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Juan Espinosa - RP Hotel Holdings, LLC ivota - r 9-0 m iAm BEAc H • 60/ 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 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. Espinosa Juan • NAME OF LOBBYIST: (Last) (First) (M.I) David Plummer & Associates 1750 Ponce de Leon Blvd Coral Gables FL 33134 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 447 - 0900 • (305) 444 - 4986 Juan.Espinosa c©dplummer.com TELEPHONE NUMBER: FAX NUMBER: • EMAIL: Please notify this office if your contact information changes: address, phone, or a -mail address. I. LOBBYIST RETAINED BY: • RP Hotel Holdings, LLC • NAME OF PRINCIPAUCLIENT: RP Hotel Holdings, LLC 100 Fillmore Street, Suite 600, Denver CO 80206 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) E. c 720 - 284 -6418 - = - xi TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) C Fill out this section if principal is a Corporation, Partnership or Trust [Section 2.482 (c)] -v s • NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: XI RP H Holdings, LLC U, < • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCFORWRAT N , PARTNERSHIP OR TRUST: See Attached -n �..r ii.SPECIFIC LOBBY ISSUE: `T` The James Hotel at Royal Palm �j t ,/py S b`l • / // , / s fl Mil - Issue to be lobbied (Describe in detail): /3 ill. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: Pursuant to City Code Section 2-482(aX4) include the commissioner or personnel sought to be lobbied, and whether the lobbyist has entered Into any contractual relationship (paid or unpaid) with said city commissioner or personnel from 12 months preceding such person's commencement of service with the city to the present date, stating the general nature of the subject contractual relationship. Sec 2- 482(a)(4) Full Name of Individual and Contractual Relationship (Explain) YES NO title of person to be lobbied Historic Preservation Board, Board of Adjustment i.441/1 � Planning Board City Departments Pursuant to City Code Section 2 -482(g) Every registrant shall be required to state the extent of any business, financial, familial or professional relationship, or other relationship giving rise to an appearance of an impropriety, with any current city commissioner or city personnel who is sought to be lobbied as identified on the lobbyist registration form filed. Sec 2- 482(g) Any Financial, Familial or Professional Relationship mod /f/6" • • 1 - -y ci . . 1? , A IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE 0l 1 C '� '" OTHER): . A) LOBBYIST DISCLOSURE: (Required) Ao ez A- % • B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): 1 ' , �s . (Required). eV CAI f The following nformation must be answered: g - - • 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 bld 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 lobbying on a pending application fora Development Agreement with the City or application for change of zoning mar) designation or change to the Ci!tv'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. 1 • . ❑ Yes ® No: Are you representing a not - for -profit corporation or entity without special compensation or reimbursement. . V. SIGNATURE UNDER OATH: ON FEBRUARY 28th OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE • CIT1J CLERK A Rog) STATEMENT UDDER, . • OATH, LISTING LOBBYING EXPENDITURES. AS WELL 4S COMP _, =A 0 • N RECEIV _ :i IN THE CITY OF MIAMI BEACH FOR THE,RECEDING CALENDAR YEAR. A STATEMENT SHALL BE FIL - • r N IF HAVE BEEN NO EXPENDITURES OR • COMPENSATION DURING THE REPORTING PERIOD., : . • . S -nature o • bbylst . 1 do solemnly swear that all of the fore. • • fa - _ ' ue an • orrect a • . at I have read or am familiar with the provisions contained in Section 2-482 of the Miami Beach od: = : all reporting requirements: • Signature of Lobbyist /teale G.-- ••"" 'tAIEU1� Signature of Principal/Client • �4 , r '•• VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: lomat it • ❑ Produced ID Produced ID / %_ 1 _ ,� ••• • Lief. r • ,; .: ratio . Form of Identification •••• •Fe ` , . 6ERWIDE8 *.iirtt,,,,,,i,...,,,,,--, Nots ry Put;;c R -State of Florida .,'' ., • Personaf known V ' ) C Expires Nov21, 2011 Personally known (Principal) MY COmmieioil E V S Sept 10; 2011 • ' ` 7 + •. Commission 8 00 713061 VII. SIGNATURE AN I + : ,�i NallifiribroughNstionalNotaryAssn. _ • e6e•ovA:alegt mel jr State of Florida, County of Miaml -Dade �� State of Refills; County of • Sworn to and subscribed before me Sworn and subscribed before me This • daffy of . _ • L.. , 2011 • his .,,,dicrty of ia�- -,2011 e. ti..._.4... Af.de,.. / 4 . „--,:e.--- 3 gn - • re of Public Notary - State of Florida Signature of Public Notary - State of Florid. -- C." . N . -- rization of Lobbyist's signature Notarization of Principal's signature • ' _ . TO BE COMPLETED BY CITY CLERK'S STAF ONLY • Annual Registration fee: [ ] Yes [ ] No Amount Paid $ -g 51 .. -- # ' — i Date - aid q 4 / Lobbyist Registration Form received and verified by: e ' \$ F : \CLER ALL\aFORMS\LO8aYISTFORMS \Lobbyist Annual Registration Form.doc 4 ' r Revised 1/1 /2011 2-6)2- ' ' . t)/4//" • MP"' "ta i ' '±6 .)11: .1 iii . ii I' • . ,______,p . , r , I i I ' 1)) 1 . _ _ _ _ f, BE Ac H o 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 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 20044435. Espinosa Juan NAME OF LOBBYIST: (Last) (First) (M.I) David Plummer & Associates 1750 Ponce de Leon Blvd Coral Gables FL 33134 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 447 -0900 (305) 444 -4986 Juan.Espinosa@dplummer.