Raymond Jungles - Crown Miami Hotel Owner, LLC pv�x
MIAMI BEACH co 1101\4
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City of Miami Beach Office of the City Clerk " ' ) I LF
1700 Convention Center Drive, Miami Beach, FL 33139 2Z
LOBBYIST REGISTRATION FORM T5
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.
Jungles Raymond
NAME OF LOBBYIST: (Last) (First) (M.1)
Raymond Jungles, Inc. 242 SW 51h Street, Miami FL 33130
t:$Ub1NtbZ�-NA (Number ana Street) i y (State) (zip Mae)
(305) 858-6777 (305) 856-0742
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(9)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( Any Financial, Familial or Professional Relationship
None • , - J WEIR
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Formrevised 5-30-2012.doc
l'��IV
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required) $ �,0 /1 � u
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST cOS bN�
Q(REQUIRED). � � - )r_fT
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:
award for aoods.eauioment or service?
2) Pursuant to Miami Beach City Code Section 2-490 Entitled"Prohibited Campaign Con Zb'tions By Lobbyists On Real Estate
Development Issues":
Yes X No: r r
channe of zonona mar)desionation or change to the City's Qd use Mar)?
1
3) Pursuant to Miami Beach City Code Section 2-482 (h)Any person(except th•Se a empt from tt4definition of"lobbyist'as set
forth in Section 2-481 above) who only appe as a representative of a not-for-profit: .corporation or entity without
special compensation or reimbursement for�. e': appearance, whether di ct, or indirect, to express support of or
opposition to any item, shall register with the Ark, s required by this s otion but. shall not beJrequired to pay any registration
fees. " 1
_Yes X No
V. SIGNATURE UNDER OATH: ! �
ON FEBRUARY 2 C f. UNDER
OATH. LISTING LOQBYING E F MIAMI BEACH
FQ�t THE E E D J r E / FJ�ED EVEN IF THERE HAVE-13EEN NO
EXPENDITURES OR
Signatur o obby
I do solemnly swear that all oft 'e fore r fact rare true and correct and that I have read or am familiar with the provisions contained
in Section 2-482 of the Miami Yeac -. i dei nd all reporting requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION: RINCIPAL IDENTIFICATION:
_Produced ID !Produced ID
Form of Identification Form of Identification
►' Personally known(Lobbyist) Personally known(Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade State of Florida, County of Miami-Dade
Sworn to subscri before/me Sworn and subscribed before me
ay of , 20 �; YN�m,, PATSY A.SISKIND JO5 This day of 2012
r ; A.)."
Notary Public-State of FlMy Comm.Expires Oct 18.i nature of Public N to State of "•° Commission#EE 10Ua of Public Not a State of Florida
Notariz ton of Lobbvi t s signature � Bonded Through National Nollion of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF gylL( Z
Annual Re istration fee: Yes No Amount Paid b O MCR q / Date Paid
Lobbyist Registration Forth received and verified by:
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State of California
County of San Francisco
Subscribed and sworn to (or affirmed) before me on this 5th
day of March 2013 , by Thomas M. Gottlieb
proved to me on the basis of satisfactory evidence to be the
e so s w o r ed-4eigre me.
JOHN I GREENE
Commission# 1945321
a = s Notary Public -California z
Z San Francisco County
NI Comm.Expires Jul 24 2015
(Seal) Signature
F:.\CLE istration Form.doc ','Revised 04/27/2012
MIAMBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office
Rafael E. Granado, City Clerk CityClerk @miamibeachfl.gov
Tel: 305.673.7411 , Fax: 305.673.7254
LOBBYIST NAME: Raymond Jungles
I understand that no later than February 28 of each year, I must file the following form,
pursua s nt'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 e registered to lobby on has been resolved, or f am no longer t
lobbying on that issue or r at principal, I am required to immediately notify-the City Clerk's
Office of lobbyist withdr alI writinglity.Clerk:shaIV Pursuant to Sectio -48 (d), they notify any lobbyist(or principal) who.
fails to timely file S ement end. in ,addition to any other,.:penalties which may be
imposed as provi' ed i ` Section -485:1, a'fine.of $50.00 a day shall be assessed for all
Statement(s) °fill �d--aft/ r the dud ,dates The City Clerk shall notify the Miami-Dade
County Commi sio. n Ethics.'nd Public Trust-of the failure of a lobbyist.(or principal).
to file the Sta men or pay they ssessed fines after notification.
Any lobby t,= w fails to a' He the required Statement by April 30th, 20'12, shall be
automatic' Ily s ended fr° m lobbying until,all fines are paid,. unless the fine has been
appealed. o th ami-Da County Commission on Ethics and Public Trust:
i'
C3 ° ° 03
5 2
Slgna _r Date:
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Formrevised'5-30-2012.doc
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 1Vliami 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 7h 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 Real 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 70' 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
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EXHIBIT
DISCLOSURE OF INTEREST
for
Crown Miami Hotel Owner, LLC
4041 Collins Avenue
Miami Beach, Florida 33140
Members of Geolo JdV,LLC:
Geolo Capital H,LP-Lewis Linn,Trustee(72.82%)
Pier 5,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, 5"'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%)
270 East Saddle River Road
Saddle River,NJ 07458
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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 Bolding Company,LLC: 100.00%
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