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Louis J. Terminello/Heafey/Bentley Hotel, LLC~ 1V11A1~11 BEACH ~;~~':-~`~~~~ ZGDI DEC 28 Q~i 9~ 30 City of Miami Beach Office of the City Cierk 1700 Convention Center Drive, Miami Beach, FL 33139 ~~i i Y ~Lta~:~'~'S QF~~=l~: c LOBBYIST REGISTRATION FORA~I Lobbyist means all persons employed or retained, whether paid or not, by a prinopal who seeks to encourage the passage, defeat or modification of any ordinance, resolution, action or dedsion 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 [he entire decision-making process on such action, decision or recommendation that foreseeably will be heard or reviewed by the city commission, or a ciry board or committee. The term speciFcally includes the principal as well as any employee engaged in lobbying activities. The term "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435. Tenninello Louis T ivHric ur ~udtsrl5i: (Last) (First) (M.I) Terminello & Terminello P A 2700 SW 37th Avenue Miami Florida 33133 BUSINESS NAME AND ADDRESS (Number and Street) (City) (5[ate) (Zip Code) 305.444.5002 305.448.5566 ljt@terminello.com i ~~crrtuivt ivur'itstK: FAX NUMBER: EMAIL I. LOBBYIST RETAINED BY: Heafey / Bentley Hotel, LLC NAME OF PRINCIPAL/CLIENT: 1717 North Bayshore Drive, Suite 102, Miami, Florida 33132 nu~livt55 NAMt ANIJ ADDRESS (Number and Street) (City) (State) (Zp Code) ~05.523.3~44 TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) Fill out this section if pnnctpal ~s a Corporation, Partnership or Trust [Section 2-482 (c)] • NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: See attached. • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECT'LY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIPORTRUST: See attached. II_ SPECIFIC LOBBY ISSUE: Application for Conditional Use Approval for Restaurant 2t 101 Ocean Drive Issue to be lobbied (Describe in detail): III. CI7Y AGENCIES/INDMDUALS TO BE LOBBIED: A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship Planning Board No Planning Director No N. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT R.4 TE OR OTHERJ: A) LOBBYIST DISCLOSURE: (Required) _-'+' ~~~~~ ~ F L~ 1 2 ~i- T~~ B) PRINCIPAL'S DISCLOSURE (OF LOBBYISTCOMPENSATION): (Required)._ ~~r ~ dD ~ Lf}-T ;Z,~} i CZ ~ 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 15 No: Are you lobbvinq on a present or pendinq bid for uoods equipment or services or on a present or oendinn award for qoods equiament or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": OYes ~No: Are you lobbvinq on a pendinn application for a Development Aureement with the Citv or ~plication for chanqe of zoninu map desinnation or chanqe to the Citv's Future Land Use Maa? 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.. p Yes ~No: Are vou representinq a not-for-orofit corporation or entitv without s~ecial compensation or reimbursement. . V. SIGNATURE UNDER OATH: ON OCTOBER 1~ OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMEN7 UNDER OATH, LISTING LOBBYING EXPENDTTURES, WELL AS COMPENSATION RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING ALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURE 0~2 COMPENSATION DURING THE REPORTING PERIOD. I Signature of Lobbyist I do solemnly swear that all of familiar with the provisions cont requirements. Signature of Lobbyist: Signature of Principal/Client: L VI. LOBBYIST IDENTIFICATION: ^ Produced iD ~regoing facts are true and correct and t in Section 2-482 of the Miami Beach City Form of Identification ~ Personally known (Lobbyist) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade Sworn to ~ndw subscribed before me This day ~ 2p s7 Sign ure of Public Notary - State of Florida No rization of LobbyisYs signature PRINCIPAL IDENTIFICATION: ^ Produced ID Form ofIdent ersonally known (Principal} State of Florida, County of Miami-Dade Sworn and~bscribed before me This ~'l day of ¢Gtw 20 ~l vrnsry Publfc - Stab of Fbrida Commission Expires Jan 31, ZOt Commission A~ DO 5126~4 ~By lQafional Notary Assn. ~a~El A. RUBER-~~ ~ry P~~ - ~~e of Florlde ~ ~0~~101~ ~P~es Jan 31. 2010 Bonded g~fon # DD 5126qq y Nationa~ Notary Assn. i Signature oPPLblic Notary - State of Florida Notarization of Principal's signature FOR CLERK'S USE Q~1LY e~ Annual Registration fee: [ ] Yes [ No Amount P 'd ` „ ~'~~ MCR # ~ / ~ ~~ ~" Date Paid ~'~ ~~ ~•'~ Lobbyist Registration Form received and verified by: -" a, .~,-"-`? , F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM 05.doc ' Revised 12/08/04 CITY OF MIAMI BEACH DEVELOPMENT REVIEW BOARD APPLICATIOIV DISCLOSURE OF INTEREST 1. LIMITED LIABfLITY COMPANY If the property which is the subject of an 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 discloses the identity of the individual(s) (natural persons) having the ultimate ownership interest in the entity.