Adrian Gonzalez Board Application package pending photo MIAMIBOARD AND COMMITTEE APPLICATION FORM
Last Name First Name Middle Initial
/V-0/ b 93 AD = V\A, � . ' 331317
Home Address City State Zip Code
Home Telephone Work Telephone Cellular Telephone Email address
1�4v ;015 6)FIE7 ( 4wer',
Business Name Occupation
V.�-F co AV-e- A&?
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 Pd or No
• Demonstrates ownership/interest in a business in Miami Beach for a minimum of six months: Yes IM or No Ca
• Are you a registered voter in Miami Beach: Yes Im or No ED
• I am now a resident of: North Beach U South Beach 0 Middle Beach
• I am applying for an appointment because I have special abilities, knowledge and experience. Please list below:
-e-v CV `-Z"J
• Are you presently a registered lobbyist with the City of Miami Beach?Yes[:1 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 0 Planning Board
0 Bicycle-Pedestrian Adviso Committee ❑Health Advisory Committee O Police Citizens Relations Committee
❑Board of Adjustment* ❑Health Facilities Authority Board ❑Production Indust Council
❑Budget 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 Committe )6 Marine Authority ❑Trans ortation and Parking Committee
0 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 eO
❑Waterfront Protection Committee
��-1
�S :01 HV 61 013S EIR
i...Q
Page 1 of 4 -r
F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION 46 BOARDS 82813.doc
°O Note: If applying for Youth Center Advisory Board, please indicate your affiliation with the Scott Rakow Youth Center:
1. Past service on the Youth Center Advisory Board:Yes No Dates of Service:
2. Present participation in Youth Center activities by your children:Yes U No E3
If yes, please list below the names of your children,their ages and the programs in which they participate:
Child's name: Age: Program:
Child's name: Age: Program:
• Have you ever been convicted of a felony?Yes or No NO If yes, please explain in detail:
• Do you currently have a violation(s) of City of Miami Beach Code?Yes�or No�If yes, please explain in detail:
• Do you currently owe the City of Miami Beach any money?Yes or No PQ If yes, explain in detail:
•Are you currently serving on any City Board or Committee?Yes or No 14 If yes,which board/committee?
• In what organization(s) in the City of Miami Beach do you currently hold membership?
Name Position
Name Position
• List all properties owned or in which you have an interest within the City of Miami Beach:
•Are you now employed by the City of Miami Beach?Yes ID or No
Which department and title?
• Pursuant to City Code Section 2-25 (b): Do you have a parent [1, spouse �, child brother or sister 1 who is
employed by the City of Miami Beach?Check all that apply. /VIA -
The If"Yes," identify person(s)and department(s):following information is voluntary and is neither part of your application nor has any bearing on your consideration for
appointment. It is being asked to comply with City diversity reporting requirements.
Gender: Male IX Female
Race/Ethnic Categories
What is your race?
African-American/Black
Caucasian/White
Asian or Pacific Islander
Native-American/American Indian
Other—Print Race:
Page 2 of 4
F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION 46 BOARDS 82813.doc
Do you consider yourself to be Spanish, Hispanic or Latino/a?Mark the "No"box if not Spanish, Hispanic, Latino/a.
No
Yes
Do you consider yourself Physically Disabled?
—&No
4i 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, EMPLOYEE AGENCY MEMBERS AND ALL OTHER APPLICABLE COUNTY AND/OR STATE LAWS AND
STATUTE ACCO G
Ab(� tv 0(.,p
App re Date Name of Applicant(PLEASE PRINT)
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 82813.doc
i i
M ^� BEACH
City of Miami Bench
1700 Convention Center Drive,
Miami Beach, Florida 33139,
wn w.miam bea hfl: ov
CITY CLERK'S OFFICE CityClerk @mlamibeaehfl,gov
Telephone: 305.673.7411 Fax: 305,673.7254
Acknowledgement of fines/suspension for Board/Committee Members for failure to comply with Miami-
Dade County Financial Disclosure Code Provision Code Section 2-11.1(i) (2)
Board Member's Name:16? P�t�j Go-)z,4z
1 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
Financial 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 they may have been recently appointed.
One of the following forms must be filed with the City Clerk of Miami Beach, 1700 Convention Center Drive,
Miami Beach, Florida, no later than 12:00 noon of July 1, of each year.
1. A "Source of Income Statement"
For your convenience, the form is attached. The form can also be downloaded at:
http://www.miamidade.gov/elections/Library/source of income statement.pdf
2. A "Statement of Financial Interests (Form 1)"
For your convenience, the form is attached. The form can also be downloaded at:
http://www:eth cs.state,fl.,-us%ethics/forms.htm1
3. A Copy of your 2012 Federal Income Tax Return
Failure to file one of these forms, pursuant to the Miami-Dade County Code, may subject the person to a fine
of no more than $500, ays in ' r both.
Signature Date
F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC Application revised 5-22-13 FINAL.doc
Updated:Wednesday,August 28,2013
Page 4 of 4
F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION 46 BOARDS 82813.doc
MIAMI CE SOURCE OF INCOME STATEMENT
COUNTY
Disclosure for Tax Year Ending Last Name First Name Middle Name/Initial
2014 Gonzalez Adrian
Mailing Address—Street Number,Street Name,or P.O.Box
5000 LakeView Drive
City,State,Zip ID Number
Miami Beach, FL 33140
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(check one)
0 County/Public Health Trust ED Municipal:
(Municipality)
Department
Position or Title
Work address Work telephone Employment began on/ended on
Filing as a Board Member(check one)
County Board 0 Municipal: City of Miami Beach
(Municipality)
Board where serving
Visitor Convention Athority
Alternate address(if home address is exempt) Work telephone Term began on/ended on
(305) 534-8736
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
David's Cafe Cafecito 919 Alton Road, MB FL 33139 Restaurnt
I her- s -. (or affir, )th.•the information above is a true and correct statement. RECEIVED BY ELECTION DEPARMMENT
Hardcopy r
411Wr i=_ Electronic Copy r%)
Signat of Person Disclosing
9/ 24/
Date signed
OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/Initials: _Scanned Date/Initials:
138 SP-14 COE 2015
f
Adrian Gonzalez
1401 Bay Rd., #208
Miami Beach, FL 33139
T/305.206.8249
E/Adrian @ag-vp.com
_Committee Experience
Elected Vice-President, The Sails Condo Association, 2005- 2006
Elected President, The Sails Condo Association,2006- 2008
Elected to Board,The Sails Condo Association, 2008- Present
Appointed Board Member,Marine Animal Rescue Society, 1998-2006
• Involved primarily with Public Relations, Marketing, and Fundraising decisions
• Also served on the Rescue Team and saved countless marine animals
Appointed Board Member,Transportation and Parking Board for City of Miami Beach,
1996-2002
• Helped provide parking solutions for the city regarding current and future locations
• Reviewed RFPs for current parking meter systems
Elected President,Lincoln Road Mercantile Association, 1994-1999
• Head liaison for the merchants of Lincoln Road to the city of Miami Beach
• Organized and conducted monthly public meetings
Work Experience
President,AG Ventures and Productions, 2004- Present
• Head of operations, Marketing, and global future events.
Vice President, David's Cafe Inc., 1994- Present
• Spearhead company wide Public Relations, Marketing, & Future Business
• Oversee operations at restaurant locations
Education
High School Diploma, Miami Beach Senior High School, 1989-1992
• Graduated in June 1992
Florida State University
• Attended 1993-1995
Languages
English
• Fluent
Spanish
• Fluent
References Available Upon Request