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William W. Riley, Jr. - Versailles on the Ocean • ■ 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 Avenue, Suite 2300, Miami, FL 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) Zip Code) 305 - 375 -6139 305 - 351 -2285 wrileyebilzin.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: I. LOBBYIST RETAINED BY: Versailles on the Ocean, LLC NAME OF PRINCIPAUCLIENT: 404 Fifth Avenue, Suite 600 New York NY 10018 ' 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: Joseph Chetrit, • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP • INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: • - II. SPECIFIC -LOBBY ISSUE: All land use /zoning matters regarding application for property at 3425 Collins Avenue, Miami Beach, FL 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 and n/a c7 staff — • o c c r ---+ _ rn W O © 71 EV 'Q7 f-rl (/ Sr IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, ' • FLAT RATE OR OTHER) A) LOBBYIST DISCLOSURE: (Required) $435/hr t 3) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $435/hr Q / , „ ' a The following information must be answered: Q � ,-'4... ( ! ' 1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By ibbbyiskivOn " `} Procurement Issues ": : L` '� ❑ Yes El 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? L`' 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On, Real Estate ' Development Issues ": • ❑ Yes Q 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 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.. ❑ Yes Ea No: 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 I 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 P IOD. Li r /t ‘' Sign re of Lobbyist i 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 a 0 reporting requirements. 'Signature of Lobbyist: __. /%/ ' F Signature of Principal /Client: / Ca i % — - - VI. LOBBYIST IDENTIFICATION: PRINCIPAL !DENT/ I TION: Produced ID Li Produced I n Form of Identification r Form of Identification LOIS HUTTER SANC,HEZ Personally known (Lobbyist) it Personally known (Principal) Notary Public, State of New York i No. 01 HU504251$ 2' M Y ' '' i "6A AND STAMP OF NOTARY: Qualified in Queens C►ou Commission Ex ires 20 1 `�..) * EXP a 0 \4 to &Watt P Aprii 24, _ & '41 - {• ' ounty of Mia oe o .�° , 01 1 6,, State off , County of .°F PI ' wor o an su scribed beforriom mama :S3 aremta HIdX3 - r 1,!1, . "_ ' Sworn and subscribed before me This.! 7 day of October, _ 01 CM0 33 # NOISSI11100 All * %` ` -'\ 4 This AS ay of October, 2011 i r / 1 / - • Hl san3 4, 6;;:,-,,;;;N.0+ -,,;;;1o+ ' Signat 40 Public Notary — rs) of Florida Signature of Public Notary Stat ofd Nom^' 1o10c.. Notariz - on of Lobbyist's signature Notarization of Principal's signature ' FOR CLERK'S USE ONLY 22 Annual Registration fee: [ ] Yes [ ] No Amount Paid 3 v0 MCR #✓ f 0J7 Date Paid 0 ' // • Lobbyist Registration Form received and verified by: ■ prim asir Revised 05/05/2010 �. I I , iI MIAMI BEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov LOBBYIST NAME: William W. Riley, Jr. I understand that no later than February 28 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 1, 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. I Signs e: Date: • r 7 T1 CD to MIAMI 2628520.1 7954836356 , . 10/25/11 Co