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James E. Rauh/WSG 34 Street, LLCm MIAMIBEACH 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 enrnurage 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. ~ ~r4 kff ~•~t E'S' G. NAME OF LOBBYIST:. (Last) (First) (M.I) /2osE.~ ,,5~-~rilre5 ~ I~~/Ti.,r ~G., ~-f'~? G,,yto~i.. ~~ P~ SE ~,~,r- ~ 3c~ BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 3U5 s4Y y~s~ - 3~S 5~~r 55~~ ;~~K~ ®~~s~.,a.,~S~:~Jc~f.~~« TELEPHONE NUMBER: FAX NUMBER: EMAIL: I. LOBBYIST RETAINED BY: NAME OF PRINCIP L/CLIENT: b4 ~4rtr~-kQ ~ ~~ ~~E-y Z©~-o . S-fe- ~. /~ Ig~-i V~~~~ ~~ 33f3~- BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zp Code) 3a 5 6 73 3 ?0 7 TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) Fill out this section if principal is a Corporation, Partnership or Trost [Section 2-482 (c)] • NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:jl~'r iQ~'i}G(~~ , IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: ~~~~~~ II. SPECIFIC LOBBY ISSUE: Issue to be lobbied (Describe in detail): ~ j~ ~ ~ O ~ III. CITY AGENCIES/INDMDUALS TO BE LOBBIED: h o c-c...~r t ~W e~ µ E C 6 otA~.+ sa,,, os hhr~t.) A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship ~t,Clb~ Pc.a~-~ MAN~C,G.we,~z-' ~O~' ~v G7 IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, PLAT RATE OR OTHERf A) LOBBYIST DISCLOSURE: (Required) ~ !. ~ ~© MONT $L B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required).~9 ~~ ~t e..• T+i G y 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-'~'No~ Are you lobbvina on a aresent or uendina bid for goods eauiament or services, or on a present or uendina award for goods equipment or service? Z) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": ^Yes f9~No• Are you lobbvina on a pending application for a Development Agreement with the City or application for change of zoning map designation or change to the Citv's Future Land Use Man? 3) Pursuant to Miami Beach City Code Z-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 anot-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 [+J'No• Are you representing anot-for-profit corporation or entiri without special compensation or reimbursement. . V. SIGNATURE UNDER OATH: ON OCTOBER 1~ 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 EXPENDITU R CO~SATION DURING THE REPORTING PERIOD. of I do solemnly swear that all of the foregoing facts familiar with the provisions contai in~~ectltxa~2-q requirements. ~~ and correct and that I have read or am the Miami Beach City Code and all reporting Signature of Lobbyist: Signature of Principal/Cli~•(f: VI. LOBBYIST IDENTIFICATION: ^ Produced ID Form of Identification PRI/NCIPAL IDENGT~IFICATION: afiroduced ID t ~L~ ~~1 O ""C~ 32- ^ ~~ ~ O ~ ~ ^ (~ Form of Identification T~ Personally known (Lobbyist) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade Sworn to and subscribe befQr~,me day f ~`~ ''z0~ S TO~l .:' ~~,_ io DD287204 .ark it e , 2008 ature of Public Nota =~ '~of ric~nded Tluv Notarization of Lobbyis s signatu"'rE'hc Bonding Co., Inc. ^ Personally known (Principal) State of Florida, County of Miami-D' Sworn anal subscrib d before me This .