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William w. Riley, Jr. - Savoy Hotel Partners, LLCi City f Miami Beach Office of the City erk ,�X k tY �l �- yti� 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,Jr. WILLIAM W. NAME OF LOBBYIST: (Last) (First) (M.1) 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 wrileyla-bilzin.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: I. LOBBYIST RETAINED BY: SAVOY HOTEL PARTERNS, LLC NAME OF PRINCIPAL/CLIENT: 770 Lexinton Ave New York NY 10065 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 212-317-7770 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: Eric D. Hadar • 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 property at 400, 410&420 Collins Avenue and 2214 Street 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 and staff n/a A �.> : i IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE 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�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 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�No: Are you representing a not-for-profit corporation or entity without special compensation or reimbursement? V. SIGNATURE UNDER OATH: ON FEBRUARY 28TH 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 L,/;, , ' Sig ure of Lobbyist 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 they Miami Beach City Code all reporting requirements. Signature of Lobbyist: 11,41 V" Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: P oduced ID 0 Produced ID Form of Identification Form of Identification Personally known (Lobbyist) 0 Personally known(Principal) VII.SIGNATURE AND STAMP YIV 'ARY: IBISDIAZ * MY COMMISSION#DD 994845 State of Florida, County of Mia r EXPIRES:May 24,2014 State of Florida, County of Miami-Dade Sworn to and sub cribed before M.;PLOV Bonded Thru Budget Notary SeMoes Sworn and subscribed before me This day f ,20 This day of ,20 Signature o Pu lic Notary—State of o a Signature of Public Notary—State of Florida Notarization of Lobbyist's signature Notarization of Principal's signature FOR CLERK'S USE ONLY 2 Annual Registration fee: []Yes[ ] No Amount Paid 3 s0 MCR#g 7 ��Date Paid L r � Lobbyist Registration Form received and verified by: Revised 05/05/2010 i IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE 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 qN08 Are you lobbyinci 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 VNo: 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 VNo: Are you representing a not-for-profit corporation or entity without special compensation or reimbursement? V. SIGNATURE UNDER OATH: ON FEBRUARY 28TH 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. Signature of Lobbyist I do solemnly swear hat all of the.foregging 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: C Produced ID 0 Produced ID Form of Identification Form of Identification C Personally known(Lobbyist) seXpersonally known(Principal) LOREDANAM.LONGARPi y VII. SIGNATURE AND STAMP OF NOTARY: NOTARY PUBLIC.STATE()F NEIL fd0.01=LO6053770 AJ LIFTED IN�tlb fi CITY State of Florida,County of Miami-Dade State of-pieoda, County of Sworn to and subscribed before.me Sworn and subscrib ed before me This day of , 20 This d Y day of /lu , ,20� F Signature of Public Notary—State of Florida Signature of Public Notary— - idaki , � I Notarization of Lobbyist's signature Notarization of Principal's signature i FOR CLERK'S USE ONLY Annual Registration fee:[]Yes[ ] No Amount Paid MCR# Date Paid I Lobbyist Registration Form received and verified by: Revised 05/05/2010 MIAMI BEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.jov 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. Sign re: Date/. MIAMI 2896687.1 7765528945