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Daniel E. TaylorR~ ~ q~o~~08 ~sf~ sWS ~ ~ 1`'i- ors i~' ,; :.' i t ``,` ' ~ ~.... ~ ~,,~ x 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 oommlttee; 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 spedfically includes the principal as well as any employee engaged in lobbying activities. The term "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435. Taylor Daniel E NAME OF LOBBYIST: (Last) (First) (M.I) Tripp Scott, P.A. 110 S.E. 6th Street, 15th Floor, Ft. Lauderdale, FL 33301 BUSINESS NAME AND ADDRESS (Number and Street} (City) (State) (Zip Code) 954-760-4926 954-761-8475 det@trippscott.com TELEPHONE NUMBER; FAX NUMBER: EMAIL: LOBBYIST RETAINED BY: Southern Waste Systems NAME OF PRINCIPAUCLIENT: 790 Hillbrath Drive Lantana FL 33462 BUSINESS 561E 582A668~SS (Nu S~lansiBStree~)_74 (City) (State) (Zip Code) TELEPHONE NUMBER: FAXSSNUZMBEbbR: (Optional) EMAIL: (Optional) or NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Charles Gusmano IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5°k OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: unknown Ii.SPECIFIC LOBBY ISSUE: RFQ 49-07/08 Issue to be lobbied (Describe In detail):- iii. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: Pursuant to City Code Section 2.482(8) include a statement of the extent of arty business, flnanclal, familial, professional or other relationship, giving rise 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 said City personnels' commencement of service with the City to the present date, stating the general nature of the subject contractual relation. A Full Name of Individual Title B An Financial, Familial or Professional Relationship None None 90 .~ ~d OZ 83.E 60~Z .... ~yf IY. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: {Required) hourly rate is $350 B) PRINCIPAL'S DISCLOSour~yF ratelS~s OMPENSATION): (Requin;d). ~hh ~~•ji•5~UU The following information must be answered: 1) Pursuant to Miami Beach Ciry Code Sedlon 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists On Procurement Issues": I~ Yes .0 No• Are you tobbving on a present or pending bid for goods eaufpment or services or on a present or pending award for goods. eauioment or service? 2) Pursuant. to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": Q,Yes ~ No• Are you lohbvtna on a pending apolication for a Development Agreement with the City or application for chance of zoning man designation or chance to the Citv's Future Land. Use. ~~ 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 2-495 above) who only appears as a representative of anotfor-profit corporation or entity without spedal compensation or reimbursement for• the appearance, whether d'p'ect, or indirect, to express support of or opposition to any item, shall regis#er with the clerk as required by' this section but, shall not be required to pay any registration fees. g Yes ~ No An: you representing anot-for-profit corporation or entit~r without spacial compensation or reimbursement. . .SIGNATURE UNDER OATH: I do solemnly swear that all of the provisions contained in Sectl~-4 facts are Mire and correct and that 1 have read or am familiar with the Fiam( BeaFlr City ~ and all reporting requirements. Signature of Lobbyist: Signature of Ptineipal/Client:) ~ .~ VF. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: ~ Produced ID ~. Produced ID Form of Identification Form of Ident~cation Personally known (PrincFpat~OTARY P1;JB'LItfSTATE OF FLORIDA William Lacasse Gotrimission # DD898192 ~cpires: I-tr1R. 30, 2009 State of Florida, County of Miar~l- hru 9tlendc Bonding Co., Inc. Swom a~td subscriF~ed before me This j~_day of eb~r 2 Signature of PubNc Notary -State of Florida Notarization of PrTnoipal's signature Personally known {Lobbyist) Vlt. 91GNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade Swom to nd subscribed before me This ~~day of 2009 Signature of Public Notary -State of Florida Notarisation of Lobbyist's signature TO BE COMPLETED BY CITY CLERIE'S STAFF ONLY Annual Registration fee: [ ]Yes [ ] No Amount Paid S MCR # Date Paid Lobbyist Registration Form received and verified by: F:1,CCERti#ALt.~iFORMS~t.OB6YT5Y FORMS~lobbytstRegistratioe Form 21109.do¢ lteyised 02/11/2009 m City of Minmi Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov CITY CLERK Office CityClerk@miamibeachfl.gov Tel: 305.673.741 1 ,Fax: 305.673.7254 LOBBYIST NAME: - Jr--~~/ht ~-~ __ ~'_` ___ ~ ~d~ 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. ~ f ©~ Signat re: Dat F °i~;1.i~lL~?Yi STtI_ol;rtayi~t 1~eglstraYi~~r~ ~€a~r~~ 527~13.~i~ic