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James E. Rauh - 1426A Alton Road 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.1) Terminello&Terminello, P.A. 1111 Lincoln Road Miami Beach Florida 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305)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: FOXHOLE BAR, LLC NAME OF PRINCIPAL/CLIENT: FOXHOLE BAR, LLC 1426A ALTON ROAD, MIAMI BEACH, FLORIDA 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zio Code) (305)993-4480 (305)993-4408 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: Jason Cochran, Manager • 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 conditional use approval for a neighborhood impact establishment, consisting of an alcoholic beverage establishment,also operating as an entertainment establishment,with an occupancy -)f more than 199 persons,at 1426A Alton Road(aka 1218 14th Court). I ul.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 I 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. ) .J Sec 2-482(g)Any Financial,Familial or Professional Relationship '' -t _, j ) � 00 .01 .tV None d `� V , 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 4o: 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 N(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. El Yes too: 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. Signat of bbyist I do solemnly swear that all of the foregoing facts are true nd 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 Principal/Client: VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: M o � � \\ o o ❑ Produced ID o ,�; I1�Produced ID �� 1,/� .2 a N Form of Identification a Form of Identification o o N ^sZ� a � Eoo 0 t C N Personally known(Lobbyist) o a El Personally known(Principal) .2 o � x 3 0 E� VII. SIGNATURE AND STAMP OF NOTARY: W z C o m co State of a,Co of Miami-Dade s°� �� State of Florida, County of Miami-Dade Z 2 2 ul S t d su cr efore me Sworn and subscr,ibW before me �'' is d 01 i� oN s�� This ay of ,r�.� .,2011 '� o t nat ublic Notary—'(State of Flori Signature ublic Notary Mate of Florida �Nota ion of Lobbyist's signature Notarizati of Principal's signature TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: [ ]Yes[ ]No Amount Paid$ Z MCR Date Paid Lobbyist Registration Form received and verified by: :tiC,1 �, 3. .sb:�3s E *,;"tE3&iEBYiST a"'�kStPs��.�P€,i Fie73 e d. e,;�iisa�i.� 'tarm. Revised 1/11/2011 City of Miami Reach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibec)chfl.gov CITY CLERK Office CityClerk@miamibeachfl.gov Tel: 305.673.741,1 , 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. I) 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. S1 V atur : Date: EXHIBIT "B" DISCLOSURE OF INTEREST FOXHOLE BAR, LLC Name and Address % of Ownership 5151 Entertainment,Inc. 49.5% 5151 Collins Avenue,Suite 321 Miami Beach,Florida 33140 Angel Fabres 50% 5151 Collins Avenue,Suite 321 Miami Beach,Florida 33140 Conrad Gomez 50% 5151 Collins Avenue,Suite 321 Miami Beach,Florida 33140 BD Equity,LLC 18.5% 1000 Lincoln Road,Suite 200 Miami Beach,Florida 33139 Brian I.Gordon 50% 1000 Lincoln Road,Suite 200 Miami Beach,Florida 33139 David Grutman 50% 1000 Lincoln Road,Suite 200 Miami Beach,Florida 33139 Black and Yellow Management Group,LLC 20% 524 Woodhaven Court Pittsburgh,Pennsylvania 15209 Joe Lopez 50% 524 Woodhaven Court Pittsburgh,Pennsylvania 15209 Jason Cochran 50% 524 Woodhaven Court Pittsburgh,Pennsylvania 15209 Jay Coc Entertainment,LLC 4% 524 Woodhaven Court Pittsburgh,Pennsylvania 15209 Jason Cochran 100% 524 Woodhaven Court Pittsburgh,Pennsylvania 15209 Chatani Ventures,Inc. 5% 401 W 30th Street Miami Beach,Florida 33140 Navin Chatani 100% 401 W 30"'Street Miami Beach,Florida 33140 Fortune 51,LLC 3% 2799 NW Boca Raton Boulevard,Suite 203 Boca Raton,Florida 33431 Jonathan Vilma 100% 2799 NW Boca Raton Boulevard,Suite 203 Boca Raton,Florida 33431