Ofer Shtark/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.
Shtark Ofer
NAME OF LOBBYIST: (Last) (First) (M.L)
STA Architectural Group 3526 North Miami Avenue Miami Florida 33127
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 571-1811 (305) 571-1821' OFER[a~STAArchitecturalgroup.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
LOBBYIST RETAINED BY;
2K South Beach Hotel, 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(a 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% O,R MORE
OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST:
t°a ru
See Exhibit "A" attached. "~' °
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II. SPECIFIC LOBBY ISSUE:
v~; --~ ~~
Modification of Conditional Use Permit for the property located at 1020 Ocean Drive c._: -~
-,-•
Issue to be lobbied (Describe in detail): _ `
;-~ ~
--.,
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) ftom 12 months preceding the
commencement of service of City personnel to be lobbied.)
A Full Name of IndividuallTitle B An Financial, Familial or Professional Relationship
City of Miami Beach Planning Board - None.
City of Miami Beach Mayor/Commissioners None
City of Miami Beach Committees None
MIADOCS 3153473 1
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER
HOURLY, FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
ltl l
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 ®No Are you lobbying on a present or pending bid for. goods, equipment or services, 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":
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 ®No Are you representing a not for profit corporation or entity without special compensation or
reimbursement.
V. SIGNATURE UNDER OATH:
_.. ....~........~ .st „r ~wnu vcwo enrtu 1 nRRV1AT CHAI 1 ~!
IN
Signature of Lobbyi~i'- Ofer Shtark
I do solemnly swear that all of the foregoing facts are true and correct and that l 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:
• Michael L. Palma, Manager of 2K South Beach Hotel, LLC
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
^ Produced ID
Form of Identification
®. Personally known (Lobbyist)
~o W VII. SIGNATURE AND STAMP OF NOTARY:
~.
o p State of Florida, County of Miami-Dade
Sworn to and subscribed before me
`~ ' ~ ~ This ~, day of ~~, 2008
~ ~o
~a'E°
o'= ,. a Signature of Public Notary -State of Florida
Z ~ ~ `~ Notarization of Lobbyist's signature
"r~~ TO BE COMPLETED
~~~~ Annual Registration fee: [ ]Yes (] No Amount Paid S_
Lobbyist Registration Form received and verified by:
c•~~i Ftzu naRVlsnl ohhvist Registration Form 32708.doc
^ 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 Printiipal's signature
CLERK'S USE ONL
MIADOCS 3153473 1
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER
HOURLY, FLATRATE 4R OTHER):
A) LOBBYIST DISCLOSURE: (Required)
B) PRINCIPAL' DISCL SURE (OF LOBBYIST COMPENSATION):
{Required).
The following information must be answered:
t) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
2) Pursuant to Miami Beach Clty 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 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 a not for-profit corporation or entity without special compensation or
reimbursement.
PERIOD.
Signature of Lobbyist -- Ofer Shtark
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 Miami Beach City Code and all reporting requirements.
Signature of Lobbyist:
r 9r Gn.ZgU r orracn n~~ai, ~w
PRINCI L IDENTIFICATION:
Signature of PrincipallClient:
Michael L. Palma,
VI. LOBBYIST IDENTIFICATION:
^ 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 Lobbvlst's signature
Produced ID ~i ~(/, L~CGh_f~
Form of Identification
^ Personally known (Principal)
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This ,(~, dayn of 0 ¢ ^. ; 2008
~n ,~~~ D~{~ ~l d~,~~
Signature of Public Notary -State of Florida
Notarization of Principal's signature
TO BE COMPLETER BY CITY CLERK'S USE ONLY
Annual Registration fee: [ ]Yes [ ] No Amount Paid S MCR * $ Date Paid
Lobbyist Registration Form received and verffied by: Revised 03/27!2008
F:\CLER\LOBBYIST1Lobb st Re istralion Form 32708.doc
`` - av a~ NOtar~ ° ihhc Mate Of Florida
MIADOGS 3153473 1 4r o.P ®,
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V. SIGNATURE UNDER OATH:
m MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miaml Beach, Florida 33139, www.miamibeachfl.aov
CITY CLERK office CityClerkCa~miamibeachfl.gov
Tel: 305.673.7411., Fax: 305.673.7254
LOBBYIST NAME: Ofer Shtark
I understand that no later than October 1St 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: Ofer Shtark Date:
MIADOCS 3153473 1
2K SOUTH BEACH HOTEL, LLC
LEGAL ENTITY OWNERSHIP STRUCTURE
bavid Dane on 8 Luc
3 US TRUST Neeley
Co-Trustees ~ 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)
Ron 6 LudMe
Nesley
('RN' a'LN~
Ssftlors a 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
Beneficiaries
Beneficiary
20.00% (LP) X79.00% (LP)
100%
THE JONATHAN LEE NEELEY
TRUST,
DATED APRIL 2, 1996
100%
ABIGDESTINATIONS, LLC
A DELAWARE SMLLC
10% (SGP)
~ RNLN CAPITAL ~
INVESTMENTS, LP
A DELAWARE LIMITED PARTNERSHIP
RNLN REAL ESTATE
HOLDINGS, LLC
A CALIFORNIA SMLLC
BRIO INV. GROUP, INC.
A CALIFORNIA C-CORP
90°h (GP)
99% 1 % (GP)
THE MAILING ADDRESS FOR
ALL ENTITIES LISTED HERE ~ RNLN REAL ESTATE
IS AS FOLLOWS: ' ADVISORS, LP
~ A DELAWARE LINKED PARTNERSHIP
_/
750 "B" STREET, SUITE 1930
SAN DIEGO, CA 921 O1 _ MIKE PALMA, MANAGER
2K SOUTH BEACH ('~
HOTEL, LLC
A DELAWARE SMLLC
i
~ THE
~\ CLEVELANDER
~ HOTEL
(FEE SIMPLE)
9