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Alexander I. Tachmes 2K South Beach Hotel, LLC ei tte4 kix M A 1 EACH __ .56 0 ,dp I f/ nib ti City of Miami Beach Office of the City Clerk j-' I�° r13 1700 Convention Center Drive, Miami Beach, FL 33139 0 LOBBYIST REGISTRATION FORM r rl Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to enc ragghe passage, defeat or modification of any ordinance, resolution, action or decision of any commissioner; any ac ion, a..-- decision, recommendation of the City Manager or any city board or committee; or any action, ctobsianzi or recommendation of any city personnel during the time period of the entire decision - making process on spch act bn, decision or recommendation that foreseeably will be heard or reviewed by the city commission, or a cittboatf or ::--1 committee. The term specifically includes the principal as well as any employee engaged in lobbying activites. ..Ih term "Lobbyists" has specific exclusions. Please refer to Ordinance 2004 -3435. (11 Tachmes Alexander I. NAME OF LOBBYIST: (Last) (First) (M.I.) c/o Shutts & Bowen LLP, 201 S. Biscayne Boulevard, Suite 1500, Miami Florida 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: Please notify this office if your contact information changes: address, phone, or e-mail address. I. LOBBYIST RETAINED BY: 2K South Beach Hotel, LLC NAME OF PRINCIPAL /CLIENT: Clevelander Hotel 1020 Ocean Drive, Miami Beach, Florida 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 OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: • See Exhibit "A" attached II. SPECIFIC LOBBY ISSUE: Modification of Conditional Use Permit Issue to be lobbied (Describe in detail): III. CITY AGENCIES /INDIVIDUALS TO BE LOBBIED: Pursuant to City Code Section 2- 482(g) include a statement of the extent of any business, financial, familial, professional or other relationship, giving rise 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 said City personnel's commencement of service with the City to the present date, stating the general nature of the subject contractual relation. A) Full Name of Individual /Title B) Any Financial, Familial or Professional Relationship City of Miami Beach Planning Board NONE City of Miami Beach Historic Preservation Board City of Miami Beach Mayor /Commissioners NONE City of Miami Beach Committees NONE MIADOCS 4912289 1 1 1 IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) $450.00 B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $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 ": FlYes RI 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 ": rlYes 6a No: Are you lobbying on a pending application for a Development Agreement with the City or 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 a not - 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.. rlYes RI No: Are you representing a not - 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 EXPENDITUR• - OR COMPENSATION DURING THE REPORTING PERIOD. Sign:turenf Lobbyist Alexander I. Tachmes I do solemnly swear that all of the oregoing facts are true and correct and that I have read or am familiar with the provisions contained in Section 2 : l f the Miami B City Code and all reporting requirements. Signature of Lobbyist: - Alexander I. Tachmes Signature of Principal /Client: Michael L. Palma, Manager of 2K South Beach Hotel. LLC VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: ❑ Produced ID ❑ Produced ID Form of Identification Form of Identification r T OF FLORIDA Persona'fiji,knoWn"( Sa ri ❑ Personally known (Principal) u VII. SIG NAT Expires. � r'; � " " at. BONDING CO., INC, o State of Florid01 y of Miami -Dade State of Florida, County of Miami -Dade Sworn to and su scribed before me Sworn to and subscribed before me This ' day s of 2010 This day of , 2010 • cite ure of Public Notary — State of Florida Signature of Public Notary — State of Florida Notarization of Lobbyist's signature Notarization of Principal's signature TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: [ ] Yes o Amount Paid $ 1 . CD CR # r i / Date Paid /a/ fU Lobbyist Registration Form rec ved and verified by: +.