Loading...
Jason P. Neal/Waste Management Inc. Of Florida 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 20 43435. ~_ NAME OF LOBBYISZ: (Last) (First) (M.I) ~, BUSINESS NAME AND ADDRESS 3~S~Sy~--~p02 TELEPHONE NUMBER: I. LOBBYIST RETAINED BY: ~,~s~ ~~~ NAME OF PRINCIPAUCLIENT: 021~~ N~ 1 c? Lt~r/~-T 1~~~~ , ~G. ~31d ~ BUS~SS~IANJE AND ADDRESS (Number and Street) (City) (State) (Zip Code) TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) ~3D.~- ~~1 ~ -- ~o z 3o.~-s~~~- L/~~~ Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)] • NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: ~~~ l/~`l"~A/~il~~j ~~ • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIREFTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: ~/ /~ II.SPECIFIC LOBBY ISSUE: to be lobbied (Describe in detail): Cl-~-il~9-" ~~~ ~t~7 III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: (Pursuant to city code section 2-4s2(g) include a statement of the extent of any business, financial, familial, professional or other relationship, giving raise to an appearance of an impropriety, with any City personnel sought to be lobbied; further, pursuant to City Code Section 2- 482(a)(4) include a statement of any contractual relationship (paid or unpaid) from 12 months preceding the commencement of service of City personnel to be lobbied.) A Full Name of Individ al T itl e u B) Any Financial, Familial or Professional Relationship ` ~ ~ ^ ~~ f C~-~ V ~ /"~~G~~S ~~~ ~j~- f' / ~ ~'~Ti j~ " /~©/~~ ~tS ~ 1 ~~ 6' ~3Q 800Z %i~ ~W rD cvv~e i , 7~~y~1~ ~G ,~~31~~ ~" o2laS and Street) (City) ~ ©~-sy~- ~~~~ (Zip Code) ii/~L o2 ~G/ly1 ~b~''') FAX NUMBER: tMAIL: fJ IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) ~/~/~ ~- ~"~G~~~j,~~~ B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): ~/y1 ~ ~~~~~~C777'lt (Required). ~"TT~~ ~~~° ~`'~~ 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": L~J Yes ^ No• Are you lobbvina on a present or pendina bid for aoods, eauipment or services, or on a present or pendina award for aoods eauipment or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": ^ Yes LN' No• Are you lobbvina on a pending application for a Development Agreement with the City or application for change of zoning map designation or change to the Citv'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 snot-for-profit corporation or entity without special compensation or reimbursement. . V. SIGNATURE UNDER OATH: ON OCTOBER 1sT OF EACH YI STATEMENT UNDER OATH. LIST IN THE CITY OF MIAMI BEACH F EVEN IF THERE HAVE BEEN NO Lobbyist I do solemnly swear that all f the provisions contained in Secti~i 2-4j Signature of Lobbyist: Signature of Principal/Clielft:L~ VI. LOBBYIST IDENTICCFICATION: iMi,}~y ,,~9d~@iglfl~l. KENT :~ Commission Q€b6a43~ddentification •.. ~= Expires May 28, 2011 eonaee rnN rmy wn maxan~e eoa~rrn~~ ersonally known (Lobbyist) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade Sworn to and subscribed before me This S L~/ day of ~E~~66~t , 2008 Signature of Pukilic Notary -State of Florida Notarization of Lobbyist's signature TO BE COMPLETED BY Annual Registration fee: [ ]Yes [ ] No Amount Paid g Lobbyist Registration Form received and verified by: ~:~,~~ ~R~I^oas~rxs~r~ loin acts are tr a and correct and that I have read or am familiar with the the ami Bea City Code and all reporting requirements. ~A W ~ ~ Ih$ IPAL IDENTIFICAT~N: ^ Produced ID ~~ ce~[res; ~e~-}- Form of Identification Personally known (Principal) ~-roward. State of Florida, County of~AAiar~i-Bacig Sworn and subscrib ~d~be~fo~r~~,~me This $day of _~~n.1b,1ft~08 • V Signature of Public Notary -State of rida Notarization of Principal's signat~ at'`; •••.~o ROSALINA VEDA LERK'S STAFF Ot~Y ~ n~,q7 * 4 t~IYCOMMISSIONNDD603431 ''~ MCR# D__ ___= EXPIRES:Cct. r9, 2010 ~~0 F~OPr' BOIIdAd TIIN B11Egl1 ~IOfaIy SEIYIC85 Revised 03/27/2008 I ~g/D ~ m City of Miami Beath, 1700 Convention Center Drive, Miami Beuch, Florida 33139, www.miamibeachfi.gov CITY CLERK Office Tel: 305.673.741 1 ,Fax: 305.673.7254 LOBBYIST NAME 1~}sr~~ ~~-~ CityClerkC miamibeachfl.gov 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. r i nature: /~-5 %~ ~ Date: ;toy.