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Michael A. Pizzi - Choice Environmental,~ ,, ~ a ' City of Miami Beach Office of the~City Clerk - :• ' " ` ~~ ~ 1700 Convention" Center Drive,. Miami Beach, FL 33139 ~ . ~ , ' • ~ ~ LOBBYIST REGISTRATION FORM ~ " • Lobb ist..means all ersdns em to ed or retainedr whether aid or not, b a rinci al hd seeks to encoura a the assa e, defeat or modification of ', ~ Y P P Y P Y P 9 P 9 artp•drdinance; resolution; action,or decision of any commissioner, any action, dec' ion, recommendation of the City Manager or anq city board or committee; or..any action, decision dr recommendation of, any city- personnel g 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 commissidri, or a city board or co mittee. The Perm ' specifically includes the principal as w a arty employee engaged in lobbying activities. The term "Lobbyists" has specific elusions. Please , refer to Ordinance 2004-3435. .. ' ~ • ,., > i NA OF LOB~¢YIST: (Last) (First (M.I) ~ ~ _ ~~ US ES N E D ADDRESS (Nu rand ~' ~ reet) (City) - (State) Zip Cod :,, TELEPHONE NUMBER: FAX NUMBER: EMAIL: ~ a~ I. LOBBYIST ETAINE~D BY: \ ~ - ~ r1. `~ ~1 ~~ ~ ~~,~1 G~ f'o U1~~ ~I~ NAME OF~~AUCL:IE ~ ~ ~ , ~ L I AME S u e Stree ( i ate) (ip ode) TELEPHO E NUMB R: ~ .NUMBER: (Optonal) EMAIL: (Optional) Fill-out this section if principal is a Corporation,,Partnership or Trust jSection 2=482 (c)] • NAME OF CHIEF.OFFICER, PARTNER, OR BENEFICIARY: • IDENTIFY ALL PERSONS HOLDING; DIREGTLY OR INDIRECTLY, A' 5% OR MOREOWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: ~ -_ ~' n.SPECIFIC BB ISS E: ~ '1 • ' Issue to:be lobbied (Describe in detail): ~ ~ ' nC CITY AGENCIES/INDIVIDUALS ~O BE LOBBIED: pursuant to city Code section z-4s2(q) include . a ,statement of the extent of any business, financial, familial, •professional or other relationship, giving rise to an appearance ofan.impropciety with .any City personnel sought to be lobbied --further, pursuant to•CityCode Section 2- 482(x)(4) include a statement of any contractual relationship (paid or unpaid) from. 12 months preceding said City s personnels' commencement of service with the City to the present date, stating the general nature of -the subject ' contractual relation. A Full am of Ihdividual/Title $) Any Financial, Familial or Professional Relationship _ ~i./~'3.. C~.J~~ .. . .. ,. _ ' ~ ~. "01 ~~ ~' Cl ~ b (~-1'O Z 7~'-ee~s' ~~. y t1 ~"o o ---- . ~ 9 .,.,i .,i .. ..,~, / . Nia,y. i. 2010 5:11P~r'i Michael A. Pl~~i, Jr., P.H. No. 3,2(3 p IY. DISCLOSURE OF 7ERM8 ANO A~40UNT5 OF LOBBYIST COMPENSATION (OISCt.O tiVHETHe: HOURLY, FLAT Rg7E OR OTHER): A) LOBBYIST DISCLOSURE: (Rog4ired) ~~ ~ ~ SW b ~~ PkrNGIPAI,S OISCLO&URE (OF The following information must be answered: V ~ ©_ "~ O i) Pursuan fto Miami Beach City Code Secllon 2,488 Entitlsd "Prohlblled Campaign Contributions D Lo56 tsts~ ,~ On Pr ~uremant Issues": y ~_y ~ ,. J '~:. G7 ^ Yas o: o b In o resent or endln bid for ood a ul er or se ices or o --~- present or pandlnst award far Goods, equlnment or sarvlce? ~.- u% ~ 2) Pursue t to Miami Beach Clty Code'2-490 Entitled "Prohlblled Campaign Gontributlons By Lobhyisls Ori-~, ~ Real tats Development Issues": .. ._..F - W f r1.. rT .. _. __ _.._ 9) Puf6usnt to Miami Beach City Coda 2184 (h} Any person (except thoso exompl from the deltnlrlon of "lobbylsl° as set foRh tf1 3ectlon 2-461 above) who only appears as a roproaentatlve or ~ f,ot-for-pro(t ' eorporall or entity without special mmpensatlon or rulmbutsomeni for the appearance, whether direct, or tndlrect o express support of or opposltiori le any Item, shall roglster with the clerk as requlrod by this socllo but, shall not be raqulrod to pay any rogistratlon foes. ~ I do solomnly swear that all of the foreyolr>,g facts aro truo and cor of nd that 1• hsve read or am farNllar tvllh thr.. orovlslons conteln~d in Secllon 2-462 or the laml Beach CI o ail reporting requirements. Signature o(l.obbylst: n ,/ Signature o(PrinclpaVCli°nt: '"~~ ~-) _~.