Jason P. Neal/Waste Management (2)
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 derision of any commissioner; any action, derision, recommendation of the City Manager or any city board or
committee; or any action, deasion or recommendation of any city personnel during the time period of the entire deasion-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 inriudes the principal as well as any employee engaged in lobbying activities. The term "lobbyists" has speclflc exclusions. Please
refer to 0~~~ 43435. ~~~~~
NAME
~~ l~~itr~G~i~-r~T a~~s-.r~~/ ~o ~T
3D ~ ~y~ G UZ
(M.I)
~~ 331d ~
(Number and Street) (City) (State) '(Zip Code)
I. LOBBYIST RETAINED BY:
~1/~s i ~~ l~l~~/~6~'~r~i
NAME OF PRINCIPAUCLIENT:
/l/G/ to C i ~~~~~ ~
33/,2'
~ ~P ~
~~~ ~
(State) (zip Code)
_S,A~ ~
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
SOS -.S Y'"/- C~ ~ z `~
I out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: ~.~//] ~~rt~iC~,Lx/S Y ' ' '
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIREC LY, A 5% OR MORE OWNERSHIP INTEREST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST: , /~yf
u.SPECIFIC LOBBY ISSUE:
So~~, Gib ~ ~ ~~c yG~sv~ s~~~~~
Issue to be lobbied (Describe in detail):
Ill. 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 Relationshi
~G EZT~~ c~Fi~-~-~~ LS ~D.t/~
~~"~ / ~~~ /~ONc
~, „ !I /i ~ C~S. EMAIL:
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) ~//'A~,~ _f~ L~~'~~
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): ~v~ ~(/~ ~ ~~~~~
(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":
present or pendina award for goods. eauipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On
Real Estate Development Issues":
^ Yes I!1 No: Are you lobbvina on a pendina 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. .
V. SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
of
I do solemnly swear that all of the foregoing facts are~t(ue and correct and that I have read or am familiar with the
provisions contained in Section 2-}~2 of thei Beach City Code and all reporting requirements.
Signature of Lobbyist:
Signature of Principal/~1ient:
VI. LOBBYIST IDENTIFICATION:
^ Produced ID
Form of Identification
Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miamiiami-D~ad~~~~~Wr
Sworn and subscribe ~ -- LUC~AMIRABAL
Thi (~ day of . '~~OMMISSI~V ~ DD 534772
_ ~ _ ~ ~ _ _ _ . "'! EXPIRES: AprN 26, 2010
Sighature of Public Notate
Notarization of Lobbyist's signature
PRINCIPAL IDENTIFICATION:
~ Produced ID
Form of Identification
Personally known (Principal)
State of Florida, County of Miami-Dade
wor d subscribed a re me
day of •,
.: ~
ignature of Public Notary - S t
Notarization of Principal's si
LUCRECIA MIRABAL
MY COMMISSION N DD 534n2
- EXPIRES: Aplil 26, 2010
Bawled 71w Namur PubYc u~aen
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ ]Yes [ ] No Amount Paid S ~ MCR # Date Pald
Lobbyist Registration Form received and verified by:
F:`CLER\LOBBYIST~Labbyist Registratian Farm 32708.dac Revised 03/27/2008
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office CityClerk@miamibeachfl.gov
Tel: 305.673.7411 ,Fax: 305.673.7254
c~
LOBBYIST NAME: V ~~~ ~~ ~-
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 thefity Clerk's Office of lobbyist withdrawal in writing.
S
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F:ICLERILQBBYiSTiLnbbyist Registration Farm 32708.dnc