'' 1 -/' VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: ❑ Produced ID ❑ Produced ID Form of identification Form of Identification ��E PHMNE JEAN FN)OFIES Personally known (Lobbyist) �'" ! r• BRAD STEVEN FLEET p known (Pr �, DD 866281 !�l =.,. MY COMMISSION # DD816769 EXPIRES: Apt 26, 26,201 3 VII. SIGNATURE AND STAMP OF $ r '-: ; -: EXPIRES: A ugust 21, 2012 . ' Bonded T ru Notary Public tMderw'iters c,�, 1-404-3. . ' Y ri, 1404yy Di.wunt Alum co, State of Florida, County of Miami -Dade ' " ' ' - - - - - State of Florida, County of Miami -Dade Sworn subscribed ore me Sw• - d subscrib- : before me This d -y of . , 2011 is , day o • - +`t - �i. ` r .,.k is! /i i i Signature of P •tic Note. — State of Florida Al Sign. ure of Public N•`a •- ;�) da Notarization of Lobbyist's signature' Note : '. of Principal's - • 1 . re TO BE COMPLETED BY CIT CLERK'S STAFF ONLY Annual Registration fee: [ ] Yes [ o Amount Paid $. WISP # ; Date Paid 9Ji9 Lobbyist Registration Form rece d and verified by: ! t' -�T1' -' &V C) --' F : \CLE12 \$Ai.L WORMS \LOBBYIST FORMS \Lobbyist Annual R OiStrati I n orni.dac Revised 1 /11/2011 IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) $375.00 per hour B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): $375.00 per hour (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": 1zl ❑ Yes No: Are you Iobbyinq 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 g 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 Any person y h () y p so (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 lM 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. C2-- Signatur- of .•byist I do solemnly swear that all of the foregoing facts are true : d 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: ba--"--t- V--------" Signature of Principal /Client: VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: ❑ Produced ID ❑ Produced ID Form of Identification Form of Identification IiKrsonally known (Lobbyist) .,.,,, , ❑ Personally know BRAD STEVEN FLEET y n (Principal) VII. SIGNATURE AND STAMP OF ; MY COMMISSION # DD816769 . EXPIRES: August 21, 2012 i ''' ' TARY IL Nat Discount Assoc. Co. State of Florida, County of Miami -Dade State of Florida, County of Miami -Dade Sworn subscribed ore me Sworn and subscribed before me This I d -y of . , 2011 This day of , 2011 _ •- t,tl a* ' Jam! i Signature of P •lic Nota - State of Florida Signature of Public Notary - State of Florida Notarization of Lobbyist's signature Notarization of Principal's signature TO BE COMPLETE' :Y .CITY CLERK'S STAFF ON Y Annual Registration fee: [ ] Yes [ o Amount Paid $ .,, ' - MC # . 0 Date Paid 9 00 Lobbyist Registration Form receiv and verified by: AMP' `� , 1., : =,C S s L FO $ S\L 'IS m .'O% MS \Lobtypst Asr rsudi Reg ,'. exa. r< F ;. n Revised 1/11/2011 1 EXHIBIT "B" DISCLOSURE OF INTEREST SING SING KARAOKE, INC. Name and Address % of Ownership Ok Soon Lee 100% 9422 Via Elegante Wellington, Florida 33411 President and Director Michael Pilicer 0% 7918 Parsons Pine Drive Boynton Beach, Florida 33437 Vice President and Director Kellie Pilicer 0% 7918 Parsons Pine Drive Boynton Beach, Florida 33437 Secretary and Director 1 CA I\ A I P\ k 5 a3 iH W..B P P r f City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33134, www.miamibeaq Pis CITY CLERK Office CityClerk @mian f1 9 P '7/2. Tel: 305.673.741 1 , Fax: 305.673.7254 �, L � � 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. • S ig nat . re: Date: