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Sylvester Lukis/Waste Pro, Inc..City of Miami Beach Office of the City Gferk° 1700 Convention Center Drive, Miami Beach, FL 33139 LOBBYIST REGISTRATION FORM ' ~ Lobbyist means all .persons employed dr retained, whether paid or not, by a principal who seeks to encourage the passage, defeat or modificafioh of any. ordinance, resolution, actibn or,depision :of any commissioner; any action; decision, recommendation of the. City Manager or any city board or 'committee;, or any action, decision or recdmmendation of any city personnel during, the time period of the entire decision-making process on such action, decision of recommendation that foreseeably will be heard or reviewed by the city commission, or a city board or' committee.. The term ' specifically includes the principal as welh as any employee engaged in lobbying activities. The term "Lobbyists",.has specific exclusions. Please , , . refer to Ordinance 20043435. r~ re ,q:. ' .NAME OF LOBBYIST: (Last) (First) (M.I) .. ' : St Lv~s r _ ~ ' J ~ r S sst7G r n . a- C 33 6 m it d ft' ~~ st. Lc~~eO L . BUSINESS NAME AND ADDRESS (Number and Street) {Cit ~~~~ • y) (State) (Zip Code) . ~ o ~l y S~ ~esr~,-, ~. k~ ~ :3.~i 3 ~-j • TELEPHONE NUMBER: FAX NUMBER: EMAIL: ~p+c, ~ . ' ~ L LOBBYIST RETAINED BY: , ~ ~ C ~~~ ' " , wry >A ~-r-~ P~, o ~iv'c. / ~Z. !J -S ~` ~ L U ~/1 /~ Gle.'t NAME OF PRIN IPAL/CLIENT: BUSINESS NAME A DAD ESS Number and Street ( ) (City) (State) {Zip Code) ' • .TELEPHONE NUMBER: FAX NUMBER: (Optional) -' EMAIL: (Ootionall Y a / • ~~~ • ~"~©G Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 `(c)] ' • NAME OF CHIEF, OFFICER, PARTNER, OR BENEFICIARY; ,^ ~~'~ v~nl~r~6S • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR"TRUST:.: •' ~'~ -u.SPECiFIC L®BBY ISSUE:. - Issue to be lobbied (Describe m detail): .~ nl. CITY'~4GENCIES/INDFVIDUALS TO BE LOBB{ED: Pursuant to City Code Section 2.462(8) include a statement of the extent of any business, financial, familial, professional or other relationship, giving .rise to an appearance of an impropriety. with any City personnel sought to be lobbied -- further, pursuant to City Code Section 2- ' 462(a)(4) include a statement of "any contractual. relationship (paid or unpaid) from 12 months preceding said City personnels' commencement. of service with the -City to the present date, stating the general nature of the subject ~' contractual relation. A °Full Name of Individual Title. B) Any Financial, Familial or ProfessionalRelationship . ~ ~~Cl/': ~ A/f J / ~C'i/r~ ~~/~V . ~ ". .~ ~ r ~ .~ . - .. - f . . IV. DISCLOSURE OF TERMS AND AMOUNTS-0F LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE, OR OTHER): i . A) LOBBYIST DISCLOSURE: (Required) ~ ~~~~ y~~ - i /- . • ~.fi,. ,,~~ .- ' B) PRINCIPAL'S-DISCLOSURE (OF,LOBBYIST COMPENSATION): ~ +~ ~ P ~~~ ~ (Required). 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": l~f 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 services • . 2} Pursuaht to Miami Beach.City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development issues`',: n.,.... ICI ci_- ~--.----. ,_~~_.:__ __ - __ _ _.. .. .. - - .. application for change of zoning map designation or change to the Citv's Future Land Use M. ap? . 3) Pursuaht to Miarni Beach City Code 2-484 (h) Any ,person (except those exempt from the. definition• of ` 'lobbyist" as set forth ih. Section 2-481 above) -who only appears as a representative of anot-for-.profit corporation or entity'without•special compensatiori-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 hot be required to pay any registration. fees. ` Yes ~No: Are you reoresentina a not-fnr.nrnfit rnrr,nrn4inn nr on+cti.:.,~.~.....« ~..__:_~ __~_____.:_~ __ reimbursement... • • ` V. SIGNATURE UNDER OATH: I do solemnly swear that all o r oin provisions,cohtaihed ip Se on 2- f t .Signature of Lobbyist: ~ ; .~ Signature of Principal/Client: J VI, LOBBYIST'IDENTIFICATION: `t'~ Q~ ~ . = ~ Produced ID L.~..~o ~~ gj -yam -~5~-0 i° Form of Identification w°;°~ C~ii"°~ . ~ 0 N ~ ° ^ Personally knowh (Lobbyist)- 0 a ~ w Z • VII. SIGNATURE AND STAMP'OF NOTARY: Fgocz Z.~a€ S - ,. ~ m. q~` v "°~ :~ 0. ~~~ ~ ~r PRINCI~~ IDENTIFICATION:. -~ , Produced ID ~~Q~ -7~3 ~~-~p7=~U Form of identification ^ Personally known (Principal) 3 i tale of Flonda, County of Miami-Dade . State of Florida; County of Miami-Dade - Sworn fo and subscribed before me Sworn and subscrib d before me This . ~~ day of rn~,eu~ , ~~ ~p~p This ~ S day: of 2009 I ~or~ri r Signature of Public Nota - State o ~ ~~~~~"~-~--~l~~h ry f Florida Signature of Public Ndtary -State of Florida Notarization of Lobbyist's signature Notarization of Principal's signature TO BE COMPLETED'BY CITY CLERK'S STAFF ONLY AnnuahRegistratiori'fee. [ ;,] Yes;[ , i.No "Amount!P.aid:$ -:M # • D Date Raid Lobbyist Registration Form-received:and•verified;b • Y~. a F:\CLER\SAEL\aF.ORMSILOBBYSST.F.ORMS\LObby~st'.Registration Form:211Q9idoc ' RPViearl,n7 /r~ o ~ -` ~' m n ~~~~ ~~z r ~2 Amp z,~.zm ~~~~ -+ v a iv ~ m a~< ~o~~ ` D • facts are true'ahd correct and that I-have read or am familiar with the Miaryii+Bea City Code and all reporting requirements. ~` ~ , City of Miami Beach, 1700 Convention :Center Drive, -Miami Beach, Florida-33139, www.miomibeachA:gov CITY CLERK Office ~ CityClerk@miamibeachfLgov • Tel: 305.673.741.1 ,Fax: 305.673.7254..: , - ~ .`~ . LOBBYIST NAME: .S'y ~v rya 7 je ~ L~J Ix- ~ s~ ~ . = 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 J 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, Lam .required to immediately notify the .City Clerk's Office of lobbyist withdrawal in writing. Si ~ure: ~ Date: