Roberto Sanchez III / Waste Pro of Florida, Inc.i
City of Miami Beach Office of the City Clerk ~n1n
1700 Convention Center Drive, Miami Beach, FL 3~~~~~ ' 7
~'~9 2~ ~ 0
LOBBYIST REGISTRATION FORM ?~a e ~ LLL'~~s` o , ,
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 foresaeably will be heard or reviewed by the city commission, or a city board or committee. The term
specifically includes the principal as well as any employee engaged in lobbying activities. The term "Lobbyists" has specific exclusions. Please
refer to Ordinance 2004-3435. ~~
NAME OF LOBBYIST: (Last) (First) ~j (M.Ij
BUSINESS NAME AND ADDRESS ' (Number and Street) (City) (State) (Zip Code)
o ~ - 79Y-- ~7~~
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
i. LOBBYIST RETAINED BY:
t U f o r ,'ct c r 1 /~ L f Y\ ~J S S C ~~ 1~
NHMt Ur t'KINC;IF'AUC:LItN I : f/ r
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BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
TELEPHONE NUMBER. FAX NUMBER: (Optionaq EMAIL: (Optional) .•- -
Fill out this section if principal is a Corporation, Partnership or Trust (Section 2-482 (c))
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST:
nSP>ECiFIC LOBBY ISSUE:
Issue to be lobbied (Describe in detail):
111. CIT~Y4t%A~GEN`C~IE'S/INDIVIDUALS TO BE ;LOBBIED: Pursuant.to City code section 2-4s2(g) 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 Clty personnel sought to be lobbied -'further, pursuant to Clty Cade 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 Professional Relationship
C~ ~~ h~4 nc~ y~~ ~ ~~ ~
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER):
i
'A) LOBBYIST DISCLOSURE: (Required)~~ ~~
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• B) PRINCIPAL'S DISCLOS ~• E (OF LOBBYIS OMPENS ION):
(Required), n(f ~~ ~
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":
~u Yes u 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
Reaf Estate Development Issues":
- -- --• ^•~ ~~ ~~~~ ~~~ ~~~ a C~~u~~~ a ncauon ror a uevelo ment A reement with the Cit 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 defihition of
"lobbyist" as set forth in Section 2-481 above) who only appears as a representative of anot-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.
is Are you repress
reimbursement. .
f 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 Section 2-482 of the Mia i ach City Code and all reporting requirements.
T~
Signature of Lobbyist:
Signature of Principal/Client: ~ ~~(_~__~/~ l~ ~ ~`-""
1/I. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
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Produced ID ~~~ ~ S~Jo~oZ-7~ ~a -(7r~-C~Produced ID ~L OL f~ I>7ZZ~0 -~,3~)"7-~7-0
Form of Identification
Form of Identification ~r---~'•'"~"
^ Personally known (Lobbyist)
SIGNATURE AND STAMP OF NOTARY:
tats of Florida, County of Miami-Dade
worn to and subscribed before me
his ~77` day of AQR~ ~- . 2nn
^ Personally known (Principal) ~~~ ~ o
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State of Florida, County of Miami-Dade ~ ^~ ~ ~-!?
Sworn and subscribed bef re me :~t u' ~ ~ I
This lam"" `-" '''
ay of 2/ , 2009 ~~ "' QS 1
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5igna re of Pub is Notary -State of Florida t?~~> ~,,~;C-r.~i'~=~~
Notarization of PrincipaPs signature it` ~`<... r; .-~=
Public Nbtary -State of Florida
of Lobbyist's signature
TO BE COMPLETED BY CITY CLE K'S STAFF ONLY
Annual•Re,gistration-fee. ;[ .,] Yes;:[ j No sAmount'P.aid'~ MC
_Lobbyist-Registration Porm receivetl.and•verified b :Date'~Baid
F:\CLER\SACL\aFORMS\LOBf3YIST.FORMS\LObbyist Registration Form:211Q9.doc ~
>Revised 02/11
V. SIGNATURE UNDER OATH:
,~ s
City of Miami Beath, }700 Convention Center Drive, Miami Beach, Florida 33139, vrvrw.miamibeachfl.gov
CITY CLERK Office
Tel: 305.673.741 1 ,Fax: 305.673.7254
LOBBYIST NAME: ~"~~ D~~~D ~
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.
~` ~-2d/
Sign ure: .Date.:
F:ICLER1L08BYI5T1Lobbyist Registration Form 32708.doc