Don Washburn/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 or retained, whether paid or not, by a principal who seeks to encourage the
passage, defeat or modification of any ordinance, resolution, action or derision 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 qty personnel during the time period of the entire derision-rttalcing process on such action,
decision or rec:ornrrrendation that foreseeabfy wiN be heard or reviewed by the ~Y corrxnissron, ~ a city bond or
a~rrrtritfee. The term spedfrcaNy ir~ludes the prindpat as well as any employee engaged in lobbying activities. The
term "Lobbyists" has specific excl~ioris. Please refer to OMinance 21104 3435.
Washburn Don
NAME OF LOBBYIST: (Last) (First) (M.I.)
clo The Audio Buq Inc. 3800 Hillcrest Drive, Unit 102 Hollywood, FL 33021
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(954) 983-2788 (954) 983-2789 audiobugl@aol.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
2K South Beach Hotel, LLC
NAME OF PRINCIPAUCLIENT:
_1.020 Ocean Drive Miami Beach, FL 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(786) 276-1414 N/A mpalma Qdevelander.com
T~ PHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
FiN out this
is as
or Trust [Section
NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
IDENTIFY ALL PERSONS HOLDING, DIRECTLY CR INDIRECTLY, A 5% OR
OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: ~d
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See Exhibit "A° attached.
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11. SPECtFtC LOBBY ISSUE: ~ ~ ~°Tl
Modification of Conditional Use Permit for the property located at 1020 Ocean Drive ~~~
Issue to be lobbied (Describe in detail): !-n ~'
III. CITY AGENCIESANDIVIDUALS TO BE LOBBIED: (Pursuant to City Code Section 2-482(8) include a
statement of the extent of any bus"mess, financial, familial, pr~essional or other relationship, giving rise to an
appearance of an irnpropriety, with arty City personnel sough to be lobbied; further, pursuant to City Code Section 2-
482(a)(4) inducts a statement of any contractual relationship (paid or unpaid) from 12 months pre~c~eding the
oo~mmencement of service of City personnel to be lobbied.)
A FuN Name ofi Individual/-AJe B) Financial, Familial or Prdessional Reladonshi
City of Miami Beach Planr~ Board None
City of Miami Beach MayorlCommissioners None
City of Miami Beach Committees None
MIADOCS 3148090 1
_ - - --
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPEN5AT1oN IDiscwst=
' HOURLY, FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
$9,700.00
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
(Required).
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 288 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
Yes ®No• Are You lobbvina on a present or pending bid for goods equipment or services. or on a
^~psent 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°:
Yes 6a No• Are you lobbvina on a pending application for a Development Agreement with the City or
application for chance of zoning map designation or chance to the Citv's Future Land Use Man?
3) Pursuant to Miami Beach City Code 2-484 (h} Any person (except those exempt from the definition of
"IobbyisY as set forth in Section 2-481 above) who only appears as a representative of anot-for-profd
.corporation or entity without special compensation or reimbursement for the appearance, whether direct, or
Indirect, to express support of or opposition to any item, shalt register with the deck as required by this
section but, shall not be required to pay any registration fees..
f~lYes 6a No: Are you representing anot-for-profit corporation or entity without special compensation or
reimbursement
V. SIGNATURE UNDER OATH:
Signature of Lobbyist:
Signature of PrincipaUCtient:
M'~chael L. Patina, Manager of 2K South Beach Hotel, LLC
VI. L08BYIST IOENTIFICATION: PRINCIPAL IDENTIFICATION:
6 ~,~ ^ Produced ID
~ °~ $ N ~ Form of Identification
N O
~ A N ~ ~ Personally known (Lobbyist)
o c, ~
c ~ ~ VII. SIGNATURE AND STAMP OF NOTARY:
y .~ H ~ State of Florida, County of Miami-Dade
3 ~ ~ ~ ~ Sworn tto and subscribed before rrre
~ ~ ~ ~'~ This ~ da of .~~~~,,,GG2,, 008
..J'`J
~ tune of Publk otary - Sta f Flarida
~ ~ Notarization of Lobbvist's sy afore
^ Produced ID
Form of Identification
^ Personally known (Principal)
State of Florida, County of Miami Dade
Sworn to and subscribed before me
This _ day of , 2008
Signature of Public Notary -State of Florida
Notarization of Principal's signature
TO l3E COMPLETED BY CITY CLERK'S USE NLY
Annnal Rsgietradon tea: [ ] Y~ [ ] No Anwwlt Paid i ~ NCR; i Die Paid
Lobbyief. Ragis~on Fam reeetvsd and verified by:
F:1CtEitli_ Forth 32708.doC Revised 03/27/2008
MIADOCS 31480901
1 do so~rrnnly swear that aN of the fads are tore and and that I have read or am familiar with the
provisions ~ in Section 2-482~Nham C/jrty ~'~ a~eporbn9 requ~e~.
