Calvin Kohli 12/31/2014 City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov
OFFICE OF THE CITY CLERK, Rafael Granada,City Clerk
Tel: (305) 673-7411, Fax: (305)673-7254
Email CityClerk @miamibeach.gov
12/13/2012
Calvin Kohli
6039 Collins Ave. #929
Miami Beach, Florida 33140
SUBJECT: Safety Committee
Congratulations! You have been reappointed by Commissioner Jerry Libbin
to the above referenced agency, board or committee for a term ending: 12/31/2014.
If you are unable to accept this appointment, please notify the City Clerk's Office at
(305) 673-7411.
Please read the enclosed material carefully. Again, congratulations and good luck.
Sincerely,
Rafael E. Granado
City Clerk
cc: Saul Frances, Parking Director
Clifton Leonard
ATTACHMENTS:
Letter of Appointment
Oath
City Code Ordinance section, applicable to agency, board or committee
City Code Section 2-22, 2-23, 2-24, 2-25, 2-26, 2-2458, 2-459
Ordinance 2006-3543-Amendment to City Code Section 2-22
Miami-Dade County Code Section 2-11.1 -Conflict of Interest and Code of Ethics Ordinance
City Wide Permit Application -(Parking Department Form)
Booklet-Guide to the Sunshine Amendment and Code of Ethics for Public Officers and
Employees
We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community.
MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov
OFFICE OF THE CITY CLERK, Rafael Granada,City Clerk
Tel: (305)673-7411, Fax: (305)673-7254
Email CityClerk @miamibeach.gov
TO Calvin Kohli
RE: Safety Committee
I do solemnly swear or affirm to bear true faith, loyalty and allegiance to the Government of the United
States, the State of Florida, and the City of Miami Beach, and to perform all the duties of a member
of the above-mentioned board or committee of the City of Miami Beach to which I have been appointed
for a term ending: 12/31/2014.
1 have been issued a copy of Section 2-11.1 of the Miami-Dade County Code (Conflict of Interest and
Code of Ethics Ordinance), as well as the Florida Commission on Ethics Guide to the Sunshine Amend-
ment and Code of Ethics for Public Officers and Employees, and understand that as a member of a City
of Miami Beach Board and/or Committee, I must comply with the financial disclosure*requirements of
Miami-Dade County or ithe State of Florida (depending on the board or committee on which I serve)on
July 1, following the closing of the calendar year on wh' I-hr served.
\� n
Calvin
Sworn to and subscribed before me this day of d� , 20
Silvia Prieto
Deputy Clerk
*Please visit the City of Miami Beach website at www.miamibeachfl.gov under City Clerk/Board and Comm
for additional information regarding the Financial Disclosure Requirement
a"We are committed to providing excellent public service and safety to all who live, work and ploy in our vibrant, tropical, historic community.
M I A M I•DADE
SOURCE OF INCOME STATEMENT
Please Print or Type First Name Middle Name/Initial Last Name
Disclosure
L For Tax Year
Name: Yr/V O Ending:
Mailing Address: to D
City/State/Zip:
Social Security Number:
Filing as a: ® County Employee: ` nn
® Municipal Employee of: \v l
Position held or sought: 9OA")
.�
Board where serving: K11--n or Employment
� Began on:
Department where employed:
Work Address:
If your home address is exempt from public records pursuant to
Florida Statutes§119.07 please check here(read instructions): ® Work Telephone:
r—
Home Address:
Street Address
City State Zip Code
Please list below in descending order with the largest source first, the name, address and
principal business activity of every source of your income including public salary you
received or any person received for your benefit or use during the disclosure period. The
income of your spouse or any business partner need not be disclosed. If continued on a
separate sheet,check here:
Description of the Principal
Name of Source of Income Address Business Activity
. .a - Y M
- L-)
I hereby�swear�dr affirm)that the aforesaid information is a true and correct statement.
Signature of person disclosing Date signed
A1\A
BEACH
city of Miami Beoch,
1700 Convention Center Drive,
Miami Beach, Florida 33139,
v^VW miamibeochfLQov
CITY CLERK Office CityClerk@miamibeachfi..gov
Tel: 305.673.741 1 , Fax: 305.673.7254
Acknowledgement of fines/.suspension for Board Mein bers for.failure
to comply with Miami-Dade County Financial.Disclosure Code Provision
Code Section 2-11 J(i) .(2)
Board Member name:. /Z AZ <017 Z L—
understand that no :later than July '1, of .each year all members of.Boards and
Committees of the .City of Miami Beach, including those of a purely advisory nature, are
required-to comply with Miami-Dade County Disclosure Requirements, This means that-the
members of City Advisory:Boards, whose.sole -or primary:responsibility -is to recommend
legislation or give advice to-the City Commission,must-ftle,:even-though you may have..been
recently appointed.
You must file one ofthe-following with the City Clerk of Miami Beach, 1700 Convention
Center.Drive, Miami :Beach, Florida,.by.July 1 each:year.
1. A"Source.of.income Statement' (attached)or
2. A"Financial Statement" (attached(or]
3. A Copy of the person's current Federal income Tax Return
Failure to file, according-to the Miami-Dade:County Code Chapter 1, General
Provision, Section 1-5 may subject the person-or firm to a fine not-to exceed
$500.00 or by imprisonment'in the county.jail for-a period not to exceed sixty
days, or both.
`` r" ate:
Calvin Kohli
6039 Collins Ave. #929
Miami Beach Florida 33140
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, vvww.miamibeachf1.9ov
City Clerk's Office
Telephone: 305.673.7411 FAX: 305.673.7254
CityClerk @miamibeachfl.gov
Date: May 1, 2012
To: Members of City of Miami Beach Advisory Boards
Subject: Financial Disclosure - Section 2-11.1(i) (2) Code of Miami-Dade County
All Boards and Committees of the City of Miami Beach, including those of a purely advisory
nature, are required to comply the with Miami-Dade County Disclosure Requirements. This
means that the members of City Advisory Boards, whose sole or primary responsibility is to
must file even though you may
recommend legislation or give advice to the City Commission, 9 y Y
have been recently appointed.
You must file one of the following with the City Clerk of Miami Beach, 1700 Convention Center
Drive, Miami Beach, Florida, by July 2, 2012.
1. A "Source of Income Statement" (form attached), or
2. A "Statement of Financial Interests (Form1) (form attached), or
3. A Copy of the 2011 Federal Income Tax Returns
Failure to file, pursuant to the Miami-Dade County Code, may subject the person to a fine of no
more than $500, or 60 days in jail, or both.
Should there be any questions, please direct them to Ms. Silvia Prieto at (305) 673-7000 ext.
6269.
Rafael E. Granado
City Clerk
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