Chris P. Growald 12/31/2014 MIANAIBEACH
City of Miami Beach,1700 Convention Center Drive,Miami Beach,Florida 33139,www rniamibeachfi gov
OFFICE OF THE CITY CLERK,Rafael Granado,City Clerk
Tel:(305)673-7411,Fax:(305)673-7254
TO: Chris P. Growald
RE: Affordable Housing 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: 12/31/2014.
I 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 Amendment and Code of Ethics for Public Officers 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 st, following the closing of the calendar year on which I
have served.
Ch Is P. Growald
Sworn to and subscribed before me this day of `f , 2014
r-.
Silvia Prieto
Deputy Clerk
*Please visit the City of Miami Beach website at www.miamibeachfl.gov under City Clerk/Board and
Committees for additional information regarding the Financial Disclosure Requirements.
We arer rp ?i � Q � ,, lle ��F?, !lp ? ? 1Syr Qrl f�'y R !v �}'�!o � �� ��d!�K�b�� (�IfoRlr+b�I hc�t�t%ic community.
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/V\1AM1 BOARD AND COMMITTEE APPLICATION FORM
C.-R&W 4�_�, VO
Last Name First Name Middle Initial
� -,r c_��L 4 a VA-1-1--- 3 5 ( r3- 7
Home Address City State Zip Code
ht-,vo 6D 06 I-Lsdu 1) 0�1
Home Telephone Work Telephone Cellular Telephone / Emai 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 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 or No
• Demonstrates ownership/interest in a business in Miami Beach for a minimum of six months: Yes�D or No
• Are you a registered voter in Miami Beach: Yes I o No
• I am now a resident of: North Beach South Beach . Middle Beach ID
• I am applying for an appointment because I have�pecial abilities, knowled�ag.@�and experience. Please list below:
�jga)rJI r, Pfd -7. �' � f f l�G� k�
• Are you presently a registered lobbyist with the City of Miami Beach?Yes 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 Committee Centennial Celebration ❑Health Advisory Committee ❑Parks and Recreation Facilities Board °O
❑Affordable Housing Advisory Committee ❑Health Facilities Authority Board ❑Personnel Board
❑Art in Public Places Committee ❑Hispanic Affairs Committee ❑Planning Board
❑Board of Adjustment* ❑Historic Preservation Board ❑Police Citizens Relations Committee
❑Budget Advisory Committee ❑Housing Authority ❑Production Industry Council
❑Committee on the Homeless ❑Marine&Waterfront Protection Authority ❑Sustainability Committee
❑Committee for Quality Education in MB ❑Miami Beach Commission for Women ❑Transportation,Parking,&Bicycle-Pedestrian
Facilities Committee
❑Convention Center Advisory Board ❑Miami Beach Cultural Arts Council ❑Visitor and Convention Authority
❑Design Review Board* ❑Miami Beach Human Ri hts Committee
❑Disability Access Committee ❑Miami Beach Sister Cities Program
❑Gay,Lesbian,Bisexual and Transgender ❑Normandy Shores Local Government
Enhancement Committee GLBT Neighborhood Improvement
* Board members are required to file Form 1 —"Statement of Financial Interest"with the State.
*11f 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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F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 06022014.docx
°O Note: If applying for the Youth Center positions of the Parks and Recreations Facilities Board, please indicate your affiliation with
the Scott Rakow Youth Center and/or the North Shore Parks Youth Center:
i
• Please describe your past service with the City's Youth Centers(include dates of service):
• Present participation in Youth Center activities by your children:Yes ZI No
If yes, please lilt 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 ZI If yes, please explain in detail:
• Do you currently have a violation(s)of City of Miami Beach Code?Yes[.--a or NoID If yes, please explain in detail:
• Do you currently owe the City of Miami Beach any money?Yes Ca or No 0 If yes,explain in detail:
•Are you currently serving on any City Board or Committee?Yes ID or No LJ If yes,which board/committee?
• In what organizatilon(s)in the City of Miami Beach do you currently hold membership?