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER
HOURLY, FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
B) PRINCIPAL'S D1SCL~U4R~o(O~F LOBBYIST COMPENSATION}:
(Required).
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 Wending bid for goods. equipment or se_rv_ __ices, or on a
present or pending award for Goods eauipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On
Real Estate Development Issues":
^Yes ®No Are you lobbying on a pending application for a Development Agreement with th_e City or
a lication for chance of zoning map designation or chance 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 anot-for-profit
corporation or entity without special compensation or reimbursement for the appearance, whether direct, or
indirect, to express support of or opposition tp 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 representing a not for profit corporation or entity without special compensation or
reimbursement.
V. SIGNATURE UNDER OATH:
l 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:
Signature of Principal/Client: ~~ ~ ~ ~"'
V1.
Michael L. Palma, Manager of 2KG?lutli Beach
LOBBYIST IDENTIFICATION: PRINCIPAL IDE
^ Produced ID
Form of Identification
^ Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This ~ day of , 2008
Signature of Public Notary -State of Florida
Notarization of Lobbyist's signature
CATION:
Produced ID ~L V1 ~(wrlw
Form of identification
^ Personally known (Principal)
State of Florida, County of Miami Dade
Sworn to and subscribed before me
This (~ day of fyCU~tL~; 2008
Signature of Public Notary -- State of Florida
Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S USE ONLY
Annual Registration fee: [ ]Yes [ ] No Amount Paid $ MCR # $ Date Paid
Lobbyist Registration Form received and verified by:
F•1CLER\LQBBYIS'T~Lobbyist Registration Form 32708.doc Revised 03127!2008
MIADOCS 3148090 t ''~''``F~ `~ " ~~ ~~
J J ...,,..u ~'y~:
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Signature of Lobbyist -Don Washburn
m MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK office CitvClerk(a~miamibeachfl.gov
Tel: 305.673.7411, Fax: 305.673.7254
Don Washburn
LOBBYIST NAME:
I understand that no later than October 1~ of each veer, 1 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) DisGosure 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 withdrawal in writing.
Signatuna: Don hbum
November 12, 2008
Date:
MIADOCS 3148090 1
2K SOUTH BEACH HOTEL, LLC
LEGAL ENTITY OWNERSHIP STRUCTURE
t)avid Dane\ on 8 Luc
8 US TRUST Nealey
Co-Trustees ~ Settlors
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)
Ron 8 Lu61N
NAY
('RN' it'LN~
Setltors b Trustees
100%
~" THE NEELEY FAMILY
THE ALISON REVOCABLE TRUST
NEELEY 1998 TRUST, DATED SEPT. 15, 1981
DATED 11/5!98
Alison Neeley, Ron 8 Lucille Neeley
Beneficiary Beneficiaries
20.00% (LP) 119.00% (LP)
100%
THE JONATHAN LEE NEELEY
TRUST,
DATED APRIL 2, 7998
BRIO INV. GROUP, INC.
A CALIFORNIA C-CORP
ABIGDESTINATIONS, LLC
A DELAWARE SMLLC
t0% (SGP)
~ RNLN CAPITAL ~
INVESTMENTS, LP
A DELAWARE LIMITED PARTNERSHIP
RNLN REAL ESTATE
HOLDINGS, LLC
A CALIFORNIA SMLLC
90% (GP)
99% 1 % (GP)
THE MAILING ADDRESS FOR
ALL ENTITIES LISTED HERE , RNLN REAL ESTATE
IS AS FOLLOWS: ` ADVISORS, LP
\
A DELAWARE LIMITED PARTNERSHIP
750 "B" STREET, SUITE 1930
SAN DIEGO, CA 92101 MIKE PALMA, MANAGER
'
2K SOUTH BEACH i
HOTEL, LLC
A DELAWARE SMLLC
__ _ _-
~~ THE
~ CLEVELANDER
~~ HOTEL
\ (FEE SIMPLE)
9