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: RP Hotel Holdings, LLC NAME OF PRINCIPAUCLIENT: RP Hotel Holdings, LLC 100 Fillmore Street, Suite 600, Denver CO 80206 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) C? 720 - 284 -6418 -~- = - 1 TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) "� f Fill out this section if principal is a Corporation, Partnership or Trust [Section 2 -482 (c)] "L7 rin 8T ro • NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: RP Hotel Holdings, LLC • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCI ORIZ RATIO, PARTNERSHIP OR TRUST: -r- •• See Attached tin ri.SPECIFIC LOBBY ISSUE: The James Hotel at Royal Palm Issue to be lobbied (Describe in detail): CITY AGENCIES /INDIVIDUALS TO BE LOBBIED: Pursuant to City Code Section 2-482(a)(4) include the commissioner or personnel sought to be lobbied, and whether the lobbyist has entered into any contractual relationship (paid or unpaid) with said city commissioner or personnel from 12 months preceding such person's commencement of service with the city to the present date, stating the general nature of the subject contractual relationship. Sec 2- 482(a)(4) Full Name of Individual and Contractual Relationship (Explain) YES NO title of person to be lobbied Historic Preservation Board, Board of Adjustment Planning Board City Departments Pursuant to City Code Section 2.482(g) Every registrant shall be required to state the extent of any business, financial, familial or professional relationship, or other relationship giving rise to an appearance of an impropriety, with any current city commissioner or city personnel who is sought to be lobbied as identified on the lobbyist registration form filed. Sec 2 -482(g) Any Financial, Familial or Professional Relationship -2 c p . � "k IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE Oil' OTHER): A) LOBBYIST DISCLOSURE: (Required) 1 g 4.. - 'La B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): t'► (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 IN No: Are you lobbying on a present' 1r 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 ": 0 Yes ® No: Are you lobbying on a pending application for a Development Agreement with the City or application for chin c ofzoninry ma, dasi•.. ton or thane to the Ci 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 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. • Yes L No re our: • : -ntin• a not or -•r• tt o roratio or e houts•e> ial co •e Lt. a:on or r ibursement. V. SIGNATURE UNDER OATH: ON FEBRUARY 28th OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH LISTING LOBBYING EXPENDITURES AS WELL AS COMPENSA RECEIV IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FIL EN IF T HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. S': nature o obbyist I do solemnly swear that all of the fore' • • fa = ue an• orrect an at I have read or am familiar with the provisions contained in Section 2 -482 of the Miami Beach od= - - all reporting requirements. Signature of Lobbyist: ••' "'•• � gh p1 EUX•. Signature of Principal /C , ,� „ ��` .. • cr; hanitt VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: • • " P UBLI C ❑ Produced ID 0 Produced ID Laid 1. ED' •• r ► 4ificatiolk C R Fein Of Ident`fivad.^.n •••...N• • OSAR BERUVIDES ` s $ Notary Put. c - State of Florida Personally known t J n 31 OnExpiresNov21,2011 Personally known (Principal) ' God 10, 2011 ''!` Commission VII. SIGNATURE AN P Nenlif IxoupN NatiDona l 71ary National re,4,e,O., State of Florida, County of Miami -Dade State of Fiefide; County of Sworn to and subscribed before me Sworn and subscribed before me This day of A • u , 2011 r his .sz r of A ,,k_', ,2011 td,z<v • gn ure of Public Notary — State of Florida Signature of Public Notary — State of Ftoride -- e °1-49A - " z " N • r rization of Lobbyist's signature Notarization of Principal's signature TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: [ ] Yes [ 1 No Amount Paid $ MCR # Date Paid Lobbyist Registration Form received and verified by: fir\ CLEFT\ LL \aFO .MS LOB Y! T FORMS \Lo byist Annual Rccistration Forrn.doc Revised 1/11/2011 MIAMBEAC.H City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov CITY CLERK Office CityC{erkOrniamibeachfl.gov Tel: 305.673.7411 , Fax: 305.673.7254 LOBBYIST NAME: J " a' I / , 'L"O5 ' 1 understand that no later than February 28th of each year, I must file the following form, 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 and Compensation 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 of lobbyist withdrawal in writing. id/ Sig ture: Date: Revised 09/24/2010 - REP F: \CLER \LOBBYIST\Expenditure & Disclosure Forrn Itr.doc We ore committed to providing excellent public service and safety b otl who live, work, and ploy in our vibrant, tropical, historic community,