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Jason P. Neal/Waste Management Inc. of FlaSo((`~ tJe~Sl'~ f~i° ~ o - °~~ ~ City of Miami Beach Office of the City Clerk 2009 t~0`d 30 P~ 1 ~ 42 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 tens spec~cally includes the principal as well as any employee engaged in lobbying activRies. The term "Lobbyists" has speclflc exclusions. Please refer to Ordinance 20043436. ~ E~"~ ~~~~o~ / . MME OF L ASTF (Last) (First) (M.I) ~~~ ~ F~ ~/aS .~/ti/ /t~ Cd~/~e,l l~I~?i ~~ 33l a r7 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 3d~ -sy!I-~~v4z y 3~s"-s'~~ -`/~~,/~ ~,t/~,9~.~`~ C~~r, con+~1 1. LOBBYIST RETAINED BY: Ash ~9ii~/ ~E ~".~=~C• v~~L- 7~ ~w~s NAME OF PRINCIPAUCLIENT: ADDRESS (Zip Code) I tLtrrl~lvt IvuMrstK: FAX NUMBER: (Optiona EMAIL: (Optional) 3©,~'- ~y ~ - X02 ~~-3~~-~~~/8 Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)1 • NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: ~ ~ ~ ~~~ • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR SUCH CORPORATION, PARTNERSHIP OR TRUST: u.,SPECIFIC LOBBY ISSUE:; Issue to be lobbied (Describe in detail): `~~2~ l2LE- P.pr~~~?.~7vi ~Y, A 5°k OR MORE OWNERSHIP INTEREST IN - _.,. nl. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED': (Pursuant to city code section 2-482(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 72 months preceding the commencement of service of City personnel to be lobbied.) A Full Name of Individual Title B) An Financial, Familial or Professional Relationshi ,,c~Lz2'/~~ ~ ~G~'~ S /~~~ IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): ~. ~A) LOBBYIST DISCLOSU : ( iced) ~'~-G /1Q y~~ B) PRINCIPAL'S D CLOSURE F OBBYIST COMP SATION): The following information must be answered: 1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions 8y Lobbyists s--'"~ . On Procurement Issues": ,d 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 ,Rea/l Estate Development Issues": ^ Yes L~f No: Are you lobbvina on a aendina application for a Development Agreement with the City or application for change of zoning map designation or chance to the Citv'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 s~ec~tion but, shall not be required to pay any registration fees. ^ Yes Ld'No• Are you representing anot-for-profit comoration or entity without special compensation or reimbursement. . V. SIGNATURE UNDER OATH: ON OCTOBER 1sT OF EACH YI STATEMENT UNDER OATH. LIST IN THE CITY OF MIAMI BEACH F EVEN IF THERE HAVE BEEN NO I do solemnly swear that all of the provisions contained in Se~ion 2,Q( Signature of Signature of Princidd(/Client: VI. LOBBYIST IDENTIFICA ^ Produced ID Form of Identification Personally known (Lobbyist) '~G.L'Ns ~Nz~?- ~ p ~~ PRIN~PAL IDENTIFICATION: ~ Produced ID Form of Identification Personally known (Principal) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade Sworn to and subscribed b o e T~ 2D d of IV8 ~,~,~.,,,., WCRECIAMIRABAL ~ ' s.: ;~= MY COMMISSION # DD 534772 S: April 26, 2010 G Signature of Public Notary FIOnmiNwaryP~ctlnderwriters Notarization of Lobbyist' State of Florida, County of Miami-Dade sworn and subscribed before me - • ~ ''•.. LtICRECIA MIRABAL ~~ ~ ~_:."': MY COMMISSION # DD 534772 of Public Notary - 'rir62haaa~ S: April26, 2010 on of Principal's s ~~ ~ ~0~""'~`~ facts r true and correct and that I have read or am familiar with the lia ach CityCo/de and all reporting requirements. ~/~"S0~ /~~~~ TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: ]Yes [ ] No Amount Pald $ . MCR # Date Paid 1 Lobbyist Registration Form received and verified by: 3.SA F:\CLER\LOBBYIST\tobbyisk Registration Farm 32TO8.dot Revised 03/27/2008 a ~ MIAMIBEACH City of Miami Beath, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov CITY CLERK Office Tel: 305.673.7411 ,Fax: 305.673.7254 CiyClerk@miamibeachfl.gov ~~ ~~-~ LOBBYIST NAME. V I understand that no later than October l st 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 2J 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. ~l~ ~~ d~ S'g at e: Date: F:ICLERILOBBYIST1Lobbyist Registration Form 32708.doc