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James E. Rauh - TBS Realty, LLC m AM. 0. .-- v of Miami Beach S City a each Office of the City Clerk kb( 1700 Convention Center Drive, Miami Beach, FL 33139 /CV 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. I. LOBBYIST RETAINED BY: TBS Realty, LLC; Tudor South Beach Resort Condominium, Inc.; Tudor South Beach Resort Condominium Association, Inc. NAME OF PRINCIPAL /CLIENT: TBS Realty LLC 1111 and 1119 Collins Avenue, Miami Beach, Florida 33139 BUSINFSS NAMF ANn AInIrRFSS (Niimhar and Straatl (City) (Statal (7in Cnrial (305)673 -4747 (786)673 -6871 peggybenua @dreamsouthbeach.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: Rabinder Singh, VP, TBS Realty Inc.;Sec.,Tudor So. Beach Resort Condo. Assoc. Inc.;Tudor So. Beach Resort North Condo. Assoc.Inc. • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST. As to TBS Realty, LLC, see Attached Exhibit ii.SPECIFIC LOBBY ISSUE: Conditional Use Permit issued under Planning Board File No. 1886 for the hotel property located at 1111 and 1119 Collins Avenue, Miami Beach, Florida 33139. _ Issue to be lobbied (Describe in detail) 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 th) 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 cur cr gpn city pirsonnel who is sought to be lobbied as identified on the lobbyist registration form filed. 1 J Sec 2- 482(g) Any Financial, Familial or Professional Relationship ZE :C Ud 61 d3S 1101 None OA 3 el 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 8) 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 ": 0 Yes Q 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 L7 No: Are ou (obb in • on a • endin • a • +lication fora Deveio • ment A. reement with the Cit or a. +lication 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. D 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, Signature of Lobbyist I do solemnly swear that all of the foregoing facts are true and correct and that ( have read or am familiar with the provisions contained in Section 2-482 of the Miami : - 1.- • City Code reporting requirements. Signature of Lobbyist: Signature of PrincipaVClie VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: ❑ Produced ID 0 Produced ID Form of Identification - f.4 Form of identification Personally known (Lobbyist) ` '$ oo' Personally known (Principal) VII. SIGNATURE AND STAMP OF NOTARY: a o t7 fill , i .. gay.) $uirK 1Jaw 1 State of Florida, County of Miami -Dade o C State of He County of Mi..�- Sworn t _,l • subscribe. b- • re me z z Sworn and subscribed before me T. day of - A , 2011 •- u 12 r - This i'4 day of Sep -em z i11 lig Ter- Signature of Public Not - ry – Sta e of Florida Signature of Public Notary – State of Florida Notarization of Lobbyist's signature Notarization of Principal's signature A _ .........................__.. TO BE COMPLETED BY t.'(TY CLERK'S STAFF ONLY Annual Registration fee: f 1 Yes ( 1 No Amount Paid $ '2 , 50 ) -- MCR # ' .411Pji1allniliJI. ate P d ? / / // Lobbyist Registration Form received and verified by: , f F: \DEER \$ALL \aFORMS \LOBBYIST FORMS \Lobbyist Annual Registration Forin•cioc 0 ' i• evise 1/11 /2 11 J tra New MIA/v\I BEAC City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeochfl.gov CITY CLERK Office CityClerk@miomibeachN.gov Tel: 305473.7411 , Fox: 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 lihave registered to lobby on has been resolved, I am required to immediately notify the City Clerk's Office of lobbyist withdrawal in writing. dIP • I- if- Sign. ure: Date: r 1 d r 1. • • • • • • , • I .... 1.11 i •: • , • e ,1 • • i1ll V ' � Y • • • ' . • • • • • al 1 ... • • • . ✓... k •• , • 1 • , STRUCTURE C HART — DRBA.M SO' BBA H • • • • • PaxcsimanIL Chat i Vtvek claatwai Wont t Cha'ty 1. , . • — • o t �5% 2� °/n . • ' • 50 /a • • ' • C atwal' amfy, LAC , con as ' . • INS' limited ''t�► p Y . . • 100% • , • • •• • • i Cll=tel Properties, LLC . . ' N`Y lim d liab� company . . - • I . • •j ' 100% } • ' . • MS " otgl ' • i M) �� / j L � ef t Corp. . • 1 H • • •l% • 9% • • • • • • .1:.17{? Realty Lr�.►C I. 4. limited 1i�bi1L company • - • i i 1 , ' , • I I Dream Soutb•eaoh , ' • • • , 1 1111 Collins A•ve m . • • 1 ' l • Miami Beach, I . • i ' • I • i • • ' j f , • i , • I • 1 . ' • • • • • ,