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James Rauh - ROK, LLC I>'tlMTll lIe...;tI bftd rriiP m 2QU3 - 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 prindpal 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 Cty Manager or any city board or committee; or any action, decision or recommendation of any dty personnel defined in any manner in this section, 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 dty commission, or a dty board or committee. The term specifically includes the principal as well as any employee engaged in lobbying activities. The tenn "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435. . BUSINESS NAME AND ADDRESS ~~S) S 3 '1- ~7 ~7 TE PHONE NUMBER: ,..-:-- J -4~e) (First) J2o~~ ~;./k~ &k",,,,,.. iF A,;" 1'( <fi). L""c.t;v (Number and Street) (Cty) ( ~QS) t:"3?- c-r-Or./ FAX NUMBER: , NAME OF LOBBYIst: 1<4 w 1+ (Last) /lI~ .;It ,..,..... C (State) ~. (M.!) q #".e If' Fe (Zip Code) EMAIL: I. LOBBYIST RETAINED BY: /l6 ~ J Le, C NAME OF PRINOPAl/CUENT: / fI~S CCc.-c..r,.....~ BUSINESS NAME AND ADDRESS A-1/ ~ /"'1 ,..,."", I' (Number and Street) /!J G'C.e-H It '3]15 '? (Cty) (State) (Zip Code) ----.J TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) Fill out this section if prindpal is a Corporation, Partnership or Trust [Section 2-482 (c)] . NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: (lc J.u. /. (11J C&-", . IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIREcrL~A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: ph 1111's, / ~ J'~ 1<>"".,. f: L t1W.r40 ,.~ II. SPECIFIC LOBBY ISSUE: p1 '01 ~,e Afto..v ftJ- Issue to be lobbied (Describe in detail): III. CITY AGENCIES/INDMDUALS TO BE LOBBIED: (OIVt)/~ fA. ~ ~ I'lHt- "r A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship . . p l. q..." N ,AI' {7, 41).(l- fJ ...t....".. , ,.",..., . . . t":'~ ~ .. .... ~ IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY. FLAT RATE OR OTHER): , A) LOBBYIST DISCLOSURE: (Required) A ;'60...0 /'If "",rill ~ h. ~/1'.f (;.I/'#,..,.., I e-4',J. B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). J" ~O . - /VI ...,,,:1(,., r (t rZ~ S~/k t"LIIo('''f'~ D Yes ~o: Are YOU reDresentina a not-for-Drofit corDoration or entity without sDecial comJensation or reimbursement. Pursuant to Ordinance No. 2004-3435. 1) Pursuant to Ordinance No. 2003-3393 Amendinc Miami Beach City Code Chaoter 2. Article VI~ Division 5 Thereof Entitled "Camoaign Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Pr hibited Campaicn Contributions By LobbYists On Procurement Issues": 2) Pursuant to Ordinance No. 2003-3395 Amendinc Miami Beach City Code Chaoter 2. Article VII Division 5 thereof Entitled "Camoaicn Finance Reform", Via The Addition Of Code Section 2-490 Entitled "Prohibited Camoaicn Contributions Bv Lobbyists On Real Estate Develooment Issues": DYes D~: Are YOU lobbyina on a Dendina aDDlication for a DeveloDment Aareement with the City or aDDlication for chanae of zonina maD desianation or chanae to the City's Futur~ Land Use MaD? V. SIGNATURE UNDER OATH: ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH, UmNG LOBBYING EXPENDITURES, AS WELL AS COMPENSATION RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STAT MEN SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXP NDITURES OR COMPENSATION D N T REPORTING PERIOD. #1 Signature of Lobbyist I do solemnly swear that all of the foregoing facts are true and 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 repq .. g requirements. v Signature of Lobbyist: fignature of Principal/Client: VI. LOBBYIST IDENTIFICATION: t'l-I/,ts o Produced ID ./ Form of Identification ~~~aIlY known (Lobbyist) P_RINC~L IDENTIFI~TION: D Produced ID Form of Identification ~~ally known (Principal) VII. SIGNATURE AND STAMP OF NOTARY: e" \