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William W. Riley/Cabi DevelopersCity 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. Rile William W• NAME OF LOBBYIST: (Last) (First) (M.I) Bilzin Sumberg Baena Price & Axelrod LLP 200 South Biscayne Boulevard Suite 2500, Miami Beach FL 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) Zip Code) 305 375 6139 (305) 351 2285 wrilev~cr)bilzin.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: LOBBYIST RETAINED BY: Cabi Develo ers NAME OF PRINCIPAL/CLIENT: 19950 West Count Club Drive #900 Aventura FL 33180 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-466-1810 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: :Elias Amkie • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: SPECIFIC LOBBY ISSUE: Land use and zoninq issues for property located at 4100 and 4120 Pinetree Drive and 340 West 42"d Street. Miami Beach Florida 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 Planning Board, Historic Preservation Board, none : Board of Adjustment a _.. ._. .. ~ none Design Review Board I none IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER) A) LOBBYIST DISCLOSURE: (Required) $325 00 per hour B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $325.00 per hour 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 lobbvinq 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 ~^ No: Are you lobbvinq 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 snot-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 OCTOBER 15~ 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. h/ W • ~- Willi W. Riley 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: Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: ^ Produced ID Produced ID Form of Identification Form of Identification Personally known (Cobb ""~"- Personally known (Principal) ;~,:~~:e~~~. MERCEDES PADRON MY COMMISSION q DD 608768 VII. SIGNATURE AND STAMP O ~1~Y: EXPIRES: November 9, 201G ~~~'£A,f„Fh`~~, sondes Thru Pichard Insurance Agency State of Florida, County of Miami- ate of Florida, County of Miami-Dade Sworn to and subscribed before me Sworn and subscribed before me This 1~ day of-~~ 2008 This day of , 2008 ,%: Signature bf Public Notary -State of Florida Signature of Public Notary -State of Florida Notarization of Lobbyist's signature Notarization of Principal's signature FOR CLERK'S USE ONLY ~ *- ~~ ~~ Annual Registration fee: [ ]Yes [ ] No Amount Paid `~ MCR # ~~•~~~ Date Paid Lobbyist Registration Form received and verified by: F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST FORM 05.doc Revised 12/08/04 =f ziC ;'2-rte.-~L2.= IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER) A) LOBBYIST DISCLOSURE: (Required) $325 00 per hour B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $325.00 per hour 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 lobbyina on a present or pending bld for aoods equipment or services or on a present or pendina award for aoods, equipment or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Reai Estate Development Issues": ~ Yes '~^ No: A_re you lobbying on a pendina application for a Development Aareement 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 snot-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, shaft not be required to pay any registration fees.. C_I Yes ~? ; No: Are you representing a not-for-profit corporation or entity without special compensation or reimbursement? V. SIGNATURE UNDER OATH: ON OCTOBER 15S OF EACH YEAR, EACH LOBBYIST SWALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION RECEIVED, IN TWE C[TY OF MIAMI BEACH FOR 7HE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. ~. ~. Willia W. Riley 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: Signature of PrincipaUClient: _ VI. LOBBYIST IDENTIFICATION: I.' Produced ID PRIN~IPAL IDENTIFICATION: ltY Produced ID ~~~5 ~0 ~~ Form of Identification Form of Identification ~% Personally known (Cobb ==-- . ~ Personally known (Principal M ~CED~0~8'I66 :~K^.^~~~: Idi:i9CEDESPADRON , ~:r'vi;,' MISSION• 2p10 PAY COMMISSION ~ DD 606758 ;P°.. .;:-: MV COM vembe~ 9, encv VII. SIGNATURE AND STAMP O ~~': EXF)RES:Novemh.~rs,20tr i =;•` '."= EXPtRES~ct°,srainsu~~A° '~P.M~; BoroedThruPichardlns;ranceAgenc~ "y'•, 'e' BondedThN State of Fbrida, County of Miami- ate of Florida, County of Mi , Swom to and subs~nbed before me Swom d subscribe b fore " This i~ day of 7~-~.-r~' , 2008 Th' ~ day of ~ , 2008 ( ~ - fi • 9. ~. ~~ i;~~.t ltd) Signature $f Public Notary -State of Florida Signatu a of Public Notary -State of Fforida Notarization of Lobbyist's signature Notariz tlon of Principal's signature FOR CLERK'S USE ONLY c~ ~ ~ Annual Registration fee: [ ]Yes [ ] No Amount Paid MCR / S3 Date Paid ~/ Lobbyist Registration Form received and verified by: ~ ' F:ICLERI$ALLIMARIA-M1LobbyistlLOBBY{ST FORM 05.doc -- ~ '. Revised 12/08/04 MIAMI BEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.~ LOBBYIST NAME: WzLLIAM W. RILEY 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. ~ ~ ~ Will' m W. Riley Date: MIAMI 1603631.1 7644823491