Roberto Sanchez- Choice Environmental Services
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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 decision-making process on such
action, decision or recommendation that foreseeably will be heard or reviewed by the city commission, or a cdy board or committee..The term
specifically includes the princpal as well as any em~ploy~ee e~ng~aged in lobbying activities. The term "lobbyists" has specific exclusions. Please
refer to Ordinance 2004-3435. ~. ~'C~'Z~
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NAME OF LOBBYIST: (Las
BUSINESS NAME AND ADDRESS
(First) (M.I)
(City) (State) (Zip Code) ~ 7) /
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
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Glao~~`ENV~R®ti.h~e•~t~,L SeQi/,~es 1330 ~.1e,v 38%'~ C7- oPq-l~ct~A /=L 33oS~1
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
`Zb`I-1`~ 1-1`7 2``I `75~1~~?•?`18L1 ("~Ceti~~.l~lo;ce(,~v>Si~
Fill out this section if principal is a Corporation, Partnership or Trust [Section 282 (c)]
NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: ,
jve%4 L R-0~>2~ g ~~ L' F o, N, c ~c L'v- s s~ v N -~ ~,v;c~.
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST:
II.SPECI~IC LOBBY ISSUE: `
Issue to be lobbied (Describe m detail): 1
III. CITY AGENCIESIINDIVIDUALS TO BE LOBBIED: (Pursuant to city code section z-4s2(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 Fi
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cial, Familial or Professional Relationship
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A) LOBBYIST DISCLOSURE: (Required) ~~ S G G/) /~~~ /"
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHERJ:
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
(Required).
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On
Real Estate Development Issues":
^ Yes No: Are you lobbving on a pending application 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 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.
reimbursement. .
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V. SIGNATURE UNDER OATH:
Signature of Lobbyist:
of Principal/CI
LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
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Produced ID ~L" 'J~Z-~7~~~Z~ ^ Produced ID
Form of Identification Form of Identification
^ Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
personally known (Principal)
State of Florida, County of Miami-Dade State of Florida, County of Miami-Dade
Sworn to and subscri d before me Swor ubscrib fo e me D/ /~
This ~f~day of 2895 ~~~ This a of (J
Si ature of Public otary -State of Florida gnature of Public Ddotary -State of Florida
Notarization of Lobbyist's signature Notarization of Principal's signature
,TO BE COMPLETED B CI CLERK'S STAFF NL
Annual Registration fee: J Yes [ ) No Amount P ' $ MC Date Paid
Lobbyist Registration Form received and verified by:
E=:lCLCIt~L086YC571Lo`:3Uyisk F2EV.7istra2as~ Form `s2708.doe Revised 03/27/2008
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present or pending award for goods. equipment or service?
I do solemnly swear that all of the foregoing facts are true an and that I have read or am familiar with the
provisions contained in Section 2-48e Miami Beach City fd~od~d all reporting requirements.
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City of Miami Beath, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miomibeachFl.gov
CITY CLERK Office
Tel: 305.673.741 1 ,Fax: 305.673.7254
CityClerk@miamibeachfl.gov
LOBBYIST NAME: 0~ S4 ~G/' - ~~
I understand that no later than October 1st of each year, 1 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.
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