-7/Yr q-g/4/EG-
Name OAYI� Position
Name Position
• List all properties owned or in which you have an interest within the City of Miami Beach:
I
•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 0, spouse �, child 1:3 brother 0 or sister 0 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 La
Race/Ethnic Categories
What is your race.?
I
African-American/Black
I
Caucasian/White
Asian or Pacific Islander
ID Native-American/American Indian
Imo, I
4�Other—Print Race:
Page 2 of 4
F:\CLER\$ALL1aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 06022014.docx
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
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:
o Prohibition from directly or indirectly lobbying City personnel(Miami Beach City Code section 2-459).
o Prohibition from contracting with the City(Miami-Dade County Code section 2-11.1).
o 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).
o Requirement to disclose.,certain financial interests and gifts(Miami-Dade County Code section 2-11.1).
o 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 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.
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; 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."
cy
14 e t S r-)-Q�0
Applicant's Signature Date Name of Applicant(PLEASE PRINT)
Received in the City Clerk's Office by:
Name of Deputy Clerk Control No. Date
PLEASE ATTACH A CURRENT RESUME, PHOTOGRAPH AND A COPY OF ANY
APPLICABLE PROFESSIONAL LICENSE.
l� ATTACH ADDITIONAL SHEETS, IF NECESSARY, TO PROVIDE REQUIRED
INFORMATION.
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F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 06022014.docx
I
MIA)MI
City of Miami Beach
1700 Convention Center Drive,
Miami Beach, Florida 33139,
www.miamikeachfl.gov
CITY CLERK'IS OFFICE CityClerk @miamibeachfl.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:
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 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.
I
1. A"Source of Income Statement„
2. A Statement of Financial Interests (Form 1)
3. A Copy of your latest 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 bate
Updated:Monday,June 02,2014
Page 4 of 4
F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 06022014.docx
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Jan 13 14 01:28p Chris Growald 305 673 0043 p.1 -
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.lanuaazy 10,2014
a'
Dear All,
As a retired Tennis Professional and Court Builder,, 1.can fully commit the hours required to do a good jab for
Miami Beach. lr/1y commitment to our Community has been by doing, not,just talking. Over the past 14 ye-aXs 1 have '.
shared my expertise with Kevin Smith, Andy Plotkin and other staff members of the Department of l-"arks and
Recreation. I have been playing recreational doubles every morning at Flamlingo for the last 1.4 years an,d have
contributed to its morphing into a top of the line facility.
Resume and Qualifications :
i graduated from Temple University in 1966.. 1.then served two years in the United States Anny dw-iricy thie,
Vietnam.Conflict. I was honorably discharged. After my military service 1 built and ran.temilis laclllne s �t,/Jlh a
primary school friend. We had five different locations with a total of 52 indoor courts. 1 did this for tw'elvc
years during which I played.and taught Tcnni.s professionally. After my tennis career T party eFed wid-1.an
established Builder who taught me the business. During that time we built many communi.tics
that included Golf and Tennis faciliti.es.We were partners for twenty eight years, until I mal-r:ied Ba.l Kara and _
retired to Florida. The best decision 1 ever made.
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Very truly yours,
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MI AM DADE SOURCE OF INCOME STATEMENT
Disclosure for Tax Year Ending Last Name First Name Middle Name/Initial
Mailing Address—Street Number,Street Name,or P.O.Box
City,State,Zip 10 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
A
F] County Board Member Municipal Board Member, Name of Municipality:
Board where serving f
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f�1 S ///f//s
Work address Vlork telephone rm 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 dour
benefit. However, the income of your spouse or any business partner deed not be disclosed. If continued on a separate sheet,check here.
Name of Source of Income Address Description of the Principal Business Activity
w-dt S-A 9-K57 �15..5
hereby sv ar for affirm) that the information above is a,irue and correct statement. RECEIVED BY ELECTIONS DEPARTMENT:
�^ �]Hardcopy
i rA
❑ Electronic Copy
Signature of pers isclosing
o Pj,*+L
Print name DeVT
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OrFICr US`Ot`lC-Y P.�tc.r�..�' !' I ''.1 J '!Ci