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James Rauh/KAAMOS, LLC 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, 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 inGudes 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) 2700 S.W. 37 AVE. MIAMI, FLORIDA 33133 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zlp Code) 305-444-5002 305-448-5566 JRAUH@TERMINELLO.COM TELEPHONE NUMBER: FAX NUMBER: EMAIL: LOBBYIST RETAINED BY: KAAMOS, LLC NAME OF PRINCIPALlCLIENT: 650 WEST AVENUE, SUITE 1712 MIAMI BEACH, FLORIDA 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-793-4437 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: TED SNIDER • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: SEE ATTACHED. II.SPECIFIC LOBBY ISSUE: VARIANCE(S) TO EXTEND HOURS OF OPERATION OF ACCESORY OUTDOOR BAR COUNTERS. Issue to be lobbied (Describe in detail): ul. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: (Pursuant to city code section 2-4s2(g) include a statement of the extent of any business, financial, familial, professional or other relationship, giving raise to an appearance of an impropriety, with any City personnel sought to be lobbied; further, pursuant to City Code Section 2- 482(a)(4) include a statement of any contractual relationship (paid or unpaid) from 12 months preceding the commencement of service of City personnel to be lobbied.) A Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship ZONING BOARD OF ADJUSTMENT NO 90 ~~ ~d ~- ~l~ B~QZ ~, IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) $7,500 FLAT FEE THROUGH FIRST PUBLIC HEARING. $300 PER HOUR THEREAFTER. B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): $7,500 FLAT FEE THROUGH FIRST PUBLIC HEARING. (Required). $300 PER HOUR THEREAFTER. 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 eauipment 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": application for change of zoning map designation or chance 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 L~ No• Are you representing snot-for-profit corporation or entity without special compensation or reimbursement. . V. SIGNATURE UNDER OATH: ON OCTOBER 1sT OF EACH YEAR STATEMENT UNDER OATH. LISTING IN THE CITY OF MIAMI BEACH FOR EVEN IF THERE HAVE BEEN NO EXPI of Lobbyist I do solemnly swear that all of the provisions contained in Secti -482 of Signature of Lobbyist: Signature of Principal/Client ~ VI. LOBBYIST IDE FICATION: ^ Produced ID Form of Identification Personally known (Lobbyist) ar and correct and that I have read or am familiar with the Beach Ci Code and all reporting requirements. PRINCIPAL IDENTIFICATION: ~ Produced ID Form of Identification ersonally known (Principal) VII. SIGNATURE AND STAMP OF NOTARY: mate of Floi Sworn r~: Thi c DIY ~~ro~ EXPIRES 220 1 Signature of Put Notarization of ~qL 1~NN lIAO >fi@dpMMISSION # DD72101i0 EXPIRES October Q2, 2011 October 0 1 TO BE COMPLETED BY CITY CLERK'S STAFF ONLY ~~~'~"•`~°"~""- ] Yes [ ] No Amount Paid 3 MCR # Date Paid ~ Lobbyist Registration Form received and verified by: Fr\CLER~L048YIST\~obbyist Registration Forrn 32708.doc ~ ~ ReYISE:d 03~27~2DO$ i . ,. ~~ ~ ~~ ft '` {` ~: -~ ~ ~~ City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov CITY CLERK Office CilyClerk@miamibeachfl.gov Tel: 305.673.741 1 ,Fax: 305.673.7254 - `~~ LOBBYIST NAME: ~1 rT'M'~5 ~~~ 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 Miami-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. Z ~ Op Sig Date: F:1GLEf2tLOBBYIST1Lobbyis# f2egis#ra#iort Form 32708.doc CITY OF MIAMI BEACH DEVELOPMENT REVIEW BOARD APPLICATION DISCLOSURE OF INTEREST 1. LIMITED LIABILITY COMPANY If the property which is the subject of an application is owned or leased by a CORPORATION, list the principal stockholders and the percentage of stock owned by each. Where the principal officers or stockholders consist of another corporation(s), trustee(s), partnership(s) or other similar entity, further disclosure shall be required which discloses the identity of the individual(s) (natural persons) having the ultimate ownership.interest in the entity.