Jason P. Neal/Waste Management^R~' ~ j
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 prinapal who seeks to encourage the passage, defeat or modification of
any ordinance, resolution, action or deasion 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 term
specifically inGudes the prindpal as well as any employee engaged in lobbying activities. The term "Lobbyists" has specltic exclusions. Please
refer to O mance 2004-3435. ,_____.~
SAL., ~~~~~
NAME OF L
~~~ s~
BUSINESS
3®5`
TELEPHON
OBBYIST: (Last) t~~~~a ~•~•••~
d~~,~~~"rl-I~~'/~ ~lo?~ ~4'~/ /~ Ctii~~i '~vi.~.~9v~1..~= ~'~ 33/a''7
NAME AND ADDRESS (Number and Street) (City)
~sy ~- ~~~ y 3®~ -~~-- ~1~~~8
ER:
(State) (clp coae)
1 i1/~r4~ ~ ~~rJ~'l~- ~4w1
I. LOBBYIST RETAINED BY:
NAME OF PRINCIPAUCLIENT:
~1~5~ il~r~/ /o c~~~,eT ~..~-~ Wiz- ~3/a'7
BUSIf~~5~i~ME~~ID ADDRESS (Number and Street) (Cdy) (State) (Zip Code)
TELEPHONE NUMBER: FAX N MBER: (Optional) EMAIL: (Uptional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY'~^ ~~/~ ~~~Y-'[~~ Y
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRFrCTLY, A 5% OR MORE OWNERSHIP INTEREST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST: x~~~
c ~- / y
Issue to be lobbied (Describe in detail):
lll. 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) An Financial, Familial or Professional Relationship
"~ ~ ~ ~~: ~ ~~~9~s ----.
,~1/O~/~
~t ~ ~5~~= /1%~~~?/~
i'. E ~Z Wd 8 - d3S 6001
u~ni~~~a G~~
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER): ~ ~!
A) LOBBYIST DISCLOSURE: (Required) ,F]~~~
B) PRINCIPAL'S DIS~J.~$J,1,RE1OF LOBBYIST COMPENSATION):
(Required). /(/ G//[/~
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 lobbvina on a present or pendina bid for aoods. eauipment or services. or on a
present or pendina award for aoods eauipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On
Real Estate Development Issues":
^ Yes Lw1 No+ Are you lobbvina on a pendina application for a Development Agreement with the City or
a iication for chance of zoning map designation or chance 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 definition 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)aut, shall not be required to pay any registration fees.
reimbursement. .
I do solemnly swear that all of the
provisions contained in Se,~tio~2-4
V. SIGNATURE UNDER OATH:
a facts~ia~re true and correct and that I have read or am familiar with the
Miami Beach City Code and all reporting requirements.
~111~
^ Produced ID
Form of Identification
^ Produced ID
Form of Identification
'~ Personally known (Lobbyist) ~ Personally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of M' ,;of Florida, County of Miami•
Sworn to ~d subscribed bef e,~y ~.,_ U!(~Egp1~RABAL wo i a d subscribed be4re me
Ada of [~- MY COMMISSION # DD 534Tf~is day of F~ , 2~
EXPIRES: April 213, 2010 ~
/- ei~ .. Banded Tteu Walery Pudb
Signature of Public Notary - S~I'I'
Notarization of Lobbyist's signature
mature of Public Notary -State of F
Notarization of Principal's signature
LtJ(XiEC1A MIRABAL _..._
MY CDMMISStON N DD 534:
EXPIRES: April 26, 20~ r)
Raided Thru NaYry PobYc uraerrnters
TO BE COMPLETED BY CITY C ERK'S STAFF ONLY
Annual Registration fee: [ ]Yes [ ] No Amount Paid $ MCR # Date Paid D
Lobbyist Registration Form received and verified by:
F:~CLER\LO$$YYST\Lobbyist R45t3'a$tE2€1 FOCdtt ~27(~$.dOC Revised 03/27/2008
VI. LOBBYIST IDENTIFICATION ... PRINCIPAL IDENTIFICATION:
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 e~tober 1st of each year, l 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.
~ ~"~Z°~~
i
iSignature: Date:
V
// 1
V
F.ICLERILq£iBY1ST1Lobbyist Registration Farm ",2706.doc
mod'
O
~ A
_F
H f~l
~ ~f 1 ~~i
1 _1 ~'+~i
~'
~~F~l O
F....i
1 ~1 r ~1
~.~ 1,~ i
~. •..[i
.FJ iT•.
t~ tl~
i~I
FLI
t~?] yi
i"mot i8i
i',1 ~»,
.wF .~ 1
!~'~ tl(
"~
Ij ;!
~~"'~ (~,
~F ..i
T
a
m
GC
.c =
wv
V u~
v, m
o~
mg
acac ~
~o
~ V
c~
r
U
a
Z
q a
3
d
`~