Michael Phang 12/31/2015 MIAMI
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
January 8, 2014
Dr. Michael Phang
SUBJECT: MAYOR'S BLUE RIBBON PANEL ON FLOODING MITIGATION
Congratulations! You have been appointed by Mayor Philip Levine to the agency, board
or committee named above for a term ending: 12/31/2015.
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,
R faeI E. ado
City Clerk
cc: Saul Frances, Parking Director
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
City Wide Permit Application -(Parking Department Form)
Booklet-Guide to the Sunshine Amendment and Code of Ethics for Public Officers
We are committed to providing excellent public service and safety to all who live, work and play in our vibrant,tropical,historic community.
MIANAIBEACH
City of Miami Beach,1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.aov
OFFICE OF THE CITY CLERK, Rafael Granado,City Clerk
Tel:(305)673-7411,Fax:(305)673-7254
TO: Dr. Michael Phang
RE: Mayor's Blue Ribbon Panel on Flooding and Sea.Rise
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: 01/06/2015.
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 Amendment and Code of Ethics for Public Off7cers 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.
h,,�r, -Q
Dr. Michael Phang
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.
�'®°A°E SOURCE OF INCOME STATEMENT
Disclosure_ for Tax Year Ending Last Name First Name Middle Name/lnitial
'K
2013
�.n tha�i
Mailing Address—Street Nu [r,Street Name,or P.O.Box
VVI
City,State,Tip ID Number
ru S,5t
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 ❑Municipal Board Member,Name of Municipality:
Board where serving l rr
rIj Ya .ei.-Y�'+ 1��/' OAS. �l L►•B Q f p/� 1 v+.�i� �/ . �1004�N �j,p� �L��;,�
Work address V Work telephone Tenn 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
DfAA vG:k-11 X64
Ordry N"
12 Lx-
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
r
• Somme of Income Inform@tion
r Required by the MiarRf-Dade County Code,Section 2-,11.1(1) � ,
The term INCOME shall include, but is not limitedl to, tine fdlowing`items:.Wdges, salaries••tips;=bonuses
commissions & fees; dividends, interest; profits from businesses and professions; your share of profits-from
partnerships, and small business corporations; pensions,.annuities & endowments; profits from the sale or
exchange of real Mate,securities or other property, including personal residence; rents and royalties;your share
or estate or trust income,. including accumulated distributions; alimony, separate maintenance.or support
payments; prizes, awards and gifts; fees as an Executor,' Administrator or Director; disability retirement
payments;workmen's compensation,insurance;damages;.etc.
Filing Instructions
A"Source of Income Form,"°State Form 1,"or a copy of the personal income tax forms may be filed
to satisfy the filing requirement for County employees, municipal employees, and advisory board
members not required to file under State law.
This form must be filed by July 1'of each year.
This form should not be used as a substitute for State Form 1 for those required
to file under state requirements.
Miami-Dade County Personnel and Advisory Board members shall file completed forms with
Miami-Dade Elections Department
2700 NW 87th Avenue
Miami,FL 33172
or
P.O.Box 521550
Miami,FL 33152-1550
or at
financial.disclosuresCa)miamidade.QOV
Municipal Personnel and Advisory Board Members shall file completed forms with
their respective Municipal Clerk.
For further information contact the -
Miami-Dade Elections Department-financial Disclosure Section at 305-499-8413 or your Municipal,;
;, •Clr 's Office,
Note re: Florida Statutes § 119.07: The role of our office is to receive and maintain forms filed as
public records. If your home address is exempt from disclosure- and you do not wish your home
address to be made public, please use your office or other address for your mailing,address. The
following persons are exempt from disclosing their home-addresses: active or former law enforcement
personnel, including correctional and correctional probation officers, personnel of the Department of
Children.artd Family Services-whose duties include the investigation of abuse, neglect, exploitation,
fraud, theft, or other>crlminal activities, personnel of the Department of Health whose duties are to
support the investigation of child abuse or neglect, and personnel of the Department of Revenue.or
local governmLants whose responsibilities include revenue-collection and enforcement or child support
enforcement; firefighters; justices and judges; current or former state attorneys, assistant state
attorneys, statewide prosecutors, or assistant statewide prosecutors; county and municipal code
inspectors and code enforcement officers.
COE 212014
t
0
MIAMI BEACH BOARD AND C"OND-411TI-EE APPLICIATION FORM
Last Name First Name Middle Initial
f k 6Z v, C\A i G1,3-& K -
Home Address City State Zip Code
Ch ke,. AA pl,'; _11-0
Home Telephone Work Telephone Cellular Telephone Email address
Q- 4- 'ti$G- ys 6 -$bbd tf l a•�-�, 1� � ti, C
Business Name cc ation
"r_� "411(PIA
Business Address City State Zip Code
p P r a
Professional License(describe): `ro{.QSS d -� � r�. l�.l etr-,'S lt( ZAX'tA4x pires:
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 gami Beach for a minimum of six months: Yes or No
registered• Are you a voter in Miami Beach: Yes in
No ZI• I am now a resident of: North Beach South Beach Middle Beach
• I am applying for an appointment because I have special abilities, knowledge and experience. Please list below:
IC]li b I&W&FMI 101 A i� 5,0, ft'ly�
Ile
• 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* 0 Historic Preservation Board ❑Police Citizens Relations Committee
❑Budget Advisory Committee ❑Housing Authority ❑Production Industry Council
❑Committee on the Homeless 0 Marine&Waterfront Protection Authority ❑Sustainability Committee
0 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 Rights 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.
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:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED.docx
oO 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:
• 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 ED 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 1:1 or No If yes, please explain in detail:
• Do you currently have a violation(s)of City of Miami Beach Code?Yes Za or No .!If yes, please explain in detail:
• Do you currently owe the City of Miami Beach any money?Yes Z)or No elf yes, explain in detail:
•Are yojj current se se i g on a CJ y oard o omm'ttee?Y s�or No If es, w h board/committee?Voo
• In wh t orga ization(s)in the City of Miami Beach do you currently hold me bership?
A6^X.
Name Position
Name Position
• List all properties wned or' which you have an interest within the CI K of Mi mi Beach:
C.o hn 4 ,T1o� �i a�, �a tnn i t`J p-� �'Imo- 3 4-y
•Are you now employed by the City of Miami Beach?Yes 1:1 or No
Which department and title?
• Pursuant to City Code Section 2-25 (b): Do you have a parent IZI, spouse , child �:a 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 W Female
Race/Ethnic Categories
IDis your race?
4D African-American/Black
aucasian/White
sian or Pacific Islander
Native-American/American Indian
ID Other-Print Race:
Page 2 of 4
F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED.docx
Do you consider yourself to be Spanish, Hispanic or Latino/a?Mark the "No"box if not Spanish, Hispanic, Latino/a.
al 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:
• 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, EMPLOYEES AND AGENCY MEMBERS AND ALL OTHER APPLICABLE COUNTY AND/OR STATE LAWS AND
STATUTES ACCORDINGLY."
fl�l(41
Applicant's Signature D e Name of Applicant(PLEASE PRINT)
Received in the City Clerk's Office by
` 491 a
Name of Deputy Clerk Control No. hate
PLEASE 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 REVISED.docx
! •
AA I A/\A I B EAC H
City of Miami Beach
1700 Convention Center Drive,
Miami Beach, Florida 33139,
www.miamibeachfl.gov
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-
Dade County Financial Disclosure Code Provision Code Section 2-11.1(i) (2)
Board Member's Name:
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"
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.
to
Signature Date
Updated: Monday,June 02,2014
Page 4 of 4
F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED.docx