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Michael W. Larkin - Crown Miami Hotel Owner, LLC NAIAMI BEACH n w� �;N� C44--.. ✓� �, 1 � 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. Larkin Michael W NAME OF LOBBYIST: (Last) (First) (M.1) Bercow Radell & Fernandez, PA 200 S. Biscayne Blvd, Suite 850, Miami, FL 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 377-6231 (305) 377-6222 mlarkinabrzonincilaw.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: Crown Miami Hotel Owner LLC NAME OF PRINCIPAUCLIENT: Same Pier 5, The Embarcadero, Suite 102, San Francisco CA 94111 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (415)694-5820 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: Thomas Gottlieb,Manager of Crown Miami Holding Co.,LLC,which is the sole member of Crown Miami Hotel Owner, LLC • 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: Development approvals& permitting issues for Crown Hotel & Parking Garage located at 4041 Collins Avenue &228 W 401h Street Issue to be lobbied(Describe in detail): III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: Pursuant to City Code Section 2-482(a)(4) include the commissioner or personnel sought to be lobbied,and whether the lobbyist has entered into any contractual relationship (paid or unpaid) with said city commissioner or personnel from 12 months preceding such person's commencement of service with the city to the present date,stating the general nature of the subject contractual relationship. Sec 2-482(a)(4)Full Name of Individual and Contractual Relationship(Explain) YES NO title of person to be lobbied Staff of Planning Department, Building Department,and Public Works None X De artment PB,HPB, BOA,City Commission,as necessary None X Pursuant to City Code Section 2-482(g)Every registrant shall be required to state the extent of any business,financial,familial or professional relationship,or other relationship giving rise to an appearance of an impropriety,with any current city commissioner or city personnel who is sought to be lobbied as identified on the lobbyist registration form filed. ;)� ,�_!�� ,1��;L �X.l 10 Sec 2-482 Any Financial, Familial or Professional Relationship, A Nonee 7:� C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) $445/hour B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): (REQUIRED). $445/hour 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 X No: Are you lobbying on a present or pending bid for goods.eauipment or se rvices.or on a present or oendina award for goods,equipment or service? 2) Pursuant to Miami Beach City Code Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": _Yes X 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 Section 2-482 (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. _Yes X No* Are you rgoresentina a not-for-profit corporation or entity without special compensation or reimbursement. V. SIGNATURE UNDER OATH: ON FEBRUARY 28 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 EM THE PRECEDING CALENDAR YEAR, X STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. Signature of Lobbyist 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: A ;.. Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: Produced ID ao; d Produced ID Form of Identification °°•'''� Form of Identification T;D� Personally known(Lobbyist) N � Personally known(Principal) o � VII. SIGNATURE AND STAMP OF NOTARY: a. m N State of Florida, County of Miami-Dade �'� a State of Florida, County of Miami-Dade Sworn t nd subs 'bed efore me 3 Sworn and subscribed before me This —day �! 0 `° This day of ,2012 Signa re of Pub=otary State of orida Signature of Public Notary—State of Florida No ization of signature Notarization of Principal's signature TO BE COMPLETED BY CITY CLERK'S STAFF ONLY / r/ Annual Registration fee: Yes No Amount Paid$ MCR# Date Paid Lobbyist Registration Form received and verified by: C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content. utlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc State of California County of San Francisco Subscribed and sworn to (or affirmed) before me on this 7th day of January , 2013 , by Thomas M. Gottlieb thuelbai of satisfactory evidence to be the 'o (s)�vh4�� p F6d be o me. ommission # 1945321 '`� •, z Notary Public -California: z San Francisco County r My Comm. Expires Jul 24,2015 (Seal) Signature F:\CLE istration Form.doc Revised 04/27/2012 �WAMIBEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov CITY CLERK Office Rafael E. Granado, City Clerk CityClerk @miamibeachfl.gov Tel: 305.673.7411 ,Fax: 305.673.7254 LOBBYIST NAME: Michael W. Larkin I