Raymond L. Jungles - Sergio Jalife MIAMIBEACH
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION FORMA
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.
0 .3 tj
(NAME OF LOBBYIST: (Last) a 1/,Z (First) (M.I)
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)7
oldr- Pil. (V 1;�TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes:address,phone, or e-mail address.
I. LOBBYIST RETAINED BY:
NAME OF PRINCIPAL/CLIENT:
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
'3o S-- 4f3y-10%(27
TELEPHONE NUMBER: FAX NUMBER:(Optional) 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's••, x
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST:
ii(SPECIFIC LOBBY ISSUE A
Issue to be lobbied(Describe in detail):
m.CITY AGEN CIE S/IISIDIVIDUALS TO BE LOBBIED':
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 eneral 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
mss,
Pursuant to City Code Section 2-482(g)Every registrant shall be required to state the extent of any business,financial,fainilial�professional
relationship,or other relationship giving rise to an appearance of an impropriety,with any current city commissioner or--city personnel-who is
sought to be lobbied as identified on the lobbyist registration form filed.
rr-:
tz.ter v A
Sec 2-482(g)Any Financial,Familial or Professional Relationship
ter;
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
I 0 � /-7/2•olti
W. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required) \ 1 r] kr-
B) -1 PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION):
(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":
_YesjNo: 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 Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
_Yes-jNo: Are you lobbying on a pending appllcation for a Develooment Agreement with the City 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 Section 2-482(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 a not-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.
Yes).No: Are you re resentin a not-for- rofit corporation or entity without s eci m satton or reimbursement.
V. SIGNATURE UNDER OATH:
ON FEBRUARY 28 OF EACH YEAR EACH LOBBYIST SHALL SUB O THE CLERK A SIGNED STATEMENT UNDER
OATH LISTING LOBBYING EXPENDITURES AS WELLAS COMBORSATION E D IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEM FILED EVDIT I&JIRWE HAVE BSEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PEAMI .
'00/ZOOOOOO
%oature of Lob yist
I do solemnly swear that all o e foregoin cts ar a and correct aents.
at I h ad or am familiar with the provisions contained
in Section 2-482 of the Mi Beach City de reporting requi
Signature of Lobbyist-
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
_Produced ID _Produced ID
Form of Identification Form of Identification
Personally known(Lobbyist) _Personally known(Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida,Count State of Florida,County of Miami-Dade
Sworn ubsc' e PATSY A.SISKIND Sworn and subscribed before me
a o `� 1 ry Public-State of Florida This day of ,201_
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Commission#EE 108206
Signature o Publi Not - tgt+d�of FfARQ1r�Through National Notary Assn, Signature of Public Notary-State of Florida
Notarizati of 1:01 t s n u Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY wh? 1Z.44
Annual Registration fee: [ ]Yes[ ]No Amount Paid$ D 77 MCR# Date Paid
Lobbyist Registration Form received and verified by:
F:\CLER\SALL\aFORMS\LOBBYIST FORMS\Lobbyist Annual Registration Form.doc Revised 01/2212014
Registration Form.doc
FORMS\Lobb ist Re r ,i
F:ICLERI$ALL1aFORMSILOBBYIST Y 9
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required)
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION):
(REQUIRED). r
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":
_Yest No: Are you lobbyinq 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 Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
_Yes�No: Are you lobbvinq on a pending application for a Development Agreement with the City or application for
00�� change of zoning map designation or change to the City's Future Land Use Map?
3) Pursuant to Miami Beach City Code Section 2-482(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 a not-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.
Ye N o: Are you representing a not-for-profit corporation or entity without special compensation or reimbursement.
V. SIGNATURE UNDER OATH:
ON FEBRUARY 28 OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER
OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION RECEIVED, IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
Signature of Lobbyist
I 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 Miami Beach City Code and all reporting requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST ID PRINCIPAL IDENTIFICATION:
Produced ID Produced ID
Form of Identification Form of Identification
'.L Personally known (Lobbyist) Personally kno
\,\,111111,, �
.�•tPA"°�e'� ANNET GONZALEZ
VII. SIGNATURE AND STAMP OF NOTARY: '_.` Notary Public-State of Florida
My Comm.Expires Nov 26,20 16
State of Florida, County of Miami-D a ;r State of Florida,Co tjY" l-Dam
mmission#EE 854046
\\\1111/ff 1111111
`°� ANNET GONZALEZ Sworn
Sworn o and subscribed before me ,o ""�;. nd subscrib
This d f Q, +�f Notary Public-State of Florida T ' day of ,201
s.9" •o;? My Comm.Expires Nov 26,2016
IFOF Fv. Commission#EE 8540
nature of ary—State ., i r of Public Notary t f Florida
Notarizatio ist's signature ization of Princi alts s� ure
TO BE COMPLETED BY CITY CLERK'S TAF F ON
Annual Registration fee: [ ]Yes[ ]No Amount Paid$ MCR# Date Paid
Lobbyist Registration Form received and verified by:
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Annual Registration Form.doc Revised 01/22/2014
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
/V\ � BEACH
City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfi.gov
CITY CLERK Office
Rafael E.Granado, City Clerk CityClerk @miamibeachfl.gov
Tel: 305.673.741 1 ,Fax:305.673.7254
LOBBYIST NAME: &IAMUDAL�
I understand that no later than February 28 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.
1) 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, or I am no
longer lobbying on that issue or for that principal, I am required to immediately notify
the City Clerk's Office of lobbyist withdrawal in writing.
