Michael S. Goldberg 12/31/2014 MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.gov
OFFICE OF THE CITY CLERK,Rafael Granado,City Clerk
Tel:(305)673-7411,Fax:(305)673-7254
03-31-2014
Michael Goldberg
11480 North Bayshore Drive
North Miami, FL 33181
FUNEW Convention Center Advisory Board
Congratulations! You have been appointed by Commissioner Michael Grieco
to the agency, board or committee named above for a term ending: 12/3112014.
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 shall 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 at 305-673-7411. Please read the enclosed materials carefully.
Congratulations again and good luck.
Sincerely,
/_ �j
Rafael E. Granado
City Clerk
cc: Saul Frances, Parking Director
Max Sklar
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, 2-458 and 2-459
Ordinance No. 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 Employee
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 Granado,City Clerk
Tel:(305)673-7411,Fax:(305)673-7254
TO Michael Goldberg
RE: Convention Center Advisory Board
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 the State of Florida (depending on the board or committee on which I serve) on
July 1, following the closing of the calendar year on whi h I have served.
Michael Goldberg
Sworn to and subscribed before me this day of 1\9jZtL , 2014.6
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.
CITY OF MIAMI BEACH
BOARD AND COMMITTEE APPLICATION FORM
GoldbergMichaelS
NAME:
First Name
Last Name
Middle Initial
FL33181
HOME ADDRESS
:
11480 North Bayshore DriveNorth Miami
Home No./StreetState
Apt No.City
Zip Code
mgoldberg@gibraltarprivate.com
305-213-3763305-468-4148305-695-4006
PHONE
:
WorkEmail Address
HomeFax
Senior Vice President/Miami Beach Market Executive
Business Name:
Gibraltar Private Bank & Trust
Position:
400 Arthur Godfrey Road
Miami BeachFL33140
Address:
State
CityZip Code
Street
Pursuant to City Code section 2-22(4) a and b:
Members of agencies, boards, and committees shall be affiliated
requirement shall be fulfilled in the following ways: a) an indi
months; or b) an individual shall demonstrate ownership/interest
No
Yes
No
Middle Beach
circle one): I am now a resident of:
No
123Please note that only three (3)
Please list your preferences in order of ranking [] first choice [] second choice, and [] third choice.
choices will be observed by the City Clerks Office.
(Regular Boards of City)
Choice 1:Convention Center Advisory Board
Choice 2:
Choice 3:
Note
: If applying for Youth Advisory Board, please indicate your aff
1. Past service on the Youth Center Advisory Board:
No
Years of Service:
if yes, please list the names of your children, their
No
2. Present participation in Youth Center activities by your chil
ages, and which programs. List below:
No
Have you ever been convicted of a felony:If yes, please explain in detail:
No
Do you currently have a violation(s) of City of Miami Beach codeIf yes, please explain in detail:
No
Do you currently owe the City of Miami Beach any money:If yes, please explain in detail:
No
Are you currently serving on any City Boards or Committees:If yes, which board?
What organizations in the City of Miami Beach do you currently h
NameTitle
Miami Beach Chamber of CommercChairman of the Board
List all properties owned or have an interest in, which are loca
No
I am now employed by the city of Miami Beach:Which department?
The following information is voluntary and is neither part of yo
being asked to comply with federal equal opportunity reporting r
Gender:Male
Race/Ethnic Categories
What is your race?White
Mark one or more races to indicate what you consider yourself t
Other Description:
Are you Spanish/Hispanic/ Latino? Mark the "No" box if not Spani No
No
Physically Challenged:
NOTEIf appointed, you will be required to follow certain laws which
:
These laws include, but are not limited to, the following:
Prohibition from directly or indirectly lobbying city personnel
o
Prohibition from contracting with the city (Miami-Dade County Co
o
Prohibition from lobbying before board/committee you have served
o
Beach Code section 2-26).
Requirement to disclose certain financial interests and gifts (M
o
(re: CMB Community Development Advisory Committee): prohibiti
from having any interest in or receiving any benefit from Co
or those with whom you have business or immediate family ties
Upon request, copies of these laws may be obtained from the
I hereby attest to the accuracy and truthfulness of the applica
VII of the City Code Standards of Conduct for City Officers,
I Michael Goldberg agreed to the following terms on 3/2/2014 1:2
Received in the City Clerk's Office by:
Name of Deputy Clerk Control No.Date
MI®°ADE SOURCE OF INCOME STATEMENT
Disclosure for Tax Year Ending Last Name First Name Middle Name/Initial
'p-0) 3 ' D/ - � L-
JL� �
Mailing Address—Street Number,Street Name,or P.O.Box
City,State,Zip ID Number
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
❑ County Board Member unici al Board Member, Name of Municipality:
Board where serving
Work address Work telephone Term began on
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
C,&41�4,- h �,4 6A�k-r'ita5l- qa) "W LJ 4 Ryl,
I hereby swear(or affirm)that the information above is a true and correct statement. RECEIVED BY ELECTIONS DEPARTMENT.
❑ Hardcopy
❑ Electronic Copy
Signature of person disclosing
Print name Date signed
I
OFFICE USE ONLY Accepted: Y/ N Deficiency: Processed Date/Initials: Scanned Date/Initials:
138 SP-14 2/13
/ BEACH
City of Miami Beach,
1700 Convention Center Drive,
Miami Beach,Florida 33139,
www.miamibeachfl gov
CITY CLERK Office CityClerk @miamibeachfl.gov
Tel:305.673.7411 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)
r
Board Member name:
61 V
I 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 complywith Miami-Dade County Disclosure Requirements. This meansthatthe
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.
CK
1 1>
Signature: Date: