James E. Rauh/Mokai Lounge, LLCa 33 ~~ ~
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 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 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, Suite 400 Miami Beach Florida 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(786) 276-2343 (305) 673-5505 jrauh@terminello.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
LOBBYIST RETAINED BY:
Mokai Lounge, LLC
NAME OF PRINCIPAUCLIENT:
Mokai Lounge, LLC 690 Lincoln Road, Suite 201 Miami Beach Florida 33139
BUSINESS NAME AND ADDRESS _ (Number and Street) (City) (State) (Zip Code)
(305) 695-8411 (786) 507-3449 hassan@theopiumgroup.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: Roman Jones, as Manager of
Mokai Lounge, LLC
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE
OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST:
See attached.
SPECIFIC LOBBY ISSUE:
Modification of Conditional Use Permit to change owner and operator for Neighborhood Impact Establishment and
Adjacent Parking Lot at 235 23`d Street (a/k/a 233 23`d Street) and 219 23`d Street, Miami Beach, Florida 33139.
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, Fami ' I ssiona lati ip
City of Miami Beach Planning Board None `' ` ' ' ' `
City of Miami Beach Planning Staff None
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City of Miami Beach Mayor/Commissioners None t
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City of Miami Beach Land Use & Development None
Committee '.. '_ "'~.i
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City of Miami Beach Committees None ..
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER
HOURLY, FLAT RATE OR OTHER):
LOBBYIST DISCLOSURE: (Required) $7,500 flat fee.
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
(Required). $7,500 flat fee.
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 6a No: 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?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On
Real Estate Development Issues":
^Yes ~ No: Are you lobbying on a pending application for a Development Agreement with the Citv or
application for change of zoning map designation or chance 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 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 6a No: Are you representing anot-for-profit corporation or entity without special compensation or
reimbursement.
V. SIGNATURE UNDER OATH:
ON OCTOBER 18t OF EACH YEAR EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
PERIOD.
i ure of 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 oft Miami e~~h City Code and all reporting requirements.
Signature of Lobbyist: ~~
Signature of Principal/Client:
R an Jones, as Ma ager of Mokai lounge, LLC
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
`~
s ^ ~ Produced ID L~' Produced ID /,~'Gt~~~,"~-e-
Form of Identification Form of Identification
[~ Personally known (Lobbyist) ^ Personally known (Principal)
Iu
VII. SIGNATURE AND STAMP OF NOTARY: ~ .-
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State f lorida, County of Miami-Dade State of Florida, County of Miami-Dade ~ ° M
Swor _ t nd su ri ed before me Sworn to nd subscribed before me o~ z ~ a
-~~. ~ Ti's of ~ , 2009 This ,/Z~ay of d 2009 ~ W o
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S ri u f P blic a > v
~`~~ ry -State of Flori gnatu -State of Flor a ~ $
~ No do f L b fist's signature Notarization of Principal's signature
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TO BE COMPLETED BY CITY CLERK'S USE ONLY :4
Annual Regist lion fee: [ j Yes [ ] Ho Amount Paid $ MCR # $ Date Paid . %~ ••••'~.~
Lobbyist Regi ation Form received and verified by:
/~
m MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK office CitvClerk(a~miamibeachfl.gov
Tel: 305.673.7411, Fax: 305.673.7254
James E. Rauh
LOBBYIST NAME:
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.
!l l6 Zvo
Date:
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) having the ultimate ownership interest in the entity.*
MOKAI LOUNGE LLC
LIMITED LIABILITY COMPANY NAME
NAME, ADDRESS, AND OFFICE
Roman Jones Companies, Inc.
c/o Levine & Partners, P.A.
1110 Brickell Ave., Suite 700
Miami, Florida 33131
Member
OF MEMBERSHIP INTEREST
Promophot, Inc.
c% Levine & Partners, P.A.
1110 Brickell Ave., Suite 700
Mianu, Florida 33131
Member
Eric Milon Management Co. Inc.
c/o Levine & Partners, P.A.
1110 Brickell Ave., Suite 700
Miami, Florida 33131
Member
JL Club Holdings, LLC
c/o Levine & Partners, P.A.
1110 Brickell Ave., Suite 700
Miami, Florida 33131
Member
Integrated Equities, Inc.
c/o Levine & Partners, P.A.
1110 Brickell Ave., Suite 700
Miami, Florida 33131
Member
[CONTINUED TO NEXT PAGE]
35
12.5
12.5
10%
10%
IF THERE ARE ADDITIONAL CORPORATIONS, L/ST 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-B (1j
~~ CITY OF MIAMI BEACH
DEVELOPMEiVT REVIEW BOARD APPLICATION
DISCLOSURE OF INTEREST
[CONTINUED FROM PREVIOUS PAGE]
Nomade Consulting, Inc.
c/o Levine & Partners, P.A.
