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Brian S. Adler - Hotel Place 24 LLC Z3 � 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_Pction, decision, recommendation of the City Manager or any city board or committee; or any actionr?dec�on o(., recommendation of any city personnel during the time period of the entire decision-making process on-suctt*tion; decision or recommendation that foreseeably will be heard or reviewed by the city commission, or a �(ty board or�t committee. The term specifically includes the principal as well as any employee engaged in lobbying activitief.,The• ) term "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435. fl _ J Adler Brian S. NAME OF LOBBYIST: (Last) (First) o i (M.1) N Bilzin Sumbero Baena Price&Axelrod LLP. 1450 Brickell Avenue, Suite 2300, Miami, FL 33131 Ln BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) Zip Code) 305-350-2351 305-351-2206 badlerabilzin.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: I. LOBBYIST RETAINED BY: SEE ATTACHED EXHIBIT"A" NAME OF PRINCIPAUCLIENT: BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 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 Attached Exhibit"B" ISSUE:II. SPECIFIC LOBBY All land use/zoning and permitting matters regarding property at 2377 Collins Avenue, 2340 Collins Avenue and 2322 Collins Avenue, Miami Beach, FL Issue to be lobbied (Describe in detail): III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: A) Full Name of Individual/Title B)Any Financial, Familial or Professional Relationship Building Department, Planning&Zoning n/a Department Fire Department and staff City Managers Office n/a Historic Preservation Board and Board of Adjustment and Planning Board n/a MIAMI 3679281.1 79794/40353 IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER) A) LOBBYIST DISCLOSURE: (Required) $570/hr B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $570/hr 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,equipment or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": ❑ Yes VNo: 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.. ❑ 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 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. Signatur of Lobbyist—Brian S. Adler 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: Brian S.A er MIAMI 3 6792 81.1 79794/40353 2377 Collins Resort,L.P.,a Delaware limited partnership By:2377 Collins Resort GP, L.L.C., a Delaware limited liability company, its General By: VI. LOBBYIST IDENTIFICATION: PRINCIPAL 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 and subscribed before me Sworn and subscribed before me ay of 20j_;�L_ This day of , 20 �oZS b�'�A z-- Signature of Public Notary—State of Florida Signature of Public Notary—State of Florida Notarization of Lobbyist's signature Notarization of Principal's signature 2�lPaY.POB,c IBIS DIAZ * * MY COMMISSION A DD 994845 EXPIRES:May 24,2014 I',fEOF F." Bonded Thru Budget Notary Services MIAMI 3 679281.1 79794/40353 I 2377 Collins Resort,L.P.,a Delaware limited partnership By:2377 Col1' Resort GP,L.L.C., a Delawar Ii d lia 'ity company,its General � I By: anu oug a ! VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDEN IFICATION: I ❑ 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 New York,County of New York Sworn to and subscribed before me Sworn and subscribed before me This day of ,20 A d This 16a f 20��/Jo� . This I1 .