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James E. Rauh - Para Picchu Holdings Group, LLC ZGOo (.511(05 4)e.) MIAMI BEA 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) Greenspoon Marder, P.A. 1224 Washington Avenue, Miami Beach, Florida 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-602-8245 305-448-5566 james.rau h @gmlaw.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: Please notify this office if yourcontact information changes:address,phone, or e-mail address. I. LOBBYIST RETAINED BY: Para Picchu Holdings Group, LLC NAME OF PRINCIPAUCLIENT: 625 North Flagler Drive, Suite 402 West Palm Beach, Florida 33401 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 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: John T.Gannon, Manager • PA IDENTIFY ALL P ER ONS'HOLDI G.OIREglY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, Ii SPECIFIC LOBBY ISSUE: Any and all land use,zoning,and licensure issues relating to the property located at 2000 Collins Avenue;Miami Beach,Florida 33139. issue to be tabled(Describe in detail): 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 Planning Director and Staff X Planning Board 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 NONE F:ICLERI$ALLIaFORMSILOBBYIST FORMS\Lobbyist Registration Form.doc • Iv, DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) $375- Hourly B) PRI CIP L'S DISCLOSURE(OF LOBBYIST COMPENSATION): $375 - Hourly 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.XNo: Are ou.Iobb in. on a •resent or •endin• bid for goods e•ui•ment or services or on a 'resent or •endin• 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 An ) y ( )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 io: 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 SH -• FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. V signaior Lobbyist I do solemnly swear that all of the foregoing facts are true - • correct and that I have read or am familiar with the provisions contained in Section 2-482 of the Miami B-- City Code and all reporting requirements. Signature of Lobbyist: � , f/P7W-Signature of Principal/Client:—,;.; A A. ,die/`\----- VI: LOBBYIST IDEN+ ICATION: PRINCIPAL IDENTIFICATION: Produced ID " �lt ..'.4?-'- Produced ID t ,, % Form of Identification �� ; :? Form of Identification .�. ., ',�,��s ••f Personally known(Lobbyist) ,4f'('"• - :. Y { Y ) V Personally known(Principal) a w i SIGNATURE AND STAMP OF NOTAR :[F.' ' m �'�' o -4aYnm a E , , g Florida,County of Miami-Dade a m State of Florida,County of Miami-Dade z Z•o•' 4 •--: o and subscribed before me tI ' - z Sworn and subscribed before me b.� '� i _1 .�d day of.�'IC1�ib 2t)1� "z" m' T This y day of Drell t.,201,6— z(02,41 .‘g-litb ,e,,i,t, 1 ''. -.. ;:ii71 I r (.re of Public Notary State of Florida. Signature of ublic Notary—State of Florida * & . : $ tat,l ation of Lobbyist's signature Notarization of Principal's signature °k'•s TO BE COMPLETED BY CITY CLERK'S STAFF ONLY ' 3 Annua egistration fee: r ]Yes(` )No Amount Paid$ 359 MCR# 1b 5 SS Date Paid 12)9/IS" •••, t Registration.Form receive nd verified by: `1 ,�'r"t�o,rn v� F;\CLErt\$ALL` ORMS\L€t BYIS Foi Ms\Lobbyist Amami rtegisur::,t;ic ,r~ortu,eicc Revised 01/22/2014 F:\CLERI$ALL1aFORMSILOBBYIST FORMS\Lobbyist Registration Form.doc i\AAMIBEA(CH City of Miami Beach, 1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.gav CITY CLERK Office Rafael E.Granada,City Clerk CityClerk @miamibeachfl.gov Tel:305.673.7411 ,Fax:305.673.7254 LOBBYIST NAME: James E. Rauh 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$50.00 a day shall be assessed for all Statement(s) filed after the due date. The City Clerk shall notify the Miami-Dade County Commission on Ethics and Public Trust of the failure of a lobbyist(or principal) to file the Statement or pay the assessed fines after notification. Any lobbyist,who fails to file the required Statement by April 30th of each year,shall be automatically suspended from lobbying until all fines are paid, unless the fine has been appealed to the Miami-Dade County Commission on Ethics and Public Trust, - - 7 ✓ 2v /5 Signature: Date: F:ICLERI$ALL1aFORMSILOBBYIST FORMS\Lobbyist Registration Form.doe EXHIBIT 66A" 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.* Para Picchu Holdings Group, LLC CORPORATION NAME NAME AND ADDRESS % OF STOCK Para Picchu Holdings Group,LLC Arjan Waney 35% 625 North Flagler Drive, Suite 402 West Palm Beach, Florida 33401 John T. Gannon 30% 625 North Flagler Drive, Suite 402 West Palm Beach, Florida 33401 Dugus Group 30% 625 North Flagler Drive, Suite 402 West Palm Beach, Florida 33401 Tom Muir 5% 625 North Flagler Drive, Suite 402 West Palm Beach, Florida 33401 24783981v1 v 1` ✓S 1 - p q..e 5s tS' �1 zt f t,-..�.�v_✓,Y�JS� ai E'+,N�+ --"�. i 1 _ t 1 Mlsceilaneous Cash;Re-v-ceipt i. �Y•.� _ A — — z — _ 1` �— ^� is CITY.::0 .AM�'��/ Y r Y Received of ' • A 1 Fo■ i✓ l.i c,' ��e°tr° f4 � �„� ' /,{v\ Y_7. ; ,1 2 5 C (THIS INFORMATiON MUST DE COMPLETED Office of Fi ance Director 1` :Account Number. 0 1 1 _ ..f t_ '_ City of Miami Beach-Florida Finance Department 1 City Hall 1534113-1 1i07J2015 BR1 T137 Mon Dec07,2015 02:59PM Trans#75 75 75 $350,00 MCRCLERK - MCR-City Clerk * MCR#: 408355 1 ITEM(S): TOTAL: $350.00 Check (001008) PAID $350.00 Have a nice day!