Kobi Karp - Crown Miami Hotel Owner, LLC MIAMI BEACH
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.
Karp Kobi
NAME OF LOBBYIST: (Last) (First) (M.1)
Kobi Karp Architecture 2915 Biscayne Blvd, Suite 200, Miami FL 33137
(Number and Street) i y (state) (zip o e
(305) 573-1818 (305) 573-3766 info(d*obikar).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:
Crown Miami Hotel Owner, LLC
NAME OF PRINCIPAUCLIENT:
Same Pier 5, The Embarcadero, Suite 102, San Francisco CA 94111
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(415)694-5820
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: Thomas Gottlieb,Manager of Crown Miami Holding Co.,LLC,which is the
sole member of Crown Miami Hotel Owner, LLC
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: See attached.
ii.SPECIFIC LOBBY ISSUE:
Development approvals& permitting issues for Crown Hotel & Parking Garage located at 4041 Collins Avenue &228 W
40th Street
Issue to be lobbied(Describe in detail):
III. 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
Staff of Planning Department, Building Department,and Public Works None X
De artment
PB, HPB,BOA,City Commission,as necessary None X
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 om .s 'o ,r or city personnel who is
sought to be lobbied as identified on the lobbyist registration form filed. -'��.:.E=•J{ J.�, a t,.J'
Sec 2-482(g)Any Financial, Familial or Professional Relationship till I I Air
None
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Formrevised 5-30-2012.doc
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required) $ J_,—
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATICV):
(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 X No: Are you lobbying on a oLgsent or pending bid for goods,equipment or services.or on a present or oendina
award for goods.eguipment or service?
2) Pursuant to Miami Beach City Code Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
_Yes X No: Are you lobbying on a pending application for a Develooment Agreement with the City or application for
chanae of zoning map designation or change to the City's Future Land Use Map?
3) Pursuant to Miami Beach City Code Section 2-482(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 X No: Are you reoresentina a not-for-profit corporation or entity without special compensation or reimbursement.
V. SIGNATURE UNDER OATH:
ON_FEBRUARY 28 OF EACH YEAR. EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER
C CITY OF MIAMI BEACH
f.Q$ IHE PRgr&Q21bjQ CALENDAR
EXPENDITURES OR C12MPENSATIQN DURING THE REF __ 1
Signature of Lobbyist
I do solemnly swear that of the foregoing fa re true and correct and t at I h e read or am familiar with the provisions contained
in Section 2-482 of the Mi Beach reporting requireme s.
Signature of Lobbyist:
Signature of Principal/Client: A 9
VI. LOBBYIST IDENT ATION: ' PRINCIPAL IDENTIFICATION:
Produced ID Produced ID
Form of Identification Form of Identification
Personally known(Lobbyist) Personally known(Principal)
VII. SIGNATURE AND LEVANA MARKHOFF
`�'•,'
State of Florida, County of Mi rfii Notary Public•Stater Florida State of Florida, County of Miami-Da e
•
!1 7--
.• My Comm.Expires Apr 3,2013 Sworn and subscribed before me
Sworn to and subscribed be � �;
This / °) day o •;;F �O••' Commission#EE 179221
Bonded Through National Notary Assn. This day of ,2012
ignature of Public tary State lorida Signature of Public Notary—State of Florida
Notarization of signature Notarization of Principal's signature
TO BE COMPLE156/Dolt;CITY CLERK'S STAFF ONLY
Annual Registration fee: Yes No Amount Paid$ MCR# Datefaid 3
Lobbyist Registration Form received and verified by: Of
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State of California
County of San Francisco
Subscribed and sworn to (or affirmed) before me on this 7th
day of January , 2013 , by Thomas M. Gottlieb
proved to me on the basis of satisfactory evidence to be the
person s e me.
JOHN I GREENE
` 14P Commission # 1945321
= :1, Notary Public -California z
San Francisco County D
My Comm.Expires Jul 24,2015
(Seal) Signature
F:\CLE istration Form.doc Revised 04/27/2012
�AIAr'I" AIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office
Rafael E. Granado, City Clerk CityClerkamiamibeachfl.gov
Tel: 305.673.7411 , Fax: 305.673.7254
LOBBYIST NAME: Kobi Karp
I understand that no later than February 28 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, or I am no longer
lobbying on that issue or for that principal, I am required to immediately notify the City Clerk's
Office of lobbyist withdrawal in writing.
Pursuant to Section 2-485 (d), the City Clerk shall notify any lobbyist (or principal) who
fails to timely file a Statement and in addition to any other penalties which may be
imposed as provided in Section 2-485.1, a fine of $50.00 a day shall be assessed for all
Statement(s) filed, after the due date. The City Clerk shall notify the Miami-Dade
County Commission on Ethics and Public Trust of the failure of a lobbyist (or principal)
to file the Statement or pay the assessed fines after notification.
Any lobbyist, who fails to file the required Statement by April 30th, 2012, shall be
automatica suspended ro lobbying until all fines are paid, unless the fine has been
appealed o the Miami-Dade Co my Commission on Ethics and Public Trust.
