Attachment A – Business
Principal Disclosure
CITY OF PALM SPRINGS – PUBLIC INTEGRITY DISCLOSURE
APPLICANT DISCLOSURE FORM
(Revised 05/16/19)
PUBLIC INTEGRITY DISCLOSURE
APPLICANT DISCLOSURE FORM
1. Name of Entity
2. Address of Entity (Principle Place of Business)
3. Local or California Address (if different than #2)
4. State where Entity is Registered with Secretary of State If other than California, is the Entity also registered in California? Yes No
5. Type of Entity
Corporation Limited Liability Company Partnership Trust Other (please specify)
6. Officers, Directors, Members, Managers, Trustees, Other Fiduciaries (please specify) Note: If any response is not a natural person, please identify all officers, directors, members, managers and other fiduciaries for the member, manager, trust or other entity _________________________________________________ Officer Director Member Manager [name]
General Partner Limited Partner
Other ____________________________________
_________________________________________________ Officer Director Member Manager [name]
General Partner Limited Partner
Other ____________________________________
_________________________________________________ Officer Director Member Manager [name]
General Partner Limited Partner
Other ____________________________________
Serena 386, LLC
3080 Bristol Street, Suite 630, Costa Mesa, CA 92626
--
California
■
Suncal Serena, LLC ■ ■
SP Serena Park LLC ■
See Section 6 Supplement Attached
CITY OF PALM SPRINGS – PUBLIC INTEGRITY DISCLOSURE
APPLICANT DISCLOSURE FORM
(Revised 05/16/19)
7. Owners/Investors with a 5% beneficial interest in the Applicant Entity or a related entity
EXAMPLE
JANE DOE
[name of owner/investor]
50%, ABC COMPANY, Inc.
[percentage of beneficial interest in entity
and name of entity]
A.
[name of owner/investor] [percentage of beneficial interest in entity and name of entity]
B.
[name of owner/investor] [percentage of beneficial interest in entity and name of entity]
C.
[name of owner/investor] [percentage of beneficial interest in entity and name of entity]
D.
[name of owner/investor] [percentage of beneficial interest in entity and name of entity]
E.
[name of owner/investor] [percentage of beneficial interest in entity and name of entity]
I DECLARE UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF CALIFORNIA THAT THE FOREGOING IS TRUE AND CORRECT.
Signature of Disclosing Party, Printed Name, Title Date
PENALTIES
Falsification of information or failure to report information required to be reported may subject you to administrative action by the City.
See Section 7 Supplement Attached
J Randolph Poag - authorized signatory
May 29, 2024
305853_2
City of Palm Springs – Public Integrity Disclosure – Applicant Disclosure Form Serena 386, LLC
Section 6 Supplement – Business Entity Disclosure
Suncal Serena, LLC (15% managing member of Serena 386, LLC x PNG1, LLC (sole member)
o Kendra Elieff (manager and sole member)
o Jeffrey Benice (manager)
o J. Randolph Poag (manager)
SP Serena Park LLC (85% member of Serena 386, LLC)
x SP Serena Parent LLC (sole member and manager)
o Silverpeak Co-Invest LLC (sole member/manager)
Non-Member Managers: Brett Bossung and Mark Walsh
AD SP Holdings LLC (5% member)
x Arash Dilmanian (sole99% member/manager)
Silverpeak Capital V LLC (82.55% member/manager)
x Silverpeak Capital Holdings LLC (66.67% member/manager) o Silverpeak Capital LLC (sole member/manager)
Brett Bossung and Kenneth Bossung (50%
beneficial members)
Mark Walsh and Lisa Walsh (50% beneficial
members)
x VARK Investments LLC (33.33% member)
o Kaushik Amin (manager / 65.3949% direct & beneficial
member)
o Rosebud Elijah (34.6051% direct & beneficial member)
No other member has 5% or more interest
Section 7 Supplement – Natural persons with beneficial financial interest in Serena 386, LLC Name Percentage of beneficial interest and name of entity A. Kendra Elieff 100% PNG1, LLC
B. Kaushik Amin 65.3939% VARK Investments LLC
C. Rosebud Elijah 34.6051% VARK Investments LLC
D. Brett Bossung 50% Silverpeak Capital LLC (with Kenneth) E. Kenneth Bossung
F. Mark Walsh 50% Silverpeak Capital LLC (with Lisa)
G. Lisa Walsh
H. Arash Dilmanian 99% AD SP Holdings LLC