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James E. Rauh - LFP Churros Miami, LLC r B E, 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 aay 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 LOBBYIST: (Last) (First) (M.i) Terminello&Terminelio,P.A 1111 Lincoln Road Miami Beach Florida 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (786)276-2343 (305)448-5566 jrauh @terminello.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: Please notify this office if your contact Information changes:address,phone, or e-mail address. i. LOBBYIST RETAINED BY: LFP Churros Miami,LLC NAME OF PRiNCiPAUCLIENT: LFP Churros Miami,LLC 444 North Michigan Avenue Chicago Illinois 60611 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (zip Code) (312)267-4191 NIA acummis(@11forestaurant.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: Adam Cummis,as Manager of LFP Restaurant Management,LLC, Manager of LFP Churros Miami,LLC • IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST iN SUCH CORPORATION, PARTNERSHIP OR TRUST: See Attached Exhibit ii.SPECIFIC LOBBY ISSUE: Application for a Variance to waive the minimum seating requirement of 60 seats to serve beer,wine and liquor for the property located at 511 Lincoln Road,Miami Beach,Florida,33139. Issue to be lobbied(Describe in detail): —`—' CITY.AGENCIESiINDIVIDUA. S.:Tb.BE.'LQBBIED: Pursuant to City Code Section 2.482(a)(4)Include the commissioner or personnel sought to be lobbied,and whether the lobbyist has entered Into any contractual relationship (pald or unpaid) with said city commissioner or personnel from 12 months preceding such person's commencement of service with the city to the present date,stating the general nature of the subject contractual relationship. Sec 2-482(a)(4)Full Name of individual and Contractual Relationship(Explain) YES NO title of person to be lobbied City of Miami Beach Board of Adjustment None X City of Miami Beach Planning Director/Staff None X City of Miami Beach Mayor and Commissioners None X Pursuant to City Code Section 2482(g)Every registrant shall be required to state the extent of any business,financial,familial or professional relationship,or other relationship giving rise to an appearance of an Impropriety,with any current city commissioner or city personnel who is sought to be lobbied as identified on the lobbyist registration form flied. f. Sec 2-482 An Financial,Familial or Professional Relationshi f None grv I 0 • IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) $375.00 an hour. B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): $375.00 an hour. (Required). 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": El 5 Yes No: Are you lobbying on a present or pending bid for goods,equipment or services,or on a present or pending award for oods a ui ment or service? 2) Pursuant to Miami Beach City Cade 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": ❑Yes B/No: Are You lobbying on a pending application for a Development Agreement with the City or application for change of zoning map designation or change 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 2481 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 lJ No: Are you representing a not-for-profit corporation or entity without special compensation or reimbursement . V. SIGNATURE UNDER OATH: ON FEBRUARY 28th OF EACH YEAR,EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH LISTING LOBBYING EXPENDITURES,AS WELL AS COMPENSATION RECEIVED,IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHA ILED EVEN lF RE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. Signat of bbyist i do solemnly swear that all of the foregoing facts are nd correct and that I have read or am familiar with the provisions contained In Section 2-482 of the Miami B ity Ca �rtd'a I reporting requirements. Signature of Lobbyist: Signature of Principal/C' Vl. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION * '•`� MARINEL M CAHILL ❑ Produced ID Produced ID OFFICIAL MY COMMISSION EXPIRES Form of Identification Form of iden 'gn``��° MAY 4,2014 RrPersonally known(Lobbyist) Personally known(Principal) VII. SIGNATURE AND STAMP OF BRAD STEVEN FLEET (� State of Florida,County of Miami-Dade MY COIN"SSION 0 DDSU164 State of Ff�Tltx''a,Count of Mier -ode WIM:Aug Zt,4OI2 y Sworn t nd subscribed before me , JMTARY e.NowyV1600 stAaw.Co. Sworn d subscrib before me This ^da ,201 This t��ay of 1 .2011- Signature of Public Notary-State of Florida Signature of Public Notary-State of - 1L." Notarization of Lobbyist's signature Notarization of Principals signature TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: [ ]Yes[ ]No Amount Paid$ MCR# Date Paid Lobbyist Registration Form received and verified by: - �- F Oft MS, Lrj5hyist Annu I DRevised 1/11/2011 ! ) n City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfi.gov CITY CLERK Office CityClerk @miamibeachfl.gov Tel: 305.673.741 1 , Fax: 305.673.7254 James E. Rauh, Esq. LOBBYIST NAME: understand that no later than February 28th of each year, I must file the following form, 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 and Compensation 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 of lobbyist withdrawal in writing. C Signatu Date: EXHIBIT "B" DISCLOSURE OF INTEREST LFP CHURROS MIAMI, LLC Name and Address % of Ownership UP Restaurant Management, LLC 100% 444 North Michigan Avenue Suite 3500 Chicago, Illinois 60611 Manager Levy Family Partners, LLC 100% 444 North Michigan Avenue Suite 3500 Chicago, Illinois 60611 Larry Levy 41% 444 North Michigan Avenue Suite 3500 Chicago, Illinois 60611 Trust for the Benefit of Steven Florsheim 14.75% 444 North Michigan Avenue Suite 3500 Chicago, Illinois 60611 Sole Beneficiary, Steven Florsheim Trust for the Benefit of Andrew Florsheim 14.75% 444 North Michigan Avenue Suite 3500 Chicago, Illinois 60611 Sole Beneficiary, Andrew Florsheim Trust for the Benefit of Robert Florsheim 14.75% 444 North Michigan Avenue Suite 3500 Chicago, Illinois 60611 Sole Beneficiary, Robert Florsheim Trust for the Benefit of Ari Levy 14.75% 444 North Michigan Avenue Suite 3500 Chicago, Illinois 6061 Sole Beneficiary,Ari Levy