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James Rauh/Noah Restaurant, Inc.m MIAMIBEACH City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 LOBBYIST RLGIS'fR.aTION 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, derision, recommendation of the City Manager or any city board or cornrnitter, or any action, decision or recommendation of any city personnel during the time period of the entire decision-making process nn such action, decision or recommendation that foreseeably will be heard or reviewed by [he city commission, or a city board or committee. The term specifically rncludes the principal as well as any employee engaged in lobbying activities. The term "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435. Ra ~h Tames E NAME OF LOBBYIST: (Last) (First) (M.I) Terminello & Terminel]o P A 2700 SW .37th Avenue, Miami, Florida 33133 BUSINESS NAMk_ AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305.444.5002 305.448.5566 ~rauh@terminell_o.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: I. LOBBYIST RETAINED BY: Noah Restaurant, Inc. NAME OF PRINCIPAL/CLIENT: Noah, 4770 Biscayne Boulevard, Suite 60, Miami, Florida 33137 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zp Code) TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) pis section if principal is a Corporation, Partnership or Trust [Section 2-482 Pierre Heafey NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: IDEN rIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: Pierre Heafey (50~) and Thomas Billante (S0~) II. SPECIFIC LOBBY ISSUE: Application for Conditional Use Approval for Kestaurant at 101 Ocean Drive Issue to be lobbied (Describe in detail): III. CITY AGENCIES/INDNIDUALS TO BE LOBBIED: A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship Planning Board No Planning Director No IV. DISCLOSURE OF TERM' D AMOUNTS OF LOBBYIST COMPENSATION (Dl .OSE WHETHER HOURLY, FLAT RATE OR OTHERr A) L088Y1S1 DISCLOSURE: (Required) - __ ~ ~ T ~ N ,~ ~},t /}~ r.J6 B) PRINCIPAL'S DISCLOSURE (OF L088YIST COMPENSATION): (Required)~_ZUn (FC',4 r r~/f r ~~~~ g 3O0 ` ~ Prig H~o u R A-FT~ I s T --} t `N` ''`r ~' 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 l~ 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': 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 anot-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.. 4 Yes l~ No• Are you representing anot-for-profit corporation or entity without special compensation or reimbursement. . V. SIGNATURE UNDER OATH: ON OCTOBER 1sT 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 EXP U ES OR COMPENSATION DURING THE REPORTING PERIOD. Signature of Lobbyist I do solemnly swear that all going f cts e true and correct and that I have read or am Familiar with the provisio contained in ecti 2 of the Miami Beach City Code and all reporting requirements. Signature of Lobbyi: Signature of P~incip VI. LOBBYIST I[ ^ Produced ID Form of Identification 't~ersonally known (Lobbyist) VII. SIGNATURE AND ^ Produced ID Form of Identification ~sonally known (Principal) State of Flori ty~~ rb~~2~~~, State of Florida, County ,i~~Sl~jotary Public -State of Flonda Sworn t ri~-Q '~'""P~D~ Swor and subsCrit~d b _ ~' ^l. My ComrnissionF~esAprl},2008 This _ j~~f ~ _ This _ day Commrssion #f DD309244 -~` '• Bonded By National Notary Assn. Signature I' Nota - S to f Florida Signatur I" -State of Florida Notarization of Lobbyist's s ture Notarization of Principal's signature FOR CLERK'S USE ONLY ~ `~ /" Z Annual Reyrstration fee: [ `'/] Yes [ ) No Amount Paid •O~~ MC~/ Date Paid ~ CL ~/ Lobbyist Registration Form received and verified by: ~ 2-,..a'~ F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM 05.doc ~ Revised 12/08/04