Hiram A. Ruiz/Rob Schuler - City's Cleaning ContractCity of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, Ft. 33139
LOBBYIST REGISTRATION FORM
Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeFs 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
rtity commission, or a city board or committee. The term speafically inGudes the principal as well as any employee engaged in
lobbying activities. The term "Lobbyists" has specific exclusions. Please refer to Ordinanua 2004-3435.
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NAME OF LOBBYIST: (Last) (First) (M.i)
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BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
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TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
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NAME OF PRINCIPAUCLIENT:
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BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Gotle)
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TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
Fill out this section If principal Is a Corporation, Partnership or Trust
NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5°k OR MORE OWNERSHIP INTEREST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST:
u. S~'EC~IFIC L,UB$Y #.SSUE: C~ `( ~`s ~ ~~- ,• ~ .~~ ~• ~ ~~~rJ
Issue to be lobbied (Describe in detail):
III. CITY ,AtiEMCIE$~lNIbI1~Al..S TQ~ ~..Q~~~:
A) Full Name of IndividuaUTitle B) Any Financial, Familial or I7rofessional Relationship
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHERx
A) LOBBYIST DISCLOSURE: (Required) ~ n / -
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). (~'
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The following information must be answered:
i) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Cami~aign Contributions By Lobbyists
On Procurement Issues":
Y A i n or i fr mn o on
present or pending award for goods, eguioment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Cortributions By Lobbyists On Real
Estate Development Issues":
^Yes [3'IVO• Are you lobbying on a cending 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
MaD?
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 snot-for-profit
corporation or entity without special wmpensation or reimbursement for the appearance, whether direct, or
indirect, to express support of or opposition to any item, shall register wi=:h the clerk as required by this
_ section but, shall not be required to pay any registration fees..
Yes ^ No: Are you representing goof-for-profit corporation or entity without special comcensation
or reimbursement .
V. SIGNATURE UNDER OATH:
ON OCTOBER 1~ OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO 1'HE CITY CLERK A SIGNED
STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS MNELL 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.
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Signature of Lobbyist
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 and all reporting
requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
~i Produced ID
Form of Identification
Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn t nd subscri efor e
This =day off(' 2Q~
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Siggia~,GrE of Public'IQotary -State of Florida
No rization of Lobbyist's signature
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PRINCIPAL IDENTIFICATION:
i Produced ID .,r'~~ 'KOr~
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Form of Identification
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/~i Personally kr~wn (Principal)
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State of Florida, County of Miami-Dade \
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Sworn subscri befo a me ~ `~ ;,, ~ r-
This ay of l~ 20~ ; ` ~ ~
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Signat re of Public Notary -State of Florida
Notarization of Princ:ipal's signature
FOR CLERK~S~,I,SE ONLY ~ ~, ~ ~ ~ ~ - Ro
Annual Registration fee: [ ]Yes [ J No Amount Paid ~~_ MCR #NP) J -~~Date Paid
Lobbyist Registration Form received and verified by:
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM OS.doc Revised 12/08/04