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James E. Rauh/South Beach Heights I, LLC (5)m MIAMIBEACH City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 LOBBYIST REGISTRATION FORM Lobbyist means atl persons employed or retained, whether paid or not, by a principal who seeks to encourege the passage, defeat or modification of any ordinance, resolutbn, action or decision of any commissioner, any action, decision, recommendation of the City Manager or eny city board or committee; or eny acton, decision or recommendation of any city personnel during the time perbd of the entire decision-making process on such action, decision or recommendation that foreseeabty will be heard or reviewed by the cUtty commission, or a city board or committee. The term speci(fcalty Includes the prindpal as well es eny employee engaged in lobbying activities. The teen "Lobbyists" has specific exclusions. Please refer to Ordinance 200M3435. 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) (Zip Code) 305-444-5002 305-448-5566 JRAUHQTERMINELLO.COM TELEPHONE NUMBER: FAX NUMBER: EMAIL: LOBBYIST RETAINED BY: SOUTH BEACH HEIGHTS I, LLC NAME OF PRINCIPAUCLIENT: 2200 BISCAYNE BOULEVARD MIAMI, FLORIDA 33137 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-374-5700 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: RUSSELL W. GALBUT • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5°~ OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: SEE ATTACHED. u.SPEC{FIC LOBBY ISSUE: SEE ATTACHED. 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 An Financial, Familial or Professional Relationshi DESIGN REVIEW BOARD NO J~1~3iJ 4.j~~,l~~.J ~~~J i S ~8 ~~ ~ ~ ~fl'~ 8001. ~~~€~~~ IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required)' t ~~ F r, ~}T ~I'i'r T~'~~b ~ ~>,~ss7 ~ae~tc 1'~G~W6 ~ op ~ Q R A B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST CO~ SATION): ~ ~y ~ BOO F4'1'T F~~ T ~~ ~~ iN ~`RS T (Required). ~~ Vtt. t~t?e.4L1nI ~ ;O o pt!t2 ~ti T'N•tEttC•~PT 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 Lr1 No• Are you lobbvina on a aresent or aendina bid for aoods eauiament or services or on a aresent or eendina award for aoods. eauiament or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On ~R,e/al Estate Development Issues": ^ Yes LY No• Are you iobbvina on a aendina aoaiication for a Deveionment Agreement with the City or apalication for chanae of zoning maa designation or chanae 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 section but, shall not be required to pay any registration fees. reimbursement. . of I do solemnly swear that all of ewc, provisions contained in S ion 2-482 of e and correct and that I have read or am familiar with the City Code and all reporting requirements. Signature of Lobbyist: Signature of Princi U~'a CI~~ VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: ^ Produced ID Form of Ident~cation Personally known (Lobbyist) VII. SIGNATURE AND STAMP OF NOTARY: State of Flori o of i i- e Sworn .n o and u ore m y~pA s ~ a+c+- Stag of Fbrida ~ onaNaaioa EfipNaa Mar 16, 2011 saloa~OD~6N032 Si natu of b ' ~ ~~~~~ Notariz ion 0 Produced ID Form of Identification Personally known (Principal) .~•""r'i""'•. DAYAMIAGUTAR '~~ ~~ u° °' Notary PuDgc - Stets of Fbrida State of Florida, Count ~ ~d Swo d subscri ed ' ~ ~~ ~aa Mar t6, 20tt ~hiday of Commisaion g DD tip+032 °]~~~ Banded Through Natia~al NotaryAaan. S natu of Publid`Notaty -State of Florida N tariz ion of Princiual's signature AFF ONLY Annual Registration fee: [ ]Yes [ .< ] No :..Amount`Paid S MCR # Dafe`Paid '"r' X""'T~ Lobbyist.Registration Form received and verified by:. /9 Pe\ciEe\LOHBYLST\Lnbbvist Registration ~Fonn 32708.doc ~ ~ Revised 03/27/2008 V. SIGNATURE UNDER OATH: SPECIFIC LOBBY ISSUE: Design Review Approval of Renovation and redesign of existing three story hospital structure to mini storage enclosed with retail uses; reposition of the existing ten story medical office building to a flex office space to allow flexibility for office and apartmentllive-work spaces, which includes recladding the exterior curtain wall system to a window wall system and architectural modifications to the street level; and architectural modifications to existing three story parking structure for property at 630 Alton Road (sometimes referred to as 600 Alton Road) m MIAMIBEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeochA.gov CITY CLERK Office CityClerk@miamibeachfl.gov Tel: 305.673.7417 ,Fax: 305.673.7254 1~~a LOBBYIST NAME: `---~/~`M'~~ I understand that no later than October 1st of each ear, 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. 7i f7 D e: F:\CLER\LOBBYIST1Lobbyist Registration Form 32708.doc