Loading...
Martha Saroza~~ t'~ ~r~ ~~_ ~ ~~vY ~~~.. 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 prinripal who seeks to encourage the passage, defeat or modification of any ordinance, resolution, action or derision of any commissioner; any action, decision, recommendation of the City Manager or any city board or committee; or any action, derision or recommendation of any rity personnel during the time period of the entire derision-making process on such action, derision or recommendation that foreseeably will be heard or reviewed by the rity commission, or a city board or committee. The term specifically indudes the prinripal as well as any employee engaged in lobbying activities. The term "Lobbyists" has specific exclusions. Please refer to Ordinance 20043435. Saroza Martha NAME OF LOBBYIST: (Last) (First) (M.I) World Waste Services, Inc. 4701 NW 35 Avenue Miami, FL 33142 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 636-44334 (305) 633-8226 msaroza@worldwasteservices.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: LOBBYIST RETAINED BY: World Waste Services, Inc. NAME OF PRINCIPAUCLIENT: 4701 NW 35 Ave Miami, FL 33142 BUSINESS NAME AND ADDRESS (Number nd Street) (City) (State) (Zip Code) (305)636-4434 (305633-8226 msaroza@worldwasteservices.com 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: Mike Adams • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: Mike Adams , Martha Saroza, and Robert Saroza u.SPEGIFIG LOBBY ISSUE: RF 49-07-08 / Agenda Item: R7-I Issue to be lobbied (Describe in detail): ul. GITY AGENCIES/INI~IVI©UALS TO BE I.OBBIEC3: (Pursuant to city code section 2-aa2(g) 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) An Financial, Familial or Professional Relationship Miami Beach Commission & Mayor None Procurement None Evaluation Committee None IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): ` A) LOBBYIST DISCLOSURE: (Required) } ~ C~ / _ ~ ~ j ~.-7 ~, B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): ~~% ~~~ r „ ("~ ~ !~} ~ t ` f ' ~~ ~ I ,., (Required). (~~ V C` ~J l,.iC The following information must be answered: Cj(~ ~~'( 1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists On Procurement Issues": Yes ^ No• Are you lobbyina on a present or pendina bid for aoods, eauipment or services, or on a present or pendina award for aoods, eauipment or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": ^ Yes No: Are ou lobb in on a endin a lication for a Develo ment A reement with the Ci or application for chance of zoning map designation or chance 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 anot-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 (~NO' Are you representing anot-for-profit corporation or entity without special compensation or reimbursement. . V. SIGNATURE UNDER OATH: Signature of Lobbyist: Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: P INCIPAL IDENTIFICATION: Produced ID ~.»t~'bl~'S3~" l.~Produced ID JL~ G ~jC-~ Form o Ott, tion Form of Identfi ..~ ^ •'L v cry i9- ^ Personally known (Lob ~.•~~°~ ^ Personally known (Princi p:,. ~~ ~ •i19i ~°~` F~~y i {t,~ VII. SIGNATURE AND STAMP o~~~~ -,~ ~ F`co~~ ~ ~ fA State of Florida, County of Miami-Dade v~~1~9~y~sp~C~t~ ~ry State of Florida, County of Miami-Dad a~29~cS'.`r`S/p~~C~ Sworn to d subscrib before me 32,~~'.;~~r- z,' ' Swor and subscribed before me °dz ~~~ o~ This ~~ day of Jar , 2009 ~ -, Thiday of Fe 2009 e 9 s c~a0y~"~ • 7~p~~~ r ~ -:. S gnature of ublic Notary -State of Florida Si nature of Puf,~lic Notary - State o lorida ~~~~~ Notarization of Lobbyist's signature Notarization of Principal's signature TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: [ ]Yes [ ] No Amount Paid $ MCR # Date Paid Lobbyist Registration Form received and verified by: F;\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form 211Q9.doc Revised 02/11/2009 I do solemnly swear th II of the foregoing fact are true and correct and that I have read or am familiar with the provisions contained in e I 2-482 of the ~6tiarra;h City Code and all reporting requirements. City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov CITY CLERK Office Tel: 305.673.7411 ,Fax: 305.673.7254 LOBBYIST NAME: Martha Saroza CityClerk@miamibeachfl.gov 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. Date: F;IGLERILC?BBYiSTILobbyist Registration Farm 327Q8.doc d c Z C m I` i m (\ i ~`~ O `~J Z .~ ~ ( n C "J -N.1~ m \yV n .~ . r m v v V \~ Y V m ~ ~ C7 m w C1 N a. n n ~ ~~ A ~' 0 ~_ C n n ~ _ ? m ~4. _;,; ~~ ~+i „1 t':~ [r. ~ ~~ t.. t ,-~ ~~-a , i f;) `~ ~+ ~wr ~, i .. r p..1 T"~ ~i l ~ J .•~ ~ h`.a r,a r-.:~ L~,. ~~ -.., -- r:~; ~_i+. i_ ` ti t~~ ~~~ ~ ~i r. . ~ Z. O N O n ~ ~