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James E. Rauh/Rok, LLC RokbarC~ ~~ A~f 19'oS ~~~ r ~ ,. /"""t ~- ., ~~.. City of Miami Beach Office of the City Clerk + 1700 Convention Center Drive, Miami Beach, FL 33139~a~9 Ll(~Ij~~ 23 p~ ~, ~4 LOBBYIST REGISTRATION FORM ~I r ~ ~ ~ ~ ~ 4 ~,~ , ., ~? ~. „ Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage ~h~ ` ~ ~ ~ ~_ 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 bond 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.) c/o Terminello &Terminello, P.A. 1111 Lincoln Road Miami Beach, FL 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (786) 276-2343 (305) 673-5505 jrauh(a~terminello.com _ TELEPHONE NUMBER: FAX NUMBER: EMAIL: LOBBYIST RETAINED BY: Rok, LLC NAME OF PRINCIPAUCLIENT: Rokbar 1905 Collins Avenue Miami Beach, FL 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (312) 718-0000 (305) 531-1239 OPSO47C~aol.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: Phillip Sylvester, Manager IDENTIFY ALL PERSONS HOLDING, DIRECTLY CR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: Phillip Sylvester (100%), Manager and Member SPECIFIC LOBBY ISSUE: Modification of Conditional Use Permit for the property located at 1905 Collins Avenue. Issue to be lobbied (Describe in detail): III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: (Pursuant to City Code Section 2-482(g) include a statement of the extent of any business, financial, familial, professional or other relationship, giving rise to an appearance of an impropriety, with any City personnel sought to be lobbied; further, pursuant to City Code Section 2- 482(a)(4) include a statement of any contractual relationship (paid or unpaid) from 12 months preceding the commencement of service of City personnel to be lobbied.) A) Full Name of Individual/Title B) An Financial, Familial or Professional Relationship City of Miami Beach Planning Board None City of Miami Beach Planning Staff None City of Miami Beach Mayor/Commissioners None MIADOCS 3142023 1 5~ IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) $375 per hour. B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $375 per 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": 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": 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 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 ~ No• Are you representing snot-for-profit corporation or entity without special compensation or reimbursement. V. SIGNATURE UNDER OATH: ON OCTOBER 1St OF EACH YEAR EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED PERIOD. Lobbyist -James E. Rauh 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 th_,~~lliar~i Bea~ode and all reporting requirements. Signature of Lobbyist: Signature of Principal/Client: `"- ~ ~ ' Phillip S vester, Manager and Member of Rok, LLC VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: F~ D~ Produced ID ~`lQ~- 5~U57~ - 3`f9_v ~, Produced ID .DG~ ~ yea- 6706 - ~~ Form of Identification Form of Identification ~- Personally known (Lobbyist) VII. SIGNATURE AND ST N" ' ISABELSKICFELL State of Florida, County of Mia MY COMMISSION#DD87 Sworn to and subscribed before EXPIRES: April 13, 2a This day of ~y~/Q. , 2~0 ,~ ~,, r sa~dded rnm wavy wwic and gnature of ruoiic ivotary Notarization of Lobbyist's signature ^ Personally known (Principal) to f Florida, County of Miami-Dade wor o and subscribed before me iieiMlfBS 27day of ~~°, 0 Signa ure of Public Notary -State of Florida Notarization of Principal's signature TO BE COMPLETED BY CLERK'S USE Annual Registration fee: (]Yes [ ] No Amount Paip $~ mcrc s;_Cuare rasa ~G~ ~ - i Lobbyist Registration Form received and verified by: ~~ .~ .. , ~~,~, ~~~e MIADOCS 3142023 1 m MIAMIBEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov CITY CLERK office CityClerkCa~miamibeachfl.gov Tel: 305.673.7411, Fax: 305.673.7254 LOBBYIST NAME: James E. Rauh I understand that no later than October 1ST of each vear, I must file the following forms, 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 Form 2) Disclosure 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 for lobbyist withdrawal in writing. _ - z~ -©~ Date: MIADOCS 3142023 1