William W. Riley, Jr. - Kevin Colket 4 w 0 1AJe
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MIAMI BEACH At
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.
Riley William W. , Jr.
NAME OF LOBBYIST: (Last) (First) (M.I)
BILZIN SUMBERG BAENA PRICE & AXELROD LLP, 1450 Brickell Ave. , #2300, Miami, FL 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 375-6139 (305) 351-2285 wriley @bilzin.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes:address,phone, or e-mail address.
1. LOBBYIST RETAINED BY:
SEE ATTACHED SHEET
NAME OF PRINCIPAL/CLIENT:
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: KEVIN COLKET
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST:
N.SPECMI. 8BY II
Governmental land use and permitting issues for The Perry South Beach and the properties
located at 201 Collins Avenue; 2377 Collins Avenue, 2340 Collins Avenue and 2322
Issue to be lobbied(Describe in detail): Go.Llins Avenue,Miami Beach, FL
In.CITIVASSI 1CIEM.WdIVID' 10 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 eneral 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
Building Department; Fire Department;
Planning and Zoning Department; City
Manager's Office; Planning Board; Histori Preservation Board
Pursuant to City Code Section 2.482(8)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
1 3 zi
v ,
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLA T RA TE OR OTHER)
A)LOBBYIST DISCLOSURE: (Required) $460/hr
B)PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):(Required). $460/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 ONo: 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 ONo: 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.. I
❑ Yes ONo: Are you representing 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 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.
V
Williaffi W. Riley,Jr.
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: `',/• ✓
William W. RR , Jr.
2377 Collins Resort, L,P., a Delaware limited partnership
By: 2377 Collins Resort GP, L.L.C., a Delaware limited liability
company,its en /Pa ner
Signature of Principal/Client: By:
Kevin olket,Vice President
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
SHaRr J.naval:
❑ Produced ID �/Personally roduced ID N0M8yPUBLIG
Form of Identification Form of Identificati NO. 158995
known Princi al �MI�ON EXPIRESAUG.3,,2GPersonally known{Lobbyist) (Principal))
VII.SIGNATURE AND STAMP OF Nq;A ELIZABETHOf4TiZ Lai,#
State of Florida, County of Miami-D * MY COMMISSION#EE 043223 State of County of
ir EXPIRES:December f7,2014 Swor subscri before me Sworn to and subs r'b d before me ��''oFF . BordedThruBudgetNotary Sakea This da of ,2012
This day of 0 2 , Y
Signatur rnof blic Notary-St e of Flo ' a Signature of Public Notary-State of Florida
Notariz t' Lobbyist's signature Notarization of Principal'-signature
FOR CLE�NLY
Annual Registration fee:[]Yes[ ]No Amount Paid MCR# Date Paid 71/0 v
Lobbyist Registration Form received and verified by:
Revised 05/05/2010
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
MIAMI BEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach,Florida 33139,
www.niiamibeachfl.gov
LOBBYIST NAME: William W. Riley, Jr.
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.
l /; L/ -/ /,-)- 0i,:�,
Signat e: Date:
MIAMI 2911687.1 7957236593