James Rauh/Heafey Bentley Hotel, LLC Amended Formm MIAMIBEACH
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
~,r~F..ows €„rT-
LU13l3YI "T REGISTRATION FURI.1
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 Drdinance 2004-3435.
Ra ih Tames E __
NAME OF LOBBYIST: (Last) (First) (M.I)
Terminello & Terminello P A 2700 SW 37th Avenue, Miami. Florida 33133
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305.444.5002 305.448.5566 ~rauh@terminello.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
LOBBYIST RETAINED BY:
Healey / Bentley Hotel, LLC
NAME OF PRINCIPAL/CLIENT:
1717 North Bayshore Drive, Suite 102, Miami, Florida 33132
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zp Code)
305.523.3344
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-~
Pierre Heafey
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: See attached~'o i~l-~+~ -~lM.
II. SPECIFIC LOBBY ISSUE:
Application for Conditional Use Approval for Restaurant at 101 Ocean Drive
Issue to he lobbied (Describe in detail):
III. CITY AGENCIES/INDNIDUALS TO BE LOBBIED:
A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship I,
Planning Board No
Planning Director No
IV. DISCLOSURE OF TERM' D AMOUNTS OF LOBBYIST COMPENSATION (Dl ,OSE WHETHER HOURLY,
PLAT RATE OR DTHERf ?~., ,.~' -n
A) LOBBYIST DISCLOSURE: (Required) - / ~~ L~ ~ IZ ~T~ ~~~ ~ `~-~'~ ~~ ~"~` ~~~~ SSG
~7 i1F ~4C2 ~
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required).~__ /f `] UD (F1r~ r (~fi i ~~, rrk~.v ,~ 3ov , o0
aE'R V~ vr~- ~}~- t S T hf+c Ate- t ./ C~
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 lobbving on a present or pending bid for goods, equipment or services, or on a
present or pending award for goods, equipment ar service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
nYes L~ 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 Citv'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 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..
V. SIGNATURE UNDER OATH:
ON OCTOBER 1~ 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.ENDiT'URES`O MP SATION DURING THE
REPORTING PERIOD, ~ )
I do solemnly swear that all of the foregoing
familiar with the provisions contained ' is
requirements.
Signature of Lobbyist:
Signature of Principal/Client: ~:~"'
VI. LOBBYIST IDENTIFICATION:
^ Produced ID
Form of Identification
are ~ and correct and that I have read or am
3 the Miami Beach City Code and all reporting
v Produced ID
(_ ersonally known (Lobbyist)
VII. SIGNATURE
State of FI
of
of Florida
Form of Identification
personally known {Principal)
State of Florida, County of Miami-Dade
Sworn and subscri before me
This day of 20~ , ~~~ .,, tOUR(.~ES CECiL;A OCAMP
~ -', ~,'-'-~'~~y`~~_Nnlary P~1L,;iC -State of Flor
Signature of No -State of li~~ a:` Comm~~.ion # l)~~:;;_~924~
' ~f~f~t~~•`•
Notarization o "al's signat re '" Bonded By tJrnSonr:a! NotCir~ ~:
~.
FOR CLERK'S USE ONLY
Annual Registration fee: [ )Yes [ ] No Amount Paid MCR # Date Paid
Lobbyist Registration Form received and verified by:
F:\CLER\$ALL\MARiA-M\Lobbyist\LOBBYIST fORM 05.doc Revised 12/08/04