� , Li F: \CLER \$ALL \aFORMS \LOBBYIST FORMS \Lobbyist Registration Form.doc (S &B #4701574) Revised 05/28/2010 MIADOCS 4912289 1 I IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) $450.00 B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $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 ": nYes 61 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 ": I Fa No: Are you lobbying on a pending application for a Development Agreement with the City or 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 a not - 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.. fYes NI No: Are you representing a not - 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 OR COMPENSATION DURING THE REPORTING PERIOD. Signature of Lobbyist Alexander I. Tachmes I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am familiar with the provisions contained in Section 2 -482 of the Miami Beach City Code and all reporting requirements. Signature of Lobbyist: Alexander I. Tachmes Signature of Principal /Client: Michael L. I n of South Beach Hotel. LLC VI. LOBBYIST IDENTIFICATION: PR NCIPA NTIFICATION: ❑ Produced ID ❑ Produced ID Form of Identification Form of Identification ❑ Personally known (Lobbyist) Personally known (Principal) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami -D - CtlItloinrida, County of Miami -Dade ••v+" ^� ' Sworn to and subscribed before me At. EAorn to and subscrib d before ilIpi This day of , 2010 =*: '` MY COMMISSION # fT451 l y of ELIAS CARRI ° cc/ -7 EXPIRES: December 30, / •� ' ' g' Bonded Th Notary Public Underwriters 10: /L Ana`` ni Signature of Public Notary - State of Florida Signature of blic Notary - State of Florida Notarization of Lobbyist's signature Notarization pf Principal's signature TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: [ ] Yes ( o Amount Paid $ 0 MCR # $ S 9 Date Paid /-/ 3f Ca Lobbyist Registration Form rece�fved and verified by: • F: \CLER \$ALL \aFORMS \LOBBYIST FORMS \Lobbyist Registration Form.doc (S &B #4701574) Revised 05/28/2010 MIADOCS 4912289 1 wr.rrrr IANAI BEACH City of Miami Beach, 1 700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov CITY CLERK Office CityClerk(c7miamibeachfl.gov Tel: 305.673.741 1, Fax: 305.673.7254 Acknowledgement of fines /suspension from lobbying for failure to comply with City of Miami Beach lobbying Laws LOBBYIST NAME: Alexander I. Tachmes understand that no later than Octob. r1st of each year, lobbyists subject to lobbyist registration requirements shall submit to the city clerk a signed statement under oath listing all lobbying expenditures, as well as compensation received, for the preceding calendar year with regard to the specific issue on which the lobbyist has been engaged to lobby. A statement shall be filed even if there have been no expenditures or compensation during the reporting period. The statement shall list, in detail, each expenditure by category, including food and beverage, entertainment, research, communication, media advertising, publications, travel, lodging and special events. FAILURE TO TIMELY FILE THE EXPENDITURE AND FEE DISCLOSURE REPORT WILL RESULT IN A FINE OF $50.00 PER DAY. ANY LOBBYIST WHO FAILS TO FILE THE REQUIRED EXPENDITURE REPORT BY DECEMBER 1, SHALL AUTOMATICALLY BE SUSPENDED FROM LOBBYING UNTIL ALL FINES ARE PAID, UNLESS THE FINE HAS BEEN APPEALED TO THE MIAMI -DADE COUNTY COMMISSION ON ETHICS AND PUBLIC TRUST. In the event a lobbyist fails to either file the report and /or pay the assessed fines, the Clerk shall notify the Miami Dade County Commission on Ethics and Public Trust. 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. 12. Signature. Alexander I. Tachmes Date: MIADOCS 4912289 1 2K SOUTH BEACH HOTEL, LLC LEGAL ENTITY OWNERSHIP STRUCTURE AS OF OCTOBER 31, 2010 US TRUST on d Lucdi Ron 6 Lucille Trustees / Nee1A Neeley j Seniors / ( 3 - LM) Swears 6 Trustees 100% THE JONATHAN LEE THE STEVEN LEE THE ALISON THE NEELEY FAMILY NEELEY 1996 TRUST, NEELEY 1996 TRUST, NEELEY 1996 TRUST, REVOCABLE TRUST DATED 11096 DATED 11/5!96 DATED 11/5/96 DATED SEPT, 15, 1981 % Varies % Varies % Varies (LP) _ (LP) (LP) % (LP) Varies 100% BRIO INV. GROUP, INC. ABIGDESTINATIONS, LLC A CALIFORNIA C -CORP A DELAWARE SMLLC % Varies (Special General Partner) %Varies (GP) 1 % Varies (GP) RNLN CAPITAL INVESTMENTS, LP A DELAWARE LIMITED PARTNERSHIP • r— mm �• . a Bit;. 0 my D Varies Varies CLASS B co LIMITED PARTNERS RNLN REAL ESTATE ADVISORS, LP A DELAWARE LIMITED PARTNERSHIP 2K SOUTH BEACH HOTEL, LLC / A DELAWARE SMLLC THE `, CLEVELANDER ` HOTEL % \ (FEE SIMPLE) / 7