~ ~'r,(day of ~~ 20~ Signature Public Nota -State c Notarization of Principal's sign. ~s '~{/ f Florida r~'rrs iture FOR CLERK'S USE O LY ~t Annual Registration fee: [ ~ J Yes [ ] No Amount Pa' ~~- C7~MCR # U l/ ~ Date Paid Lobbyist Registration Form received and verified by: F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST FORM 05.doc Revised 12/08/04 CITY OF MIAMI BEACH DEVELOPMENT REVIEW BOARD APPLICATION DISCLOSURE OF INTEREST 1. LIMITED LIABILITY COMPANY If the property which is the subject of the application is owned or leased. by a CORPORATION, list the principal stockholders and the percentage of stock owned by each.. Where the principal officers or stockholders consist of another corporation(s), trustee(s), partnership(s) or other similar entity, further disclosure shall be required which disclosures shall which discloses the identity of the individuals} (natural persons) having the ultimate ownership interest in the entity}.* WSG 34TH STREET. LLC _ LIMITED LIABILITY COMPANY NAME Name, Address, and Office % OF STOCK Philip Wolman 46.25 Eric Shepard 46.25 Canyon Partners, LLC 5.00 Canyon Sands Venture, LLC 2.50 IF THERE ARE ADDITIONAL CORPORATIONS, LIST OTHERS, INCLUDING CORP. NAME(S) AND EACH INDIVIDUAL'S NAME, ADDRESS, OFFICE AND PERCENTAGE OF STOCK, ON A SEPARATE PAGE. NOTE: Notarized signature required on page 8 CITY OF MIAMI BEACH DEVELOPMENT REVIEW BOARD APPLICATION DISCLOSURE OF INTEREST 1. LIMITED LIABILITY COMPANY If the property which is the subject of the application is owned or leased by a CORPORATION, list the principal stockholders and the percentage of stocl: owned by each. Where the principal officers or stockholders consist of another corporation(s), trustee(s), partnership(s) or other similar entity, further disclosure shall be required which disclosures shall. which discloses the identity of the individual(s) (natural persons) having the ultimate ownership interest in the entity). CANYON PARTNERS. LLC LIMITED LIABILITY COMPANY NAME Name, Address, and Office % OF STOCK Jeffrey Krieger 50 Matthew Krieger 10 Daniel Adler 9.5 Gerald Rosen IF THERE ARE ADDITIONAL CORPORATIONS, LIST OTHERS, INCLUDING CORP. NAME(S) AND EACH INDIVIDUAL'S NAME, ADDRESS, OFFICE AND PERCENTAGE OF STOCK, ON A SEPARATE PAGE. NOTE: Notarized signature required on page 8 6 Robert Goldstein 10 Robert Pearlberg Robert Egger John Cerreta Joshua Bratter 2.5 IF THERE ARE ADDITIONAL CORPORATIONS, LIST OTHERS, INCLUDING CORP. NAME(S) AND EACH INDIVIDUAL'S NAME, ADDRESS, OFFICE AND PERCENTAGE OF STOCK, ON A SEPARATE PAGE. NOTE: Notarized signature required on page 8 6 Terrance Smith 5.882352941 David White 5.882352941 Fred Wilson 23.52941176 IF THERE ARE ADDITIONAL CORPORATIONS, LIST OTHERS, INCLUDING CORP. NAME(S) AND EACH INDNIDUAL'S NAME, ADDRESS, OFFICE AND PERCENTAGE OF STOCK, ON A SEPARATE PAGE. NOTE: Notarized signature required on page 8 6 CITY OF MIAMI BEACH DEVELOPMENT REVIEW BOARD APPLICATION DISCLOSURE OF INTEREST LIMITED LIABILITY COMPANY If the property which is the subject of the application is owned or leased by a CORPORATION, list the principal stockholders and the percentage of stock owned by each. Where the principal officers or stockholders consist of another corporation(s), trustee(s), partnership(s) or other similar entity, further disclosure shall be required which disclosures shall. which discloses the identity of the individual(s) (natural persons) having the ultimate ownership interest in the entity). CANYON SANDS VENTURE, LLC LIMITED LIABILITY COMPANY NAME Name, Address, and Office % OF STOCK David Birnbaum 17.64705882 Tom O. Hanson 5.882352941 Niclc Muscato 11.76470588 Mark Rankin 11.76470588 Allen. Schwartz 17.64705882 IF THERE ARE ADDITIONAL CORPORATIONS, LIST OTHERS, INCLUDING CORP. NAME(S) AND EACH INDNIDUAL'S NAME, ADDRESS, OFFICE AND PERCENTAGE OF STOCIS, ON A SEPARATE PAGE. NOTE: Notarized signature required on page 8 6