Dr. Ronald Shane 12/31/2015 4'
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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
05-15-2014
Dr. Ronald Shane
2522 Fisher Island
Miami Beach, Florida 33109
SUBJECT ; Marine and Waterfront Protection Authority
Congratulations! You have been appointed by Commissioner Joy Malakoff
to the agency, board or committee named above for a term ending: 12/31/2015.
Pursuant'to Ordinance No. 2006 73543, 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,
Rafael E. Granado
City Clerk
cc: Saul Frances, Parking Director
Manny Villar
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 Dr. Ronald shane
RE: Marina and Waterfront Protection Authority
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.
{�
A-,
Dr Ronald shave
Sworn to and subscribed before me this day of ,1A 2013. �2
A
Silvia Prieto '
Deputy Clerk
*Please visit the City of Miami Beach website at www.miamibeachfi.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®°i1°1°E SOURCE OF INCOME STATEMENT
Disclosure for Tax Year Ending Last Name First Name Middle Name/Initial
2013 5 H L. tAf
Mailing Address—Street Number,Street Name,or P.O.Box
City,State,Zip ID Number c? o
XLLA—%IK
c- i
v
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. ';,; 47
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 EJ- unicipal Board Member,Name of Municipality: __!A t
Board where serving.
Work address Work telephone Term began on
3 a-' C
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
I hereby swear(or affirm)that the information above is a true and correct statement. RECEIVED BY ELECTIONS DEPARTMENT:
❑Hard copy
❑ Electronic Copy
l
L7
Signature of person disclosing
Av—aL
Print name Otte sig ed
OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/Initials: Scanned Date/Initials:
138 SP-14 2/13
C
VdAMIBE*CH BOARD AND COMMITTEE APPLICATION FORM
Last Name 1 First Name. Middle Initial
Home Address City State Zip Code
G4LG 84 Q� Cc
Home Telephone Work Telephone Cellular Telephone Email address
Business Name Occupation
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 fora'
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 or No
• Demonstrates ownership/interest in a business in M11 mi Beach for a minimum of six months: Yes&Or No ZI
•Are you a registered voter in Miami Beach: Yes U or No LEV-"
• l am now a resident of: North Beach I.J South Beach 1:3 Middle Beach
• I am applying for an appointment because I have special abilities, knowledge and experience. Please list below:
•Are you presently a registered lobbyist with the City of Miami Beach?Yes ID 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 ❑Disability Access Committee ❑Miami Beach Human Rights Committee
❑Ad Hoc Committee Centennial Celebration ❑Gay,Lesbian,Bisexual and Transgender ❑Miami Beach Sister Cities Program
Enhancement Committee(GLB
❑Affordable Housing Advisory Committee ❑Health Advisory Committee ❑Normandy Shores Local Government
Neighborhood Improvement
❑Art in Public Places Committee ❑Health Facilities Authority Board ❑Parks and Recreation Facilities Board
❑Board of Adjustment* & ❑Hispanic Affairs Committee ❑Personnel Board
❑Budget Advisory Committee ❑Historic Preservation Board ❑Planning Board
❑Committee on the Homeless ❑Housing Authority 0 Police Citizens Relations Committee
0 Committee for Quality Education in MB ardne&Waterfront Protection Authority ❑Production Industry Council
❑Convention Center Advisory Board ❑Miami Beach Commission for Women ❑Sustainability Committee
❑Design Review Board* ❑Miami Beach Cultural Arts Council ❑Transportation,Parking,&Bicycle-Pedestrian
Facilities Committee
❑.Visitor and Convention Authority
* 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-
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°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 LJ No Dates of Service:
2. Present participation in Youth Center activities by your children:Yes ID No
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 If yes, please explain in detail:
• Do you currently have a violation(s)of City of Miami Beach Code?Yes U or No, If yes, please explain in detail:
• Do you currently owe the City of Miami Beach any money?Yes or No .t If yes,explain in detail:.
•Are you currently serving on any City Board or Committee?Yes ID or No If yes,which board/committee?
• In what organization(s)in the City of Miami Beach do you currently hold membership?