� f Signature of Public Notary—State of New York Signature of Public Notary—State of Florida Notarization of Principal's signature I Notarization of Lobbyist's signature ARNOLD S. LEHMAN Notary Public, State of New York No. 31-4815239 Qualified in New York County Commission Expires April 30, 20 I Ii I i MIAMI 3679281.1 79794/40353 MIAMI BEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov LOBBYIST NAME: Brian S. Adler 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 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 30`h, 2012, shall be automatically 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. dT i' 1 1-1-3 Signature: Date: MIAMI 3679281.1 79794/40353 2377 Collins Resort, L.P. Sandy Lane Master Association, Inc. 591 West Putnam Avenue 2377 Collins Avenue Greenwich, CT 06830 Miami Beach, FL 33139 Telephone: 203-422-8195 Telephone: 203-422-8195 West Collins Land Investors, L.P. 591 West Putnam Avenue Greenwich, CT 06830 Telephone: 203-422-8195 EXHIBIT "A" 1. CORPORATION If the property which is the subject matter of the application is owned or leased by a CORPORATION, list the principal stockholders and the percentage of stock owned by each. Where the principal officers or stockholders consist of another corporation(s), trustee(s), partnership(s) or similar entity, further disclosure shall be required which discloses the identity of the individual(s) (natural persons) having the ultimate ownership interest in the entity.* Hotel Place 24,L.L.C. CORPORATION NAME NAME,ADDRESS, AND OFFICE %OF INTERESTS HP 24 Holdings,L.L.C. 50% 591 West Putnam Avenue Greenwich,Connecticut 06830 Hotel Place 24 Investors, L.L.C. 50% 591 West Putnam Avenue Greenwich,Connecticut 06830 HP 24 Holdings,L.L.C. CORPORATION NAME NAME, ADDRESS, AND OFFICE % OF INTERESTS SOF-VIII U.S. Hotel Co-Invest Holdings. L.P. 100% 591 West Putnam Avenue Greenwich,Connecticut 06830 Hotel Place 24 Investors,L.L.C. CORPORATION NAME NAME, ADDRESS, AND OFFICE %OF INTERESTS IMRF Hotel Member, LLC 50% Corporate Trust Center, 1209 Orange Street Wilmington, Delaware 19801 LF 24th&Collins, LLC 50% 1007 North Orang`treet,Suite 210 Wilmington, Delaware 19801 INIRF Hotel Member,LLC CORPORATION NAME NAME, ADDRESS, AND OFFICE % OF INTERESTS Invesco Mortgage Recovery Master Loans ATV, L.P. 82.77% Corporate Trust Center, 1209 Orange Street Wilmington, Delaware 19801 MIAMI 3001642.1 7957236593 4/9/12 2:53 PM WLR Whole Loan Fund, L.P. 16.41% Corporate Trust Center, 1209 Orange Street Wilmington, Delaware 19801 Invesco SPPIF(GP)Feeder Fund,LLC 0.82% Corporate Trust Center, 1209 Orange Street Wilmington, Delaware 19801 Invesco SPPIF(GP)Feeder Fund,LLC CORPORATION NAME NAME,ADDRESS,AND OFFICE %OF INTERESTS Invesco, Ltd. 100% Corporate Trust Center, 1209 Orange Street Wilmington,Delaware 19801 Invesco,Ltd. CORPORATION NAME NAME,ADDRESS,AND OFFICE %OF INTERESTS Publicly Traded on NYSE No Further Disclosure Required LF 24h& Collins LLC CORPORATION NAME NAME, ADDRESS,AND OFFICE %OF INTERESTS RL Capital Realty Assoc LLC 35% 1007 North Orange Street, Suite 210 Wilmington,Delaware 19801 SR Capital Realty Assoc LLC 45% 1007 North Orange Street, Suite 210 Wilmington,Delaware 19801 14L Pauline Tucker 2010 GST Trust 10% 1007 North Orange Street,Suite 210 Wilmington,Delaware 19801 JL Pauline Tucker 2010 GST Trust 10% 1007 North Orange Street,Suite 210 Wilmington,Delaware 19801 MIAMI 3001642.1 7957236593 4/9/12 2:53 PM RL Capital Realty Assoc LLC CORPORATION NAME NAME,ADDRESS, AND OFFICE %OF INTERESTS Richard LeFrak 99% Corporate Trust Center, 1209 Orange Street Wilmington.Delaware 19801 Stone Control LLC 1% Corporate Trust Center, 1209 Orange Street Wilmington,Delaware 19801 Stone Control LLC CORPORATION NAME NAME, ADDRESS, AND OFFICE %OF INTERESTS Richard LeFrak 99% Corporate Trust Center, 1209 Orange Street WilminZon, Delaware 19801 Stone Manager Corp 