Alex L. Gonzalez/Waste Management.,
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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 princpal who seeks to encourage the passage, defeat or modification of
any ordinance, resolution, action or derision of any commissioner; any action, derision, recommendation of the Cky Manager or any city board or
committee; or any action, decision or recommendation of any city personnel during the time period of the entire derision-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 speclflc exclusions. Please
refer to Ordinance 2004-3435.
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y~INESS N~^E AND ADDRESS (Number and Str t) (City) (State) (Zip C~
LOBBYIST RETAINED BY:
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NAME OF PRINCIPAL/CLIENT: ,.
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BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
tEPHO E NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
F tout this section if principal is a Corporation, artnership or Trust [Section 2-482 (c)]
NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: ~~ ~~.,,~~/j//S
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST:
II.SPECIFIC LOBBY ISSUE:
Issue to be lobbied (Describe in detail):
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ill. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: (Pursuant to city code section z-482(91
include a statement of the extent of any business, financial, familial, professional or other relationship, gluing 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 Individual Title B) An Financial, Familial or Professional Relationship
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City of Miami Beath, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK OFfice CityClerk@miamibeachfl.gov
Tel: 305.673.7411 ,Fax: 305.673.7254
LOBBYIST NAME: ~l~ ~d~t Z~/C~
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.
Signature
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Date:
F:\CLERlLOE'~BYtSTiLabbyist Registration Farms 32708.doc
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