1 SL
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 or No
Which department and title?
• Pursuant to City Code Section 2-25 (b): Do you have a parent rLj, spouse �, child brother or sister who is
employed by the City of Miami Beach?Check all that apply.
If"Yes,"identify person(s)and department(s):
The 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 Female
Race/Ethnic Categories
What is your race?
�D African-American/Black
C
�'Cfr�aucasian/White
Asian or Pacific Islander
I�Native-American/American Indian
4�Other—Print Race:
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Do you consider yourslWo be Spanish, Hispanic or Latino/a?Mark th o"box if not Spanish, Hispanic, Latino/a.
No
Yes
Do you consider yourself Physically Disabled?
UE 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).
o Sunshine Law - Florida's Government-in-the-Sunshine Law was enacted in 1967. Today, the Sunshine Law regarding open
government can be found in Chaoter 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.
o 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; AN-01 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."
Ap licant's Signature Date Name of Applicant(PLEASE PRINT)
Received in the City Clerk's Office by:_ ��-1� .`� D S ?7
)Name of Deputy Clerk Control No. Efate
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.
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CURRICULUM VITAE
Ronald W. Shane, MD
Date of Birth: July 10, 1932
Place of Birth: Bethlehem, Pennsylvania
Pre-Medical Education:
Muhlenberg College 1950- 1954
Medical School:
Temple University School of Medicine 1954- 1958
Degree—MD
President of Class
Post-Graduate Training:
Internship (Rotating) 1958- 1959
Duval County Medical Center
Jacksonville, Florida
Medical Residencies:
Mount Sinai Medical Center 1959- 1960
Miami Beach, Florida
Veterans Administration Hospital 1960- 1961
Oakland, California
Mount Sinai Medical Center 1961 - 1962
Chief Medical Resident
Other:
Director of Medical Education 1962- 1963
Mount Sinai Medical Center
Miami Beach, Florida
Fellowships:
Trainee, (National Institute of 1963 - 1965
Arthritis and Metabolic Diseases,
assigned to Section of Metabolism,
Department of Medicine,
University of Miami School of Medicine
Full-time faculty, Instructor in Medicine, 1965 - 1966
Department of Medicine,
University of Miami School of Medicine,
Jackson Memorial Hospital, Miami, Florida
Jay • ��+ .
Ronald W. One, MD
Curriculum Vitae
Page 2
Positions and Honors Past and Present
Lecturer and Consultant on Kidney Disease
Faculty of numerous Scientific Seminars
Miami Beach Chamber of Commerce:
Member of Board of Governors
Lifetime Trustee
Member of Board, Temple Beth Sholom
President, Physicians Committee for American Friends of Hebrew University
First Physician Recipient of Distinguished Humanitarian Award of the Anti-
Defamation League
Recipient of Keys to the City of Miami Beach
President, Dialysis Corporation of America
President, National Infusion Services
President, Jewish Community Center of Miami Beach
Mount Sinai Medical Center:
President of Medical Staff
Chief, Division of Nephrology
Member of Board of Trustees and its Executive Committee
President of Foundation
Society Member
President, Greater Miami Dialysis Center
Lifetime Member, Dade County Medical Association
Chairman, Board of the Performing Arts Academy of South Florida
Chairman, Board of the Miami Beach Watersports Center, Inc
Chairman, Board of the Shane Family Foundation
MIAMI BEACH
City of Miami Beach
1700 Convention Center Drive,
Miami Beach, Florida 33139,
www.miamibeachfl.gov
CITY CLERK'S OFFICE CityClerk @miamibeachfl.gov
Telephone: 30.5.673.7411 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: 1"R C9 AIA.J. ?A1, )'
I understand that no later than Julv 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 laterthan-12:00,no6n"-of July,— 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 gdf
2. A "Statement of Financial Interests (Form 1)"
For your convenience, the form is attached. The form can also be downloaded at:
http://www.ethics.state.fl.us/ethics/forms.htmi
3. A Copy of your 2013 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, 60 days in jail or both.
Signature Date
Updated:Thursday,March 13,2014
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