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Matthew Krieger 12.31.2017 MIAM1BEAC 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 December 22, 2015 Mr. Matthew Krieger 1000 South Pointe Dr. #1902 Miami Beach, Florida 33139 SUBJECT: Personnel Board Dear Mr. Matthew Krieger: Congratulations! You have been reappointed by the City Commission to the above referenced board or committee,for a term ending: 12/31/2017. If you are unable to accept this appointment or have any questions, please call the Office of the City Clerk at 305.673.7411. Please read the enclosed materials carefully. Congratulations and good luck. Respectfully, Ra ael Gran do City Clerk cc: Saul Frances, Parking Director Sylvia Crespo-Tabak, City Liaison 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 Employees 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: Mr. Matthew Krieger RE: Personnel 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: 12/31/2017. 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 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 1st, followin•.the cl•sing of the calendar year on which I have served. Mr. Mai -w Krieger Sworn to and subscribed before me this _.s day of _ , 20146. AO ja4 2611, / Clar.. . -.4 . 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 are committed to providing excellent public service and safety to all who live, work and play in our vibrant,tropical,historic community. N AMI•DADE CaUN1Y SOURCE OF INCOME STATEMENT Disclosure for Tax Year Ending Last Name First Name Middle Name/Initial 2014 Kr1 e r fl' ileK1 - B Mailing Address—Street Number,Street Name,o•P.O.Box ox 1 000 S6V i- A fOIr4e. 1)10/1 IC10)\ City,State,Zi f ID Number M 1. 1 Actc,� FL 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.❑ • Filii7g 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: —!( ' L P 6 _ Board where serving pJ � Pp oa:r4 . Work address Work telephone Term began on 5 00 S . 'Pt,,,, e.. hive, 4cd 0 $ FC, 3131 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 I Address Description of the Principal Business Activity /' ri. , k.v `r. . T ►Af- I /Opo S. 40.11e_ Dr. efito - IA J • • r . . .( L ti rf,ei 418 FL 3311 L4 i l D, �-i 1 T _ C Jk 1 ( ) l I ,( ! 1 1, 1-IQ Tn5vrwi c-L JO to le( Lens• 'f'a (,LL ' t t I < J I hereby swear(or a irm)that the information above is a de and correct statement. I RECEIVED BY ELECTIONS DEPARTMENT: . ❑ Hardcopy ✓ / ❑ Electronic Copy Signature of person disclosing / 741J)te,, k'rteçi' / / /g Print name Da e si ned • OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/Initials: Scanned Date/Initials: 138 SP-14 2/13 Ir k1w A f 4A,I C I� c e �-� Pr A Ae- ,ICI )MIAMI BEACH 310ARD AND�( ; ead MC4 4�e W E . , CO.P0MITTEE APPLICATION FORM Last Name J First Name Middle Initial 1000 �eJ`��n �o,ne �r, IqO� M 8 FL 3-3 )-31 Home Address City ii State Zip Code 30s— MAe fie 'r il,(am Home Telephone Work Telephone Cellular Telephone Email addres r rner L01 Say 66"BV o CC IN CCA ft r Business Name 1 Occupation -S00 .Sao �-In PD,1114e_ k r��b MB FL 3313 4 Business Address Por City State Zip Code Professional License(describe): t I& A Expires: Al A 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 ve been a resident of the City for a mi imum of six months; or b. An individual shall demonstrate ownership/interest for a mini m of six months in a business establis d in the City for a minimum of six months. • Resident of Miami Beach for a minimum of six(6) m nths: Yes or No • Demonstrates ownership/interest in a business in iami Beac for a minimum of six months: Yes or No • Are you a registered voter in Miami Beach: Yes or No • I am now a resident of: North Beach South Beach Middle Beach • I am applying for a appointment caus I ave special a ilities, knowledge nd a erie ce. Please list below: UftIT n _ r ©A . v P P MIR Pd11U_A4A1V41CW4 •Are you presently a registered lobbyist with E;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 ❑Debarment Committee ❑Miami Beach Human Rights Committee ❑Ad Hoc Committee Centennial Celebration )(Design Review Board` ❑Miami Beach Sister Cities Program ❑Ad Hoc Committee Flooding Task Force ❑Disability Access Committee ❑Normandy Shores Local Government Neighborhood Improvement ❑Affordable Housing Advisory Committee ❑Fine Arts Board ❑Parks and Recreation Facilities Board ❑Art in Public Places Committee ❑Gay, Lesbian,Bisexual and Transgender Personnel Board / Enhancement Committee GLBT ❑Beautification Committee ❑Golf Advisory Committee ❑Planning Board ❑Bicycle-Pedestrian Adviso Committee ❑Health Advisory Committee ❑Police Citizens Relations Committee ❑Board of Adjustment" ❑Health Facilities Authority Board ❑Production Industry Council ❑Budget Advisory Committee ❑Hispanic Affairs Committee ❑Safety Committee ❑Capital Improvements Projects Oversight ❑Single Family Residential Review Panel Committee ❑Committee on the Homeless ❑Housing Authority ❑Sustainability Committee ❑Committee for Quality Education in MB ❑Loan Review Committee ❑Tennis Advisory Committee ❑Community Development Advisory Committee ❑Marine Authority ❑Transportation and Parking Committee ❑Community Relations Board ❑Miami Beach Commission for Women )Visitor and Convention Authority ❑Convention Center Advisory Board ❑Miami Beach Cultural Arts Council ❑Youth Center Advisory Board ❑Waterfront Protection Committee * 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: rr-- � Type of Professional License f" 0 r 9 �� License Number -1' '^t�` ii �/ r• •' �!;� � �'��� Ili ,-;-;. License Issuance Date 1°��`b License Expiration Page 1 of 4 C t- _ F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION 46 BOARDS 12-16-2013.do -- r'+ 7� r-r� C.) i I �?�,� f 4 (j ��fy1 - D t 4 F 31 Y Cnraa d •�L xn:if e 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: Q 1-1- a. to ri a ar 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. 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 $500, 60 days in jail or both. //X// Signature Date Updated:Wednesday,April 09,2014 Page 4 of 4 F:\CLERI$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED.docx MIAMI L. DIVERSITY STATISTICS REPORTING • Name: ( HIQcl� �. Board / Committee: Pv ,ovtvat 800 r Appointment Date: 1 Z 22 /6j Pursuant to City of Miami Beach Ordinance 2009-3632, the City is required to annually prepare and present a report to the City Commission identifying the City's diversity statistics. This form allows board and committee applicants and members to voluntarily self-identify their race, ethnicity, disabled status and gender. Please check the appropriate box for each category: Gender: Male IN Female LD Race/Ethnic Categories What is your race? African-American/Black IJ Caucasian/White Asian or Pacific Islander ZO Native-American/American Indian Other— Print Race: 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? rAl.No Yes C:\Users\CENTFraN\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\NP4J9CNX\BC minority information form 05-20-13 FINAL.doc Updated: Monday,January 26,2015