Michael L. Palma - 2K South Beach Hotel, LLC TOP
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City of Miami Beach Office of the City Clerk 0 /e.; 0
1700 Convention Center Drive, Miami Beach, FL 33139 6(4‘.c- ,o
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 board 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 Florida 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 276 -1414 N/A mpalma @clevelander.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes: address, phone, or e-mail address.
I. LOBBYIST RETAINED BY:
2K South Beach Hotel, LLC
NAME OF PRINCIPAL /CLIENT:
Clevelander Hotel 1020 Ocean Drive, Miami Beach, Florida 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 OR INDIRECTLY, A 5% OR MORE OWNERSHIP
INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST:
• See Exhibit "A" attached
II. SPECIFIC LOBBY ISSUE:
Modification of Conditional Use Permit
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) from 12 months preceding said City personnel's
commencement of service with the City to the present date, stating the general nature of the subject contractual
relation.
A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship
City of Miami Beach Planning Board NONE
City of Miami Beach Historic Preservation Board
City of Miami Beach Mayor /Commissioners NONE
City of Miami Beach Committees NONE
MIADOCS 4932550 1
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER
HOURLY, FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
$ No extra compensation for lobbying
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
(Required). $ No extra compensation for lobbying
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 ":
FlYes M No: Are you lobbying on a pending application for a Development Agreement with the City or
application for change of zoning map designation or change 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 a not - 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..
nYes M No: Are you representing a not - for - profit corporation or entity without special compensation or
reimbursement.
V. SIGNATURE UNDER OATH:
ON OCTOBER 1 OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL
BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING
PERIOD.
_.....
Signature o i is Palma
I do solemnly swear that all of the foregoing facts are true and correct and tha 1 ave 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: Michael L. Palma
Signature of Principal /Client:
Michael L. Palm , ag o Sou ach Hotel. LLC
VI. LOBBYIST IDENTIFICATION: PRI CIP IDENTIFICATION:
❑ Produced ID ❑ Produced ID
Form of Identification Form of Identification
RI( Personal) known (Lobbyist) P ersonal) known
Y ( Y ) y (Principal)
VII. SIGNATURE AND STAMP OF • _ 1,:Y•
,,, EMS CARRILLO
State of Florida, C. ty of Miami -Da. !, ` - -+ * MY COMMISSION Ofef45f2FI. 'da C of Miami-D. . e
Sworn to and .. cribedobefo - . .;' EXPIRES:': - ' 0 . a . bs p c an ribe�l)before -
$ o4 B Th N o t ar y P . ! , = y
This ! _, : ; f. , _ • 10 I. _ _ r i ;' 2010
: / / 'r te _ .._ ` //
Signatu - . - ,. is Nota — State of Florida Signat = - e Notary — State of Florida
Notarization of Lobbyist's signature Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ (es [ ] No Amount Paid $ :_ P i ' C O / Date Paid /2454
j 54
Lobbyist Registration Form received and verified by: : , , air. , I
F: \CLER \$ALL \aFORMS \LOBBYIST FORMS \Lobbyist Registration Form.doc (S&B #4701574) Revised 05/28/2010
MIADOCS 4932550 1
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AMI BEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office CityClerk @miamibeachfl.gov
Tel: 305.673.741 1, Fax: 305.673.7254
Acknowledgement of fines /suspension from lobbying for failure to
comply with City of Miami Beach lobbying Laws
LOBBYIST NAME: Michael L. Palma
1
I understand that no later than Octob,frr ist of each year, lobbyists subject to
lobbyist registration requirements shall submit to the city clerk a signed
statement under oath listing all lobbying expenditures, as well as
compensation received, for the preceding calendar year with regard to the
specific issue on which the lobbyist has been engaged to lobby. A statement
shall be filed even if there have been no expenditures or compensation
during the reporting period. The statement shall list, in detail, each
expenditure by category, including food and beverage, entertainment,
research, communication, media advertising, publications, travel, lodging
and special events.
FAILURE TO TIMELY FILE THE EXPENDITURE AND FEE DISCLOSURE
REPORT WILL RESULT IN A FINE OF $50.00 PER DAY. ANY LOBBYIST WHO
FAILS TO FILE THE REQUIRED EXPENDITURE REPORT BY DECEMBER 1,
SHALL AUTOMATICALLY BE SUSPENDED FROM LOBBYING UNTIL ALL
FINES ARE PAID, UNLESS THE FINE HAS BEEN APPEALED TO THE MIAMI -
DADE COUNTY COMMISSION ON ETHICS AND PUBLIC TRUST. In the event
a lobbyist fails to either file the report and /or pay the assessed fines, the Clerk
shall notify the Miami Dade County Commission on Ethics and Public Trust.
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 OF LOBBYIST WITHDRAWAL IN WRITING.
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Signature: is alma Date:
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2K SOUTH BEACH HOTEL, LLC
LEGAL ENTITY OWNERSHIP STRUCTURE
AS OF OCTOBER 31, 2010
/
U S TRUST\ ‘Jo &Lucille Ron &Lucille
Trustees
Neeley Neeley
Settlors //z ('RN" &'LN')
Seniors & Trustees N
N.
100%
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THE NEELEY FAMILY
� THE JONATHAN LEE THE STEVEN LEE THE ALISON
NEELEY 1996 TRUST, / \ NEELEY 1996 TRUST, NEELEY 1996 TRUST, \ TRUST
DATED 11/5/96 DATED 11/5/96 / DATED 11/5/96 DATED SEPT. REVOCABLE 1
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% Varies % Vanes % Varies % Vanes
(LP) (LP) (LP) 100%
(LP)
/
BRIO INV. GROUP, INC.
ABIGDESTINATIONS, LLC A CALIFORNIA C -CORP
A DELAWARE SMLLC
/
/ % Varies (Special % Varies
General Partner) (GP) 1 % Varies
(GP)
RNLN CAPITAL
INVESTMENTS, LP
A DELAWARE LIMITED PARTNERSHIP
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m Tom Miss,
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Burchett. P
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Z % %
7i D Vanes Varies CLASS B
to LIMITED PARTNERS
RNLN REAL ESTATE
ADVISORS, LP
A DELAWARE LIMITED PARTNERSHIP
2K SOUTH BEACH V
HOTEL, LLC
j A DELAWARE SMLLC
THE '
\ CLEVELANDER /
HOTEL
', (FEE SIMPLE) ,
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