1% Corporate Trust Center, 1209 Orange Street Wilmington,Delaware 19801 Stone Manager Cora CORPORATION NAME NAME,ADDRESS, AND OFFICE %OF INTERESTS New RL Co!p Holdings LLC 100% Corporate Trust Center, 1209 Orange Street Wilmington, Delaware 19801 New RL Cora Holdings LLC CORPORATION NAME NAME,ADDRESS,AND OFFICE %OF INTERESTS Richard LeFrak 100% Co[p rate Trust Center, 1209 Orange Street Wilmington, Delaware 19801 MIAMI 300164 2.1 795 723 6593 4/9/12 2:53 PM SR Capital Realty Assoc LLC CORPORATION NAME NAME,ADDRESS,AND OFFICE %OF INTERESTS Richard LeFrak 1% Corporate Trust Center, 1209 Orange Street Wilmington. Delaware 19801 Stone Capital Realty LLC 99% Corporate Trust Center, 1209 Orange Street Wilmington,Delaware 19801 Stone Capital Realty LLC CORPORATION NAME NAME,ADDRESS, AND OFFICE %OF INTERESTS RSL 2005 Family Trust u/a/d 3/21/05 33% Corporate Trust Center, 1209 Orange Street Wilmington, Delaware 19801 HTL 2010 GST Trust 33% Corporate Trust Center, 1209 Orange Street Wilmington,Delaware 19801 JTL 2010 GST Trust 33% Corporate Trust Center, 1209 Orange Street Wilmington, Delaware 19801 RSL Stone Coital LLC 1% Corporate Trust Center, 1209 Orange Street Wilmin on.Delaware 19801 RSL Stone Capital LLC CORPORATION NAME NAME,ADDRESS,AND OFFICE %OF INTERESTS New RL Capital Realty Assoc LLC 100% Corporate Trust Center, 1209 Orange Street Wilminglon,Delaware 19801 New RL Capital Realty Assoc LLC CORPORATION NAME NAME,ADDRESS,AND OFFICE %OF INTERESTS New Stone Control LLC 1% Corporate Trust Center, 1209 Orange Street Wilmigion,Delaware 19801 MIAMI 3001642.1 7957236593 4/9/12 2:53 PM Richard LeFrak 99% Corporate Trust Center, 1209 Orange Street Wilmington, Delaware 19801 New Stone Control LLC CORPORATION NAME NAME, ADDRESS,AND OFFICE %OF INTERESTS New Stone Mana eg r Corp 1% Corporate Trust Center, 1209 Orange Street Wilmington, Delaware 19801 Richard LeFrak 99% Corporate Trust Center, 1209 Orange Street Wilmington, Delaware 19801 New Stone Manager Cora CORPORATION NAME NAME,ADDRESS, AND OFFICE %OF INTERESTS Richard LeFrak 100% Corporate Trust Center, 1209 Orange Street Wilmington, Delaware 19801 2. TRUSTEE If the property which is the subject matter of the application is owned or leased by a TRUSTEE, list the beneficiaries of the trust and the percentage held by each. Where the beneficiary/beneficiaries consist of corporation(s), trustee(s), partnership(s) or similar entity, further disclosure shall be required which discloses the identity of the individual(s) (natural persons) having the ultimate ownership interest in the entity. * HL Pauline Tucker 2010 GST Trust TRUST NAME NAME, ADDRESS, AND OFFICE %OF INTERESTS Harrison LeFrak 100% 1007 North Orange Street,Suite 210 Wilmington,Delaware 19801 JL Pauline Tucker 2010 GST Trust TRUST NAME NAME, ADDRESS, AND OFFICE % OF INTERESTS Jamie LeFrak 100% 1007 North Orange Street, Suite 210 Wilmington, Delaware 19801 MIAMI 3001642.1 7957236593 4/9/12 2:53 PM RSL 2005 Family Trust u/a/d 3/21/05 TRUST NAME NAME,ADDRESS,AND OFFICE %OF INTERESTS Richard LeFrak 100% 1007 North Orange Street, Suite 210 Wilmington,Delaware 19801 HTL 2010 GST Trust TRUST NAME NAME,ADDRESS,AND OFFICE %OF INTERESTS Harrison LeFrak 100% 1007 North Orange Street, Suite 210 Wilmington,Delaware 19801 JTL 2010 GST Trust TRUST NAME NAME,ADDRESS,AND OFFICE %OF INTERESTS Jamie LeFrak 100% 1007 North Orange Street, Suite 210 Wilmington,Delaware 19801 3. PARTNERSHIP/LIi%ffED PARTNERSH111EP If the property which is the subject matter of the application is owned or leased by a PARTNERSHIP or LIMITED PARTNERSHIP, list the principals of the partnership including general and limited partners. Where the partner(s) consist of corporation(s), trustee(s), partnership(s) or similar entity, further disclosure shall be required which discloses the identity of the individual(s) (natural persons) having the ultimate ownership interest in the entity.