James Rauh/HSS Holdings, LLC
m MIAMIBEACH..
` ~ a ~ ~ ~ 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, derision or recommendation of any city personnel during the time
period of the entire decision-making process on such action, derision or recommendation that foreseeably will be heard or reviewed
by the rity commission, or a city board or committee. The term specifically includes the princpal as well as any employee engaged
in lobbying activities. The term "Lobbyists" has speafic exclusions. Please refer to Ordinance 2004-3435.
NAME OF LOBBYIST: (Last) (First) (M.I)
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BUSINESS NAME AND ADDRESS (Number and Street) (City) tate) (Zip Code)
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TELEPHONE NUMBER: FAX NUMBER: ~ EMAIL:
I. LOBBYIST RETAINED BY:
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NAME OF PRINCIPAL/CLIENT:
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BUSINESS NAME AND ADDRESS (Number and Street) _ (City) (State) (Zp Code)
TELEPHONE NUMBER:
FAX NUMBER:
EMAIL: (Optional)
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: ~ LI ASR' S A ~ D ~A u S
out this section if principal is a Corporation, Partnership or Trust [Section 2-482
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
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Issue to be lobbied (Describe in detail): ]` '~ Z (p t((Q. sj~,~ T a~~~4 ?~ (v ,~j-~v' (pv~r'~ /~
III. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship
2e~-N~ ~ ~ d ~ ~j ~r.«~.~' ~ ~
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHERf L
A) LOBBYIST DISCLOSURE: (Required) ~ .// yi~0 • ~ ~ ~(,q,T- F~ii'
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). ~ .J! OOp • aC ZFt 4T ~~-
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 vo lobbvina on a present or Dendina bid for coed eauiDment or services or on a
present or uendma award for goods eawoment or service
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
uTes •~ No: Are v u lobbvina on.a'u~endina application for a Development Aareemen with the City or
aapl~cation for change of zomna man des~anation or change to the Citv's Future'Land Use
Ma°?
. ~ . ~ .
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. anot-for-profit
corporation~or entity•without special compensation o~ 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..
or reimbursement. .
V. SIGNATURE UNDER OATH:
ON 'OCTOBER 1~ OF EACH ~ YEAR, EACH LOBBYIST .SHALL ~ SUBMIT TO THE CITY CLERK I4' 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 N0 EXPENDITURES OR COMPENSATION DURING THE
REPORTING PERIOD.
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 fined in Section 2-482 of the Miami Beach City Code and all reporting
requirements. / /
Signature of Lobbyist:
Signature of Principal/~it: ~
VI. LOBBYIST IDENTIFICATION:
^ Produced ID a
Form ~of Identification
~onally known (Lobbyist)
PRINCIPAL IDENTIFICATION:
oduced`1D
Form of Identification
o Personally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn to and ubscribed before e
This ~da~vc~ 20 p "`~
State of Florida, County of Miami-Dade
Sworn and subscrib d befog ~r"~e
This~da~Qf_ ~%~..2oD~'7
of ' ry =
FOR CLERI ' ®LaL ` ~j
Annual Registration fee: [ es ( ] No Amount Paid (J-~MCR # ~ ~ S Date Paid ~ r ~ {
Lobbyist Registration Form received and verified by:
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM 05.doc Revised 12/08/04