* KAAMOS, LLC LIMITED LIABILITY COMPANY NAME NAME, ADDRESS, AND OFFICE % OF MEMERSHIP INTEREST Sinider Miami Beach, Inc. 15% 650 West Avenue, Suite 1712 Miami Beach, Florida 33139 Manager and Member Eclat Holdings, LLC 25% 7511 Miami View Dr. North Bay Village, Florida 33414 Manager and Member Metcalfe Miami Beach, Inc. 20% 1111 Lincoln Road, Suite 400-KLFPA Miami Beach, Florida 33139 Manager and Member Packley, Ltd. Inc. 10% 1111 Lincoln Road, Suite 400-KLFPA Miami Beach, Florida 33139 Manager and Member Enlow, Inc_ 10% 650 West Avenue, Suite 2712 Miami Beach, Florida 33139 Member Pommes, L.L.C. 5% 927 Lincoln Road, Suite 118 Miami Beach, Florida 33139 Member Inception39, L.L.C. 15% 927 Lincoln Road, Suite 118 Miami Beach, Florida 33139 Member IF THERE ARE ADDITIONAL CORPORATIONS, LIST OTHERS, INCLUDING CORP. NAME(S) AND EACH INDIVIDUAL'S NAME, ADDRESS, OFFICE AND PERCENTAGE OF STOCK, ON A SEPARATE PAGE. NOTE: Notarized signature required on page 8 6 CITY OF MIAMI BEACH DEVELOPMENT REVIEW BOARD APPLICATION DISCLOSURE OF INTEREST OFFICERS OF KAAMOS, LLC: Ted Snider 650 West Avenue, Suite 1712 Miami Beach, Florida 33139 Managing Director Jean Francois Mourier 7511 Miami View Dr. North Bay Village, Florida 33414 Managing Director Suzzette Metcalfe 1111 Lincoln Road, Suite 400-KLFPA Miami Beach, Florida 33139 Managing Director Debra L. Packley 1111 Lincoln Road, Suite 400-KLFPA Miami Beach, Florida 33139 Tax Matters Director IF THERE ARE ADDITIONAL CORPORATIONS, LIST OTHERS, INCLUDING CORP. NAME(S) AND EACH INDIVIDUAL'S NAME, ADDRESS, OFFICE AND PERCENTAGE OF STOCK, ON A SEPARATE PAGE. NOTE: Notarized signature required on page 8 6 CITY OF MIAMI BEACH DEVELOPMENT REVIEW BOARD APPLICATION DISCLOSURE OF INTEREST 1. CORPORATION If the property which is the subject of an application is owned or leased by a CORPORATION, list the principal stockholders and the percentage of stock owned by each. Where the principal officers or stockholders consist of another corporation(s), trustee(s), partnership(s) or other similar entity, further disclosure shall be required which discloses the identity of the individual(s) (natural persons) having the ultimate ownership interest in the entity.'' SNIDER MIAMI BEACH, INC. CORPORATION NAME NAME, ADDRESS, AND OFFICE % OF STOCK Ted Snider 650 West Avenue, Suite 1712 Miami Beach, Florida 33139 President 100% IF THERE ARE ADDITIONAL CORPORATIONS, LIST OTHERS, INCLUDING CORP. NAME(S) AND EACH INDIVIDUAL'S NAME, ADDRESS, OFFICE AND PERCENTAGE OF STOCK, ON A SEPARATE PAGE. NOTE: Notarized signature required on page 8 6 CITY OF MIAMI BEACH DEVELOPMENT REVIEW BOARD APPLICATION DISCLOSURE OF INTEREST 1. LIMITED LIABILITY COMPANY If the property which is the subject of an application is owned or leased by a CORPORATION, list the principal stockholders and the percentage of stock owned by each. Where the principal officers or stockholders consist of another corporation(s), trustee(s), partnership(s) or other similar entity, further disclosure shall be required which discloses the identity of the individual(s) (natural persons) having the ultimate ownership interest in the entity.* ECLAT HOLDINGS. INC. LIMITED LIABILITY COMPANY NAME NAME, ADDRESS, AND OFFICE % OF MEMERSHIP INTEREST Jean-Francois Mourier 50% 7511 Miami View Dr. North Bay Village, Florida 33414 Manager Anette Mourier 50% 7511 Miami View Dr. North Bay Village, Florida 33414 Manager lF THERE ARE ADDITIONAL CORPORATIONS, LIST OTHERS, INCLUDING CORP. NAME(S) AND EACH INDIVIDUAL'S NAME, ADDRESS, OFFICE AND PERCENTAGE OF STOCK, ON A SEPARATE PAGE. NOTE: Notarized signature required on page 8 6 CITY OF MIAMI BEACH DEVELOPMENT REVIEW BOARD APPLICATION DISCLOSURE OF INTEREST 1. CORPORATION If the property which is the subject of an application is owned or leased by a CORPORATION, list the principal stockholders and the percentage of stock owned by each. Where the principal officers or stockholders consist of another corporation(s), trustee(s), partnership(s) or other similar entity, further disclosure shall be required which discloses the identity of the individual(s) (natural persons) having the ultimate ownership interest in the entity." PACKLEY, LTD. INC. CORPORATION NAME NAME, ADDRESS, AND OFFICE