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Russell C. Mackie - Waste Pro of Florida, Inc. )' l ? MIAMBE - City of Miami Beach Office of the City Clerk C / 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. Mackie Russell C NAME OF LOBBYIST: (Last) (First) (M.I) 4701 NW 35th Avenue Miami, FL 33142 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305- 637 -3423 305 - 637 -3423 rmackie ©wasteprousa.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: Please notify this office if your contact information changes: address, phone, or e-mail address. I. LOBBYIST RETAINED BY: Waste Pro of Florida, Inc NAME OF PRINCIPAUCLIENT: 4701 NW 35th Avenue, Miami, FL 33142 BUSINESS NAME AND ADDRESS (Number and Street) City) (State) (Zip Code) 305 - 651 -7011 305 - 637 -342 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: John Jennings, CEO • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: John Jennings 73% and Roarke Capital---11% II.SPECIFIC LOBBY ISSUE: Solid Waste and Recycling Issue to be lobbied (Describe in detail): III. CITY AGENCIES /INDIVIDUALS TO BE LOBBIED: Pursuant to City Code Section 2 -482(a)(4) include the commissioner or personnel sought to be lobbied, and whether the lobbyist has entered into any contractual relationship (paid or unpaid) with said city commissioner or personnel from 12 months preceding such person's commencement of service with the city to the present date, stating the general nature of the subject contractual relationship. Sec 2-482(aX4) Full Name of Individual and Contractual Relationship (Explain) YES NO title of person to be lobbied _ Mayor and City Commissioners None X City Manager aand Administration None X Pursuant to City Code Section 2- 482(g) Every registrant shall be required to state the extent of any business, financial, familial or professional relationship, or other relationship giving rise to an appearance of an impropriety, with any current city commissioner or city personnel who is sought to be lobbied as identified on the lobbyist registration form filed. Sec 2- 482(g) Any Financial, Familial or Professional Relationship None -M1-140 � �? 11 iii 81 :1 Wd LZ AVW 1I0Z CI - A iiJ� 7/ IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE (Required) C , 29" B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): i * I / (Required) _ L / "r 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 ": Liii Yes ❑ No: Are you lobbying on a present or pendinq bid for qoods, 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 I14 No: Are you lobbying on a pendinq application for a Development Agreement with 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 "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 (XNo: Are you representing a not - for - profit corporation or entity without special compensation or reimbursement . V. SIGNATURE UNDER OATH: ON FEBRUARY 28th 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 B: FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. .1 '' / — Signature of Lobbyist I do solemnly swear that all of the foregoing facts are true and correct and that 1 familiar with the provisions contained in Section 2-482 of the Miami Be- • City ode and all re orting requirements. Signature of Lobbyist: // `- Signature of Principal /Client: 1 F ( : VI. LOBBYIST IDENTIFICATION: r PRINCIPAL IDENTIFICATION: El Produced ID (17 0 - 1 .. 7U O7 ❑Produced ID Form of Identification Form of Identification ❑ Personally known (Lobbyist) .S; �� , � DA BD��oJ // Personally known (Principal) o B O(q /y // ,iii VII. SIGNATURE AND STAMP OF NOTA : • yc OMMis s, % _I y GOMMi • '. S ' Ai o vembe� Oy a _� o vembe, 2' <O State of Florida, County of Miami-Dade = o • ; � 4 �• ; _ State of Florida, County of M bade � 9 7' .. y: Sworn • . d Subscrib- • •,-f•re me - = ■ 4 • .'. ° 9 : f.r # � • ° j • � � � : #0 � n _ Sworn ubscribe. , : z D, n T is _ day of / r , 2011 . y ?36 • z, This e ; _ day of L , t1. 4 38 6 . . . �y /. �. ?r1 : �.. !..: P ��� / __,, . _ 471.11d_?..V •• ;� -� 'F : - Notarization of Lobbyist's naturebrida / �r .T E O F F � � P�O ��� \ N of Principal s si nature �/ / /; 1 \ \\ `�`� 4 itt tiiii TO BE COMPLET BY C ITY CLERK'S STAFF ONLY Annual Registration fee: 1 Yes [ ) No Amount Paid $ ;" - MCR # . ifs Date Paid ' Lobbyist Registration Form received and verified by: / ■ �1 � F:\CLER \$ALL \aFORMS \LOBBYIST FORMS \Lobbyist Annual Registration Form.doc -7I" 1� �j Revised 1/11/2011 m► MIAMI BEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florido 33139, www.miamibeochfl.gov CITY CLERK Office CityClerk @miamibeachfl.gov Tel: 305.673.7411 , Fax: 305.673.7254 LOBBYIST NAME: Russell Mackie I understand that no later than February 28th of each year, I must file the following form, 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 and Compensation 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. / i May 23, 2011 Signature: Date: