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John Gardiner 12/31/2015 �M� 00&=1 1 /\ City of Miami Beach, ln0Convention Center Drive, Miami Beach, Florida 3ol39, OFFICE cF THE CITY CLERK, Rafael GronoJo'City Clerk Tel: (3O5)ur3-7411' Fox: (305)673-7254 12-3O-2O13 John Gardiner 28VVRivo Alto Drive Miami Beech' Florida 33139 udget Advisory Committee Congratulations! You have been appointed by Commissioner Michael-Grieco to the agency, board or committee named above for o term ending: 12/31/2015. Pursuant to Ordinance No. 2006-3543, commencing with terms beginning on or after January 1, 2007, the term of board members who are directly appointed by a member of the City Commission aho|| automatically expire on December 31 of the year the appointing elected official leaves office. If you are unable to accept this appointment or have any questions, please call the City Clerk's Office ot3O5-673-7411. Please read the enclosed materials carefully. Congratulations again and good luck. Ginoone|y. �~ � Rafael E Granodo ~ � v City Clerk U U cc: Saul Frances, Parking Director John Woodruff ATTACHMENTS: Letter ofAppointment Oath City Code/Ordinance section applicable bz agency, board orcommittee City Code Section 2-22, 2-23. 2'24. 2'25' 2'26. 2-458 and 2-450 Ordinance No. 2OO8-3543-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 Employee | ' � � We are committed to providing excellent public service and safety to a//who live, work and play a our vibrant, tropical, historic community. � . 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 TO John Gardiner RE: Budget Advisory 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: 12/31/2015. 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 which I have served. John Gardiner Sworn to and subscribed before me this A day of , 2013. t c 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 We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community. I a MIAMI BOA�IIEa AND COMMITTEE APPLICATION FORM ,l / Last Name First Name Middle Initial 4. Vo i AM,( 1Y C- ,,A<-4+ 3 Home Address City State Zip Code Home Telephone Work Telephone Cellular Tele hone Email address Business Name Occupation V9 -z- A-L_ + (A/n 4Ln-1VU* r--1- 3-) 15 q Business Address City State Zip Code Professional License (describe): Expires: Please attach a copy of currently effective professional license. Pursuant to City Code section 2-22(4)a & b: Members of agencies, boards and committees shall be affiliated with the City; this requirement shall be fulfilled in the following ways: a. An individual shall have been a resident of the City for a minimum of six months; or b. An individual shall demonstrate ownership/interest for a minimum of six months in a business established in the City for a minimum of six months. �/ • Resident of Miami Beach for a minimum of six (6) months: Yes t 2 or No • Demonstrates ownership/interest in a business in ami Beach for a minimum of six months: Yes or No • Are you a registered voter in Miami Beach: Yes EL or No • I am now a resident of: North.Beach ZI South Beach Zh Middle Beach • I am applying for an appol ment because I have special abiliti , knowledge and experience. Please list below: • Are you presently a registered lobbyist with the City of Miami Beach? Yes EZt or No Please list your preferences in order of ranking [1] first choice [2] second choice, and [3] third choice. Please note that only three 3 choices will be observed by the City Clerk's Office. ❑Ad Hoc Charter Review and Revision Board ❑Debarment Committee ❑Miami Beach Human Rights Committee ❑Ad Hoc Committee Centennial Celebration ❑Design Review Board* ❑Miami Beach Sister Cities Program ❑Ad Hoc Committee Flooding Task Force ❑Disability Access Committee ❑Normandy Shores Local Government Neighborhood Improvement ❑Affordable Housing Advisory Committee ❑Fine Arts Board ❑Parks and Recreation Facilities Board ❑Art in Public Places Committee ❑Gay, Lesbian,Bisexual and Transgender ❑Personnel Board Enhancement Committee GLBT ❑Beautification Committee ❑Golf Advisory Committee ❑Planning Board ❑Bic cle-Pedestrian Adviso Committee ❑Health Advisory Committee ❑Police Citizens Relations Committee ❑Board of Adjustment* ❑Health Facilities Authority Board ❑Production Industry Council Bud et Advisory Committee ❑Hispanic Affairs Committee ❑Safety Committee ❑Capital Improvements Projects Oversight ❑Historic Preservation Board ❑Single Family Residential Review Panel Committee ❑Committee on the Homeless ❑Housing Authority ❑Sustainability Committee ❑Committee for Quality Education in MB ❑Loan Review Committee ❑Tennis Advisory Committee ❑Community Development Advisory Committee ❑Marine Authority ❑Transportation and Parking Committee ❑Community Relations Board ❑Miami Beach Commission for Women ❑Visitor and Convention Authority ❑Convention Center Advisory Board ❑Miami Beach Cultural Arts Council ❑Youth Center Advisory Board ❑Waterfront Protection Committee * Board members are required to file Form 1 —"Statement of Financial Interest"with the State. If you seek appointment to a professional seat (e.g., lawyer, architect, etc.) on the Board of Adjustment, Design Review Board, Historic Preservation Board or Planning Board, attach a copy of your currently-effectively license, and furnish the following