Roberto Saroza:.,
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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 commissioner; any action, decision, recommendation of the City Manager or any city board or
committee; or any action, decision or recommendation of any aty personnel during the time period of the entire deasion-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 principal as well as any employee engaged in lobbying activities. The term "Lobbyisffi" has specific exclusions. Please
refer to Ordinance 20043435.
Saroza Roberto
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 rsaroza@worldwasteservices.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
LOBBYIST RETAINED BY:
world waste Services, Inc.
NAME OF PRINCIPAL/CLIENT:
4701 NW 35 Ave Miami, FL 33142
BUSINESS NAME AND ADDRESS (Number nd Street) (City) (State) (Zip Cotle)
(305)636-4434 (305633-8226 rsaroza@worldwasteservices.com
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
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.SPEC~FIC LOBBY ISSUE:
RFQ 49-07-08 / Agenda Item: R7-I
Issue to be lobbied (Describe in detail):
nl. CITY AGENCIESIINDIVIDUALS,_TO BE LOBBIED: (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, 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):
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A) LOBBYIST DISCLOSURE: (Required) !T~\ 1 _ ~ \ ~ ~Z ~,
\C C.J C~ ~'I `.
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): ,,~./' `
(Required). ~,tQ,~.J1('~ ~, (~ ~ ~J(_ _.b ~, ci, `~ ~`j~
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":
Q~Yes ^ No: Are you lobbying on a present or pending bid for goods, equipment or services, or on a
present or pending award for goods, equipment 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 lobbying on a pending 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
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 ISO. No: Are you representing snot-for-profit corporation or entity without special compensation or
reimbursement. .
V. SIGNATURE UNDER OATH:
ON OCTOBER 1sT OF EACH YEAR EACH LOBBYIST SHALL SUBMlT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH LISTING LOBBYING EXPENDITURES AS WELL AS COMPENSATION
Signature of Lobbyist: L-~`Z^~E
Signature of Principal/Client:
VI. ,~/LOBBYIST IDENTIFIC{A~~TION:
Ld" Produced ID J,~ ~°°°°°-l~~oR€€iet'~°rdE~,
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` Form of Idertt MISS~AT'~/,~~~~
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:,~,~o°cyary fa ~A o ,
^ Personally known (Lobbyists *; r` _• ~Ow
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VII. SIGNATURE AND STAMP C~~~edY^'367 •~.;
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Swom t and su scribed f of ore `meade //~~~~i Fl9 ill~t~°°°° ~k,~
This _~"'~ day of~~6-' 2009
Signature of Public Notary -State f Florida
Notarization of Lobbyist's signature
PRINCIPAL IDENTIFICATION:
L~ Produced ID sl~~~ ~7~'~ Gn~
Form of Identification
Personally known (Principal)
~~~'i~tblAM p ~,~ y,~
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State of Florida, County of Miami-Dade ~"'r~Jt
Sworn an~.subscribe efore me
This t3Zday of 2009
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Signature of Public Notary -State bf Florida
Notarization of Principal's signature
TO BE COMPLETED BY CITY CL RK'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 21109.doc Revised 02/11/2009
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 Sectiorl2-482 of the Miami Beach City Code and all reporting requirements.
City of Miami Beath, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office
Tel: 305.673.741 1 ,fax: 305.673.7254
LOBBYIST NAME: Robert~c 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.
~2 -~S c~
Signature: Date:
F:ICLERILQBBY'iSTlLobbyist Registration Farm 32748.doc
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