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James E. Rauh - NOBU Associates (South Beach), L.P. MIAMI Ave 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) • 1224 WASHINGTON AVENUE, MIAMI BEACH, FLORIDA 33139__ BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-602-8245 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: NOBU ASSOCIATES (SOUTH BEACH) , L.P. NAME OF PRINCIPAL/CLIENT: NOBU ASSOCIATES (SOUTH BEACH) , L.P. 3 EAST 57TH STREET, 7TH FLOOR, NEW YORK, NY 10022 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (212) 757-5926 JOHNK @NOBURESTAURANTS .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:MEIR TEPER, DIRECTOR • IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: SEE EXHIBIT "C" II. PECIFIC LOBBY ISSUE:` CONDITIONAL USE PERMIT FOR A NEIGHBORHOOD IMPACT ESTABLISHMENT AT 4525 COLLINS AVENUE AND ANY LAND USE, DEVELOPMENT, ZONING, DESIGN,OR LICENSING ISSUES RELATED Issue to be lobbied(Describe in detail): TO THE SUBJECT PROPERTY. III.;;CITY AGENCIES/IND:IVIDUALS 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 DIRECTOR AND STAFF X PLANNING BOARD X MAYOR AND COMMISSIONERS 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 -= F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc -� r� `i i IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY.FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) 5375/HOUR B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): (REQUIRED). $375/HOUR 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 XNo: 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? I 2) Pursuant to Miami Beach City Code Section 2.490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": _Yes XNo: 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 Section 2-482(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. _YesXNo: Are you representing a not-for-profit corporation or entity without spacial compensation or reimbursement. V. SIGNATURE UNDER OATH: ON FEBRUARY 28 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 L. • I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am familiar with the provisions contained in Section 2-482 of the Miami Beigki Code and all reporting requirements. ; •Signature of Lobbyist: MEAL�i' Signature of Principal/Client: APir AliatirellrAg- VI. LOBBYIST IDENTIFICATIO I N r PRINCIPAL IDENTIFICATION: _Produced ID :',1 57 .• 'Produced ID 1r/u''-if tr-iL4-4-- - Form of Identification Form of Identification /Personally known(Lobbyist) • _Personally known(Principal) VII. SIGNATURE AND STAMP OF NOTARY: i u, I Liiildeic State of Florida,County of Miami-Dade State of F ,Cou ty of e Sworn to and subscri•yd before me O Sworn subscrib d before e Tti is ZO t(, day of ; ,ul t ,201,E Oil T ': day of 4�..., .1,201 ILdA J A Signature of Public Notary State of Florida .ignature o '4c Iic ota'-'ta'e of Florida Notarization of Lobbyist's signature otarizati•of Principal's signature g 1 TO BE COMPLETED BY CITY CLERK'S ST/AFF ONLY • Annual Registration fee: [ ]Yes[ ]No Amount Paid$ MCR# Date Paid Lobbyist Registration Form received and verified by: f:\C:I.rfrt\SAlJ.`nf'tlUMs\I,ot:tiVIST f t7I ns\iobbyui h.niiu;il Registrtio,Ftt„ui,duc .Revised 01/22/2014 JOHN J. HACKETT F:ICLERI$ALLIaFORMSILOBBYIST FORMS1Lobbyist Registration Form.doc Notary Public, State of New York No. 4988560 Qualified in Suffolk County • Commission Expires November 12, 1 ziU • iVdA.M BEACH City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov CITY CLERK Office Rafael E. Granado, City Clerk CityClerk @miamibeachfl.gov Tel: 305.673.7411 , Fax: 305.673.7254 LOBBYIST NAME: JAMES E. RAUH I understand that no later than February 28 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, or I am no longer lobbying on that issue or for that principal, I am required to immediately notify the City Clerk's Office of lobbyist withdrawal in writing. Pursuant to Section 2-485 (d), the City Clerk shall notify any lobbyist(or principal) who fails to timely file a Statement and in addition to any other penalties which may be imposed as provided in Section 2-485.1, a fine of$50.00 a day shall be assessed for all Statement(s) filed after the due date. The City Clerk shall notify the Miami-Dade County Commission on Ethics and Public Trust of the failure of a lobbyist(or principal) to file the Statement or pay the assessed fines after notification. Any lobbyist, who fails to file the required Statement by April 30th of each year, shall be automatically suspended from lobbying until all fines are paid, unless the fine has been appealed to the Miami-Dade County Commission on Ethics and Public Trust. dB g - zo - 2-0/s Sign- Date: , iF . .F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc EXHIBIT"C" DISCLOSURE OF INTEREST NOBU ASSOCIATES(SOUTH BEACH),L.P. CITY OF MIAMI BEACH DEVELOPMENT REVIEW BOARD APPLICATION DISCLOSURE OF INTEREST 1. PARTNERSHIP/LIMITED PARTNERSHIP If the property which is the subject of the application is owned or leased by a PARTNERSHIP or LIMITED PARTNERSHIP, list the principals of the partnership, including general and limited partners. Where the partner(s) consist of another partnership(s), corporation(s), trust(s) or other similar entity, further disclosure shall be required which discloses the identity of the individual(s)(natural persons)having the ultimate ownership interest in the entity. Nobu Associates(South Beach), L.P. PARTNERSHIP or LIMITED PARTNERSHIP NAME Name and Address %of Ownership Nobu Associates(South Beach),L.P. Robert De Niro 27.72% 1901 Collins Avenue Miami Beach,Florida 33139 Meir Teper 21.78% 1901 Collins Avenue Miami Beach,Florida 33139 Nobuyuki Matsuhisa 44.55% 1901 Collins Avenue Miami Beach,Florida 33139 Richard Notar 4.95% 1901 Collins Avenue Miami Beach,Florida 33139 Nobu South Beach Corp. 1% 1901 Collins Avenue Miami Beach,Florida 33139 Nobu South Beach Corp. Robert De Niro 28% 1901 Collins Avenue Miami Beach,Florida 33139 Meir Teper 22% 1901 Collins Avenue Miami Beach,Florida 33139 • Nobuyuki Matsuhisa 45% 1901 Collins Avenue Miami Beach,Florida 33139 Y EXHIBIT"C" DISCLOSURE OF INTEREST NOBU ASSOCIATES(SOUTH BEACH), L.P. Page 2 of 2 Richard Notar 5% 1901 Collins Avenue Miami Beach,Florida 33139 CITY HALL CASHIER OFFI 1700 CONVENTION CNTR DR MIAMI BEACH, FL 33139 08/24/2015 15:34:10 CREDIT CARD VISA SALE tli.'. CARD# XXXXXXXXXXXX5682 Chip Card AID: A0000000031010 ATC: 0002 IC: F9AB980B95A570FE INVOICE 0001 SEQ#: 0001 City of Miami Beach-Florida Batch#: 001612 Finance Department Approval Code: 024459 Entry Method: Chip Read 1 City Hall Mode: Issuer 1523613-1 08/24/2015 BR1 T113 Tax Amount: $0.00 Mon Aug24,2015 03:34PM Trans#12-12 12 $350.00 MCRCLERK - MCR-City Clerk SALE AMOUNT $350,00 * MCR#: 407128 1 ITEM(S): TOTAL: $350.00 Credit Car PAID $350.00 CUSTOMER COPY Have a nice day! Miscellaneous Cash Receipt -,,_ r= ; . :* .24./{ F = i �j 1- , , CITY OF MIAMI BEACH 1, I tv c i 4,,.,k t ,i'8 $7,-.0, •. No. � , r 3 50 ____. :7' ''''' / kj , e, 0 :-_, „..... ,..,, } ❑ Cash 0 Credit Card ❑Check# $ - A ( Z"( 20- Received of . ,L °i r- Ea:L 0 4. T ot.01 i ri „ill-, :: .. 4 � ti . ,:: Address 2-10 0 7 -- ` - PI k v► , a 3 3 -. ,-�,,1 6,6-YA, ' 0 c- i .. ly,, i- n.,f. .-- INS f. lit t')( II .'� :4 t'1 !'-'.S'For �': -� f'A^t'!/!d i 9 Yet 4aP 4 i r) kJ'1-« 7)4._i.';_ :_-_,/ I-,c i.-.,--,,1 -I s&,-t.... 'if-t ic.,t. ) -4-0-41, s..,LI. i I:),- ti----11 i (THIS INFORMATION MUST BE COMPLETED) Offi-e of/Finance Director 1= By --- - Account Number if Preparers ( D p ---