* HEAFEY/BENTLEY HOTEL LLC LIMITED LIABILITY COMPANY NAME NAME, ADDRESS, AIVD OFFICE Ocean Once Investments, LLC 1717 North Bayshore Drive Suite 102 Miami, Florida 33132 Member % OF STOCK 20% Nathalie Heafey 1717 North Bayshore Drive Suite 102 Miami, Florida 33132 Member PH Bentley Bay Inc. 1717 North Bayshore Drive Suite 102 Miami, Florida 33132 Managing Member Julie Grimes 1717 North Bayshore Drive Suite 102 Miami, Florida 33132 Member 14% 52% 14%a 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. CITY OF MIAMI BEACH DEVELOPMEIVT REVIEW BOARD APPLICATION DISCLOSURE OF INTEREST 1. CORPORATION If the property which is the subject of an appfication 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 discloses the identity of the individual(s) (natural persons) having the ultimate ownership interest in the entity.* PH BENTLEY BAY INC. CORPORATION NAME NAME, ADDRESS, AND OFFICE % OF STOCK Heafey Grand, inc. 80% 1717 North Bayshore Drive Suite 102 Miami, Florida 33132 Pierre Heafey Family Trust 20% 1717 North Bayshore Drive Suite 102 Miami, Florida 33132 IF THERE ARE ADDITIONAL CORPORATIONS, LIST OTHERS, INCLUDING CORP. NAME(S) AND EACH INDtVIDUAL'S NAME, ADDRESS, OFFICE AND PERCENTA6E OF STOCK, ON A SEPARATE PAGE. CITY OF MIAMI BEACH DEVELOPMEIVT REVIEW BOARD APPLICATION DISCLOSURE OF INTEREST 1. CORPORATION If the property which is the subject of an 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 discloses the identity of the individual(s) (natural persons) having the ultimate ownership interest in the entity.* HEAFEY GRAND INC. CORPORATION NAME NAME, ADDRESS, AND OFFICE % OF STOCK Heagrand, Inc. 100% 1717 North Bayshore Drive Suite 102 Miami, Florida 33132 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. CITY OF MIAMI BEACH DEVELOPMENT REVIEW BOARD APPLICATIQN DISCLOSURE OF INTEREST 1. CORPORATION If the property which is the subject of an 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 discloses the identity of the individual(s) (natural persons) having the ultimate ownership interest in the entity.* HEAGRAND, INC. CORPORATION NAME NAME, ADDRESS, AND OFFICE % OF STOCK Pierre Heafey 100% 1717 North Bayshore Drive Suite 102 Miami, Florida 33132 IF THERE ARE ADDITIONAL CORPORATIONS, LIST OTHERS, INCLUDING CORP. NAME(S) AND EACH INDIVIDUAL'S NAME, ADDRESS, OFFtCE AND PERCENTAGE OF STOCK, ON A SEPARATE PAGE. CITY OF MIAMI BEACH DEVELOPMENT REVIEW BOARD APPLICATION DISCLOSURE OF INTEREST 1. LIMITED LIABILITY COMPANY If the property which is the subject of an 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 discloses the identity of the individual(s) (natural persons) havingthe ultimate ownership interest in the entity.* OCEAN ONE INVESTMENTS LLC LIMITED LIABILITY COMPANY NAME NAME, ADDRESS, AND OFFICE % OF STOCK Aries Development Group, LLC 1717 North Bayshore Drive Suite 102 Miami, Florida 33132 Managing Member Bentley Holdings Group, Inc. 1717 North Bayshore Drive Suite 102 Miami, Florida 33132 Member 50% 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. CITY OF MIAMI BEACH DEVELOPMENT REVIEW BOARD APPLICATI4N DISCLOSURE OF INTEREST 1. LIMITED LIABILITY COMPANY If the property which is the subject of an 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 discloses the identity of the individual(s) (natural persons} having the ultimate ownership interest in the entity.* ARIES DEVELOPMENT GROUP LLC LIMITED LIABILITY COMPANY NAME NAME, ADDRESS, AND OFFICE % OF STOCK Gino Falsetto 1717 North Bayshore Drive Suite 102 Miami, Florida 33132 Managing Member Rajesh Kalwani 1717 North Bayshore Drive Suite 102 Miami, Florida 33132 Member 70% 30% 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. CITY OF MIAMI BEACH DEVELOPMENT REVIEW BOARD APPLICATION DISCLOSURE OF INTEREST 1. CORPORATION {f the property which is the subject of an 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 discloses the identity of the individual(s) (natural persons) having the ultimate ownership interest in the entity.* BENTLEY HOLDINGS GROUP INC. CORPORATION NAME NAME, ADDRESS, AND OFFICE %a OF STOCK Andrea Alberghini 100%o 1717 North Bayshore Drive Suite 102 Miami, Florida 33132 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. CITY QF MIAMI BEACH DEVELOPMENT REVIEW BOARD APPLICATION DISCLOSURE OF INTEREST 2. TRUSTEE - If the property which is the subject of an application is owned or leased by a TRUSTEE, list the principal stockholders and the percentage of interest owned by each. Where the beneficiaries/beneficiary consist of corporation(s), another trust(s), partnership(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.* PIERRE HEAFEY FAMILY TRUST CORPORATION NAME NAME, ADDRESS, AND OFFICE % OFINTEREST Pierre Heafey 1717 North Bayshore Drive 100% Suite 102 Miami, Florida 33132 ~ IF THERE ARE ADDITIONAL CORPORATIONS, LIST OTHERS, INCLUDING CORP. NAME(S) AND EACH '~~t~ -, INDIVIDUAL'S NAME, ADDRESS, OFFICE AND PERCENTAGE OF STOCK, ON A SEPARATE PAGE. ~~~ ~~. .'~-~'~. . ~i :._~5;~,";.