William W. Riley, Jr./The Decoplage Condo AssociationCity 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 Sumbera Baena Price & Axelrod LLP 200 So Biscayne Blvd. Miami, Florida 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305 375 6139 305 351 2285 WRILEYI gnbilzin com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
LOBBYIST RETAINED BY:
The Deco la e Condominium Association Inc.
NAME OF PRINCIPAL/CLIENT:
100 Lincoln Road Miami Beach Floridra 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-672-3594 305-672-7295
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:The Decoplage Condominium Association, Inc./Sherry
Roberts
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST:
SPECIFIC LOBBY ISSUt:
Application to the Board of Adjustment for Property located at 4041 Collins Avenue
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
~ Building Department. ~ none ~
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER)
A) LOBBYIST DISCLOSURE: (Required) $325 per hour
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $325 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 B 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 0 No: Are you lobbying on a pending application for a Development Agreement with the City or application for
change of zomna 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 0 No: Are you representing anot-for-profit corporation or entity without special compensation or reimbursement
V. SIGNATURE UNDER OATH:
ON OCTOBER 151 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.
Y ti/ .
Sign ure of Lobbyist - i iam W. Riley, Jr.
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/nd all re~rti requirements.
Signature of Lobbyist: _ ,~/,( `^~~~(/~
William W. Riley'
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
^ Produced ID
Form of Identification
Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn to end subscribed before me
Thiscs~ day of ~~20 ~
PRINCIPAL IDENTIFICATION:
Produced ID
Form of Identification
Pe sonally known Principal)
~ oc~. ~
State of Florida, County of Miami-Dade
Swo n bscri d bef re me
Thi ~ , d~ of _~, 20~
5igna i 'd
Notar ,L '9f P~1.~a ~t~LF~
""~•Rf;f.~~,, Raided Thru F~ichartl Insurance Agency ~' ~ ~ ~ ``~ ` e m 9r ~ 'S USE ONLY
] No Amount Paid la°~)sse-oass F ridePlotaryservi~. to Pai ~ ~
Lobbyist Registration Form received and verified by:
F:\CLER\$ALL\MARIA-M\LobbyistlLOBBYIST FORM 05.doc „~-- Revised 12/08/04
MIAMI 1635 772.1 783 9731062
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 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.
W .~ ~/a~-/~S
Si ature: Date: