Raymond Jungles - 120 Ocean Drive, LLC (� O
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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 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 includes the principal as well as any employee engaged in
lobbying activities. The term"Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435.
Jungles Raymond
NAME OF LOBBYIST: (Last) (First) (M.1)
Raymond Jungles, Inc. 242 SW 5th Street Miami Florida 33130
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 858-6777 (305) 856-0742 www.raymondiungles.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes:address,phone, or e-mail address.
I. LOBBYIST RETAINED BY:
I. LOBBYIST RETAINED BY:
120 Ocean Drive, LLC .
NAME OF.PRINCIPAUCLIENT:
120 Ocean Drive, LLC -2675 S. Bayshore Drive, Coconut Grove, FL 3313
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) ( i C )
305 416-4556 305 377-3040 D M a rt i n2 aep
pm
TELEPHONE NUMBER: FAX NUMBER:(Optional) EMAIL: O ti I
Fill out this section if principal is a Corporation,Partnership or Trust[Section 2-482(c)]
• NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY:David Martin j000
�°.fld eJ'L r
AVQ Ped ry fll&fin,(60 "
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: See attached
II.SPECIFIC LOBBY ISSUE:
Development Approvals and Permitting Issues,including,but not limited to Historic Preservation Board and Planning Board approvals for modifications to
design and robotic/mechanical parking for the property located at 120 Ocean Drive,Miami Beach,FL
Issue to be lobbied(Describe in detail):
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
i
Pursuant to City Code Section 2-482(a)(4)include the commissioner or personnel sought to be lobbied,and whether the lobbyist has entered
into any contractual relationship (paid or unpaid) with said city commissioner or personnel from 12 months preceding such
person's commencement of service with the city to the present date,stating the general nature of the subject contractual relationship.
Sec 2-482(a)(4)Full Name of Individual and Contractual Relationship(Explain) YES NO
title of person to be lobbied
Planning Department and Building Department Staff None
PB, DRB, HPB, BOA, FPCity Commission, as None
necessary*
Pursuant to City Code Section 2-482(g) Every registrant shall be required Pursuant to City Code Section 2-482(g) Every registrant shall be
required to state the extent of any business,financial,familial or professional relationship,or other re do ghiprgiyikingrisse to an appearance
bbied
of an impropriety,with any current city commissioner or city personnel who is sought to be lo t6dtifie I,8n .61 lo�$b�(si k@gistration
form filed.
Sec 2-482(g)Any Financial,Familial or Professional Relationship �,f
i
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1 ��
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR
OTHER): ,f
A) LOBBYIST DISCLOSURE:(Required)$ V
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION):
(Required).
I 'l al
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 X No: Are you lobbying on a aresent or pending bid for aoods.eauil2ment or services.or on a present or nendina
award for aoods,eauiarnent or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
❑Yes X No: Are ou lobbying on a gending goolicalion for a Development Agreement wiACity or al2l2licatiop fgr
change of zoning mai3 desi nation or ch n e to the City's Future Land Us
3) Pursuant to Miami Beach City Code 2-484 (h)Any person (except those exempt fro th efinition of"lobbyist" as set forth in
Section 2-481 above) who only appears as a representative of a not-for- fit rporation or entity without special
compensation or reimbursement for the appearance, whether direct, or indir t, t express s , ,rt of or opposition to
any item, shall register with the clerk as required by this section but,shall not be quir to pay anyr�gistration fees.
❑Yes X No: Are o rei2resentina a m2 -for- rofit corooration or entitv wi hou esiall com ens t '�or reimbursement.
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V. SIGNATURE UNDER OATH: /Al QN FEBRUARY 28tb QE C C C
OATtj. LI TING LOBBYING EXPEbIDITURES. AS WELL AS COMPENSAMONZIECEIVEDAW THE CITY OF MIAMI BEACH
EM D EfJtW IF IHE13E HAVE BEEN NQ
EXPENDITURES OR COMPENSATION DURING THE REPO TING PERM.
1
Signature of Lob is
I do solemnly swear that all of the foregoing facts are true and c ect a I have reor am familiar with the provisions contained
in Section 2-482 of the Miami Beach City Code and all reportin , quir
Signature of Lobbyist:
Signature of Principal/Client: ..
VI. LOBBYIST IDENTIFICA ON: PRINCIPAL IDENTIFICATION:
❑ Produced ID ❑ Produced ID
Form of Identification Form of Identification
Y Personally known(Lobbyist) I/ Personally known
(Principal)VII. ,;,• `,���'a��P�.���, 6MP F
"•••,,�, PATSY A.SISKINO ,�a
NOTARY: s Notary Public=State of Florida =, *_ Commission i EE 178res
My Commission Expires
�• •s my Comm.Expires Oct 18,2015
r, 30, 2016 mi-Dade
State of Florida, mi-fti nission#EE 108206 _W I
Sworn su oreft& al*WyAssn. orn and su crilipd before me
d o his rrdaf YlO , 20�°
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ignatur f Public Notary—State of Florida 4Na u Public ry—State of Florida
Notariza n of Lobbyist's signature zation of PridgiRtIE5 signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY /
Annual Registration fee: Yes No Amount Paid$
�Sv M C R# 321/ V to Paid t .�
Lobbyist Registration Form received and verified by: '
I
® NAIAMI
City of Miami Beach, 1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.gov
CITY CLERK Office CityClerkCmiamibeachfl.gov
Tel: 305.673.741 1 ,Fax: 305.673.7254
LOBBYIST NAME: Raymond Jungles
I understand that no later than February 28th of each year, I must file the following
form, pursuant to Section 2-485 of the Miami Beach City Code, with the City Clerk's
Office for all active lobbying issues.
l) Lobbyist Expenditure and Compensation 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 OfffcJ�of lobbyist withdrawal in writing.
Pursuant to Section 2-485 (d), the City,,( lerk shall notify any lobbyist (or principal) who fails to
timely file a Statement and in addlton to any other penalties which may be imposed as
provided in Section 2- .1, a fine,of $50.00 a day shall be assessed for all Statement(s)
filed after the due dat e City lerk shall notify the Miami-Dade County Commission on
Ethics and Public Tr of e failur, of a lobbyist (or principal) to file the Statement or pay the
r
assessed fines afte otifi tion. Z",
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Any lobbyist, ho f ' s to Ile the required Statement by April 30th, 2012, shall be
automatically suspen ed f'',m lobbying until all fines are paid, unless the fine has been
appealed t e Mi i-Da e County Commission on Ethics and Public Trust.
t. lee 13
Signature: Date:
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