Atlantic Indian Creek 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, derision, recommendation of
the City Manager or any city board or committee; or any action, decision or recommendation of any city personnel defined in any
manner in this section, 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.I.)
Bilzin Sumberg Baena Price & Axelrod LLP, 200 So. Biscayne Blvd., Suite 2500, Miami, Florida 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-375-6139 305-351-2285 wriley~bilzin.com
TELEPHONE NUMBER: FAX NUMBER:
I. LOBBYIST RETAINED BY:
ATLANTIC INDIAN CREEK, L.C.
EMAIL:
NAME OF PRINCIPAL/CLIENT:
18851 NE 29 AVENUE, SUITE 901
AVENTURA, FL
33180
BUSINESS NAME AND ADDRESS (Number and Street)
305-931-4959 (305) 931-4606
TELEPHONE NUMBER: FAX NUMBER: (Optional)
(City)
(State) (Zip Code)
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: JEAN PIERRE REIN
· IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5%
OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST:
OR MORE
II. SPECIFIC LOBBY ISSUE:
Application (Variance) Board of Adjustment - 6529 Indian Creek Drive
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/Title I B) Any Financial, Familial or Professional Relationship
Board of Adjustment & Staff I NONE
MIAMI 886379.1 7319010200
Yes
Yes
Yes
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION
WHETHER HOURLY, FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) $240.00 per hour
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required).
No: X Are you representing a not-for-profit corporation or entity without special
reimbursement. Pursuant to Ordinance No. 2004-3435.
1)
(DISCLOSE
$240.00 per hour
compensation or
Pursuant to Ordinance No. 2003-3393 Amending Miami Beach City Code Chapter 2. Article VII. Division
5 Thereof Entitled "Campaign Finance Reform" Via The Addition Of Code Section 2-488 Entitled
"Prohibited Campaign Contributions By Lobbyists On Procurement Issues":
No: X Are you lobbying on a oresent or pending bid for goods~ equipment or services~ or on a present or
oending award for goods, equipment or service?
2)
Pursuant to Ordinance No. 2003-3395 Amending Miami Beach City_ Code Chapter 2. Article VII Division
5 thereof Entitled "Campaign Finance Reform". Via The Addition Of Code Section 2-490 Entitled
"Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues":
No: X Are you lobbyine on a pending apolication for a Development Agreement with the City or
application for change of zonine mad designation or change to the City's Future Land Use Map?
V. SIGNATURE UNDER OATH:
ON OCTOBER 1 ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK 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. ~/~ Sig~ ~ture ~~okbyist
I do solemnly swear that all of the foregoing facts are tree and correct and that I have read or am familiar with the
provisions contained in Section 2-482~f the Iv~Irr6 Beach City Code and all reporting requirements.
Signature of Lobbyist: k/j/~t/
Signature of Principal/Client:/' A c~r .~-~ ~
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
[] Produced ID [] Produced ID
Form of Identification Form of Identification
[] Personally known (Lobbyist) ~ Personally known (Principal)
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This ~ay ~ ~. ,20 0~'.
-
Signature of Public Notary- St'~,-~f Florida
Notarization of Lobbyist's signature
State of Florida, County of Miami-Dade
Sworn and subscribed before me
Th~of~."~ ,20 ~O~
Sil~tu~e of Public Notary - State of Florida
Notariiation of Principal's si~
Annual Registration fee: ~t'] No Amount PgRtx~]~/~, ,~gR ~ '//~/~ Date Paid
Lobbyist Registration Form received and verified b~fff, c~.j
F: CLER~LLWI~BBYIST~LOBBYIST FORM 04
Revised 02/10/04