information: Type of Professional License License Number License Issuance Date License Expiration Date Page 1 of 4 F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION 46 BOARDS 12-16-2013.doc Do you consider yourself to be Spanish, Hispanic or Latino/a? Mark the "No"box if not Spanish, Hispanic, Latino/a. Z No �YeS Do you consider yourself Physically Disabled? No Yes NOTE: IF APPOINTED,YOU WILL BE REQUIRED TO FOLLOW CERTAIN LAWS THAT APPLY TO CITY BOARD/COMMITTEE MEMBERS.THESE LAWS INCLUDE, BUT ARE NOT LIMITED TO: • Prohibition from directly or indirectly lobbying City personnel(Miami Beach City Code section 2-459). • Prohibition from contracting with the City(Miami-Dade County Code section 2-11.1). • Prohibition from lobbying before the board/committee you have served on for period of one year after leaving office(Miami Beach City Code section 2-26). • Requirement to disclose certain financial interests and gifts (Miami-Dade County Code section 2-11.1). • CMB Community Development Advisory Committee: prohibition, during tenure and for one year after leaving office, from having any interest in or receiving any benefit from Community Development Block Grant funds for either yourself, or those with whom you have business or immediate family ties(CFR 570.611). • Sunshine Law - Florida's Government-in-the-Sunshine Law was enacted in 1967. Today, the Sunshine Law regarding open government can be found in Chapter 286 of the Florida Statutes. These statutes establish a basic right of access to most meetings of boards, commissions and other governing bodies of state and local governmental agencies or authorities. • Voting conflict—Form 8B is for use by any person serving at the county, city or other local level of government on an appointed or elected board, council, commission, authority or committee. It applies equally to members of advisory and non-advisory bodies who are presented with a voting conflict of interest under Section 112.3143, Florida Statutes. Upon request, copies of these laws may be obtained from the City Clerk. I HEREBY ATTEST TO THE ACCURACY AND TRUTHFULNESS OF THE APPLICATION; AND I HAVE RECEIVED, READ AND WILL ABIDE BY CHAPTER 2, ARTICLE VII, OF THE MIAMI BEACH CITY CODE, ENTITLED "STANDARDS OF CONDUCT FOR CITY OFFICERS, EMPLOYEES AND AGENCY MEMBERS AND ALL OTHER APPLICABLE COUNTY AND/OR STATE LAWS AND STATUTES ACCORDINGLY." licant's Signature Date Name of Applicant(PLEASE PRINT) v Received in the City Clerk's Office by: Name of Deputy Clerk Control No. Date PLEASE REMEMBER TO ATTACH A CURRENT RESUME, PHOTOGRAPH AND A COPY OF ANY APPLICABLE PROFESSIONAL LICENSE. ATTACH ADDITIONAL SHEETS, IF NECESSARY, TO PROVIDE REQUIRED INFORMATION. Page 3 of 4 F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION 46 BOARDS 12-16-2013.doc MIAMI BEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach,Florida 33139, www.miamibeachfi.gov CITY CLERK Office CityClerk @miamibeachfl.gov Tel:305.673.741 1 ,Fax:305.673.7254 Acknowledgement of fines/suspension for Board Members for failure to comply with Miami-Dade County Financial Disclosure Code Provision Code Section 2-11.1(i) (2) Board Member name: J U rl A RD IN ERA 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 file,even though you may 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 1, 2010. 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. 1 :2 25 20 1'3 Signature: Date: "'®°iADE SOURCE OF INCOME STATEMENT Disclosure for Tax Year Ending Last Name First Name addle Name/Initial t-1 'e Mailing Address—Street Number,Street Name,or P.O.Box /s' 2r A �3 City,St g,Zip � ee- ID Number A- QJ If your home address is your mailing address,and your home address is exempt from public records pursuant to Fla.Stat.§119.07,read instructions on the following page and check here.❑ Filing as an Employee ❑County Employee [].Municipal Employee,Name of Municipality: Position held or sought Department where employed Work address Work telephone Term began on Filing as a Board Member Count Board Member unici al Board Member Name of Municipality: �-C/c7 a i-c r�4�^ r /✓�" ❑ Y [� p � Board where serving (' C✓r- C -j .c, I c�P X15 �►" �.. Work address Work telephone Term began on 112,1 ��,� � ?� /�lg 3 3/3 �I fy _24 b -M ;� 3 List below every source of income you received,along with the address and the principal activity of each source.Include your public salary.Place the sources of income in descending order,with the largest source first.Also, include any source of income received by another person for your benefit. However,the income of your spouse or any business partner need not be disclosed. If continued on a separate sheet,check here.❑ Name of Source of Income Address Description of the Principal Business Activity �( � ,�✓ ,� �.,,� rn tea,-� �,� -? L l��f. ��/�'t 1 /�e�,�( Pte. ����l dj C,o.-t C� f f" c �/ l�Yv�f A%,e(n fj 6 c,, f� 4 •�.1 C r A ('/-f!i( tit SGL(3 �G(v I O nt 2;1 Z�S��i e. , /n v>!/ ^`-�.�/ rat! /�A-�G( /ee I hereby swear(or affirm)that the information above is a true and correct statement. RECEIVED BY ELECTIONS DEPARTMENT: ❑ Hardcopy ❑ Electronic Copy ature of person disclosing ej . J 6- 12-- Print name Date signed OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/Initials: Scanned Date/Initials: 138 SP-14 2/13