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William Riley/Fontainebleau Resorts 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. NAME OF LOBBYIST: Riley (Last) William w., Jr. (First) (M.I) Bilzin SumberQ Baena Price & Axelrod LLP, 200 South Biscayne Blvd.. Suite 2500, Miami, Florida 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) Zip Code) 305-375-6139 TELEPHONE NUMBER: 305-351-2285 FAX NUMBER: wrileyl@bilzin.com EMAIL: I. LOBBYIST RETAINED BY: Fontainebleau Resorts NAME OF PRINCIPAUCLlENT: - Glenn Schaeffer 4441 Collins Avenue, Miami Beach, Florida 33140 BUSINESS NAME AND ADDRESS (Number and Street) 305-538-2000 TELEPHONE NUMBER: (City) (State) (Zip Code) 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: II. SPECIFIC LOBBY ISSUE: Master Plan for Fontainebleu Hotel Issue to be lobbied (Describe in detail): III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: A) Full Name of IndividuallTitle B) Any Financial, Familial or Professional Relationship Planning and Zoning Department none Historic Preservation Board none Planning Board none City Manaqer's Office MIAMI 1265307.\ 7650823990 IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RA TE OR OTHER) A) LOBBYIST DISCLOSURE: (Required) $295,,/hourIV B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $295 /hourlv 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": DYes [X]No: Are YOU 10bbyinQ on a present or pendinQ bid for Qoods, equipment or services. or on a present or pendinQ award for Qoods. equipment or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": DYes IRI No: Are you 10bbyinQ on a pendinQ application for a Development AQreement with the City or application for chanQe of zoninQ map desiQnation or chanQe 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.. DYes [XJ No: Are YOU representinQ a not-for-profit corporation or entity without special compensation or reimbursement? V. SIGNATURE UNDER OATH: ON OCTOBER 1st 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.J! L/ (j)f Si~Of LObbYi~ 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 Cit ode an reporting requirements. G ' '~::'iH~ IDENTIFICATION: Signature of Lobbyist: Signature of Principal/Client: ~M~m'- VI. WR....1j5;T IDENTIFICATION: Produced ID Produced ID Form of Identification ~rsonally known (p.:,. i",oII) '-0 lo"Yu.-\ ./ -/5 Form of Identification Personally known lb.ehll~ ilt) .p"",,^~, VII. SIGNATURE AND STAMP OF NOTARY: ~A.. ~\o.t\l... State of ~a, County of Mi R'li OaQii. Sworn d subscr"bed before me hi ayof ( ,20~ '. ,~..",~ IB&S mAl State of Florida County of N'''~ MY COMMISSION II DO S29254 , - , . : EXPIRES' May 18 2010 Sworn and subscribed befor ",,: " ._ 1"'iJ~.. Bonded ThrU PIdlerd IMUI8l'tCI no--' Th~m....'~ '" Signa Public Notary - State of FlOrida Notarization of~signature 1.0.--,' ~~ ~~ONLY tJ szl V Ll MCR . 1/ ! Revised 12/08/04 . \tIONICA'" ,NotIfY,' NIII~ ... ......,.. AWT. NO. OIl.,.....'., ...---- . MIAMI 1265307.\ 7650823990