Louis J. Terminello/KNR Michigan LLCa i s
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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 includes the principal as well as any employee engaged in lobbying activities. The term "Lobbyists" has specific exclusions. Please
refer to Ordinance 2004-3435.
Terminello Louis J.
NAME OF LOBBYIST: (Last) (First) (M.I)
Terminello &Terminello, P.A. 2700 Southwest 37th Avenue Miami Florida 33133
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 444-5002 (305) 448-5566 Ijt@terminello.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
LOBBYIST RETAINED BY:
KNR Michigan, LLC
NAME OF PRINCIPAL/CLIENT:
KNR Michigan, LLC d/b/a Sosta Pizzeria & Carpaccio Bar, 1691 Michigan Avenue, Suite 325 Miami Beach, Florida 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: KARIM MASRI
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST: SEE ATTACHED.
u.SPECIFIC LOBBY ISSUE:
APPLICATION FOR VARIANCE TO WAIVE MINIMUM SEATING REQUIREMENT TO SELL BEER, WINE AND LIQUOR AT RESTAURANT
LOCATED AT 1025 LINCOLN ROAD (A/K/A 1021 LINCOLN ROAD).
Issue to be lobbied (Describe in detail):
Ill. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: (Pursuant to city code section 2-4sz(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
NO
ZONING BOARD OF ADJUSTMENT
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) $7,500 THROUGH FIRST PtJB?,IC HEARING; $350 PER HOUR THEREAFTER
B) PRINCIPAL'S DISCLOSURE (oF LoBBY15T COMPENSATION): HOURO~HEREAFTERFIRST PUBLIC HEARING; $350 PER
(Required).
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":
application for change of zoning map designation or change to the Citv's Future Land Use
Man?
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 snot-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
sectign but, shall not be required to pay any registration fees.
reimbursement. .
I do solemnly swear that all of the~er~going facts are true and correct and that I have read or am familiar with the
provisions contained in Section 2- 2 of the Miami Beach City Code and all reporting requirements.
Signature of Lobbyist:
M ~ ~ Signature of Principal/Client:
'~~~'
r~g VI. LOBBYIST IDENTIFICATI
^ Produced ID
~ Form of Identification
~. L7 Personally known (Lobbyist)
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~.~~;- VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn t d subscribe before
This day of , 2008_..__.
Signatx(fe of Public Notary -State of Florida
Not rization of Lobbyist's signature
PRINCIPAL IDENTIFICATION:
~ Produced ID
Form of Identification~~~ Connie S Givens
++~ My Commission DD336494
Personally known (Principal) ~.,~~ ExpiresAupuet27,2008
State of Florida, County of Miami-Dade
Sworn ardd subscribed before e
This2 "' day of __ .I.Gu_2008
Cp NIA S. G(~~-JS-
Signature of Public Notary -State of lorid
Notarization of Principal's signatur
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ es [ ] No Amount Paid $ S '~ Oi? MCR # Date Paid
Lobbyist Registration Form received and verified by:
':t ~€.K.. is ~~ ~'r'~ a ,. :a} i<~~ rt ~ .,;at ~ ,t , c;r:n . ~,~r~? ' - Revised 03/27/2008
V. SIGNATURE UNDER OATH:
CITY OF MIAMI BEACH
ZONING BOARD OF ADJUSTMENT
DISCLOSURE OFINTEREST
LIMITED LIABILITY COMPANY
If the property which is the subject of the application is owned or leased by a CORPORATION, list the
principal stock holders 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).*
KNR MICHIGAN, LLC
LIMITED LIABILITY COMPANY NAME
NAME, ADDRESS, AND OFFICE
RONY SEIKALY
1691 MICHIGAN AVENUE, SUITE 325
MIAMI BEACH, FLORIDA 33139
MANAGING MEMBER
KARIM MASRI
1691 MICHIGAN AVENUE, SUITE 325
MIAMI BEACH, FLORIDA 33139
MANAGING MEMBER
NICOLA SIERVO
1691 MICHIGAN AVENUE, SUITE 325
MIAMI BEACH, FLORIDA 33139
MANAGING MEMBER
NICOLA SCHON
1691 MICHIGAN AVENUE, SUITE 325
MIAMI BEACH, FLORIDA 33139
MANAGING MEMBER
IF THERE ARE ADDITIONAL CORPORATIONS
AND EACH INDIVIDUAL'S NAME, ADDRESS,
SEPARATE PAGE.
25
25
25
25
LIST OTHERS, INCLUDING CORP. NAME(S)
OFFICE AND PERCENTAGE OF STOCK, ON
Last page must be signed and notarized
OF MEMBERSHIP INTEREST
Page A-5
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City of Miami Beoch, 1700 Canvention Center Urive, Miarni Beach, Flarida 33139, www.miamibeachfl.gav
CITY C1ERK Office CityCaerk@miamibeachfi.gov
Tel: 305.673.741 1 ,Fax: 305.673.7254
LOBBYIST NAME:
LOUIS J. TERMINELLO
I understand that no later than October 1st of each Year, 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
2J 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.
.... Off? ~ ~~~
Signature: Date:
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