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William W. Riley, Jr. - Sherry Frontenac Resort, Inc. 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 Sumbero - 200 South Biscayne Boulevard. Suite 2500. Miami. Florida 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) Zip Code) 305-375-6139 305/351-2285 wrileyt'a~Ca)bilzin.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: LOBBYIST RETAINED BY: Sherry Frontenac Resort. Inc. NAME OF PRINCIPAL/CLIENT: 6565 Collins Avenue. Miami Beach. FL 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 866-2122 (305) 866-8853 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: • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: II. SPECIFIC LOBBY ISSUE: Land Use and zonini? for property known as the Sherry Frontenac located 6565 Collins Avenue 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 Board of Adjustment and staff None 1~1.1~0 4,+,lea~ ~.~~?"tl~~.,~,~j ~~ nAMI IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER) A) LOBBYIST DISCLOSURE: (Required) Hourlv $385.00 B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). Hourlv $385.00 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 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 ®No: 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 anot-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 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. W V, Wil ' m 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 Mi mi B~eac~h Cit o and all reporting requirements. Signature of Lobbyist: ~ "y . ~' Signature of Principal/Client: f "~ VI. LOBBYIST IDENTIFICATION: ^ Produced ID Form of Identification ~o Personally known (Lobbyist) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade Sworn to and subscribed before me day nf~_ a.... , 20i U PRINCIPAL IDENTIFICATION: ~, Produced ID TZ• dam/ ye2;,s' ~-t a.e-nse Form of Identification ^ Personally known (Principal) State of Florida, County of Miami-Dade Sworn and subscr' d before me This„~_ day of ...~v r~~~us519.uR dFJ~ate of Florida Si at of Public Notary - S arF~8~i69~0afeln~bpyl~js nature Notarization of Principal's si '~,'~ Bonded Thru Pickard Insurance Agency ,, FOR CLERK'S USE ONLY g '~ Annual Registration fee: [ ]Yes [ ] No Amount Paid_~MCR #~~~/Z~Date Lobbyist Registration Form received and verified by: ~ /) ~ F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST FORM 05.doc U ~A' COMMISSION # DD 608767 EXPIRES: December 17, 2010 Bonded Thru Pickard Insurance Agency ~~ 12/08/04 b ~~ .., 'q City of Miami Beath, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov CITY CLERK Office CityClerk@miamibeachfl.gov Tel: 305.673.741 1 ,Fax: 305.673.7254 Acknowledgement of fines/suspension from lobbying for failure b comply with City of Miami Beach lobbying Laws LOBBYIST NAME: ~ I I understand that no later than Ocbber 1st of each year, lobbyists subject to lobbyist registration requirements shall submit to the city clerk a signed statement under oath listing all 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 have been no expenditures or compensation. during the reporting period. The statement shall list, in detail, each expenditure by category, including food and beverage, entertainment, research, communication, media advertising, publications, travel, lodging and special events. FAILURE TO TIMELY FILE THE EXPENDITURE AND FEE DISCLOSURE REPORT WILL RESULT IN A FINE OF $50.00 PER DAY. ANY LOBBYIST WHO FAILS TO FILE THE REQUIRED EXPENDITURE REPORT BY DECEMBER 1, SHALL AUTOMATICALLY BE SUSPENDED FROM LOBBYING UNTIL ALL FINES ARE PAID, UNLESS THE FINE HAS BEEN APPEALED TO THE MIAMf-DADS COUNTY COMMISSION ON ETHICS AND PUBLIC TRUST. In the event a lobbyist fails to either file the report and/or pay the assessed fines, the Clerk shall notify the Miami-Dade County Commission on Ethics and Public Trust. 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. Sig ature: ate: