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James E. Rauh - Shelborne Associates (2)m 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 Miami Beach, FL 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) X786) 276-2343 (305) 673-5505 jrauh _ terminello.com TELEPHONE NUMBER: FAX NUMBER: EMAIL : LOBBYIST RETAINED BY: Shelborne Associates, Costello Investments, Inc., Shelbome Ocean Beach Hotel Corp., and Beach Group III, LLC NAME OF PRINCIPAUCLIENT: Shelborne Hotel 1801 Collins Avenue Miami Beach FL 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 531-1271 (305) 531-2206 mkramer _crescenthei hts.com TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) out this section if or Trust [Section 2-482 (c)] NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Russell W. Galbut IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5°F~OR^cGAORE OWNERSHIP INTEREST 1N SUCH CORPORATION, PARTNERSHIP OR TRUST o _ ~ See attached Disclosures of Interest. ~=-=~ ~ `~~ ~ r,_, ~ ~~ II. SPECIFIC LOBBY ISSUE: Lr.', ~, ":": ''-,.. Application for variances for the property located at 1801 Collins Avenue, Miami Beach 33139. ~ o "! i Issue to be lobbied (Describe in detail): °" ~ ~ -- r-, w III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: (Pursuant to City Code Section 2-482(g) include a statement of the extent of any busines§, 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) Fuil Name of Individual/Title ~ B) An Financial, Familial or Professional Relationship City of Miami Beach Board of Adjustment . None City of Miami Beach Planning Staff None City of Miami Beach Mayor/Commissioners None City of Miami Beach Committees None IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER). LOBBYIST DISCLOSURE: Re uired $ 375 er 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": ^Yes ®No• Are you lobbvina on a present or pending bid for aoods, equipment or services, or on a present or pending award for aoods. equipment or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": C]Yes 6a No: Are you lobbvina on a pending application for a Development Agreement with the City or application for change of zoning map designation or chance to the CitV'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 ®No: Are you representing anot-for-profit coraoration or entity without special compensation or reimbursement. V. SIGNATURE UNDER OATH: Signature of Lobbyist: Signature of Principal/Client: R e I a but, o a of Shelbome Associates, Costello Investments, Inc., Shelbome Ocean Beach Hotel Corp., and Beach Group III, LLC. VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: ^ Produced ID Form of Identification Personally known (Lobbyist) N VII. SIGNATURE AND STAMP OF NOTARY: YF N 2 ~~~ z a ~. State of Florida, County of Miami-Dade ~ ~ ' Swor o Dnd-sub -'b ~~ ~-m~' g ~~ ~,~, rjhis~ day of 010 ~: ~ ~o, ----Sig lure o Notary - Stat of Florida 4: ~ rization o obb fist's 'nature 5.'•. ~ ~~N T!1 !~ll~A~l GTCf1 ^ Produced ID Form of Identification Personally known (Principal) State of Florida, County of Miami-Dade Sworn and su cri ed before me ~s day of y 2010 .~ ., 1 ~ . Si~iatu of Public hTotary -State of Florida Notari ion of Principal's signature BY CITY CLERK'S USE ONLY Fonn received and verlfted by: _ oboist Registration Form 32708.doc ,~~~ H~u~p~~,, t7AYAM1AGUlAR Notary t~liC • State of Florida My Comml:4lon Eras Mar 16, 2011 Commission 0 DD 044032 s;~~~OF, tN,,- Bonded Thrace Natlonal Note~y Assn. Si tur of Lobbyist -James Rauh I do solemnly swear that all of the foregoing facts are tru d correct and that I have read or am familiar with the provisions contained in Section 2-482 of the Miami Bea~cla-61ty L'~de ar~all reporting requirements. a? MIAMIBEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov CITY CLERK office CityClerk(c~miamibeachfl.gov Tel: 305.673.7411, Fax: 305:673.7254 James Rauh LOBBYIST NAME: I understand that no later than October"1$` 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. Sign re: James Rauh Date: EXHIBIT "B" DISCLOSURE OF INTEREST NAME AND ADDRESS % OF INTEREST SHELBORNE ASSOCIATES. A FLORIDA GENERAL PARTNERSHIP Mar Irv Investment, Inc. 50 3725 South Ocean Drive, #718 Hollywood, Florida 33137 SBH Investors, Ina 50 2200 Biscayne Boulevard Miami, Florida 33137 MAR IRV INVESTMENT. INC. Irving Cowan 100 3725 South Ocean Drive, #718 Hollywood, Florida 33137 . SBH INVESTORS, INC. Russell W. Galbut 50 2200 Biscayne Boulevard Miami, Florida 33137 Abraham A. Galbut, and Nancy K. Galbut, his wife 50 4770 Biscayne Blvd., Suite 1400 Miami, Florida 33137 COSTELLO INVESTMENTS, INC. Russell W. Galbut 50 2200 Biscayne Boulevard Miami, Florida 33137 Abraham A. Galbut, and Nancy K. Galbut, his wife 50 4770 Biscayne Blvd., Suite 1400 Miami, Florida 33137 SHELBORNE OCEAN BEACH HOTEL CORP. Russell W. Galbut 2200 Biscayne Boulevard Miami, Florida 33137 50 Abraham A. Galbut, and Nancy K. Galbut, his wife 50 4770 Biscayne Blvd., Suite 1400 Miami, Florida 33137 [CONTINUED TO NEXT PAGE] Page 1 of 2 BEACH GROUP III, LLC ARC Investors, LLC 2200 Biscayne Bouievard Miami, Florida 33137 Russell W. Gaibut, as Manager 2200 Biscayne Boulevard Miami, Florida 33137 Irving Cowan, as Manager 3725 South Ocean Drive, #718 Hollywood, Florida 33137 IMZ Investments, LLC 3725 South Ocean Drive, #718 Hollywood, Florida 33137 ARC INVESTORS. LLC Russell W. Galbut 2200 Biscayne Boulevard Miami, Florida 33137 50 0% 0% 50 50 Abraham A. Galbut, and Nancy K. Galbut, his wife 50 4770 Biscayne Blvd., Suite 1400 Miami, Florida 33137 IMZ INVESTMENTS, LLC Irving Cowan 3725 South Ocean Drive, #718 Hollywood, Florida 33137 100 Page 2 of 2