Thomas Burchett/2K South Beach Hotel LLCm MIAMIBEACH
City of Miami Beach Office of the City Cleric
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,
docision 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.
Burchett Thomas
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)
78fi 276-1414 NIA tburchett clevelander.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
LOBBYIST RETAtNEd BY:
2K South Beach Hotel, LLG
NAME OF PRINCIPAL/CLIENT:
102D Ocean Drive Miami Beach, FL 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) {State) (Zip Code)
(786) 276-1414 NIA 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:
i~
-C "°
See Exhibit "A" attached. ---t o
C: C7
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Il. SPECIFIC LOBBY ISSUE: ~-° ~
U: ~
Modification of Conditional Use Permit for property located at 1020 Ocean Drive ~,
~~~.~
Issue to be lobbied {Describe in detail):
r~
III. CITY AGENCIESANDIVIDUALS TO BE LOBBIED: (Pursuant to City Code Section 2-482Cgj inc~udo 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/T1tle B An Financial, Familial or Professional Relationship
City of Miami Beach Planning Board None
City of Miami Beach MayorlComrrrissioners None
City of Miami Beach Committees None
SI
MIADOCS 3153413 1
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER
HOURLY, FIAT RATE OR 07HER):
A} LOBBYIST DISCLOSURE: (Required}
No extra com ensation for lobb in
B) PRINCIPAL'S DISCLOSURE {OF LOBBYIST COMPENSATION):
(Required). No extra com nsatian for lobb in
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 Development 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 snot-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 ®No Are you regresentina anot-for-profit coruoratlon or entity without special compensation or
reimbursement.
V. SIGNATURE UNDER OATH:
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFIt
^ Produced ID
Form of Identification
® Personally known {Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY;
State of Florida, County of Miami-Dade
Sworn,,-~~ and subscribed before me
This L day of N04~nt r, 2008
~~ ~~~
Signature of Public Notary -State of Florida
Notarization of Lobbyist's signature
Annual
Form received and verified by:
~hvist Registration Form 32708.d
~yyr °~4 Notary public State of Flonda
MIADOCS 15~4~ Kaman Daswani
;~ _~ o` qty ~,:.,mm~ssion DD460922
Produced ID
Y
~~~~~f
Form of Identification
^ Personally known (Principal)
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This ~ day of CCs'w , 2008
Signature of Public Notary -State of Florida
Notarization of Principal's signature
Notary r~~~blic State of Flonda
vv n~Q
Q~~, r Kdn''~I %lSWan
2 x`- - , „Sy ~,~ ~D460922
~~}FOi; ~Qo- i ~~ iii, 1 ~ 11i1~,~~
I do solemnly swear that all of the fo going facts a tr and corr nn that I have read or am familiar with the
provisions contained in Section 2-4 of t~ Miami B Coc~~~~T_ \porting requirements.
m MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, pw,rw.miamibeachfl.aov
CITY CLERK office CityClerk o(~.miamibeachfl.gov
Tel: 305.673.7411, Fax: 305.673.7254
LOBBYIST NAME:
Thomas Burchett
I understand that no later than October 1`t of each year, 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 issu I have registered to lobby on has been resolved, I am required to immediately notify the
City Clerk's Office for by t withdrawal in riting.
`/~ ` ~ ~ u
Signatu :Thomas rc tt Date:
MIADOCS 3153413 1
„ 2K SOUTH BEACH HOTEL, LLC
LEGAL ENTITY OWNERSHIP STRUCTURE
'bavld Dane on a Luc
8 US TRUST\ Neetay
CaTrustees Settbrs
THE JONATHAN LEE
NEELEY 1996 TRUST,
DATED 11/5/96
Jonathan lee Neeley
Beneficiary
40.00% (LP)
THE STEVEN LEE
NEELEY 1996 TRUST,
DATED 11/5/98
Steven Lee Neeley,
Beneficiary
20.00% (LP)
THE ALISON
NEELEY 1996 TRUST
DATED 11/5!98
Alison Neeley,
Beneficiary
20.00% (LP)
RNLN REAL ESTATE
ADVISORS, LP
A DELAWARE LIMITED PARTNERSHIP
100%
THE JONATHAN LEE NEELEY
TRUST,
DATED APRIL 2, 1996
BRIO INV. GROUP, INC.
A CALIFORNIA C-CORP
ABIGDESTINATIONS, LLC
A DELAWARE SMLLC
---- -- ~10°k (SGP)
~ RNLN CAPITAL ~
INVESTMENTS, LP
A DELAWARE LIMITED PARTNERSHIP
RNLN REAL ESTATE
HOLDINGS, LLC
A CALIFORNIA SMLLC
sa~°
THE MAILING ADDRESS FOR
ALL ENTITIES LISTED HERE
IS AS FOLLOWS:
750 "B" STREET, SUITE 1930
SAN DIEGO, CA 92101
Ron a Ludge
Neelsy
(-RN' a'LN~
Sstllas a Trustees
100°~
THE NEELEY FAMILY
REVOCABLE TRUST
DATED SEPT. 15, 1981
Ron 8 Lucille Neeley
Beneficiaries
(LP)
90% (GP)
1%
MIKE PALMA, MANAGER
2K SOUTH BEACH l~
HOTEL, LLC ~~
A DELAWARE SMLLC
-- -_ - - _~
~___
THE
CLEVELANDER
~~ HOTEL
9