James Rauh/HSS Holding, LLC Amendmentm MIAMIBEACH
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
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LOBBYIST REGISTRATION I~'ORM
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)
TERMINELLO & TERMINELLO, P.A. 2700 S.W. 37 AVE. MIAMI, FL 33133
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-444-5002 305-448-5566 JRAUH@TERMINELLO.COM
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
LOBBYIST RETAINED BY:
HSS HOLDINGS, LLC
NAME OF PRINCIPAL/CLIENT:
PRIME SUSHI 726 41 STREET MIAMI BEACH, FL 33140
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Cade)
305-534-0551
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: JUDITH HERMAN
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: JUDITH HERMAN; ALBERT BENALLOUN (~h~~~)
II. SPECIFIC LOBBY ISSUE:
INTRODUCTION OF SUBSEQUENT OPERATOR - ~r t l.~c .JO , Zj 7j 3
Issue to be lobbied (Describe in detail):
III. C1TY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/Title I B) Any Financial, Familial or Professional Relationship
ZONING BOARD OF ADJUSTMENT ~ NO
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHERf
A) LOBBYIST DISCLOSURE: (Required) $1.500 (FLAT FEE)
B) PRINCIPAL'S DISCLOSURE (OF L086YI5T COMPENSATION): (Required). ~~ .500 (ELATE RATE)
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 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":
OYes ~I No: Are you lobbying on a pending application for a Development Agreement with the Cites
application for change of zoning map designation or change to the City'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..
Yes X1 No: Are you representing anot-for-profit corporation or entity without special compensation
or reimbursement. .
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 EXPENDITURES ORJ~PENSATION DURING THE
REPORTING PERIOD. /~1 / /
Signature of Lobbyist
I do solemnly swear that all of the foregoing fac true and correct and that I have read or am
familiar with the provisions Section 2-482 of the Miami Beach City Code and all reporting
requirements. ,,
Signature of Lobbyist: '~
ignature of Principal/
~ ~ ~ I. LOBBYIST IDENTIFICATION:
$~~~
~0 2 Produced ID
,~ Form of Identification
a Personally known (Lobbyist)t%
II. SIGNATURE AND STAMP OF NOTARY:
•••.~~,.~~~ . tote of Florida, County of Miami-Dade
' a worn to and subscribed before me
~~ his ~ ~ day of e~ , 20~'
i:oN S1r~• _ ? ~ ~ J
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ignature of Public Notary - Stat 'of Florida
Notarization of Lobbyist's signature
PRINCIPAL IDENTI/~F'~ICATION:
Produced ID /-'"-' va` ~C
F rm of Identification `,~~~~~~~~~~~
Personally known (Principal). : ~,`~ ,`J••• TH~,'~~'~
:o-
_ Z', •My ~mm. Expires : Z
State of Florida, County of Miami-Dads ~ :November 15.20
Sworn a_nd subscribed before me = No. DD456293
This ~ day of ~ ~/~ , /2~0x7~d ~ ~ • • pVg~~G : \QQ'`
Signature of Public Notary -State of lorida ~!ririctN~ `~~~~
Notarization of Princioal's signs ure
FOR CLERK' Y ~'
Annual Registration Fee: [ ]Yes [ ] No Amount Paid MCR # Date Paid ~
Lobbyist Registration Form received and veriFed by:
F:\CLER\$ALL\MARIA-M\Lobbyist\LOB IST FORM 05.doc Revised 12/08/09
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City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachFl.gov
CITY CLERK Office
Tel: 305.673.741 1 ,Fax: 305.673.7254
LOBBYIST NAME:
C ityClerk@m is m i beachfl. gov
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M ~S r1 A yl t"t i~ ' 'E,~M lJ.it:~ C. p `4 )~~LM ti J '~,L D ~ ~~
I understand that no later than October 1st of each xear, I must file the following
forms, 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 Form
2) Disclosure Form
Failure to file these forms on a timely basis will result in my name being transmitted to the
Mian-li-Dade County Commission on Ethics and for code violation evaluation.
In addition, once an issue I have registered to lobby on has been resolved, I am required
to immediately notify the City Clerk's Office of lobbyist withdrawal in writing.
~._' ~ ~
Sign ure: D te:
1~:~~isaci o~!oarzoos