Adrian K. Dabkowski/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 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.
Dabkowski Adrian K.
NAME OF LOBBYIST: (Last) (First) (M.I.)
Kimley-Horn & Associates 5200 NW 33`d Street, Suite 109 Ft. Lauderdale Florida 33309
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(954) 535-5144 (954) 739-2247 Adrian.Dabkowski~Kimley-horn.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
2K South Beach Hotel, LLC
NAME OF PRINCIPAUCLIENT:
1020 Ocean Drive Miami Beach, FL 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(786) 276-1414 N/A mpalmaC~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: a
--+ °
See Exhibit "A" attached. ~ ~
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II. SPECIFIC LOBBY ISSUE: ~' ~
43
Modification of Conditional Use Permit for the property located at 1020 Ocean Drive !~
-~-
Issue to be lobbied (Describe in detail): '~' ~,
i---
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: (Pursuant to City Code Section 2-482(g) include 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 IndividuaUTitle B An Financial, Familial or Professional Relationshi
City of Miami Beach Planning Board None
City of Miami Beach Mayor/Commissioners None
City of Miami Beach Committees None
MIADOCS 3147818 1
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER
HOURLY, FLAT RATE OR OTHER):
~) i QBQ;IS;DISC^ OSURE: (Required)
B) PRINCIPAL'S DISCLOSURE (OF 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 6a 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 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On
Real Estate Development Issues":
^Yes ®No• Are you lobbvinq on a pending application for a Development Agreement with the City or
application for chance of zoning map designation or chance to the City's Future Land Use Map?
3) Pursuant to Miami Beach Ciry 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 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 representing anot-for-profit corporation or entity without special compensation or
reimbursement.
V. SIGNATURE UNDER OATH:
Signature of Lobbyist:
K
Signature of Principal/Client:
Michael L. Palma, Manager of 2K South Beach Hotel, LLC
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
^ Produced ID
Form of Identification
® Personally k ~;~,,,,~~`~„~
.`~~~"' SHANDASi1TTUNtAVNE
VII. SIGNATU ~ A~IIEOQJA~ ,Plf~l(gby7~
State of Florida, Co ~ ,; 6 (qf~ ryPublkUrderOwmers
Swor d sub
Th' da ~ , 2008
ignature f P li Notary -State of Florida
Notarization of Lobbyist's signature
^ 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 BE COMP! ETED BY CITY CLERK'S USE ONLY
Annual Registration fee: [ ]Yes [ ] No Amount Paid $ MCR # $ Date Paid
Lobbyist Registration Form received and verified by:
F:\CLER\LOBBYISlILobbyist Registration Form 32708.doc Revised 03/27/2008
MIADOCS 3147818 1
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 Miar~Be~ch City` ode and~ll.re~porting requirements.
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER
HOURLY, FLAT RATE OR OTHER}:
A) LOBBYIST DISCLOSURE: (Required)
B) PRINCIPAL'S~ISC OSURE (OF LOBBYIST COMPENSATION):
(Required). ~ ~(1
The following information must be answered:
1} Pursuant to Miami Beach Clty Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
Yes No: Are ou lobb n on a resent or endin bid f r oods a ui ment or services or on a
resent or endin away for Goods a ui ment 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 lobbylnsi on a pending aoplicatian for a Development Artresment with the City or
application for chance of zoning map designation or chance he Cat 's Future Land Use Ma ?
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 to any item, shall register with the clerk as required by this
section but, shall not be required to pay any registration fees..
^Yes 64 No• Are you reuresentinst anot-for-profit corporation or entity without special compensation or
reimbursement.
V. SIGNATURE UNDER OATH:
1 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 PrincipaUClient: ~~ n nn ~
L. Palma, Manager
V1. LOBBYIST IDENTIFICATION:
^ Produced ID
Form of Identification
® Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of
Swom to and subscribed before me
This _ day of , 2008
Signature of Public Notary -State of Florida
Notarization of Lobbyist's signature
~$C`5o~th Bea Hotel, LLC
PRINCIPAL ID NTIFICATION: J~ /
Produced ID ~ W ~ C~((,~
Form of Identification
^ Personally known (Principal)
State of Florida, County of Miami-Dade
Swom to and su cribed before me
This L day of i , 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 verlfled by:
F~ICLER\LOBBYISIILobbyist Registration Form 32708.doc Revised 03/27/2008
x
MIADOCS 31A7B18 1
Signature of Lobbyist -Adrian K. Dabkowski
m MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK office CityClerkCa~miamibeachfl.gov
Tel: 305.673.7411, Fax: 305.673.7254
LOBBYIST NAME: Adrian K. Dabkowski
I understand that no later than October 15t 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 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.
Signature: Adrian K. Dabkowski
I~~)3~OF~
DatDat T
MIADOCS 3147818 1
2K SOUTH BEACH HOTEL, LLC
LEGAL ENTITY OWNERSHIP STRUCTURE
THE JONATHAN LEE
NEELEY 1996 TRUST,
DATED 11/5/98
Jonathan Lee Neeley,
Beneficiary
40.00% (LP)
David Dane on 8 Luc
8 US TRUST Neeley
Co-Trustees Settbrs
THE STEVEN LEE
NEELEY 1996 TRUST,
DATED 11/5/98
Steven Lee Neeley,
Beneficiary
20.00% (LP)
Ron a LuaNe
Naaley
('RN' a'LN7
seniors a trustee.
100°~
~ THE NEELEY FAMILY
THE ALISON REVOCABLE TRUST
NEELEY 1996 TRUST, DATED SEPT. 15, 1981
DATED 11/5/98
Alison Neeley Ron 8 Lucille Neeley
,
Beneficiary Benefiaaties
20.00°~ (LP) 19.00% (LP)
100%
THE JONATHAN lEE NEELEY
TRUST,
DATED APRIL 2, 1998
100%
ABIGDESTINATIONS, LLC
A DELAWARE SMLLC
BRIO INV. GROUP, INC.
A CALIFORNIA C-CORP
~ RNLN CAPITAL ~
INVESTMENTS, LP
A DELAWARE LIMITED PARTNERSHIP
RNLN REAL ESTATE
HOLDINGS, LLC
A CALIFORNIA SMLLC
99%
THE MAILING ADDRESS FOR
ALL ENTITIES LISTED HERE
IS AS FOLLOWS:
750 "B" STREET, SUITE 1930
SAN DIEGO, CA 92101
2K SOUTH BEACH
HOTEL, LLC F
A DELAWARE SMLLC
THE
CLEVELANDER
HOTEL
(FEE SIMPLE)
RNLN REAL ESTATE
ADVISORS, LP
A DELAWARE LIMITED PARTNERSHIP
90% (GP)
1%
MIKE PALMA, MANAGER
9