Tony Rodriguez 12/31/2015 �A B 1:
'-ACH
City of Miami Beach, 1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.Qov
OFFICE OF THE CITY CLERK,Rafael Granado,City Clerk
Tel:(305)673-7411,Fax:(305)673-7254
06-25-2014
Tony Rodriguez
1500 West 24th Street
Miami Beach, Florida 33140
{SUBJECT Convention Center Advisory Board
Congratulations! You have been appointed by Mayor Philip Levine
to the agency, board or committee named above for a term ending: 12131/2015.
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 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 afael E.yGranado
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.
MIAMI'BEACH
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: Tony Rodriguez
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: 12/31/2 015.
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
have served.
eN
Tony Rodriguez
Sworn to and subscribed before me this day of , 2014
Silvia Prieto
Deputy Clerk
*Please visit the City of Miami Beach website at www.miamibeachfi.gov under City Clerk/Board and
Committees for additional information regarding the Financial Disclosure Requirements.
We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical,historic community.
06/L3/2014 14:09 FAX 3054607838 Q0001/0005
Last Name First Name Middle Initial
Home Address City State Zips Code
Home telephone Work Telephone Cellular Telephone Email address
Business Name Occupation
Business Address City State Zip Code
Professional License(describe): Expires:
Please attach a dopy 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 thelollowing 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 irl Miami Beach for a minimum of six months: Yes ED or No
•Are Y ou a registered voter in Miami Beach: Yes or No
• I am now a resident of: North Beach 0 South Beach C0 Middle Beach U
• 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 EJ or No
Please list your preferences in order of ranking [11 first choice [2] second cho ice and [3] third choice. Please note that
only three(3) choices will be observed by the CitV Clerk's Office.
0 Ad Hoc Committee Centennial Celebration 0 Health Advisory Committee 0 Parks and Recreation Facilities Board 1
0 Affordable Housing Advisory Committee ❑Health Facilities Authority Board 0 Personnel Board
❑Art in Public Piaces Committee 0 Hispanic Affairs Committee O Planning Board
0 Board of Adjustment' ❑Historic Preservation Board ❑Police Citizens Relations Committee
06 ud et Advisory Committee 0 Housing Authority 0 Production industry Council
0 Committee on the Homeless O Marine&Waterfront Protection Authority O Sustainability Committee
0 Committee for Quality Education in MB 0 Miami Beach Commission for Women ❑Transportation,Parking,&Bicycle-Pedestrian
Facilities Committee
Convention Center Advisory Board ❑Miami Beach Cultural Arts Council O Visitor and Convention Authority
O Design Review Board' 0 Miami beach Human Rights Committee
0 Disability Access Committee 0 Miami Beach Sister Cities Program
0 Gay,Lesbian,Bisexual and Transgender 0 Normandy Shores Local Government
Enhancement Committee GLB Neighborhood improvement
Board members are required to fine 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:ICLMSALL1aFORMSI8OARD AND COMMITTEESSC APPLICATION REVISED.docx
06/"3/2014 14:10 FAX 3054607838 Q0002/0005
Note:lf 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 Q No W Dates of Service:
2. Present participation in Youth Center activities by your children:Yes 0 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 U or No If yes,please explain in detail:
• Do youcurrently have a violation(s)of City of Miami Beach Code?Yes Z)or Nol'ZI ,If yes,please explain in detail:
• Do you currently owe the City of Miami Beach any money?Yes or No if yes,explain in detail:
•Are you currently serving on any City Board or Committee?Yes or No's"yes,which board/committee?
• In what organization(s)in the City of Miami Beach do you currently hold membership?
Name �. Position ON
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 U or No
Which department and title?
• Pursuant to City Code Section 2-25 (b): Do you have a parent 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): X I
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: MaleW Female
Race/Ethnic Categories
What is your race?
