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James E Rauh - Dream South Beach (2) ' 5 Ltak), Cot , e- MIAMI i if" 14 V 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: SB Hospitality,LLC;Tudor South Beach Resort Condominium Association,Inc.;and Tudor South Beach Resort-North Condominium Association,Inc. NAME OF PRINCIPAUCLIENT: Dream South Beach, 1111 and 1119 Collins Avenue, Miami Beach, Florida 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305)673-4747 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: Mansukhbir Singh Chohan,Manager of SB Hospitality,LLC,and Rabinder Pal Singh,Director of Tudor South Beach Resort Condominium Association,Inc.,and Director of Tudor South Beach Resort-North Condominium Association,Inc. • IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: See attached Exhibit"A". r- ll.SPECIFIC LOBEYlS$UE_` Modification of Conditional Use Permit to change owner/operator at 1111 ,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): nl CITY ACENCIES/INDIVIDUALSTOPBELOBBIED. 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 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 persoq el who is sought to be lobbied as identified on the lobbyist registration form filed. --- Sec 2-482(g)Any Financial,Familial or Professional Relationship ; ., _ f N; . ) None Cr cp T, .• R13 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 lobbvinq 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": El 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 BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. L . . Signature of •.by•. I do solemnly swear that all of the foregoing facts are true a • co. -•ct and that I have read or am familiar with the provisions contained in Section 2-482 of the Miami :--__h City Code and all repo • requirements. Signature of Lobbyist: JOIF Signature of Principal/Client: __! -=�r�'!— VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: ❑ Produced ID ❑ Produced ID Form of Identification Form of Identification 0 7 •C) a 0 Kati ,/y' c. R Personally known(Lobbyist) o _�� . VPersonally known(Principal) o m 00- 1>4 ��.m° VII. SIGNATURE AND STAMP OF NOTARY: * v Z n > OD M <0 g' State of Florida,County of Miami-Dade x State of Florida,County of Miami-Dade ° N z Sworn • and; ubscribed b-f•re me o 5 Sworn and subscribed before me c o o This •a of :L. ;:•:f': , 2014 E n N g This a0 day of 0 Ct'D b�014 to A" z O Arri7 N "X Si: re o 'u of -S ate o Florida ? ignature of Public Notary-State of Florida o Notarization of Lobbyist's signature cf a Notarization of Principal's signature w TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee :[ ]Yes[, ] io Amount Paid$ ,-D MC ? ti1.O Date Paid it 2. 114 Lobbyist Registration Form received and verified by ''-O- F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist'Annual•RegistrationForm doc Revised 1/11/2011. SHARON TSO Notary Public,State of New York No.01TS6246458 Qualified in New York County Commission Expires August 8,2015 tz JvAM1EAC ;H;. 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. °�.. to 2 if 2�t I' _ 0• SigndiF Date: EXHIBIT "A" DISCLOSURE OF INTEREST SB HOSPITALITY, 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.* SB HOSPITALITY. LLC CORPORATION NAME Name and Address % of Ownership SB Hospitality, LLC MVS HOTELS CORP 100.00 do Russell W. Rosen 555 5th Avenue, 11th Floor New York, NY 10017 MVS HOTELS CORP SB (MALTA) LIMITED 100.00% c/o Russell W. Rosen 555 5th Avenue, 11th Floor New York, NY 10017 SB (MALTA) LIMITED NY Holdings Limited 100.00 % do Russell W. Rosen 555 5th Avenue, 11th Floor New York, NY 10017 NY Holdings Limited Ganesh Narayan 100.00 % do Russell W. Rosen 555 5th Avenue, 11th Floor New York, NY 10017 EXHIBIT "A" DISCLOSURE OF INTEREST TUDOR SOUTH BEACH RESORT CONDOMINIUM ASSOCIATION, INC. 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.* TUDOR SOUTH BEACH RESORT CONDOMINIUM ASSOCIATION, INC. CORPORATION NAME Name and Address % of Ownership TUDOR SOUTH BEACH RESORT CONDOMINIUM ASSOCIATION, INC. Jay Stein, President N/A Rabinder Pal Singh, Secretary Jagdish Satra, Treasurer 1111 Collins Avenue Miami Beach, FL 33139 rs 1Ua City of Miami Beach-Florida Finance Department 1 City Hall 1432920-1 11/25/2014 BR1 1131 Tue Nov25,2014 10:40A,i Trans#5-5 5 $350,00 +MCRCL ERK - MCR-C i t y Clerk 1CR#: 36220 1 ITEM(S): TOTAL: $350.00 Check (008141) FAIL $350,00 Have a nice day! 'T... !. qtr _} s'4,!!-;/2_01.4 tt ppj�.t {1 71 Miscellaneous Cash Receipt t=�. F ; } , W L C!1 Y OF MIAMI BEACH No 36220 0 Cash ❑Credit Card Check# I ✓ v - 201 '( Received of f 1 C'.LA.. ( 3r , , • Address .} For � -, ,� � 1' , (THIS INFORMATION MUST BE COMPLETED) Office of Finance Director By Account Number . . � Preparer, col :• 1. - �_ • Dept C 3 "t� ( �, P � (�-�:� EXT: . � q