James H. Sage - Choice Environmental Services
Sod+a~ ~~s~,~
City of Miami Beach Office of the City Clerk ~
1700 Convention Center Drive, Miami Beach, FL 33139 ~ a ~~
LOBBYIST REGISTRATION FORM `^
r- ~'
Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the passage, defeat or rhodificatTt7TT of _~
any ordinance, resolution, action or decision of any commissioner; any action, decision, recommendation of the City Manager or an~city boor
committee; or any action, decision or recommendation of any city personnel during the time period of the entire decision-making process on such ""°
s
action, decision or recommendation that foreseeably will be heard or reviewed by the city commission, or a city board or committd~% The~fdrm
specifically inGudes the principal as well as any employee engaged in lobbying activities. The term "Lobbyists" has specific exclusions. Prase
refer to Ordinance 2004-3435. '
NAME OF LOBBYIST: (LasNj First) ~ -(M.I) " '-'
v~ ~ ~/~ ~ ~ ~i'YI~~ ~ ins ~/,~3/3~'
I. LOBBYIST RETAINED BY:
r
gut this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
• NAME OF CHIEF ~`O-~F~`F',I~C~/E~R`, PARTNER, ORCBENEFICIARY: ~~~~ ~q ~ (~.~ C~
• I~~F~ L ~RSONS HOLDINGV~ ECTL O~ DIRE~Y,~5°~ rR MOR`' O EINTER
SUCH CORPORATION, PARTNERSHIP OR TRUST:
II.SPECIFIC LOBBY ISSUE:
e S s c~v`'r,f~ 50 ~
Issue to be lobbied (Describe in detail):
III. 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 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
r
~~~
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER):
AR ~I
v
0
~ ~
~',
o ~ m
D
<~~
az
u~
S
z ~T
•,~
~~ V
:,Ml
~t~';
,~'~ nnez`~~
A) LOBBYIST DISCLOSURE: (Required) ~OQ~ O~-i ~~
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
(Required). ~l/V
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 lobbvinq 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 IL7' No• Are you lobbvinq on a pending appliication for a Development Agreement with the City or
application for change of zoning map designation or change 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 281 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 ~lo: Are you representing snot-for-profit corporation or entity without special compensation or
reimbursement. .
V. SIGNATURE UNDER OATH:
I do solemnly swear that all of the
provisions contained in Section 2-4>;
true a cCyrecf/and that I have read or am familiar with the
;h Ci Cho ,g and all reporting requirements.
Signature of Lobbyist:
Signature of PrincipallClienf:
VI. LOBBYIST IDENTIFICATION:
^ Produced ID
Form of Identification
L~d'F'' ersonally known (Lobbyist)
PRINCIPAL IDENTIFICATION:
0 Produced ID
Form of Identification
L'I Personally known (Principal)
o § ~~
e
N ~
~~
NeUrypO'
~X
~~'~~mi~a*`'
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade State of Florida, County of Miami-Dade
Sworn~ubscribe for me Sworn a ubscrib of re me
This d y of ~ , ;?ees- ao~D This ay of - , ~ese- - /Q
S a ure of Public Notary -State of Florida nature of Public N ry -State of Florida
otarization 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 M R # Date Paid f l7
Lobbyist Registration m ceived and verified by:
1- ' ~ ` ~"'~ ~ ~` "°, Revised 03/27/2008
v ~~
City of Miami Beath, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office CityClerk@miamibeachfl.gov
Tel: 305.673.741 1 ,Fax: 305.673.7254
LOBBYIST NAME:
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.
/ ;'
Signatu ~`~ Date:
~:~~~~x_~~tL'~FS~`+.'f>i;~1g ab3~~~i~f Rf~is~raYsz~t~ Farr^~ 327fifi.cloc