Debra L. Packley 1661 Stony Brook Ln. Morris, Illinois 60450 President, Secretary and Treasurer OF STOCK 80% Thomas F. Packley 1661 Stony Brook Ln. Morris, Illinois 60450 Vice President 20% lF THERE ARE ADDITIONAL CORPORATIONS, LIST OTHERS, INCLUDING CORP. NAME(S) AND EACH lND1V/DUAL'S NAME, ADDRESS, OFFICE AND PERCENTAGE OF STOCK, ON A SEPARATE PAGE. NOTE: Notarized signature required on page 8 6 CITY OF MIAMI BEACH DEVELOPMENT REVIEW BOARD APPLICATION DISCLOSURE OF INTEREST 1. CORPORATION If the property which is the subject of an application is owned or leased by a CORPORATION, list the principal stockholders and the percentage of stock owned by each. Where the principal officers or stockholders consist of another corporation(s), trustee(s), partnership(s) or other similar entity, further disclosure shall be required which discloses the identity of the individual(s) (natural persons) having the ultimate ownership interest in the entity.* METCALFE MIAMI BEACH, INC. CORPORATION NAME NAME, ADDRESS, AND OFFICE % OF STOCK Suzzette Metcalfe 927 Lincoln Road, Suite 118 Miami Beach, Florida 33139 President 100% IF THERE ARE ADDITIONAL CORPORATIONS, LIST OTHERS, INCLUDING CORP. NAME(S) AND EACH INDIVIDUAL'S NAME, ADDRESS, OFFICE AND PERCENTAGE OF STOCK, ON A SEPARATE PAGE. NOTES Notarized signature required on page 8 6 CITY OF MIAMI BEACH DEVELOPMENT REVIEW BOARD APPLICATION DISCLOSURE OF INTEREST 1. CORPORATION If the property which is the subject of an application is owned or leased by a CORPORATION, list the principal stockholders and the percentage of stock owned by each. Where the principal officers or stockholders consist of another corporation(s), trustee(s), partnership(s) or other similar entity, further disclosure shall be required which discloses the identity of the individual(s) (natural persons) having the ultimate ownership interest in the entity.* ENLOW, INC. CORPORATION NAME NAME, ADDRESS, AND OFFICE % OF STOCK Mirielle Enlow 650 West Avenue, Suite 2712 Miami Beach, Florida 33139 President 100% IF THERE ARE ADDITIONAL CORPORATIONS, LIST OTHERS, INCLUDING CORP. NAME(S) AND EACH INDIVIDUAL'S NAME, ADDRESS, OFFICE AND PERCENTAGE OF STOCK, ON A SEPARATE PAGE. NOTE: Notarized signature required on page 8 6 CITY OF MIAMI BEACH DEVELOPMENT REVIEW BOARD APPLICATION DISCLOSURE OF INTEREST 1. LIMITED LIABILITY COMPANY If the property which is the subject of an application is owned or leased by a CORPORATION, list the principal stockholders and the percentage of stock owned by each. Where the principal officers or stockholders consist of another corporation(s), trustee(s), partnership(s) or other similar entity, further disclosure shall be required which discloses the identity of the individual(s) (natural persons) having the ultimate ownership interest in the entity.' INCEPTION39. LLC LIMITED LIABILITY COMPANY NAME NAME, ADDRESS, AND OFFICE % OF MEMERSHIP INTEREST Fred Olsson 927 Lincoln Road, Suite 118 Miami Beach, Florida 33139 Managing Member 100% IF THERE ARE ADDITIONAL CORPORATIONS, LIST OTHERS, INCLUDING CORP. NAME(S) AND EACH INDIVIDUAL'S NAME, ADDRESS, OFFICE AND PERCENTAGE OF STOCK, ON A SEPARATE PAGE. NOTE: Notarized signature required on page S CITY OF MIAMI BEACH DEVELOPMENT REVIEW BOARD APPLICATION DISCLOSURE OF INTEREST 1. LIMITED LIABILITY COMPANY If the property which is the subject of an application is owned or leased by a CORPORATION, list the principal stockholders and the percentage of stock owned by each. Where the principal officers or stockholders consist of another corporation(s), trustee(s), partnership(s) or other similar entity, further disclosure shall be required which discloses the identity of the individual(s) (natural persons) having the ultimate ownership interest in the entity.* POMMES, L.L.C. LIMITED LIABILITY COMPANY NAME NAME, ADDRESS, AND OFFICE % OF MEMERSHIP INTEREST Alex De Pommes 927 Lincoln Road, Suite 118 Miami Beach, Florida 33139 Managing Member 100% IF THERE ARE ADDITIONAL CORPORATIONS, LIST OTHERS, INCLUDING CORP. NAME(S) AND EACH INDIVIDUAL'S NAME, ADDRESS, OFFICE AND PERCENTAGE OF STOCK, ON A SEPARATE PAGE. NOTE: Notarized signature required on page 8 6