Michael A. Pizzi/Choice Environment Services, Inc.~,
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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 principal who seeks to encourage the passage, defeat or modification of
any ordinance, resolution, action or decision of any wmmissioner, 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
spec~celly includes the principal as well as any employee engaged in lobbying activities. The rm "Lobbyists" has speclf exclusions. Please
refer to Ordinance 2004-5435. ~ ` ~~ ~ ' ~ I ~ ~ ~1
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NAM OF OBBYIST: (Last) ~j ~n(yF~irst)
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B ESS NAME AN DRES (Number and St t
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LEPHONE MBER: FAX NUMB
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1. LOBBYIST RcE~TAINED BY:
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NAM OF CIPAUCLIENT: .-
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BUSINE S NAME AND ADDRESS (Number a d Street) (City) State) (Zip Code)
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: ~~ ~~ ~} ~ l`~
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IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5°k OR MORE OWNERSHIP INTEREST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST:
n.SPECIFIC LOBBY ISSUE: ~ `
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Issue to be lobbied (Describe in detail):
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ul. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: (Pursuant to city code section 2-482(8)
include a statement of the extent of any business, financial, familial, professional or other relationship, giving 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) Any Financial, Familial or Professional Relationship
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` ~ IV. DISCLOSURE OF TE. ~, AND AMOUNTS OF LOBBYIST COMPENSATION (.....CLOSE WHETHER HOURLY, FLAT
` RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
B) PRINCIPAL'S l~ OSURE (OF LO YIST OMPE ATION):
(Required). f~C ~
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°:
2)
3)
aresent or oendina award for goods equipment or service?
Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On
Real Estate Development Issues":
aoolication for chance of zoning map designation or chance to the City's Future Land Use
Map?
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 anot-for-profit
corporation or entity without special compensation or reimbursement for the appearance, whether direct, or
indirect, to ex ess support of or opposition to any item, shall register with the clerk as required by this
section bu1~l not be required to pay any registration fees.
reimbursement. .
V. SIGNATURE UNDER OATH:
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Signature of Lobbyist
I do solemnly swear that all of the foregoing facts are true and corr and tha I have read o am
provisions contained in Section 82 of the Miami Be c City Cod and II rep ~ ing requirements.
Signature of Lobbyist:
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Signature of Principal/Client:
NTIFICATION• CATION'
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z ~~ ^ Personally known (Principal)
VI. ._ LOBBYIST IDE ~ /•
Ifd Produced ID j roduced ID f'.~-~/'7yC~y "~~ ~~ ~7 ~,~~3 'v
Form of Ide ific ion Form of Identification
^ Personally known (Lobbyist)
VII. SIGNATURE AND STAMP D
State of Florida, County of Miami-Dade
Sworn to anr~ subscribed before e
This I ' day v! 201
~ "' State of Florida, County of Miami-Dad
Swom and subscri ed before me
"'+"'~-. Th}'~ ~_day of , 2008
nature of Public otary -State of FI
tarization of P incipal's signature
with the
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TO BE COMPLETED BY CITY C RK'S STAFF ONL
Annual Registration fee: [ ]Yes [ ] No Amount Paid S MCR # Date Paid
Lobbyist Registration Form received and verffled by: ~
F:\CLER\LOBBYIST\Lobbyist Registration Form 32708.doc RevisedA3/2 /2008
;Ciblic Notary - Stat~'f fj
of Lobbyist's signature
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City of Miami Beach, 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
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LOBBYIST NAME: ~ ~ L 1
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 Cler ' ffice of lobbyist withdrawal ' writing.
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Signature:
Date:
F:ICLERILOBBYIST1Lobbyist Registration Form 32708.doc