African-A merican[Black
MaCaucasian/White
rJ Asian or Pacific Islander
�e Native-American/American Indian
Other—Print Race:
Page 2of4
F:\CLER\$ALL1aFORMSIBOARD AND COMMITTEEWC APPLICATION REVISED.docx
06/23/2014 14:10 FAX 3054607838 Z0003/0005
_....... __ --.._.. ._......_......_...._.. ..__.._..__ _....__._._..........._._..._..._ _. .
FORM 1 STATEMENT OF 2013
Please print or type your name,mailing FINANCIAL INTERESTS
address,agency name,and position below: 1 FOR OFFICE USE ONLY:
LAST NAME--FIRST NAME--MIDDLE NAME:
MAILING ADDRESS:
l5_00 W C'j-" �) 1�- 3+
�* ! •-V�' ( V 33 /q is b
CITY: ZIP: COUNTY:
NAME OF AGENCY:
NAME OF OFFICE OR POSITION HELD OR SOUGHT:
�C Oly G -b i v TZ.D
You are not limited to the space on the lines on this form.Attach additional sheets,if necessary.
CHECK ONLY IF 1CC ANDIDATE OR ❑ NEW EMPLOYEE OR APPOINTEE
**** BOTH PARTS OF THIS SECTION MUST BE COMPLETED ****
DISCLOSURE PERIOD:
THIS STATEMENT REFLECTS YOUR FINANCIAL INTERESTS FOR THE PRECEDING TAX YEAR,WHETHER BASED ON A CALENDAR
YEAR OR ON A FISCAL YEAR. PLEASE STATE BELOW WHETHER THIS STATEMENT IS FOR THE PRECEDING TAX YEAR ENDING
EITHER(m st check one):
DECEMBER 31,2013 Qi3 ❑ SPECIFY TAX YEAR IF OTHER THAN THE CALENDAR YEAR:
MANNER OF CALCULATING REPORTABLE INTERESTS:
FILERS HAVE THE OPTION OF USING REPORTING THRESHOLDS THAT ARE ABSOLUTE DOLLAR VALUES,WHICH REQUIRES FEWER
CALCULATIONS,OR USING COMPARATIVE THRESHOLDS,WHICH ARE USUALLY BASED ON PERCENTAGE VALUES(see instructions for
further details). CHECK THE ONE YOU ARE USING:
❑ COMPARATIVE(PERCENTAGE)THRESHOLDS OR DOLLAR VALUE THRESHOLDS
PART A--PRIMARY SOURCES OF INCOME [Major sources of income to the reporting person-See-instructions]
(If you have nothing to report,write"none"or"n/a")
NAME OF SOURCE SOURCE'S DESCRIPTION OF THE SOURCE'S
OF INCOME ADDRESS PRINCIPAL BUSINESS ACTIVITY
-ayga"y S L AL 14 h 13 JZP 6 4gc L e51-/l e A�-T5
� L
L a j9 13 L.G S i a 9
-3
PART S-- SECONDARY SOURCES OF INCOME
[Major customers,clients,and other sources of income to businesses owned by the reporting person-See Instructions]
(If you have nothing to report,write"none"or"n/a")
NAME OF NAME OF MAJOR SOURCES ADDRESS PRINCIPAL BUSINESS
BUSINESS ENTITY OF BUSINESS'INCOME OF SOURCE ACTIVITY OF SOURCE
PART C--REAL PROPERTY [Land,buildings owned by the reporting person-See instructions] FILING INSTRUCTIONS for
(If you have nothing to report,write"none"or"n/a")
when and where to file this
form are located at the bottom
of page 2.
V INSTRUCTIONS on who must
file this form and how to fill it
out begin on page 3.
CE FORM 1-Effective:January 1.2014. (Continued on reverse side) PAGE 1
Adopted by reference in Rule 34-6.202(1),F.A.C.