understand that no later than February 28 of each year, I must file the following form, 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 AND COMPENSATION 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, or I am no longer lobbying on that issue or for that principal, I am required to immediately notify the City Clerk's Office of lobbyist withdrawal in writing. Pursuant to Section 2-485 (d), the City Clerk shall notify any lobbyist (or principal) who fails to timely file a Statement and in addition to any .other penalties which may be imposed as provided in Section 2-485.1, a fine of $50.00 a day shall be assessed for all Statement(s) filed after the due date. The City Clerk shall notify the Miami-Dade County Commission on Ethics and Public Trust of the failure of a lobbyist (or principal) to file the Statement or pay the assessed fines after notification. Any lobbyist, who fails to file the required Statement by April 30th, 2012, shall be automatically 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. /09 c16 3 Signature: Date: C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc EXHIBIT DISCLOSURE OF INTEREST for Crown.Miami Hotel Owner, LLC 4041 Collins Avenue Miami Beach, Florida 33140 NAME OF INTEREST HOLDER % INTEREST 1. Crown Miami Holding Company,LLC 100.00% (Sole Member of Crown Miami Hotel Owner,LLC) 4041 Collins Avenue Miami Beach,Florida 33140 New York,NY 10022 The Board of Managers of Crown Miami Holding Company,LLC: a. Christopher Niehaus GreenOak Real Estate Advisors 399 Park Avenue,22nd Floor New York,NY 10022 (212)359 7800 b. Sean Williams GreenOak Real Estate Advisors 399 Park Avenue,22nd Floor New York,NY 10022 (212)359 7800 c. David Chang CCL Holdings(USA), Ltd. 18401 Von Karman Avenue, Suite 350 Irvine, CA 92612 d. Goodwin Gaw Downtown Properties Holdings 818 West 7t'Street, Suite 410 Los Angeles, CA 90017 e. John Pritzker Geolo Capital Pier 59 The Embarcadero, Suite 102 San Francisco, CA 94111 (415) 694 5800 f. Thomas Gottlieb Geolo Capital Pier 5, The Embarcadero, Suite 102 San Francisco, CA 94111 (415)694 5800 1 EXHIBIT DISCLOSURE OF INTEREST for Crown Miami Hotel Owner, LLC 4041 Collins Avenue Miami Beach, Florida 33140 The Owners of Crown Miami Holding Company,LLC: a. GOGC Crown Hotel,LP 66.67% GreenOak US GP, LP (its GP) 399 Park Avenue, 22nd Floor New York,NY 10022 Partners of GOGC Crown Hotel,LP: • GreenOak heal Estate Advisors—Investment Fund(66.66%) (via funding from GreenOak US, LP&GreenOak US Parallel,LP-%'s TBD) 399 Park Avenue, 22nd Floor New York,NY 10022 • CCL Holdings (USA),Ltd.—Investment Fund(16.67%) (aka CCL Holdings) 18401 Von Karman Avenue, Suite 350 Irvine, CA 92612 • DP US Opportunity RE Holdings I,LLC.—Investment Fund(16.67%) (aka Downtown Properties) 818 West 7d' Street, Suite 410 Los Angeles,CA 90017 b. Geolo Crown Hotel Investment,LLC 33.33% Pier 5,The Embarcadero, Suite 102 San Francisco, CA 94111 Members of Geolo Crown Hotel Investment,LLC: Joie de Vivre Properties,LP—Lewis Linn,Trustee(93.913%) Pier 5,The Embarcadero, Suite 102 San Francisco, CA 94111 Commune Hotel and Resorts,LLC (2.435%) 530 Bush Street, Suite 501 San Francisco, CA 94108 Members of Commune Hotels and Resorts,LLC: i. Geolo JdV,LLC (50%) Pier 5,The Embarcadero, Suite 102 San Francisco,CA 94111 Ik , I 2- EXHIBIT DISCLOSURE OF INTEREST for Crown Miami Hotel Owner,LLC 4041 Collins Avenue Miami Beach, Florida 33140 Members of Geolo JdV,LLC: Geolo Capital H,LP-Lewis Linn,Trustee(72.82%) Pier 5,The Embarcadero, Suite 102 San Francisco, CA 94111 Stephen T. Conley(23.10%) 530 Bush Street, Ste. 501 San Francisco, CA 94108 Michael J.Wisner(1.36%) 530 Bush Street, Ste. 501 San Francisco, CA 94108 Ingrid Summerfield and Ron Hartman(1.36%) 530 Bush Street, Ste. 501 San Francisco, CA 94108 Christian Strobel(1.36%) 530 Bush Street, Ste. 501 San Francisco, CA 94108 ii. Thompson BP,LLC (50%) 54 Thompson Street, 5t'Floor NY,NY 10013 Members of Thompson BP,LLC: Jason Pomeranc(25.00%) 388 West Broadway New York,NY 10012 Michael Pomeranc(25.00%) 276 Linden Ave Englewood,NJ 07631 Lawrence Pomeranc(25.00%) 203 Walnut Street Englewood,NJ 07831 Stephen Brandman(25.00%) 270 East Saddle River Road Saddle River,NJ 07458 3 EXHIBIT DISCLOSURE OF INTEREST for Crown Miami Hotel Owner,LLC 4041 Collins Avenue Miami Beach,Florida 33140 c. Jason Pomeranc (0.913%) 388 West Broadway New York,NY 10012 d. Michael Pomeranc(0.913%) 276 Linden Ave Englewood,NJ 07631 e. Lawrence Pomeranc(0.913%) 203 Walnut Street Englewood,NJ 07831 f. Stephen Brandman(0.913%) 270 East Saddle River Road Saddle River,NJ 07458 TOTAL for Crown Miami Holding Company,LLC: 100.00% 4 i i