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James E. Rauh - Quadrum Miami Beach, LLC 18?5CdI1sAvr2. , M I ' B City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 2015 !FE --6 ; 9: 147 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. 1224 Washington Avenue, Miami Beach, Florida, FL 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: QUADRUM MIAMI BEACH, LLC NAME OF PRINCIPAUCLIENT: Quadrum Miami Beach, LLC 407 Lincoln Road, Suite 2F, Miami Beach, Florida 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305)517-1970 sschumer @quadrumglobal.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: Ben Shmul • IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: See attached Exhibit"A" II.SPECIFIC LOBBY ISSUE: Conditional Use Permit for a Neighborhood Impact Establishment at 1825 Collins Avenue,Miami Beach,Florida,33139,and any other land use, development,zoning,design or licensing issues relating to the subject property. Issue to be lobbied(Describe in detail): Ill.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 Planning Board None X Planning Director and his staff None X Parking Director and his staff 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 IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) $3755 / hour B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): $375 / 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 © No: Are you lobbying on a present or pending bid for goods,equipment or servicestor 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 © No: Are you lobbying on a pending application for a Development Agreement with the City or application for chance 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. Signatuv o obbyist I do solemnly swear that all of the foregoing facts are tru: - 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: Signature of Principal/Clie (44- 7'e t VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: 0 ❑ Produced ID ;•;�+'S "�r 0 Produced ID = �''+ Form of Identification yR,'_: ,1.4:i 1 Form of Identification ' ;-,_;141 Personally known(Lobbyist) )4 Personally known(Principal) Iii VII. SIGNATURE AND STAMP OF NOTARY: r State of Florida,County of Miami-Dade �^ I ` State of Florida Coun of Miami-Dade i 11. Sworn to and subscribed before me I s a Sworn and subscribed before me s 1 v g of Aril 201 This .- of A•ril 0 T is 0(� day P 5 ` ilLAPArilt T - f AcuidAw 3,6.4 Signature of Public Notary—State of Florida o 17b ae -II�; -7 Sign- 0 r c Public Notary" -_- of Florida f° ° d Notarization of Lobbyist's signature 0 m No rizati,n of Principal's signature TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: [ ]Yes[ ]No Amount Paid$ C'^ MCR# r Date Paid Hof• 211?,01t Lobbyist Registration Form received and verified by: C I CA-a— 4....4— F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Annual Registration Form.doc Revised 1/11/2011 di' G x • I N c e 5 L., O ON .O F- ° �D c d N an W W J C 0 •.. N V LL Q Z d gel N ea C. rn a Q C ti L lo , ? E O O O na c o C O cla C C � N t • .-, .n d - p E p O .r1 } J c ,_ .. 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Q aci .o A -0 �.` Q cci 0 0- .0 o d J ..n * Z c .= § Z c a .c o+ a cc E FP O O o_ �J d CU ° ° E o . 2 G-, al of VI ° zlV MI wl WI ci T ,- a J O1 .. •c. d M1; a E d j1 S = ' r g s 5 F a ...„__ x ,t, ___.........__............._.r ._...__.. ____________. __ _.-____________ _ _________ 1 . 1 MIAMIBEACH City of Miami Beach, 1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.gov CITY CLERK Office CityClerk @miamibeachfl.gov Tel:305.673.741 1 ,Fax:305.673.7254 LOBBYIST NAME: JAMES E. RAUH 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. � 40, male/3 Sign• - Date: EXHIBIT"A" DISCLOSURE OF INTEREST QUADRUM MIAMI BEACH,LLC CITY OF MIAMI BEACH DEVELOPMENT REVIEW BOARD APPLICATION DISCLOSURE OF INTEREST 1.CORPORATION Quadrum Miami Beach.LLC CORPORATION NAME Name and Address %of Ownership Quadrum Miami Beach,LLC(Florida) Insite US Miami,LLC(Florida) 1.6% Miami Beach Nautilus,LP(Delaware) 98.4% Insite US Miami,LLC(Florida) Insite Group,LLC(Florida) 100.0% Insite Group.LLC(Florida) Jet Stream Holdings,LLC(Florida) 100.0% Jet Stream Holdings,LLC(Florida) YS Holdings,LLC(Florida) 99.0% YB Holdings,LLC(Florida) 1.0% YS Holdings,LLC(Florida) Ben Shmul 100.0% 1825 Main Street,Suite 235 Weston,FL 33326 YB Holdings,LLC(Florida) Ben Shmul 100.0% 1825 Main Street,Suite 235 Weston,FL 33326 Miami Beach Nautilus,LP(Delaware) Miami Beach Nautilus Corp(Delaware) 90.0%capital Amathea US Trust(Delaware) 5.0%capital Europa US Trust(Delaware) 5.0%capital Miami Beach Nautilus Corp(Delaware) Dolphin Trust(Guernsey) 12.5% Aquarius Trust(Guernsey) 12.5% Auriga Trust(Guernsey) 12.5% Draco Trust(Guernsey) 12.5% Corbiere Trust(Guernsey) 25.0% Mensa Trust(Guernsey) 25.0% Amathea US Trust(Delaware) EXHIBIT"A" DISCLOSURE OF INTEREST QUADRUM MIAMI BEACH,LLC Page 2 of 2 Christiana Trust,as Trustee 100.0% 3801 Kennett Pike Suite C200 Greenville,DE 19807 Europa US Trust(Delaware) Christiana Trust,as Trustee 100.0% 3801 Kennett Pike Suite C200 Greenville,DE 19807 Dolphin Trust(Guernsey) Rysaffe Trust Co Ltd.,as Trustee 100.0% PO Box 141,La Tonnelle House Les Banques,St.Sampson Guernsey GY1 3HS Aauarius Trust(Guernsey) Rysaffe Trust Co Ltd.,as Trustee 100.0% • PO Box 141,La Tonnelle House Les Banques,St.Sampson Guernsey GY1 3HS Auriga Trust(Guernsey) Rysaffe Trust Co Ltd.,as Trustee 100.0% PO Box 141,La Tonnelle House Les Banques,St.Sampson Guernsey GY1 3HS Draco Trust(Guernsey) Rysaffe Trust Co Ltd.,as Trustee 100.0% PO Box 141,La Tonnelle House Les Banques,St.Sampson Guernsey GY1 3HS Corbiere Trust(Guernsey) Corbiere Trust Co Ltd,as Trustee 100.0% PO Box 141,La Tonnelle House Les Banques,St.Sampson Guernsey GY1 3HS Mensa Trust(Guernsey) Rysaffe Trust Co Ltd.,as Trustee 100.0% PO Box 141,La Tonnelle House Les Banques,St.Sampson Guernsey GY1 3HS