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Eileen Damasou?~~~- 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 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 inGudes the prinapal as well as any employee engaged in lobbying activities. The term "Lobbyists" has specific exclusions. Please refer to Ordinance 20043435. Damaso Eileen 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 edamaso@worldwasteservice.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 (Nu ber ~nd Street) (City) (State) (Zip Cotie) (305)636-4434 (305 633-8 26 edamaso@worldwasteservice.com TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) Fill out this section if principal is a Corporation, Partnership or • 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.SPECIFIG L©BBY ISSUE: RFQ 49-07-08 / Agenda Item: R7-I Issue to be lobbied (Describe in detail): ul. CtTY AGENCIESIINLl1YtClUA~S TO BE `LOBBIkECf: (Pursuant to City Code section 2-as2(g) include a statement of the extent of any business, financial, familial, professional or other relationship, giving raise to an appearance of an impropriety, wkh 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 72 months preceding the comrt~ncement 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) Employed by World Waste Services, Inc. B) PRINCIPAL'S DISCLOSURF~(OF LOBBYJST WaSteA SeY'V1C2S, IriC . (Required). Emplloyedd y Wor 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": Yes ^ No: Are you lobbying on a present or pending bid for goods, eguiament or services, or on a present or pending award for goods, eguiament 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 you lobbvina on a pending aaplication for a Develoament 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 snot-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 snot-for-profit corporation or entity without special compensation or reimbursement. . V. SIGNATURE UNDER OATH: Signature of Lobbyist: C.~ Signature of Principal/Cli nt: VI. LOBBYIST IDENTIFICATION: Produced ID ~L-~ ( <'""' Form of I ' <•• s~IDAe *```~ ^ Personally known (Lobbyist) ~ ~~ VII. SIGNATURE AND STAMP OF ~6 ~ State of Florida, County of Miami-Dade Sworn to and subscribed before me 4 'y This~~_day of U r , 20~ _/ // n _ 5i~nature of Public Notary -State dF Florida Notarization of Lobbyist's signature PRINCIPAL IDENTIFICATION: -IaS'~' _ProducedlD~L'~~~~0-I;c~.s3i-~ S Form of Identification ^ Personally known (Principal) ~ y~~ f State of Florida, County of Miami-Dade ,~-,A~o~~!yy ~ a o oo ~ Swom a subscri d before me q 20(~ / Thiday of -~ z9~ s~,~ ~-9~o~G ~j D l TJ , C~ A o ~ O~ ~ o ~ ~ ~~ q " i ature of Pu is Notary -State of lo Notarization of Principal's signature rida '$ °o`'gj ~'9 °' " TO BE COMPLETED BY CITY CLERK'S STAFF ONLY -. Annual Registration fee: [ ]Yes [ ] No Amount Paid 3 MCR # Date Paid Lobbyist Registration Form received and verified by: Fs1~LE~Ft\,LCPE~YTST1Laisia~€~~ E~is~~s'on Fo'r'm 32~~~.dc.~ Rexised 03/27/2l)l~ I do solemnly swear that all of the foregoing facts are true nd correct and that I have read or am familiar with the provisions contained in Section 282 g1%the Mimi Beach it 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: Eileen Damaso 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. ,~~~ ~ a s Signature: Date- F;ICLRlt_{3BBYISTII_obbyist Registration Forma 327®8.doc wF M f~ [w} I~l ty-- jj" F t~'•~ _l 'W ,i ` S ~.p' ~~ r•- ~, '~,-.-.a w:~ F~F ~.^a :~•• F;,1 r~•d F . .F ~~.~ ;y~i r., << wM rN ~ ~~~///~~~yyyy~~~t F:,J ~r { `` F~,S S w,.~ a v A ~ m W °mg Cg v0 ~~ ~v ~~ ~ ~ ~ N M N "1 O Z (f} Y .m r '~ 0 r N U 0 O O V ^~\ a ~~ v W m ~ H ~~N O d 0 z y ,~ 0 Z C `~ a \I ~S L a d