Michael Ryan,, a
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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 bond 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) (M.I.)
Ryan Michael
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code}
The Raleigh Hotel 1775 Collins Avenue Miami Beach FL 33139
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
305.673.1717 305.673.8181 mryan@raleighhotel.com
LOBBYIST RETAINED BY:
NAME OF PRINCIPAUCLIENT:
AB Green Raleigh, LLC.
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
The Raleigh Hotel 1775 Collins Avenue Miami Beach FL 33139
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
305.534.6300
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
Andre Balazs, Chief Officer
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY CR INDIRECTLY, A 5% OR MORE
OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST:
Please see attached
II. SPECIFIC LOBBY ISSUE:
Conditional Use permit for Raleigh Hotel r~~S ~ ~u-(~ -~
Issue to be lobbied (Describe in detail):
III. CITY AGENCIESIINDIVIDUALS 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 rise 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 oY unpaid) from 12 months preceding the
commencement of service of City personnel to be lobbied.)
A Full Name of IndividuallTitle B An Financial, Familial or Professiort I~tte i i -f
Mayor None
Commissioners £ ~ ;
City Administration; City Attorney's Office; None
Cit Committees; Cit Boards
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER
HOURLY, FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
None, other than normal comoensatior
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B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
(Required). None, other than normal compensation
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":
ayes 6ZI No: Are you lobbvinq on a present or aendina bid for aoods equipment or services or on a
present or aendina award for Goods, equipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On
Real Estate Development Issues":
^Yes 6a No: Are you lobbvinq on a aendina application for a Development Agreement with the City or
application for chance of zoning map desis~nation or chance 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 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..
ayes 6a No• Are you representing snot-for-profit corporation or entity without special compensation or
reimbursement.
V. SIGNATURE UNDER OATH:
PERIOD.
X
Signature
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 Beach City Code and all reporting requirements.
Signature of Lobbyist: X
J-
Signature of Principal/Client: X
VI. LOBBYIST IDENTIFICATION:
C _
Produced ID '
Form of Iden ification
PRINCIPAL IDENTIFICATION:
^ Produced ID
^ Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn to and sub cribe before me
This day of ri , 2008
Signatur~of/Pul
Notarization of
TO BE
Form of Identification
Personally known (Principal)
~1~wyo,c~ rJ~`fauc,
State of Flesxi~4e, County of Nlf~1=Bad
Sworn to and su cubed before me
is ~ day of ~,~, 200~~
tgnature of Public N tary -State of~FlerieFa- ~u-'`~~IL-
Notarization of Principal's signature
CITY CLERK'S
verified
MY COMMISSION # DD 626373
EXPIRES: May 3, 201 t
Bonded Thru Notary Public Undenvnters
Paid
SARAH PHILLI-- p- g `TER ='~°,.~"
Notary Public -State of New York
NO. O 1 CAb 135216
Auallfied !n New Yoram p~
My Commission Expires /
m MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.aov
CITY CLERK office CityClerkCa~miamibeachfLaov
Tel: 305.673.7411, Fax: 305.673.7254
LOBBYIST NAME: Michael
I understand that no later than October 1 Sc of each vear, 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 for lobbyist withdrawal in writing.
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Signatur .
X ~' i~ ~' -
Date:
MIADOCS 3466605 3
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