Pursuant to Section 2-485 (d),the City Clerk shall notify any lobbyist(or principal) who
fails to timely file a Statement and in addition to any other penalties which may be
imposed as provided in Section %06W, a fine of$50.00 a day shall be assessed for all
Statement(s) filed after the e d . The City Clerk shall notify the Miami-Dade
County Commission on E and blic Trust of the failure of a lobbyist(or principal)
to file the Statement o ay the essed fines after notification.
Any lobbyist,w ails to fi a required Statement by April 30�'of each year, shall be
automatical uspende om lobbying until all fines are paid, unless the fine has been
appeale the Miam ade County Commission on Ethics and Public Trust.
nature: Date:
FACLERULUaFORMSILOBBYIST FORMSTobbyist Registration Form.doc
Disclosure of Interest
3425 Coins,LLC
PARTN't=RSFtIPor UMJTW PARTNERSHIP NAME
NAM AND ADDRESS %OF STOCK
Leonard 8!3vatrkk 730 5th Ave.Now York,NY 10018 100
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Martinez, Maria
From: Martinez, Maria
Sent: Wednesday, November 05, 2014 4:17 PM
To: 'Matthew Wisniewski'
Cc: Prieto, Silvia; Hatfield, Liliam
Subject: RE: Lobbyists registration received by mail on 10-20-2014
The principal's signature needs to be notarized. You could send that on a separate page, if you want to.
Thanks,
Maria
Maria E. Martinez,Assistant City Clerk
CITY CLERK'S OFFICE
1700 Convention Center Drive, Miami Beach,FL 33139
Phone:305-673-7000 ext.6250/ Fax:305-673-7254/ www.miamibeachfl.gov
We are committed to providing excellent public service and safety to all who live, work and play in our vibrant,tropical,historic community.
From: Matthew Wisniewski [mailto:mvwCalraymondjungles.com]
Sent: Wednesday, November 05, 2014 1:45 PM
To: Martinez, Maria
Cc: Kiley Larson; Amanda Jungles
Subject: RE: Lobbyists registration received by mail on 10-20-2014
Good Afternoon Maria,
Thank you very much for the prompt response. Please see the attached scan. Our client has filled out the information
requested. Please let us know if that will suffice, or if we need to print and re-notarize the form.
Kind Regards,
Matthew
MATTHEW V. WISNIEWSKI, PLA
PROJECT MANAGER
Raymond Jungles, Inc.
1
i
www.raymondiungles.com
242 SW 5th St.
Miami, FL 33130
T:305.858.6777 ext.205
F:305.856.0742
The content of this e-mail is intended solely for the use of the individual or entity to which it is addressed. If you have received this
communication in error,be aware that forwarding it,copying it,or in any way disclosing its content to any other person,is strictly
prohibited. If you have received this communication in error,please notify the author by replying to this e-mail immediately.
From: Martinez, Maria [mailto:MariaMartinezC@miamibeachfl.ciov]
Sent: Wednesday, November 05, 2014 8:04 AM
To: Matthew Wisniewski
Subject: RE: Lobbyists registration received by mail on 10-20-2014
Good morning Mr. Wisniewski: As per my email below, we are holding this form pending the information needed. We
have not processed the check either. There cannot be blank spaces on this form. You also need to tell us City
agencies/individuals to be lobbied.
i
Thanks,
Maria
Maria E. Martinez,Assistant City Clerk
CITY CLERK'S OFFICE
1700 Convention Center Drive, Miami Beach,FL 33139
Phone:305-673-7000 ext.6250/ Fax:305-673-7254/ www.miamibeachfl.gov
We are committed to providing excellent public service and safety to all who live, work and play in our vibrant,tropical,historic community.
From: Matthew Wisniewski [mailto:mvw(abraymondjungles.com]
Sent: Tuesday, November 04, 2014 3:49 PM
To: Martinez, Maria
Cc: Subject: FW: Lobbyists registration received by mail on 10-20-2014
Importance: High
Maria,
Can you please confirm that the attached document is the most current version you have on file? The form has been
signed and notarized, however it appears that the items clouded in red are still required based upon your e-mail
below. Can you please confirm this is correct? We would like to resolve this matter promptly in preparation for the
Nov. 14, 2014 hearing.
Kind Regards,
2
I
•
Matthew
MATTHEW V. WISNIEWSKI, PLA
PROJECT MANAGER
Raymond Jungles, Inc.
www.raymondoungles.com
242 SW 5th St.
Miami, FL 33130
T:305.858.6777 ext. 205
F:305.856.0742
The content of this e-mail is intended solely for the use of the individual or entity to which it is addressed. If you have received this
communication in error,be aware that forwarding it,copying it,or in any way disclosing its content to any other person,is strictly
prohibited. If you have received this communication in error,please notify the author by replying to this e-mail immediately.
From: Martinez, Maria [MariaMartinez @miamibeachfl.gov]
Sent: Monday, October 20, 2014 3:01 PM
To: Raymond Jungles
Cc: Hatfield, Liliam; Prieto, Silvia; Barbou, Regis
Subject: Lobbyists registration received by mail on 10-20-2014
Dear Mr.Jungles:
The attached registration form is incomplete and cannot be processed. Please give us the Principal's information and
the specific lobby issue. Make sure the principal signs the form and his/her signature is notarized.
Thanks,
Maria
Maria E. Martinez,Assistant City Clerk
CITY CLERK'S OFFICE
1700 Convention Center Drive, Miami Beach,FL 33139
Phone:305-673-7000 ext.6250/ Fax:305-673-7254/ www.miamibeachfl.gov
3