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Liana Kozlowski - Robert Springer 4aLt RECEIVI C o kV.° A`'e- DEC 16 2022 CITY�oF�r+EMI►N C ER EI t\tV'\1 ��E'A HI Office of the City Clerk 1700 Convention Center Drive Miami Beach, FL 33139 305.673.7411 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 "Lobbyist" has specific exclusions. Please refer to City Code Chapter 2, Article VII, Division 3, entitled"Lobbyists," for additional information. Instructions: Please complete all sections of this form and submit the completed form,with the applicable fee,to the Office of the City Clerk. If you need more space to complete an answer, use a separate sheet(s)of paper. If you have nothing to report in a particular section, you must write "none" or "n/a" in that section. Any change to any information originally filed, or any additional City Commissioner or personnel who are also sought to be lobbied shall require that the lobbyist file an amendment to the registration form. The lobbyist has a continuing duty to supply information and amend the forms filed throughout the period that the lobbying occurs. Separate registration forms shall be required for each principal represented on each specific issue. I. LOBBYIST INFORMATION: Kozlowski Liana M. NAME OF LOBBYIST (Last) (First) (Middle Name) Bilzin Sumberg .1450 Brickell Ave,23 Floor Miami FL 33131 LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-350-2415 Lkozlowski@bilzin.com LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS II. PRINCIPAL INFORMATION: Springer Robert (Last) (First) (Middle Name) NAME OF PRINCIPAL Golden Palms LLC 200 Spectrum Drive, 21st Floor Irvine CA 92618 PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-350-2415 legal@sunstonehotels.com • PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS Pursuant to City Code Section 2-482(h)(1)(a): A principal of any corporation, partnership, or other entity who appears as a lobbyist on behalf of that entity,without special compensation or reimbursement for the appearance,whether direct,indirect,or contingent,to express support of or opposition to an item shall register with the Clerk as required by this subsection but shall not be required to pay any registration fees. If the principal is a Corporation, Partnership or Trust, the following information MUST be provided pursuant to City Code Section 2-482(c): NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY(if none,write N/A ):Robert Springer NAME OF ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH • CORPORATION,PARTNERSHIP OR TRUST(if none,write N/A): PubliclvTraded Page 1 of 5 III. ISSUE TO BE:LOBBIED: Describe with as much detail as is practical, including but not limited to a specific description where applicable of a pending request for proposal, invitation to bid, or public hearing number... Land use, zoning, design and development approvals from the Historic Preservation Board, and permitting issues, associated with.'property located at 4041 Collins Ave, Miami, Beach, 33.140. IV. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: Pursuant to City Code Section 2-482(a)(4), list the City Commissioner or City personnel sought to be lobbied, and whether the lobbyist :has entered into any contractual relationship.(paid Or unpaid):with said City Commissioner.or City personnel from 12 months preceding such commencement of service with-the City to the present date,stating the general nature of the:subject contractual relationship. Full Name of Individual and Contractual Relationship (If yes, explain) .' YES NO Title of Person to.be Lobbied= :. Planning Director x Planning'and Zoning Department and staff X . Historic Preservation Board members and staff. X Planning Board members and staff • X City Commission • x 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 Commissioner or City personnel who is sought to be:lobbied as identified on the lobbyist registration form filed. List any Business, Financial, Familial or Professional Relationship, or other relationship giving rise to an appearance of.impropriety(if'none,write N/A): N/A V. DISCLOSE RATE AND.AMOUNT OF LOBBYIST COMPENSATION Be a Specific: (Note that a contingency fee is prohibited pursuant'to City Code Sec: 2-485.3) $725/hour . . Page 2 of 5 • • • The following six(6)questions.MUST be answered :. . • 1) .. Pursuant to City Code Section 2488,entitled Prohibited Campaign Contributions.