06/`23/2014 14:11 FAX 3054607838 20004/0005
PART D-.—INTANGIBLE PERSONAL PROPERTY(Stocks.bonds,certificates of deposit,etc.-See instructions]
(If you have nothing to report,write"none"or"n/a")
TYPE OF INTANGIBLE BUSINESS ENTITY TO WHICH THE PROPERTY RELATES
PART E 1 LIABILITIES [Major debts-See instructions]
(If you have nothing to report,write"none"or"nia")
NAME OF CREDITOR ADDRESS OF CREDITOR
A)
PART F— INTERESTS IN SPECIFIED BUSINESSES (Ownership or positions in certain types of businesses-See instructions]
(If you have nothing to report,write"none"or"nla")
BUSINESS ENTITY#1 BUSINESS ENTITY#2
NAME OF BUSINESS ENTITY
ADDRESS OF BUSINESS ENTITY
PRINCIPAL BUSINESS ACTIVITY
POSITION HELD WITH ENTITY
I OWN MORE THAN A 5%INTEREST IN THE BUSINESS
NATURE OF MY OWNERSHIP INTEREST
IF ANY OF PARTS A THROUGH F ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE Ll
SIGNATURE (recluired)-.- DATE SLGNE D (required):
o I
If a certified public accountant licensed under Chapter 473,or attomey in good standing with the Florida Bar prepared this form for you, he or
she must Complete the following statement:
I prepared the CE Form 1 in accordance with Section 112.3145, Florida Statutes, and
the instructions to the form. Upon my reasonable knowledge and belief,the disclosure herein is true and correct.
Signature Date
EILING INSTRUCTIONS:
WHAT TO FILE: WHERE TO FILE: - WHEN TO FILE:
After completing all parts of this form,jnclud�na_ If you were mailed the form by the Commission Initially,each local officer/employee,state officer,
signing and dating It send back only the first on Ethics or a County Supervisor of Elections for and specified state employee must file within
sheet(pages 1 and 2)for filing. . your annual disclosure filing,return the form to that 30 days of the date of his or her appointment
location. or of the beginning of employment. Appointees
ffr
If you have nothing to report in a particular Local ocerVemployees file with the Supervisor who must be confirmed by the Senate must file
section, you must write "none" or "n/a" in that of Elections of the county in which they permanently prior to confirmation, even if that is less than
section(s). reside.(If you do not permanently reside in Florida, 30 days from the date of their appointment.
file with the Supervisor of the county where your Candidates for publicly-elected local office must file
NOTE: agency has its headquarters) at the same time they file their qualifying papers.
MULTIPLE FILING UNNECESSARY: State officers or specified state employees file
Generally, a person who has filed.Form 1 for a with the Commission on Ethics,P.O.Drawer 15709, Thereafter'local to em sl employees ees,state officers,
calendar or fiscal year is not required to file a Tallahassee, FL 32317-5709: physical address.- and specified state employees are required to file
second Form i for the same year. However, a. 325 John Knox Road, Building. E, Suite 200, t July 1st following each calendar year in which
they hold their positions,
candidate who previously filed Form 1 because of Tallahassee,FL 32303.
another public position must at least file a copy of Finally,at the end of office or employment, each
his or her original Form 1 when qualifying. qualifying Candidates a file this form together with their local officer/employee, state officer, and specified
q g P state employee is required to file a final disclosure
To determine what category your position falls form(Form 1F)within 60 days of leaving office or
under, see the "Who Must File" Instructions on employment.Hovmver.filing a CE Form IF(Final
page 3. Statement of Financial Interests)does not relieve
Facsimiles will not be accepted the filer of filing a CE Form 1 if he or she was in their
position on December 31.2013.
CE FORM 1-Effective:January 1,2014. PAGE 2
Adopted oy referenc+e in Rule 34.8.202(1).FAC.
MIAMI BEACH
City of Miami Beach
1700 Convention Center Drive,
Miami Beach, Florida 33139,
www.miamibeachfl aov
CITY CLERK'S 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-
D County Financial Disclosure Code Provision-Code Section 2-11.1 i 2
ade Cou y ( ) ( )
Board Members Name: O Al Y
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 roust 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.ethics.state.fl.us/ethics/forms.html
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:Wednesday,April 09,2014
Page 4 of 4
F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED.docx