VI/13
Signature: Date:
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EXHIBIT
DISCLOSURE OF INTEREST
for
Crown Miami Hotel Owner,LLC
4041 Collins Avenue
Miami Beach, Florida 33140
NAME OF INTEREST HOLDER %INTEREST
1. Crown Miami Holding Company,LLC 100.00%
(Sole Member of Crown Miami Hotel Owner,LLC)
4041 Collins Avenue
Miami Beach,Florida 33140
New York,NY 10022
The Board of Managers of Crown Miami Holding Company,LLC:
a. Christopher Niehaus
GreenOak Real Estate Advisors
399 Park Avenue, 22"d Floor
New York,NY 10022
(212) 359 7800
b. Sean Williams
GreenOak Real Estate Advisors
399 Park Avenue, 22nd Floor
New York,NY 10022
(212) 359 7800
c. David Chang
CCL Holdings(USA),Ltd.
18401 Von Karman Avenue, Suite 350
Irvine, CA 92612
d. Goodwin Gaw
Downtown Properties Holdings
818 West 7d'Street, Suite 410
Los Angeles, CA 90017
e. John Pritzker
Geolo Capital
Pier 5,The Embarcadero, Suite 102
San Francisco, CA 94111
(415) 694 5800
f. Thomas Gottlieb
Geolo Capital
Pier 5,The Embarcadero, Suite 102
San Francisco, CA 94111
(415) 694 5800
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EXHIBIT
DISCLOSURE OF INTEREST
for
Crown Miami Hotel Owner,LLC
4041 Collins Avenue
Miami Beach, Florida 33140
The Owners of Crown Miami Holding Company,LLC:
a. GOGC Crown Hotel,LP 66.67%
GreenOak US GP, LP (its GP)
399 Park Avenue, 22nd Floor
New York,NY 10022
Partners of GOGC Crown Hotel,LP:
• GreenOak heal Estate Advisors—Investment Fund(66.66%)
(via funding from GreenOak US, LP&GreenOak US Parallel,LP-%'s TBD)
399 Park Avenue, 22nd Floor
New York,NY 10022
• CCL Holdings(USA),Ltd.—Investment Fund(16.67%)
(aka CCL Holdings)
18401 Von Karman Avenue, Suite 350
Irvine, CA 92612
• DP US Opportunity RE Holdings I,LLC.—Investment Fund(16.67%)
(aka Downtown Properties) !
818 West 7 h Street, Suite 410
Los Angeles,CA 90017
b. Geolo Crown Hotel Investment,LLC 33.33%
Pier 5,The Embarcadero, Suite 102
San Francisco, CA 94111
Members of Geolo Crown Hotel Investment,LLC:
Joie de Vivre Properties,LP—Lewis Linn,Trustee(93.913%)
Pier 5,The Embarcadero, Suite 102
San Francisco,CA 94111
Commune Hotel and Resorts,LLC (2.435%)
530 Bush Street, Suite 501
San Francisco,CA 94108
Members of Commune Hotels and Resorts,LLC:
i. Geolo JdV,LLC (50%)
Pier 5,The Embarcadero, Suite 102
San Francisco, CA 94111
2
EXHIBIT
DISCLOSURE OF INTEREST
for
Crown Miami Hotel Owner,LLC
4041 Collins Avenue
Miami Beach, Florida 33140
Members of Geolo JdV,LLC:
Geolo Capital II,LP-Lewis Linn,Trustee(72.82%)
Pier 51 The Embarcadero, Suite 102
San Francisco,CA 94111
Stephen T.Conley(23.10%)
530 Bush Street, Ste. 501
San Francisco, CA 94108
Michael J.Wisner(1.36%)
530 Bush Street, Ste. 501
San Francisco, CA 94108
Ingrid Summerfield and Ron Hartman(1.36%)
530 Bush Street, Ste. 501
San Francisco, CA 94108
Christian Strobel(1.36%)
530 Bush Street, Ste. 501
San Francisco, CA 94108
ii. Thompson BP,LLC (50%)
54 Thompson Street, 5t'Floor
NY,NY 10013
Members of Thompson BP,LLC:
Jason Pomeranc(25.00%)
388 West Broadway
New York,NY 10012
Michael Pomeranc(25.00%)
276 Linden Ave
Englewood,NJ 07631
Lawrence Pomeranc(25.00%)
203 Walnut Street
Englewood,NJ 07831
Stephen Brandman(25.00°/x)
270 East Saddle River Road
Saddle River,NJ 07458
3
EXHIBIT
DISCLOSURE OF INTEREST
for
Crown Miami Hotel Owner, LLC
4041 Collins Avenue
Miami Beach, Florida 33140
c. Jason Pomeranc(0.913%)
388 West Broadway
New York,NY 10012
d. Michael Pomeranc(0.913%)
276 Linden Ave
Englewood,NJ 07631
e. Lawrence Pomeranc(0.913%)
203 Walnut Street
Englewood,NJ 07831
E Stephen Brandman(0.913%)
270 East Saddle River Road
Saddle River,NJ 07458
TOTAL for Crown Miami Holding Company,LLC: 100.00%
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