•By Lobbyists.On Procurement Issues": • _yes LNo: 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 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 Development Agreement with the City or application : • . • for change of ioninq'map designation or change to the City's Future Land Use Map? 3)'. Pursuant•to.City Code'Section 2-482(h); .any person (except those exempt from the definition of lobbyist" as .set forth in : • Section 2-481)"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 city clerk as•required by this sectioni but shall not be required to pay any registration fees. Yes XNo: Are you representing a not-for:profit corporation or entity: without special compensation or' • reimbursement? • 4) ' :Pursuant to City Code:Section 2-481; the term lobbyist"'specifically excludes the•following persons: Expert witnesses who • • • provide only scientific,technical or other specialized information or testimony in public meetings; any person who only.appears ' as;a•representative of a neighborhood association without compensation or reimbursement for the appearance,:whether direct, ' indirect or contingent,:to express support of or opposition to any item;and any person who only appears as a representative of • . _not-for m=profit community based organization for the .purpose of requesting• a grant ;without special, compensation or • reimbursement for the appearance., • • • . • : Yes XNo: '. .Are•.you providing only scientific, technical• or other specialized 'information;.appearing•as':a ' • representative of a neighborhood association•without special compensation or reimbursement or • representing a not-for-profit based organization for the 'purpose of requesting a .grant without• special compensation or reimbursement? : . . • ' 5) • Pursuant to '2 City Code Section -491(1),'no:campaign consultant shall:lobby the City Commission for a period of 12 months following the swearing in of any elected officials)for whom,the•campaign.consultant provided campaign consulting services within the past election cycle:See Section 2-491:for more information • • : ' •. . • Yes XNo:. Have you provided campaign consulting services to an incumbent member of.the City Commission within the past election Cycle?If yes,please list the incumbent member(s)of the City Commission: Yes XNo: If yes, has it been less than 1Q months since the elected officials) whom you provided campaign • consulting services was sworn iiTiA• : 6) .; Pursuant to:City;Code Section 2-482(a)(4)a., a.lobbyist who:has within the past election cycle provided campaign consulting : • services:to an incumbent member of the City Commission (which lobbying activity is not otherwise'prohibited by Code section - • 2-491) shall disclose,such•particular service on his/her•lobbyist registration form and:shall orally disclose such particular. ' service before lobbying the City Commission at a public meeting. : Yes XNo: Have you provided campaign consulting services to an incumbent member of the City Commission• : within the.past election cycle?If yes,please list the incumbent member(S)of the City Commission • - .YesXNO: If yes, were you promised or did you receive economic consideration -in exchange for campaign • :consultinp servicesr, .. . • • : : • .. • : ' . : CCLERIC'S.TO BE COMPLETED BY ITY TAFF ONLY S Annual Registration fee: [ ]Yes[ ]No Amount Paid$ MCR# Date Paid • Lobbyist Registration Form received and verified by: - F:\CLER\$ALL\sFORMS\LOPPUUYIST FORMS\Lobbyist Registration Form Revised 03-11-20 REG.doc Revised 03/11/2020 Page 3 of 5 VI. SIGNATURES UNDER OATH: . . ON FEBRUARY 28 OF'EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE OFFICE OF THE CITY CLERK A SIGNED STATEMENT UNDER OATH; LISTING 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 HAS BEEN NO EXPENDITURE OR COMPENSAT ON DURING THE REPORTING PERIOD.? Signature of Lobbyist: Date. /.Z./412 2 r a M. Kozloww i • I do solemnly swear or affirm that all of the foregoing facts statements, and disclosures in this form are true and correct, and that I have read or am familiar with the provisions contained in Chapter 2; Art. VII, Division 3, entitled "Lobbyists" of the Miami Beach City Code and all portin. e• ire.•ent Signature of Lobbyist; • Date 12.. ` 22, Tana M.Kozlowski . Signature of Principal: Date 12 f.1 ( ?o22. • VII. NOTARY SIGNATURE AN5 SEAL: LOBBYIST: PRINCIPAL State of Florida • (( . State of 1,n 4 At 'Cor-f%J c/`. .. County of: . Miami-Dade County of:: 6 f Jr(gy AA Sworn to(or affirmed)and subscribed before me,. Sworn to(or affirmed)and subscribed before mc, by means of' physical presence • by means of•❑ physical presence or 0 o li eh ot'ariza�n�, � or•❑ online notarization, this ay .of. 20� this:_day of. 20 ,by : Liana M. Kozlowski. . N. . NAME OF LOBBYIST _• NAME OF PRINCIPAL ll11 _Produced ID Produced ID • FORM OF IDENTIFICATION F IDENTIFICATION • X Pe . ally Known • 4 Persona y •wn Signature of Notary Public 4111111 Signatu Notary Public • Name of Notary,Typed, Printed or Stamped :me of Notary,Typed, Printed or Stamped • (NOTARY SEAL) r► ELOISAF.STHERBORROTOJ.OPEZ (NOTARY SEAL) +I'.N'•v * * . ConrrnissbnitHH 283736 414t7 Expires July 23,2026 • 1 The term"lobbyist"specificaRtxcludes the following persons: Expert witnesses who provide only scientific,technical or other specialized information or testimony in public meetings; any person who only appears as a representative of a neighborhood association without compensation or reimbursement for the appearance,whether direct, indirect or contingent, to express support of or opposition to any item; and any person who only appears as a representative of not-for-profit community based organization for the purpose of requesting a grant without special compensation or reimbursement for the appearance:. • Page of 5 :CALIFORNIA.JURAT WITH AFFIANT.STATEMENT GOVERNMENT CODE§8202 . • . cSee Attached Document.