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Michael Palma - 2K South Beach Hotel, LLC /\A]AM1 BEACH c� 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. Palma Michael NAME OF LOBBYIST: (Last) (First) (M.1) The Clevelander 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: 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: The Clevelander 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: Michael Palma,Manager • IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: Michael Palma Tom Burchett Alison Neeley,Steven Neeley,Jonathan Neeley,Ron and Lucille Neetey u.SPECIFIC LOBBY ISSUE: A Slgn variance. Issue to be lobbied(Describe in detail): l 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 lobbyistftas 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 eneral nature of the subject contractual relationshi : •• Y-m Sec 2-482(a)(4)Full Name of Individual and Contractual Relationship(Explain) r_; YA S UO title of person to be lobbied ` City of Miami Beach Committees and Boards None ✓ City of Miami Beach Attorneys Office and Administration None ✓ City of Miami Beach Mayor/Commissioners None ✓ 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. Sec 2-482 Any Financial,Familial or Professional Relationship None C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc - MIADOCS: 7647654v1 IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) No special compensation for lobbvinq. Lobbyist receives compensation as an officer and/or director of the Principal B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): No special compensation for lobbvinq. Lobbvist received compensation as an (REQUIRED).officer and/or director of the Principal. 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 Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": _Yes yNo: 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. _Yesy No: Are you representing 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 FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THE VE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. MAn Signature of Lo byist I " r I do solemnly swear that all of the foregoing facts are true and correct and that I have read am familiar with the provisions contained in Section 2-482 of the Miami Beach City Code and a porting requirements. Signature of Lobbyist: 1AA lior\ 17 Signature of Principal/Client: iAA VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: Produced ID Produced ID Form of Identification Form of Identification y Personally known(Lobbyist) Personally known(Principal) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, County is - a e State of Florida, Count of Miami-Dade Sworn to and subscribed a Notary Public State of Florida Sworn and subscribe e This, ,6 of - ndra Plazas Th' ate,day of - ,2oWtary Public State of Florida Commission FF 097381 v o Sandra Plazas Aires 03/02/2018 Q My Commission FF097381 pires 03/02/2018 Signature of Pub'c Notary—`State of Florida Signature of Public Notary—S i Notarization of Lobbyist's signature Notarization of Principal's signature TO BE COMPLII BY CITY CLERK'S S I Y Annual Registration fee: ]Yes[ ]No Amou aid . n # Date Paid Q Lobbyist Registration Form received and verified b F:\CLER\$ALL\aF0RMS\1_0BBYIST FORDS\Lobbyist Ann e+gistrati®n Form.doc Revised 04/27/2012 C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc MIADOCS: 7647654v1 I i City of Miami Beath, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov CITY CLERK Office Rafael E. Granado,City Clerk CityClerk @miamibeachfl.gov Tel: 305.673.741 1 ,Fax: 305.673.7254 LOBBYIST NAME. Michael Palma understand that no later than February 28 of each year, I must file the following form, pursuant to Section 2-435 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 2-435 (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 C unty Commission on Ethics and Public Trust. Signature: y Date: C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc MIADOCS: 76476540 ^ � � ^ � ��. ` ' ' owl c 78- Noll elved Addr MAT nce- -44 co n n. ' i s. City of Miami Beach-Florida Finance Department 1 City Hall 1412113-1 05/01/2014 BR1 T113 Thu May01,2014 11:30AM Trans#25-25 25 $850.00 MCRCLERK - MCR-City Clerk * MCR#; 33782 1 ITEM(S); TOTAL; $850.00 Check (00469211) PAID $850.00 Have a nice day!