___ VI. LOB MIST 1D F G ~ N: ~' P)2 I AL IDENTIFICATlO •~ ~ _ ~~ Produced ID P" roduced ID J~ 'l'" ~ •-~'r~ ~s ~ Form of Idanti cation Form of Iden rficelion ~ ~ Porsonallyknown (Lobbyist)-~ l `-' " ^ Personsll k ~ ~ y .sown (Principal) ~,~ VII. 516 NATURE AND STAMP OF NOTAaY: m . Stale of Florida, County of Miami-Dade State of Florida, CounU~ o(t~riiemi-Dade ' ~Y:1~~,c. Sworn to~ subscribr~d bejora me 2 py~ S x,~n nd aubscribod b e D ~ This day of F=~ , 2009 T t.s ay of ;?n0 ~,v/ _ ;~. ~~ SI na ure of Publ c Nola , D ry-Sts a of Florida Sic)na ur of Pu rc hlotery ate of Flo 'D Ftotar)zatlon of LobbvlsYs slBnafure Notart anon Prlncloal's slgnatura TO tat COMPLETED BY CITY CLERK'S STAFF ONLY pnnval.(z•g~tslretlanitee; ~( ..]:i(e~~[ ;]~1Jo 'uAmoLnt`'Paid1# .' ~=MCR:]1,,. • ~ •~ ~•~~ 'lDal~;P•sld :''"'• :Lo6byIsC~Registraklon%i:arm'recelved;arfdv~rl(to8ia`y:;'. • „~.,'~~,v: '. , •6:,~CLER~~SALL\aFORMS~LOK6YL5T•FORniS\Ldhoptar; R~lstt~tton Farm 21r0~:doc . Rt:vj~~d OZ/•17/2009 ~~ ~=, `< Iu~ ,. -_- C i~ s c. e+`~`' n =' U ,' Q cr; r- C~ii^ .w ;~ Ietmbureement. . V. SIGNATURE UND2R OATH; ~j IV•.. DISCLOSURE OF.TERMS AND AMOUNTS OF L08BYIST COMPENSATION (DISCLO WHETHE NOt1RLY, FLAT . .. 'RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) ;CJ6 ~~ . - B) PRINCIPAL`S DISCLOSURE (OF LO ST COMPENSATION)t. /?~ . . (Required). (,' ~.. The following-ihformation must be answe d: ` 1) OnrPranurement (sBues'h City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists ~^ :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 orservice? - ' 2)- Pursua to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real fate. Development Issues": " ~ ^'Yes No¢ Are you lobbying on a pending application for a Development AgreemenYwith 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 "IobbyisY' as set forth in Section 2-481 above) who .only appears as a representative.'of anot-for-profit - corporati or entity without special compensation or reimbursement for the appearance, whetherdirect, or " ~ indirect o express support of or opposition to any item,. shall register with the clerk as required by this sectio but, shall not be-required to payany registration fees. I do solemnly swear"that all of the foregoing facts are true and cor cf and that '1-have read or am familiar with the a provisions contained ih Section 2-482 o~,Il ]iami-Beach Ci o d all reporting requirements. Signature of Lobbyist: ~ `-~'" --.~---~ Signature of, Principal/Client: VI: LOB IST ID F C 'F N: ~ P IPAL IDENTIFICATION: ~_... ~ • ., _...~_. ti _~ Produced ID ~ _ ~ _`~ . ~ ~~ ,, ^ Produced ID Form of Identi ication ~ Form of Identification ~_~ ~~~ • Q ca ~~~. ~. -, personally known (Lobbyist) ^ Personally known (Principal) ~,~cce / $,~~ DVIL ~'$IGNATURE AND STAMP OF NOTARY: m State of Florida, County of Miami-Dade State of Florida, County of Miami-Dade - "~ ~~~ Sworn to a subscribed beore me 2of0 .rr Sworn and subscribed before me ' ~' -~ This day of ~ , 2009 This.:. day of , 2009 Signa ure of. Public Notary - Sta e of Florida Signature of Public Notary-State of Florida. ` . Notarization of Lobbyist's signature Notarization•of Principal's signature TO BE COMPLETED BY CITY CLERK'S~STAFF ONLY `Aririual Registrafion fee: [' ]Yes [ '] No Amount Paid $ ` - MCR~# ~ Da4e Paid .. LobbyistRegistration Form received and verified by: _.. , F:AfLER\~At_L~aF012MS,~L08BYIST i=0RhlStiLotibyist Registration;TornS 211gy,dac `.: - Revised 02~%112009 reimbursement. SIGNATURE UNDER OATH: ,. , ,, i . _. - - ~ ~ ~. 1, i ~ ~ - - City of'Miami Beach, 1700 Convention Center Drive; Miami Beach, Florida 33139, www:miamibeachfl.gov ' ,.CITY CLERK Office CityClerk@miamibeachfl.gov ' ` Tel: 305:673,741 P ,Fox: 305.673.7254 . ~ ~~ e `- - ' ^ v L/ LOBBYIST NAME.; l . ~ ~ 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 ~Comm~ission on Ethics and for code violation evaluation. ' . In addition;.once an issue l have registered to lobby on has been resolved,l am required ,` to immediately, riotify the City Clerk's Office of lobbyist withdrawal in writing. Signature; ~ 'Da e: