2024 Lobbyist Registration Form - VCA (Zachary Daniel Gallin) -(.;r.',i�+
MIAMI BEACH o�,�ao�,he��,Y�,a� � �°�a '
1700 Convenlion Cen�ar Ddve - � - �
� Mlaml 9eech,FL 33139 � � � . . _ .
� 905.073.7411 � �.
LOBBVIST REaISTRATION FORM ,
lobbyisl means ell persons employed or re�einetl, whelher paltl or nal, by a princlpel who seeks to encourege lhe passage, deleal or
motllOcaUon of eny ortlinenw, re5olutlon, eclbn a� dadslan ol eny commissloner, any aclion, dxi6laq recommeiMallon ol lha Cdy
Managar orany Cily board or c�mmitlea;or eny eclbn,dedsion or recommendallon ol any City pe�sonnel dudiy the tima pedod ot Ihe
entire decision-making process on such acllon, tleclslon or recommendallon I�af foreseeably vAll ba heard ar revlewed by�he City
Commisslon,or a Cdy board or commtl�ee. 'I'ho�e�m sper.lfically inr.lutlas�ho ptlnclpal as woll as any employee engageE In lobbyln9
aclrvAies. The lertn'LobbylsP has specifc ezcluslons, Pleese reler lo City Codo C�ap�er 2,Adlcla Vll, Oivision J, enlMletl'LobEyls�s; .
(ot addilional Informetion.
lnstrucllons; Please complele all seqions aHhls form and sobmit ihe comple�ed Imm,wilh Ihe appllcabla fee, lo ihe Olfice ol lhe City �
Clark. If you need mora space to completa an answeq use a seperata sheeqs)of paper II yau have natbing to report in a parlicular
sectlon, you musl wrile 'none' or 'n!a' In ihal sectlon. My change to any in/ortnatbn oAginally f1e0, or eny etltlNonal Clry �
Commisaloner or personnel who are also soughl lo be lobtiled shall requlre Ual the lobbyisl ftle an amenOment lo Ihe reglslralion(nrm. '.,
The IOLbylst has a conlinuln9 tluty to supply Inlormallon antl BmeM �ha lorms ftletl IhroughoW lhe penoC Ihat ihe IobEying oauro. ,.
Separo(e reglslrelionlom�s shall Ee reqviretl for eac�pnncipal represenletl on each apeNfiC 155ua �
1. LOBBYIST INFORMATION: � ��
C�ALu� a�c,tMcw or-�—��eL ,
W1MEOiLOBBYIST (lasl) (Firsl) (MiddleName) �
INSIOZouT SQ�(�-TS t �Nl�T(W1Nwl��C 1fJ� LU-+M7� QflN[- 6 i l.ot Pa,.l�r�L�s� C.a �..
IOBBY13TBUSINESSNAMEN10pDDRESS (NumberaM51ree1) (CAy) (S�ate) (LD�e)�Do4}
`—' (�I�3'� k53�04Cb`1 �b.@ws�oeovcse. co«.
LOBBYIST9USINESSTELEVHONENUMBER CELLUWiTELEPHONENUMBER EMNLAOOHESS
II. PRINCIPAL INFORMATION: .
� C���-�1 N ZA(.FM� D Rr'\EL ,.
NAME OF PRINCIPAL (�eQ (fint) (Middla Nama)
(F�\DEDJC SQ����S 1' $rR'bC{YMw1t.�hr�C' lVRle �H-�N(�y Qfl�� � i LU2 �i�'-�-�E.''k3i '.
PRINCIPALBUSINESSNMIEANDADDRESS (NumberandSliref) �qly) � (SYale) (21pCoda) �uo4 �,
--- �'11}J kS3 — OI.�SG� 2D�Q_ I.•S�OEdn1C.Lw. i,
PRINGIPPLBUSINESSTELEPMONENUMBER CELLULVtTELEPHONENUMBER EMNLAOORESS .
pusuanl b CiIY C�Sectim"tJB3�M1)(1He): A p�mApel of enY�F��^Ibn, peMenNp,a�dMr aMhy who eppeen u e bbhyhl m�MheH ol IIW �
enliry,wilhoN apedal wmperaalbn ar�almbureem�ri far Ne apPoereze,WIreI�Br tllrtcl,intllrecl,er mnlligeN,lo avp�a Wpya�l M alappoeM1bn W
anitemaMllregMerwilM1tMClHkefreyurctl6ylMsubs 11mWahellMberpuretllopaye�ryrvpivtrclunleea. .�
If the principal is a Corporadon, Partnership or Trust, the following InPoimallon MUST be provided ''�.
pursuant to City Cotle Section 2-482�c�: I
. NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARV(11 no�e,wrl[e NIA�: �� �
. NFME OF ALL PERSONs NOLOINo,DIRECTLY oR IN�IRECTLY,A6%oR MORE OWNERSHIP INTEREST IN SUCH .
CORPORATION,PARTNERSHIPORTRUST�1fnone,wdleN/A�: '�N JH.IISDt�� �M COJ(Ll�a-� '�.
i' �a�' �fll-l•IN �,.
Pagoiof6 � ,..
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III. ISSUE TO BE LOBBIE�: i �
Oescribe with as much tlatall as is practical, including 6ut not Ilmited to a specific descripqon where i �,
applicable of a pending request far proposal, fnvltation to bid, or pubtic hearing number. i '�
l�l uu-�c��iti ��n 2 — �n r��ry�- cyr�M �N in,A+u� i
gEr,-c.a A-�Nv� �.�r n�Pnu �r+�,,v� - vc,a-
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IV.CITY AGENCIESIINDIVIDUALS TO�BE 60BBIED: '� '
Pursuant to City Code Section 2482(a)(4�, list lhe C{ty Commissioner or City personnel sought to be �.
lohhietl, antl whether the lobbyist has entered into any contractuai relatlonship (paid or unpaid) wilh ���,
said City Commissioner or City personnel from 12 months preceding such commencement of service I
with the City to the present tlate,stating the general natuie of the subject coniradual relationship. i
Fuil Name o�IndiVitlual entl Contrectual RelaliOnship�tl yes,explain) �ES NO
Ttle oi Person to be LODbtetl �,
�hVO-It�/1 — MrM" �.�1 YES,'In 11o�r F�b-n �N r�iAv-�� ✓ 'I.
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Pursuant to City Code Section 2-482(g), every reg�strant shall be requiretl to state tha eMent of any :
business, �nancial, femillal or professional relaNanship, ar other relaUonshlp 9lving dse to an �,
appearance of an impropdery,with any current Ciry Commissioner or City personnel who is sought to '
be Iobbied as identltied on the lobbyist reglstration torm filed. �
�{st any Business, Flnancial, Familial or Prolesslonal Reletlons�ip, or o�her relationehip glving dae to an �I
e are e ot Im ro Ae if none write NIA : '�
�
V. DISCLOSE RATE AND AMOUNT OF LOBBYIST COMPENSA710N— Be Soecific. (Note that a �,
contingency fee is prohibited pursuant to City Catle Sec. 2-085.3): '
N D co+v�(JL-+�sA�1or' '
Pege 2 of 6
The hllowing alx�8�queatlone MUST be answe�ed:
1) Pursuentto �yCodeSecUon2-0BB,eplitlea'Pm�ibketlCampalgnContribuliancByLobbyis�sOnProcmementissues':
Yes No: u ob rec n or din bf !or ootle u menlo er ces oro a res¢nlo
pentlina nwerE for aoada eouloment o�servlceT
2) Pursuanl lo Ciry Cotle Seclion 3AB0,enlilled'PmM1ibllod Campalgn CONribullons By Lobbylsls On Real Estale Devebpment �,
BSUBS: / '�.
Ves✓No: A�e oulobb In a o e e re iwl ih CI o a II ato �..
l ch n e I dea no e eC ' aueLe dUeaMa 9 �
3) Pursuanl to City Coae Seclion 2dBE�h�, any person (axcepl ihose exempt Irom Iha definilion o�'b�EyhY as set/orlh In
Section 2-081)wha only eppears as e mpresentetNe ol a nobloo-profil coryaratlon or¢ntltywilhoN speclal wmpenaelian or ,
ielm�u�se Mtortheappearenre,whelherJireclarindiredloevpresssuppedoloroppositionloenyilem,a�allieglstatwilh �
Ihecirycl kasreyuirepbyl�i5seclion,buls�allnolbereyuireE�opayanyregishalianlees.
Yes No: Are ou re resenlln a noUor. rofd car tdion or enC w hou • fel co neallon or
relmbursem¢MT �
4) Pursuanl b CAy Code SeGion Y�B7,the lerm"bbbyisl"speci(cally axcludes Ihe/oilovnn9 persons�. Ewped wBnesses who
provide ony scientifc,technical or olher specialixed infomullon or lestmony In public meetinps;any person wfio on�y eppears
as a represenlalive al a nelghbarhaod essociation ttilhoul compensallon or relmbmsemenl for tha appearanee,whelher airecl.
intirecl or conUngenl,�o express Suppotl ol Or oppaslllon la any it¢ml and nnV Pe�sonYfio any appean as a representalNe ol
noFlor�profi Wmmuniry bas¢tl orqan¢elion la Iha porpDse ol requeslinB a grenl wilhoul special compensalbn or
rolmburse enlloriheappeamntt, �
Ve¢ o: Are vou orovidino onlv scientific, lec�nical or olher epeaielized InbrmMbn: aoceadna as a
reaenmllve ol a e or a assac al o X o t a lal co eal o or mburoement or
re ese Hn a notlo rofil ba o e an fo f e ur e
coeciai comcensnlion or reimbursemenYl
6) Pursuanl lo Ciry Cotle Sectlon Id91�1j, no campaiqn consullanl shall bbby t�e Cdy Commisslan for a pedotl al 12 monlhs
iWlounng Ih9 swea�g In ol any elecled olficlal(s�b�wAom Ihe campelgn consulWnt providatl campalgn consulling senlcas
wdhin Ihe➢asl el¢cllon cyde.See Seclian 2491 br mare Infortnellon.
Va�✓No: Nave vou movldetl cemoalon consultlnu eervlcee lo an Incumbent member ol l�a CIN Commisslon ��.,
- wHhinihe aatel nc e i ea eaae sll el eumbenlme be a of heC ommissla . i
Vee ofJo: II vee.ha� M baen ke�Ihen 12 monthaalme�iha eYatW oMel�V�f wharrvou orovided camnN� ����
— — camulllna�ervkeswn�wemin7 '�.
8) Pursuant to Cily COAe Seclion E-0B2(a��4�e.,e Iobbyisl wM hes wilhin I�a pasl elactlon cyde pmvlded campeign consNGng
seMcas to an Incumtenl membor oi lhe CiIV Commisslon(whic�kbbying aclNity Is nd ol�em7se pmhibilad by Code secllon
2-091)shall Eisclose such patlicular servlce on MSRie�lobEylsl reglslre110n bml d h II II JI b a d I r ��,
ri b l e C' ss o a ub le aeli � �
Yas o; e ou ro Itled ca co sultin e a� Ee a1lAe CI Cammleslon ��
inihe actNecllo e I lee�elletthei cumbenlmamber I eQ Co
YeaVNo:
� coneulOna brvka9 '
II ��-/// TO 9E CAMPLEfEO BY CI1V CIERN'66TAiF ONIY �'�,
MnoalNeplsirtllanfee: [ lYesy�No AmountPtltlS MCRp�rSnG(>I ppoqlQ�L/ �I,
labbNstPaBlslratlmFwmrtalvetlmdvMAMW.DH S2.I�i — EC( ,.,..
F4ClFAtSALL�afORMS�IABYYISTFOPMS\LabbylAXplrtntlo�formAe�luEO]-IAlORE6Ex RaNwIW(11/2030 I
Page 7 016 � ��i
VI. SIGNATURES UNDER OATH: '��.
ON FEeRIIARV 28 OF EACH VEqR EACH LOBBYI9T SHALL 9UBMIT TO THE OFFICE OF THE CIN CLERK A �I'
SIGNED STPTEMENT UNDER OATH L�STING LOBBYING ERPENOITURES AS WELL AS COMPEN9ATION I,
RECEIVED FOR THE PRECEDING CALENDAR YEAR WITH REGARD TO THE SPECIFIC ISSUE ON WHICH THE '
LOBBVIST HAS BEEN ENOAGED TO LOBBY A STATEMENT SHALL BE FILED EVEN IF THERE HAS BEEN NO '
EkPENDITURE OR COMPENSATON DURING iHE REPORiING PERIOD.�
SlgnaWre of LobbylsL Date �
I tlo solemnly swear or eRrm ihat all of the bmgoing faqs, slalements, and disclosures In Ihls form are Irue ena corted, �
end thet i have read a�am familiar wilh ihe provisions conlalned in Chapler 2,Arl. VII,Divislon 3, enlXled `Lob�ylsls'of �
the MiamlBeaGi CNy Code and ull reputling requiremenls. ���.,
SgnaWreofLobbylsl: — ��� � Dele � (�.-�f ' i �,
SigneWfeofPrintipeC � Deta '�.
VII. NOTARY SIGNATURE AND SEAL• ��.
LOBBVIST: PRINCIPAL
Slate or state of
COUnIy oC COunty oE
Svom lo(or aRrtnetl)and subscnbetl berore me, Svam to(ur affirtned)antl subscdDed 6elore me, '�.
by means of O physical presence � 6y means of O physical presenCB ',,
or�online notafizalion, or�onllne notedzetlon, '�.
ihis_dey o! 20_,6y tha_tlay of .20_,Gy ',
NAME OF L09BYIST NAME OF PRINCIPAL �,,
Produced ID _Protlucetl ID '��,.
FORM OF I�EMIFICATION FORM OF IOENPFlCATION I,
_Personelly Known � - � ' � _Personally Known ;
Slgneture of Nolary Publlc SlgnaWre of No�ery Public
Neme of Notary,7ypetl,Printetl or Stampetl Name of No[ary,TyPetl,Printed o�Slamped �i
(NOTARY SEAL) (NOTARV SEAL) ',
�The lerm"IobbyisY'speNficaly excWaes�he lollovring pe�sons�. II
Expetl witnesses who provitle only sclanli�q technlcal or oNer speclalizetl Inlarmation ortaslimony In public mealings;any persanwho
I
only eppea�s as a represenlelive ot e nelghbori�ootl assaciatbu wilhou�compensation o�reimbursemont lar Iha appearance,wheNe� �il
Clrect, indirect of contingen�,lo e%press suppad of or oppoeltlon�o any ilBm;and any person who only appears as a representalrve ol
nn1-/oo-profit community based o�ganization br the putpose af requestinp a granl wAhout speclal compensellon or telmbursament lor
the appearance. I
Paga 4 0(6
CALIFORNIA JURAT GOVERNMENT CODE 4 8202 �I
m w,�suuw
j A notary public or other officer compleling ihls certi(icate ver7lies oniy lhe iAenUry o�the Indlvldual who siyne� ,I�
Lthe document to which ihis certi(icate is atla<hed,and no1 ihe tmthfulness,accuracy,orvalidlly oRhal doamenL
State of Califomia / �",
�o���vo� lvs i� ���� ���
Sobscribed antl swom lo(or affirmed)before me on
Ihls � �ib, daY of�`�'�, .. 2Q�. bY
Dafe Manfh Year
I �
;'oP?�.,siisroRy,, ��� ��^c.�a� �U��c _a ���n
,��t�� p ��
.��ry� ' ,..
_ .� i�� ' Inrid(2). _ � —I�
�= Name(s)ol SigneqsJ
'.1 . CA(�p\�ryp;
";�o,y��?��,,�.Uq�:`�.` pmveA to me on lhe basis nl satis(atlory evitlence to
� '�E"o�� .+ be thc person�s)who appeared be(ore me. .
9 . ... ... ...
/ .. .
Signawre . �''�___. . :
Place Nolory Seal and/or 5[amp Abave ��SigFle e of Nolory Public
�._�
��
�-- -� -. OPTIONAL `. ... - '�,
Completing this inlonnotion can deter alferafion o/fhe document oi ''i
lrauaulenf reattoUrment olthis/orm lo an unlntended documenl. I
Opscription o}Attached Document /� q ) �
Ti�lc or Type of Documeni ��Y�iti�'^ �/_e^� ���� �� �`tJ74v/_�"'"�'� � �
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DocumentDale�. _.. i I� ?_ � NumberofPages:
I
Signer(s)Other Than Named Above: . �
�A�6�� 1F��3+BeaBaA�m�1�06p �
�2019 Naiional Notary Associatiw '�
MIAMIBEACH
Ciy d Mioml B.a�h,q00 Co�.anfio�Gnbi Dlne,Mlaml Bw�h,Flondo 33199,xww.miomibeahll.gov �'�.,
Otllca ol Ihe Ciy Clod
Rdoel E.Granado,Ciry Clerk CIryCIa�kOmlaml6eadilLgov ,
Tol:805.677Jd1I,Pan:305.673.7234 i
NAME OF LOBBYIST:�LO_ ��.( ( I�J '�,,
1) LOBBYIST FEE EXPENOITURE AND COMPENSA710N STATEMENT �
Pursuanl to Ciry Code Section 2-485(d), the City Clerk shall nolify any lobbyist (or
principal)who tails lo file timely a Lobbyisf Fee Ezpendifure and Compensation Statement
(Statement). In addition lo any other penallies that may be imposed as provided in
Sec(ion 2-085.1, a fine of $50.00 a day shall be assessed for Slalemenls filed afler Ihe
due dale. The Ciry Clerk shall notify Ihe Miami-Dade Counry Commission on Elhics and '.
Public Tmst of lhe faiWre of a lobbyist (or principal) to file �he Statement or pay ihe '
assessed fnes afler nolification. ';
Any lobbyist, wYro fails to Tde Ihe required Statement by April 30'^of each year, shall be ��'
automatically suspended from lobbying uniil all tines are paid, unless the fine has been '�
appealed to Ihe Miami-Dede County Commission on Elhics and Public Trust.
I hereby acknowledge that on February 28 of each year, I shall submit to lhe City Clerk a ��
signed Stelement under oath listing all lobbyisl expendiWres, as well as compensalion ,
received,for Ihe preceding calendar year wilh regard to Ihe specific issue on which I have �
been engagedtolobby. '.
2) LOBBYISTWITH�RAWAL ��
Once an issue I have registeretl to lobby has concluded or I am no longer lobbying on
Nal issue, I shall immediately file u Notice of Wthtlfawal wilh lhe Oflice o(the City Clerk
3) ANNUAL LOBBYIST REGISTRATION FEE
I understand annual registration of all lobbyisls shall be required for each 12-month period
commencing Octoher 1 oF each year, and Ihe fee for such ennaal registretion shall ba
$540.00 pursuant to Secfion 2-082 of Ihe Miami Beach City Code '
Signalure�of Lobbyisl Dete �
n.e�cnuuiw�wmwomne`roxMsumrv�nw�a.e�rdm n..�w osu.pncc�
ll
PaBe 6 0(6 '
MIAM113tAC:H .����E�
CIty of MIamI 8each ;���i 1$ 2024
1700 Convenlion Cenler odve
Mlaml Beaoh, Flodda 33139 . � :�.'IAMI F;�2GH
v,�ww.miamlbeach0.gov , . . � . _ ,�. ,-i ,.„��
CIIy Clerk's Office � '��-�� �
Tel: 305-673-7411 �
Fak: 305-673-7254 Olflca Uee Only
ANNUAL IOBBYIST REGISTRATION FORM I!
i
Name: ���� p. �R'1-1i1fJ ,.
Buslness Nama: ���l0 E O U I SPDR�S r �-t�'�Z������ �,
Address: ��R� L�.-t�UR� P(+t!-� C.(kS-f� IioS Rt��E-�h.� l.A- `{a41.��- �'��..
OKce Telephone Number. �..
Cellular Telephone Number. �� � }� �'� — 0� �� __
EmailAddress: -e�'��3� INS�Q�QUCSE• LoM
I/more fhan onelob6yist,please Ilst:
�) -
2)
3) I
4)
5) �
6)
7) —.
Submil thls form to the ONice of ihe Clty Clerk, along wlth a check Tor 5500 for each I
Ioh6ylsL Please meke lha check(s) payeble to the Clty of Mlaml Beach. �
For City Clark's OHico Use Only
MCR#: t' : s 52I� �e '�.
Amountpald: �atepald: �an ��� i�03�� �i
Processed by: �}'�1 Date: ...
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