* 2377 COLLINS RESORT,L.P. PARTNERSHIP or LIMITED PARTNERSHIP NAME NAME,ADDRESS,AND OFFICE % OF INTERESTS Hotel Place 24 LP, L.P. 100% 591 West Putnam Avenue Greenwich, Connecticut 06830 Hotel Place 24 LP.L.P. PARTNERSHIP or LUAITED PARTNERSHIP NAME NAME,ADDRESS,AND OFFICE %OF INTERESTS HP 24 Holdings LP,L.P. 49.5% 591 West Putnam Avenue Greenwich,Connecticut 06830 MIAMI 3001642.1 7957236593 4/9/12 2:53 PM Hotel Place 24 Investors, L.L.C. 49.5% 591 West Putnam Avenue Greenwich,Connecticut 06830 Hotel Place 24, L.L.C. 1% 591 West Putnam Avenue Greenwich, Connecticut 06830 IIIP 24 Holdines LP,L.P. PARTNERSHIP or LIMITED PARTNERSHIP NAME NAME,ADDRESS,AND OFFICE %OF INTERESTS HP 24 Holdings, L.L.C. 100% 591 West Putnam Avenue Greenwich, Connecticut 06830 S®F-VIII U.S.Hotel Co-Invest Holdings,L.P. PARTNERSHIP or LIMITED PARTNERSHIP NAME NAME, ADDRESS, AND OFFICE % OF INTERESTS Direct and indirect ownership interests of SOF-VIII U.S. No Further Disclosure Required Hotel Co-Invest Holdings, L.P. are various investment funds and investment vehicles, and such investment funds and vehicles are owned indirectly by high net worth individuals,endowments, state employment plans,and pension plans and such high net worth individuals, endowments, state employ plans,and pension plans have more than 5,000 interests. Invesco Mortgage Recovery Master Loans AIV,L.P. PARTNERSHIP or LIMITED PARTNERSHIP NAME NAME,ADDRESS,AND OFFICE % OF INTERESTS WLR IV PPIP Co-Invest Loans AIV, L.P. 25.33% Corporate Trust Center, 1209 Orange Street Wilmington,Delaware 19801 WLR IV Loans AIV. L.P. 8.06% Corporate Trust Center, 1209 Orange Street Wilmington, Delaware 19801 Invesco Mortgage Recovery Loans AIV, L.P. 66,61% Corporate Trust Center, 1209 Orange Street Wilmington.Delaware 19801 MIAMI 3001642.1 795 7236593 4/9/12 2:53 PM WLR IV PPIP Co-Invest Loans AIV,L.P. PARTNERSHIP or LIMITED PARTNERSHIP NAME NAME, ADDRESS,AND OFFICE %OF INTERESTS Direct and indirect ownership interests of WLR IV PPIP No Further Disclosure Required Co-Invest Loans AIV. L.P.,are various investment funds and investment vehicles,and such investment funds and vehicles are owned by numerous investors. including pension plans,have more than 5,000 interests in the aggregate. WLR IV Loans AIV.L.P. PARTNERSHIP or LIMITED PARTNERSHIP NAME NAME, ADDRESS, AND OFFICE %OF INTERESTS Direct and indirect ownership interests of WLR IV Loans No Further Disclosure Required AIV.L.P., are various investment funds and investment vehicles.and such investment funds and vehicles are owned by numerous investors, including pension plans,have more than 5,000 interests in the ag rg_egate. Invesco Mortgage Recovery Loans AIV.L.P. PARTNERSHIP or LIMITED PARTNERSHIP NAME NAME,ADDRESS,AND OFFICE %OF INTERESTS Direct and indirect ownership interests of Invesco Mortgage No Further Disclosure Required Recovery Loans AIV, L.P.,are various investment funds and investment vehicles, and such investment funds and vehicles are owned by numerous investors including pension plans, have more than 5,000 interests in the aggregate. WLR Whole Loan Fund,L.P. PARTNERSHIP or LIMITED PARTNERSHIP NAME NAME,ADDRESS,AND OFFICE % OF INTERESTS Direct and indirect ownership interests of WLR Whole No Further Disclosure Required Loan Fund, L.P. are one or more pension plans having_ more than 5,000 interests in the aggregate. MIAMI 3001642.1 7957236593 4/9/12 2:53 PM