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James E Rauh - Patria Shorecrest Inc. pr),) rt, V V C°1/ 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, FL 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: Patria Shorecrest Inc. NAME OF PRINCIPAUCLIENT: Patria Shorecrest Inc. 144 Bloor Street West, 7th Floor, Toronto, Ontario, Canada M5S 1M4 OC BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (416)869-9444 tony @inkentertainment.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: Bechara Khabouth, President • IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: See attached Exhibit"A". II.SPECIFIC LOBBY ISSUE: Conditional Use Permit for a Neighborhood Impact Establishment at 1545 Collins Avenue,Miami Beach,FL 33139;and any land use,development, zoning,design,or licensing issues relating to the subject property. 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 NO title of person to be lobbied City of Miami Beach Planning Board None X Planning Director and his staff None X Parking 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 orprofessional 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 .a= None •• �1 (-11 V S 1 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 © 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 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 © 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_ : FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. A A Signat of 4 bbyist I do solemnly swear that all of the foregoing facts are tru -• correct and that I have read or am familiar with the provisions contained in Section 2-482 of the Miami Be- - ' Code and all re •- `g req i rements. Signature of Lobbyist: i .ate . _ Signature of Principal/Cli t: —° ,.-∎` ' VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: ❑ Produced ID V_Produced ID P /C31IZ4-D'71D&-(OSoL- Form of Identification pY pi, Form of Identification yp 0 •• % BRAD STEVEN FLEET 1+.- i,9 * MY COMMISSION#EE 223709 I co•e Personally known(Lobbyist) ❑ Personally known(Principal) '∎1_1.:'.,` EXPIRES:August 21,2016 VII. SIGNATURE AND STAMP OF NOTARY: ®andedl�u9ud9etNotery3ervtii Z_' State of Florida,County of Miami-Dade ate of Florida,County of Miami-Dade Q Swor .t• -nd subscribed before me orn and subscribed before me A is %� •ay of OCTOBER, 2014 his 'I day of OCTOBER,2014 g uu I F jLAC I A •i � . QJe•1u,,: %. Signature of Public Notary IF•tate of Florida Signature of Public Notary-State of Florida a; ;f`: Notarization of Lobbyist's signature Notarization of Principal's signature "o,••x° A. * .s'* TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: [ ]Yes[ No Amount Paid$ ,�SD°,y, MCR## 3(0 2 1 q Date Paid l - 1 Lobbyist Registration Form received and verified by: c./4/#s-.. - I147...... F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Annual Registration Form.doc Revised 1/11/2011 r City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov CITY CLERK Office CityClerk @miamibeachfl.gov Tel: 305.673.7411 , Fax:305.673.7254 LOBBYIST NAME: JAMES E. RAUH I 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. Signature- Date: EXHIBIT"A" DISCLOSURE OF INTEREST PATRIA SHORECREST,INC. CITY OF MIAMI BEACH DEVELOPMENT REVIEW BOARD APPLICATION DISCLOSURE OF INTEREST 1.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.* PATRIA SHORECREST, INC. CORPORATION NAME Name and Address %of Ownership Bechara Kabouth 25% 144 Bloor Street,7th Floor Toronto,Ontario M5S 1M4 OC Maher Murshed 25% 144 Bloor Street,7th Floor Toronto,Ontario M5S 1 M4 OC Daniel Sobreano 25% 144 Bloor Street,7th Floor Toronto,Ontario M5S 1 M4 OC Hanif Harji 25% 144 Bloor Street,7th Floor Toronto,Ontario M5S 1M4 OC • W 1 vimramnmwmmusommw City of Miami Beach-Florida Finance Department 1 City Hall 1432920-1 11/25/2014 BR 1 T131 Tue Nov25;2014 10:29AM Trans,3-3 3 $350.00 MCRCLERK - MCR-City Clerk * MCR#: 36219 1 ITEM(S): TOTAL: $350.00 Check (008143) PAID $350.00 Have a nice day! _,-.; f, f luk; ; t 001 131 Miscellaneous Cash Receipt E }_ :, :2;621'1,' .^,r:,,y;-00 P CITY OF MIAMI BEACH 36213 El Cash C]Credit Card Check# 6 $ • • C1 � � c 201 { : Received of U a. ' -, — Address i tT, .�•1 , 433 fj; z ' 3t 3. For L 0119, .,.s 71--- , v e I S co. j s.h., -e . M ELC )c<- • (THIS INFORMATION MUST BE COMPLETED) Office of Finance Director• By Account Number: 6 1 ` ` . ‘i Preparers C I4 -- L -- Dept: v---1 EXT: 7 [ f I