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James Rauh - Drinkhouse Fire & Ice, LLC. v �-�~�� City of Miami Beach Office of the City Clerk 1700 Convention Center C>hwe' Miami Be@ch, FL 33139 LOBBYIST REGISTRATION FORM � Lobbyist means all persons employed or netumau, whether paid or nc*, by e principal who seeks to encourage the peooage, defeat or modification of any ordinonce, naou|ution, action or decision of any commissioner; any oct|nn, dauio/on, recommendation of the City Manager or any city board or committee; or any act|on, decision or recommendation of any city nesnnna|during the time punnu of the ent|nedooio|nn+nomng pmoeoo on such act|un, decision or recommendation that fonayooab|y "vm be heard or reviewed by the city oomm|oo|on, or o city board or committee. The monn opoc|fiuoUv includes the principal as well as any employee engaged in lobbying activities. The tonn"Lobbyists" has specific exclusions. p|eone refer to Ordinance 2004'3436. Rauh James E. NAME OF LOBBYIST: (Last) (First) (M.1) Tonninaxo&To,mmexo.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'o588 jnouh@tenninoUo.00m TELEPHONE NUMBER: FAX NUMBER: EMAIL: Please notify this office if your contact information changes:mmdrmmm,phone, or e-mail address. /. LOBBYIST RETAINED BY: Drizzklzouoe Fire & Ice, LLC NAME OF PRINCIPAUCLIENT: orinkb000e Fire & Ice, LLc, 1000 Venetian Way' #113, Miami Beach, FL 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (318) 282-0263 s4l7ad@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: Sally Drinkhouse,Managing Member • IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: See Attached Exhibit x.SPECIFIC LOBBY ISSUE: � Variance for distance separation and all other land use,zoning,development,and licensing matters related to the property commonly known as 1672 Collins Avenue. Issue,voo lobbied(Describe".""=): III.CITY AOENCKRES/UNDUVUDUALS 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 (no/a or unpaid) with said city commissioner or personnel from 12 months nn,nodinm such person's commencement of service with the city to the present date,stating the eneral 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 Manager and his staff None X Planning Director and his staff None 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 None Ci IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) $375/hour B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): $375 / 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 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": ❑Yes x❑ 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 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 0 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 SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. SignaVorrect y t do solemnly swear that all of the foregoing facts are true and that I have read or am familiar with the provisions contained in Section 2-482 of the M' ach City Code and all reporting requirements. Signature of Lobbyist: e Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: a°i:0. PUe�% BRAD STEVEN FLEET _� " � L El Produced ID Produced ID Form of IdentificatioA MY COMMISSION#EE 223109 Form of Identification EXPIRES:August 21,2016 ,��QC l6�P\o� Doodad Thru Budget Notary Sw m ��P;`�f. b BRAD STEVEN FLEET Pe !Hall � n(Lobbyist) ❑ Personally known(Princia ' * MY COMMISSION#EE 223109 VII. SIGNATURE AND STAMP OF NOTARY: �q ,4, EXPIRES:August 21,2016 ��"� Banded Thro Budget Notary Services State of Florida,County of Miami-Dade State of Florida, County of Miami-Dade Sworn to a subscribed efore me Sworn and subscribe afore me T ' day of ,20� ay o 2r� . Signs ure of Public No ary—8tate of FI rida Signature of Public Notary—State of Florida Notarization of Lobbyist's signature Notarization of Principal's signature TO BE COMPLET BY CITY CLERK'S STAFF ONLY Annual Registration fee: [ ]Yes.[ Amount Pa r C # Date Paid lit Lobbyist Registration Form receiv and verified by: F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Annu istration Form.doc Revised 1/11/2011 i !f f j i; City of Miami Beath, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov CITY CLERK Office CityClerk @miamibeachfl.gov Tel: 305.673.741 1 ,Fax:305.673.7254 LOBBYIST NAME: James E. Rauh I understand that no later than February 28th ®f each dear, 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. Signat re: Date: EXHIBIT «Ap, DISCLOSURE OF OWNERSHIP INTERESTS Sally Drinkhouse 90% Nicole Pritchett 10% oo Miscellaneous Cash Receipt {��: .� E �, _ ¢ 1 €?,COO: CITY�OFTVIAMi BEACH No.�i4 04 13. Cash 0 Credit Card Check# .3 r: $......... . 4 � 5 f�,L � e Received of Y Address . 5. For = 4 ;; '. _ Soici fjj ix r 4 ej (THIS iN�ORMAT'iOi�I MUST BE COMPLETED).:_' ®fflce.®f F ance Director Ate„ ♦ By Account Number: . ' °" Prepares: Dept: `.. �; � �ra , 4:. EXT: r a�. r3 � - .•r i.rx