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Alexander I. Tachmes/2K South Beach Hotel LLCa? MIAMIBEACH 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 bond 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. Tachmes Alexander I. NAME OF LOBBYIST: (Last) (First) (M.I.) c/o Shutts & Bowen LLP 201 South Biscayne Boulevard, Suite 1500, Miami, FL 33131 _ BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 347-7341 (305) 347-7754 atachmes@shutts.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: LOBBYIST RETAINED BY: 2K South Beach Hotel, LLC NAME OF PRINCIPAL/CLIENT: 1020 Ocean Drive Miami Beach, FL 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (786) 276-1414 N/A mpalma@clevelander.com 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: IDENTIFY ALL PERSONS HOLDING, DIRECTLY CR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: See Exhibit "A" attached. r^~ ~ 0 --~ o II. SPECIFIC LOBBY ISSUE: r~--- o ~~' Modification of Conditional Use Permit for property located at 1020 Ocean Drive =-= p °~..) Issue to be lobbied (Describe in detail): <r> -~ .--~ ~e ~. ~., III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: (Pursuant to City Code Section 2-48~g) iP~lude statement of the extent of any business, financial, familial, professional or other relationship, gives rise to an appearance of an impropriety, with any City personnel sought to be lobbied; further, pursuant to City Ode S~tion 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 Relationship City of Miami Beach Planning Board None City of Miami Beach Mayor/Commissioners None City of Miami Beach Committees None MIADOCS 3142020 1 IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WWETWER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required} Hourl - $450.00 B) PRINCIPAL'S DISCLOSURE {OF LOBBYIST COMPENSATION): (Required). Hour) - $450.00 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": 2} Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Developmsnt Issues": 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: Signature of Lobbyist: /{ Signature of Principal/CUsnt: r Michael L. Palma, Manager of 2 South Beach VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTI ~ A710N: / ~",,~D ^ Produced ID Produced ID i~L D~' yl~~-f-c Form of Identification ~ Form of Identification ® Personally known (Lobbyist) ^ Personally known (Principal) VII. SIGNATURE AND STAMP OF NOTARY: Stets of Florida, County of Miami-Dade Sworn to and cribed before me This day of 20Q8 ~i._O ~ s ~-~-- Si a re of Public Notary -State of Florida tar zation of Lobbyist's signature State of Florida, County of Miami-Dade Swor to and sub cribed before me This day of 1 ~ , 2008 Signature of Public Notary -State of Florida Notarization of Principal's signature PLETED BY CITY Form received and verified by: ., ~°""'°- Linda Christian MIADOCS ~C~mnlission #DD651416 '-.,,,,,,,,,.; Expires: MAR. 23, 2011 gON~iED THRU fiiZAh"CiC BONDING CO., INC. Date MTV Revised 03l2TT2048 ~- Notary pu'ollc State of FlUndd ~' z ~~" ~"B ij Kama! U~4vaan, ~I N 2 r w ® ~ 4y Cnmm S o~ ~U~609'12 fl ~ ~'c ~_d' zw~~ie5 r,,i~y ~I ~_ __--- i '_= I do solemnly swear that all of the for ing facts are true an correct and that I have read or am familiar with the provisions contained in Section 2-48 of~ t~ Ml~ni Be~~O rde all reporting requirements. m MIAMIBEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov CITY CLERK office CitvClerkCc~miamibeachfl.gov Tel: 305.673.7411, Fax: 305.673.7254 Alexander I. Tachmes LOBBYIST NAME: I understand that no later than October 1 g` of each near, 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 for lobbyist withdrawal in writing. Signature: Alexander I. Tachmes I(-I ~-ok Date: MIADOCS 3142020 1 2K SOUTH BEACH HOTEL, LLC LEGAL ENTITY OWNERSHIP STRUCTURE 'David Dane on a Luc 8 US TRUST Neeley Co-Trustees Settbrs THE JONATHAN LEE NEELEY 1996 TRUST, DATED 11/5!96 Jonathan Lee Neeley, Beneficiary 40.00% (LP) 20.00% (LP) 100% THE JONATHAN LEE NEELEY TRUST, \ DATED APRIL 2, 1996 BRIO INV. GROUP, INC. A CALIFORNIA C-CORP ABIGDESTINATIONS, LLC A DELAWARE SMLLC 10% (SGP) THE MAILING ADDRESS FOR ALL ENTITIES LISTED HERE IS AS FOLLOWS: 750 "B" STREET, SUITE 1930 SAN DIEGO, CA 92101 THE STEVEN LEE NEELEY 1998 TRUST, DATED 11/5/98 Steven Lee Neeley, Beneficiary ~ RNLN CAPITAL ~ INVESTMENTS, LP A DELAWARE LIMITED PARTNERSHIP RNLN REAL ESTATE HOLDINGS, LLC A CALIFORNIA SMLLC Ran a Lucie Nsaley ('RN' 6 `LN7 Seltlors a Trustees 100% THE ALISON THE NEELEY FAMILY NEELEY 1998 TRUST, REVOCABLE TRUST DATED 11/5/98 DATED SEPT. 15, 1981 Alison Neeley, Ron & Lucille Neeley Beneficiary Beneficiaries 20.00% (lP) I19.00% (LP) 99°h RNLN REAL ESTATE ADVISORS, LP A DELAWARE LIMBED PARTNERSHIP 1% MIKE PALMA, MANAGER 2K SOUTH BEACH l' HOTEL, LLC A DELAWARE SMLLC _ _. -- ..; ~__ _. THE CLEVELANDER HOTEL 90% (GP) 9