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James Rauh/Heafey/Bentley Hotel, LLC~'~~~,~~~ ~ l~/11 AM I B~AC H `-. ~. 1~~, ~C C a__ :`~ City of Miami Beach Office of the Ciry Clerk ~~ d~{ S; 30 1700 Convention Center Drive, Miami Beach, FL 33139 ~~~ Y~;~.tr;~i' , ~ (jj'; ~~•r. LOBBYIST RLCISTRATION FOR114 Lobbyist means alI 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 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 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 LOBBYISf: (Last) (First) (M.I) '~erminelJ.o & Terminello P A 2700 SW 37th Avenue, Miami, Florida 33133 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305.444.5002 305.448.55b6 ~rauh@terminello.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: I. LOBBYIST RETAINED BY: Heafey / Bentley Hotel, LLC NAME OF PRINCIPAL/CLIENT: 1717 North Bayshore Drive, Suite 102, Miami, Florida 33132 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zp Code) 305 523 3344 - TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) Fill out this sedion if principal is a Corporation, Partnership or Trust lSection 2-482 (c)] • NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: See attached . . IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIPORTRUST: See attached. II. SPECIFIC LOBBY ISSUE: Application for Conditional Use Approval for Restaurant at 101 Qcean Drive Issue to be lobbied (Describe in detail): III. CITY AGENCIES/INDIVIDUALS 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 RATE OR OTHERf A) LOBBYIST DISCLOSURE: (Required) -~ 7/ 4J b~ (~L~ ~ Z q T~ / B) PRINCIPAL'S DISCLOSURE (OF LOBBYISTCOMPENSATION): (Required). ~~~`1 v0 (Fc-~r (2f} i~ The following information must be answered: i) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists On Procurement Issues": ^ Yes L~ No• Are you lobbvinq on a present or pendinq bid for qoods equipment or services, or on a present or nendinu 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": ~Yes L~'No• Are vou lobbvinq on a pendinq application for a Development Aqreement with the Citv or application for chanqe of zoninq map desiqnation or chanqe 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 t~ No• Are vou representinq a not-for-arofit corporation or entitv 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, LISTIN6 LOBBYING EXPENDTTURES, AS WELL AS COMPENSATION RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PREC NG CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EX ITU ES OR COMPENSATION DURING THE REPORTING PERIOD. Lobbyist I do solemnly swear that all forE familiar with the provisio contai d in requirements. Signature of Lobbyist: Signature of Principal/Client: ~G VI. LOBBYIST IDENTIFICATION: 0 Produced ID Form of Identification 6V Personally known (Lobbyist) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade Swom to ~a,[ ~subscrib d befo m This 1: ~ _ day of ~Q~' ,~20Q~7 ~icjnat~lre of Public Notary - State of Florida Notarization of Lobbyist's signature ~are true and correct and that I have read or am 2-482 of the Miami Beach Citu cs!~ aari~a~~rP~n~rL PRINCIPALIDENTIFICATION ^ Produced iD Form of Ider~ Personally known (Principal) Notary Public - State o( Flotida r Commission Expires Jan 31, 2010 Commissio~ ~t DD 5126M ondod flv National Notan Assn. ~AMUEL A. RUBERT Notary Publie - Slale o( Fbrida ~' ~~°^ ExPKes Jan 3 t, 2010 ~~"TM~~ * DD 51264q Bonded 8y National Notary Assn. State of Florida, County of Miami-Dade Sworn and subscribed bef re rne This '~day of G~ 7,,~~ Signature of ~fiblic Notary - State of Florida Notarization of Principal's signature FOR CLERK'S ~F ONLY ~ Annual Registration fee: [ ] Yes [ ~No Amount P ~' ~- MCR # ~~~Date Paid ~:~ ~ ~~ Lobbyist Registration Form received and verified by: ~-1~5lJ~~-r~- :. ~ i ~ 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 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.* HEAFEY/BENTLEY HOTEL LLC LIMITED LIABILITY COMPANY NAME NAME, ADDRESS, AND OFFICE Ocean Once Investments, LLC 1717 North Bayshore Drive Suite 102 Miami, Florida 33132 Member °/a 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% 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 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.* 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 INDIVIDUAL'S NAME, ADDRESS, OFFICE AND PERCENTAGE OF STOCK, ON A SEPARATE PAGE. CITY OF MIAMI BEACH DEVELOPMENT REVIEW BOARD APPLICATIOIV 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 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.* 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, OFFICE AND PERCENTAGE OF STOCK, ON A SEPARATE PAGE. CITY OF MtAMI 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 Aries Development Group, LLC 1717 North Bayshore Drive Suite 102 Miami, Florida 33132 Managing Member % OF STOCK SO% Bentley Holdings Group, Inc. 1717 North Bayshore Drive Suite 102 Miami, Florida 33132 Member 50°/a IF THERE ARE ADDITIONAL CORPORATIONS, LIST OTHERS, INCLUDING CORP. NAME(5) 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. 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.* ARIES DEVELOPMENT GROUP, LLC LIMITED LIABILITY COMPANY NAME NAME, ADDRESS, AND OFFICE Gino Falsetto 1717 North Bayshore Drive Suite 102 Miami, Florida 33132 Managing Member % OF STOCK 70% Rajesh Kalwani 1717 North Bayshore Drive Suite 102 Miami, Florida 33132 Member 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 If the property which is the subject of an appiication 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 % OF STOCK Andrea Alberghini 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 APPLICATION DISCLOSURE OF INTEREST h=~4~W.p ' .: *~.~ ~'~ Y ~ . 1'~y, ... ~ :~~ .~~ .~._ 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 % OF INTEREST 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, OFFICE AND PERCENTAGE OF STOCK, ON A SEPARATE PAGE.