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James E. Rauh - MAJ Management, LLC Z� 7" 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 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&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)448-5566 jrauh @terminello.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: -- o Please notify this office if your contact information changes:address,phone, or e-mail address. Cn I. LOBBYIST RETAINED BY: v . . MAJ Management LLC ="= NAME OF PRINCIPAUCLIENT: San Angel Bar 619 Washington Avenue Miami Beach Florida 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) CAI) (305)538-4747 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: Estefania Echeverry Prieto,as Manager • IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: See attached. II.SPECIFIC LOBBY ISSUE: Modification of Modified Conditional Use Permit issued under PB File No. 1875 to change owner and operator and any other land use and development issues relating to the property located at 619-623 Washington Avenue, Miami Bearh Florida 3313q Issue to be lobbied(Describe in detail): III.CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: 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 (paid 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 I NO title of person to be lobbied Planning Baord X Planning Director and Staff X Mayor and Commissioners X Pursuant to City Code Section 2-482(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 filed. Sec 2-482(g)Any Financial,Familial or Professional Relationship C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration A Formrevlsed 5-30-2012.doc \ IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) $375.00 per hour B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): $375.00 per 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": _Yes X 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 Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": _Yes XNo: Are you lobbying on a pending application for a Development Agreement with the Clty 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 Section 2.482(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 XNo: Are you representing a not-for-profit corporation or entity without special compensation or reimbursement. V. SIGNATURE UNDER OATH: ON FEBRUARY 28 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 SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. S(gna e o fobbyfst j I do solemnly swear that all of the foregoing facts are tru64d correct and that I have read or am familiar with the provisions contained in Section 2-482 of the Miami Beach City Code and all reporting requirements. Signature of Lobbyist: Signature of Principal/Client: A low Estefa is Echeverry rieto,Manager of MAJ Management LLC VI. LOBBYIST IDENTIFICATIOWN PRINCIPAL IDENTIFICATION: Produced ID Produced ID • e Form of identification Form of Identification Personally known(Lobbyist) !VPersonally known(Principal) 5Tonz•Opy:S381dX3 Dc` .fig 396LI 133#NOISSIN NOO b= yo VII. SIGNATURE AND STAMP OF NOTARY: 8(f21U8DU� eUd �A, State of Florida,County of Miaml-Dade ter Ptf State of Florida,County of Miami.Dade �� SHAW40N 1 MVE 1 a Sworn to and subscribed before me �° a Sworn air d subscriWd before me "'O'lle Ana Vincent IIB This�la d of So #c-"W,r * * MYC4MMISSiONliDD984835 ®l-Pm m�o4?5`•rp.''- �� 2013 T EXPIRES:April 25,2014 This-i S day_of 2013 mao. COMMISSION#EE 11 962 BWed Thru k*"Seryloes EXPIRES:AUG.21,2015 Signi urea ublic Nota —State of F 'da natu of Public Notary—State of Florida s��9'0B•°,woe°�, ONNOTARY,ciaQ1 .-1Vo�riz won of Lobbyist's signature Notarization of Principal's signature TO BE COMPLETED BY CITY CLERK'S STAFFQKLY Annual Registration fee: ( ]Yes[ ]No Amount Pa(d$ 5 CJ --MCR# ate Paid Lobbyist Registration Form received and verified by: C:1 Userslclerhatl\AppData\LocaI\Microsoft\Windows\Temporary Internet Files\Content.Outlook183LGQDDH1Lobbyi t Registration Formrevised 5-30-2012.doc IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) $375.00 per hour B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): $375.00 per 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": _Yes X 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 Section 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 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 Section 2-482(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 X No: Are you representing a not-for-profit corporation or entity without special compensation or reimbursement. V. SIGNATURE UNDER OATH: ON FEBRUARY 28 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 SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. Sign e o obbyist 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 Beach City Code and all reporting requirements. Signature of Lobbyist: Signature of Principal/Client: Estefania Echeverry Prieto, Manager of MAJ Management LLC VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: Produced ID Produced ID Form of Identification Form of Identification Personally known(Lobbyist) Personally known(Principal) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade 1Par pug SHAIVNOIHfIARV� State of Florida, County of Miami-Dade Sworn to and subscribed before me �° ��° Sworn and subscribed before me This da. of SePkMbfr 2013 * � * MYCOMMISSIONIIDD984835 This day of 2013 G EXPIRES:April 25,2014 ' / dl��rf of Fl� Bonded Thru Budget"Serum Sjgm6b 401lublic Nota —State of F ida Signature of Public Notary—State of Florida HIV zation of Lobbyist's signature Notarization of Principal's 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: C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc EXHIBIT"B" DISCLOSURE OF INTEREST MAJ MANAGEMENT LLC CITY OF MIAMI BEACH DEVELOPMENT REVIEW BOARD APPLICATION DISCLOSURE OF INTEREST 3.CORPORATION If the property which is the subject of the application is owned or leased by a CORPORATION,list ALL of the stockholders,and the percentage of stock owned by each. Where the 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.* MAJ MANAGEMENT LLC CORPORATION NAME Name and Address %of Ownership MAJ Management LLC Estafania Echeverry Prieto 100% 50 SW 10th Street,Unit 1306 Miami,Florida 33130 is :ration Fw-nodoc Revised 04/27/2 P City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov CITY CLERK Office Rafael E. Granado, City Clerk CityClerk@miamibeachfi.gov Tel:305.673.7411 , Fax:305.673.7254 James E. Rauh, Esq. LOBBYIST NAME: I understand that no later than February 28 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, or I am no longer lobbying on that issue or for that principal, I am required to immediately notify the City Clerk's Office of lobbyist withdrawal in writing. Pursuant to Section 2-485 (d), the City Clerk shall notify any lobbyist(or principal) who fails to timely file a Statement and in addition to any other penalties which may be imposed as provided in Section 2-485.1, a fine of$50.00 a day shall be assessed for all Statement(s) filed after the due date. The City Clerk shall notify the Miami-Dade County Commission on Ethics and Public Trust of the failure of a lobbyist or principal) to file the Statement or pay the assessed fines after notification. Any lobbyist, who fails to file the required Statement by April 30th, 2012, shall be automatically suspended from lobbying until all fines are paid, unless the fine has been appealed to the Miami-Dade County Commission on Ethics and Public Trust. —C Signa re- Date: C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc (FA-` S � - _ 1. : - .-� _ ~~ _ - - — 1_ _, , .- i i 1 _q \ `[ Y 1. ._. K . CD US r2o,�, C) a _ _ C 1,11 �p`rt — _ ti W F x :C - -rte ti f$gc i \ -, .# Y -IN _N 4 f y ff ..r ~f, tic. T;{ ' 1'qL_ _-� -in k � afr ,a F - ,_ J< i e Gy- = T I I- - .a�`.5a / x$ v ill I 1,�� — -4 • - .. i = - o � .--A VtV - -�,: ; �- r- -__ ,� � , & �- Q . j F S �_ -1. 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