(Notary to cross out lines:1. 0 below) �❑See Statement Below'(Lines 1-6 to be completed only by document signer[s], not'Notary) • i9 attire of Document Signer No: 1 Signature of Document Signer No. 2"(if any) A notary public or other officer completing this certificate verifies only,the identity of the individual Who signed the. document to which this certificate is attached,and not the truthfulness,accuracy,or validity of that document. : • State of California •Subscribed: and sworn to (or affirmed).before the County"of Orange on.this I •• day of i2 c Q,-y*z/ , 2072=, by' Date : . Month Year . . (1) :. ,5`� rtif LYNNAE STOEHR NELSEN (and (2) : . )+ .� � Notary Public•California _ Name(s)-of Signers) fsir = Orange County . . �,� Commission it 2374675 <<,:aMy Comm:Expires, Sep it 2025 proved to:me on the basis of satisfactory. .evidence to be the person(s)- who appeared before me. . . Signat nature of Notary Public • Sea! Place Notary.Seal Above OPTIONAL . Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document ' Description of Attached Document • Title or Type of Document: Document Date: • Number of Pages: " " Signer(s)Other Than.Named Above: ©2014 National Notary Association •www.NationalNotary:org 1-800-US NOTARY(1=800-876-6827) Item#5010 • MIAM1:BEACH .. City of Miami Beach;1700 Convention Center Drive Miami Beach,Florida 33139,www.miamibeachfl.gov, Office of the City Clerk Rafael E.Granado,City Clerk CityClerk@miamibeachfl.gov Tel 305.673.7411, Fax 305.673:7254 NAME OF LOBBYIST: Liana M. Kozlowski 1). LOBBYIST FEE EXPENDITURE AND COMPENSATION STATEMENT : Pursuant to City Code Section 2-485(d), the City 'Clerk shall notify any lobbyist (or principal)who fails to file timely a Lobbyist Fee Expenditure and Compensation.Statement (Statement). :In addition to any other penalties; that may be imposed as provided. in Section.2-485.1:,.a.fine of.$50.00'a:day shall.be:assessed for. Statements 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 of each year, 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. I hereby acknowledgethat:on February 28 of each year, I:shall submit to the City Clerk a signed:Statement. under oath listing all lobbyist expenditures, as well as compensation received,for the preceding calendar year with regard to the specific issue on which.I have been engaged to lobby.' 2) .. LOBBYIST WITHDRAWAL Once an issue I have registered to lobby has concluded or I am no longer lobbying on that issue, I shall immediately file a Notice of Withdrawal with the Office'of the City Clerk,.. 3) ANNUAL:LOBBYIST REGISTRATION FEE I understand annual registration of all:lobbyists shall be required for each 12-month period commencing October 1 of each year, and the fee for such annual registration shall be $500.00 pursuant to Section•2-482of the Miami Beach City Code. /z 6 2.2 . Si•, re of L byis Liana M..Kozlowski Date F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 03-11-20 REG.doa . Page5of5 • • THE CONFIDANTE MIA1VII BEACH .. :. .. Organizational Chart ' . • .. : - PUBLICLY TRADED •. • . • : . . SUNSTONE HOTEL INVESTORS, INC.,• • • . :a Maryland corporation. • . . EIN 20-1296886 - 100% UN.CHP I, INC,. 9.0 08 0.. 90•9 .a Delaware corporation .. : . . ' EIN 20-3761692 . . . ..SUN SHP II, •LLC, 98:9%°' . - a Delaware LLC . EIN 20-3761744 • SUNSTONE HOTEL.PARTNERSHIP, LLC, ' - . • a Delaware limited liability Company - ("OP") . . • EIN 20-1646175. 100% SUNSTONE HOTEL TRS LESSEE,INC., . .. • ' a Delaware corporation 100% . («TRS„ • • 100%. GOLDEN PALMS,LLC., GOLDEN PALMS LESSEE,INC., • • ' a Delaware limited liability company • a Delaware corporation • • • EIN:XX-XX}OCX30C EIN:XX-XX)0000C • Land,Building,FF&E Vehicles,Inventory,Supplies .N\,_ i Management'Agreement r ' Operating Lease. : • • The Confidante Miami Beach , FF&E-. 1 1 . 4041.Collins Ave : - :Hyatt Corporation .Miami Beach,.FL 33190 - J MBF o City Hall 1700 Convention Center Dr. Miami Beach , FL 33139 a�i x 305-673-7420 Welcome M'v 005855 0005 Adrian U. 12/16/2022 12:05PM • .. rt ws °' MISCELLANEOUS z ` E -g> Reference 1 MCR430936 NCR OPEN (MCR) ,�• = 2335002 Item: NCR 1 (� .00 MCR OPEN (MCR) 350.00 350.00 t 'r Subtotal 350.00 �: Total 350.00 t.,,., 4 J ' �'= x� �" a CHECI( 350.00 o ," - Check Number022515 V L. s 0° '` • Change due 0.00 Paid by: BILZIN SUMBERG BAENA PRICE & • O Z g *t� o o ac•.4. 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