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Michael L. Palma/2K South Beach Hotel LLCm 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 ar 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. Palma Michael L. NAME OF LOBBYIST: {Last) (First) (M.I.} Clevelander Hotel 1020 Ocean Drive Miami Beach FL 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) {State) (Zip Code) 1414 NUMBER: EMAIL: LOBBYIST RETAINED BY: 2K South Beach Hotef, 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. <-j N -± ®o __,- co l y rn ~V II. SPECIFIC LOBBY ISSUE: :, O Modification of Conditionai Use Permit for property located at 1020 Ocean Drive c~-. -o Jssu~ a to be lobbied (Describe in detail): -r, :. III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: {Pursuant to City Code Section 2-482{g~i clu~ 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 the commencement of service of City personnel to be lobbied.) A Full Name of Individual/Title B An Financial, Familial or Professional Relationshi City of Miami Beach Planning Baard None City of Miami Beach Mayor/Commissioners None City of Miami Beach Committees None MIADOCS 3147906 1 m MIAMIBEACH City of Miami Beach, 170D Convention Center Drive, Miaml Beach, Florida 33139, www.miamibeachfl.gov CITY CLERK office CitvClerk@miamibeachfl.gov 7e1: 305.673.7411, Fax: 305.673.7254 LOB$YIST NAME: Michael L. Palma l understand that na later than October 16~ of each near, I must fife the following forms, pursuant to Section 2-485 of the Miami Beach City Code, with the City Clerk's Office for all active lobbying issues. 1) Lobbyist Expenditure Form 2) Disclosure Form Failure to file these forms on a timely basis will result in my name being transmitted to the Miami-Dade County Commission on Ethics and for code violation evaluation. In addition, once an issue I have registered to lobby on has been resolved, I am required to immediately notify the City Clerk's Office for lobbyist with~Jta`wal in writing. nature: MAd1a~l L. ~t ~~~e~- Date. MIADOCS 3147906 1 2K SOUTH BEACH HOTEL, LLC LEGAL ENTITY OWNERSHIP STRUCTURE bavid Oorne ~fton 8 Luc 8 US TRUST\ / Neeley Co-Tru$t9as Settbrs THE JONATHAN lEE NEELEY 1996 TRUST, DATED 11/5/96 Jonathan Lee Neeley, Beneficiary 40.00% (LP) 20.00% (LP) THE ALISON NEELEY 1996 TRUST, DATED 11/5/96 Alison Neeley, Beneficiary 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°h (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 1996 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 s9°i° RNLN REAL ESTATE ADVISORS, LP A DELAWARE LIMITED PARTNERSHIP Ron 6 LuaM~ Nselsy ('RN' a'LN~ Senora a Trustees 100°k THE NEELEY FAMILY REVOCABLE TRUST DATED SEPT. 15, 1981 Ron 8 Lucille Neeley Beneficiaries 9.00% (LP) 90% (GP) 1% MIKE PALMA, MANAGER 2K SOUTH BEACH ~~ I HOTEL, LLC A DELAWARE SMLLC _ __ _'~ ~_ _ _ THE CLEVELANDER ~~ HOTEL (FEE SIMPLE) 9