1110 Brickell Ave., Suite 700
Miami, Florida 33131
Member
5%
Beto Biscaia
c/o Levine & Partners, P.A.
1110 Brickell Ave., Suite 700
Miami, Florida 33131
Mernber
Nicola Siervo
c/o Levine 8z Partners, P.A.
1110 Brickell Ave., Suite 700
Miami, Florida 33131
Member
Ghosthouse Enterprises, Inc.
c/o Levine & Partners, P.A.
1110 Brickell Ave., Suite 700
Mianu, Florida 33131
Member
Vanessa Menkes
c/o Levine & Partners, PA.
1110 Brickell Ave., Suite 700
Miami, Florida 33131
Member
5%
5%
4%
1%
Officers and Directors
Roman Jones
c/o Levine & Partners, P.A.
1110 Brickell Ave., Suite 700
Mianu, Florida 33131
Manager
0%
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-B (1)
CITY OF MIAMI BEACH
®EVELOPMENT REVIE~IIi 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 shat! be required which discloses the identity of the individual(s)
(natural persons) having the ultimate ownership interest in the entity.*
ROMAN JONES COMPANIES INC.
CORPORATION NAME
NAME, ADDRESS, AND OFFICE % OF STOCK
Roman Jones 100
c/o Levine & Partners, P:A.
1110 Brickell Ave., Suite 700
Miami, Florida 33131
Director and President
IF THERE ARE ADDITIONAL CORPORATIONS, L/ST OTHERS, INCLUDING CORP.
NAME(S) AND EACH /NDIV/DUAL'S NAME, ADDRESS, OFFICE AND
PERCENTAGE OF STOCK, ON A SEPARATE PAGE.
NOTE; Notarized signature required on page 8
6-B (2)
CITY OF MIAMI BEACH
DEiOELOPMENT REi/IEW 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.*
PROMOPHOT INC.
CORPORATION NAME
NAME, ADDRESS, AND OFFICE % OF STOCK
Francis Milon 100
c% Levine & Partners, P.A.
1110 Brickell Ave., Suite 700
Miami, Florida 33131 .
Director and President
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-B (3j
CITY OF MIAMI BEACH
DEVEL®PtVIE1VT 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.*
ERIC MILON MANAGEMENT CO. INC.
CORPORATION NAME
NAME, ADDRESS, AND OFFICE % OF STOCK
Eric Milon 100
c/o Levine & Partners, P.A.
1110 Brickell Ave., Suite 700
Miami, Florida 33131
Director and President
lF THERE ARE ADDITIONAL CORPORATIONS, L/ST 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-B (4)
CITY OF MIAMI BEACH
DEi/ELOPIVIENT REi/IEW 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 shaA be required which discloses the identity of the individual(s)
(natural persons) having the ultimate ownership interest in the entity.'`
JL CLUB HOLDINGS LLC
LIMITED LIABILITY COMPANY NAME
NAME, ADDRESS, AND OFFICE % OF MEMBERSHIP INTEREST
Justin Levine 100
c/o Levine & Partners, P.A.
1110 Brickell Ave., Suite 700
Miami, Florida 33131
Manager
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-B (5)
CITY OF MIAMI BEACH
DE~OEL®PMENT REVlEVIO B®ARD 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 shat! be required which discloses the identity of the individual(s)
(natural persons) having the ultimate ownership interest in the entity.*
INTEGRATED EQUITIES INC.
CORPORATION NAME
NAME, ADDRESS, AND OFFICE % OF STOCK
Mitchell Rubinson 100
c/o Levine & Partners, P.A.
1110 Brickell Ave., Suite 700
Miami, Florida 33131
Director and President
lF 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-B (6)
CITY OF MIAMI BEACH
®Ei/EL®PMENT REVIEVII BOARD APPLICATION
DISCLOSURE OF INTEREST
1. CORPORATION
tf 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.
NOMAD CONSULTING INC.
CORPORATION NAME
NAME, ADDRESS, AND OFFICE % OF STOCK
Hassan Benjelloun 100
c/o Levine & Partners, P.A.
1110 Brickell Ave., Suite 700
Miami, Florida 33131
Director and President
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-B (7)
CITY OF MIAMI BEACH
DEi9EL®PMENT REO/IEW BOAR® 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.*
GHOSTHOUSE ENTERPRISES INC.
CORPORATION NAME
NAME, ADDRESS, AND OFFICE % OF STOCK
Mark Lehmkuhl
c/o Levine & Partners; P.A.
1110 Brickell Ave., Suite 700
Miami, Florida 33131
Director and President
100
IF THERE ARE ADDITIONAL CORPORATIONS, LIST OTHERS, INCLUD/NG CORP.
NAME(SJ AND EACH INDIVIDUAL'S NAME, ADDRESS, OFFICE AND
PERCENTAGE OF STOCK, ON A SEPARATE PAGE.
NOTE: Notarized signature required on page 8
6-B (8J