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Kirk Paskal 12.31.2016 MI AM I 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 January 05, 2016 Mr. Kirk Paskal 7915 Crespi Boulevard Miami Beach, Florida 33141 SUBJECT: Mayor's North Beach Master Plan Steering Committee Dear Mr. Kirk Paskal: Congratulations!You have been appointed by Mayor Philip Levine to the agency, board or committee named above for a term ending: 12/31/2016. Pursuant to City of Miami Beach Code Section 2-22 (5)a,"Notwithstanding any other provision of the City Code or of any resolution, commencing with terms beginning on or after January 1, 2007, the term of every board member who is directly appointed by a member of the City Commission shall automatically expire upon the latter of: December 31 of the year the appointing City Commissioner leaves office or upon the appointment/election of the successor City Commission member." 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 again and good luck. Regards Rafael Granado City Clerk cc: Saul Frances, Parking Director Jeff Oris, 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 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. 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: Mr. Kirk Paskal RE: Mayor's North Beach Master Plan Steering 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: 12/31/2016. 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, following the losing of the calendar year on which I have served. Mr. Kirk Paskal Sworn to and subscribed before me this /2 day of \-1A , 2018 Deputy Clerk /ate 01 et 4- *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. tOAMIDADE CO SOURCE OF INCOME STATEMENT Disclosure for Tax Year Ending Last Name First Name Middle Name/Initial. 2014 Psi<ct.L k.iri�. I Mailing Address—Street Number,Street Na 7 r .0.Box f)g / C CeS 0 /PI) City,State,Zip ID Number AA 1 Awl 1,AcIA \-- L r A -1 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 I Municipal Board Member, Name of Municipality: .0 c cv�c-.- Board where serving Pile �S Or r i76 La 4`ir io/kfr, P c 6 141 J 4- Work ad ss Work telephone I Term an on vo nA 6,_,vc.0 IN) qt-Tler 7,bivi, f-1 NY eiii-y.43-vy iiii 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.n Name of Source of Income I Address Description of the Princ', al Business Activity i AIN t. -r Alhi l 6 0" Vicki( 3t/ b Ni /121u€, ._C _0, " ,ere/ be cv / V' -.!,f CAS°1 '� v- )S C�-& ' Iv .. ■U )d ' i " ��LL ,s3 "cu e information e is correct statement. RECEIVED BY ELECTIONS DEPARTMENT: I hereby swear(or affirm)that the inio�motion �bove[s a tr . and ccrr���s�a�ement. ❑ Hardcopy ❑ Electronic Copy Signature of person disclosing / ? /404 A / /z— 1 Print name Date signed OFFICE USE ONLY Accented: Y i N Deficiency: Processed Date/lniiials: Scanned D2tzfin.,. . : 135_S?-14 2h3 CITY OF MIAMI BEACH BOARD AND COMMITTEE APPLICATION FORM PaskalKirk NAME: First Name Last Name Middle Initial FL33141 HOME ADDRESS : 7915 Crespi BoulevardMiami Beach Home No./StreetState Apt No.City Zip Code KPaskal@gmail.com 305-469-2413954-563-4444 PHONE : WorkEmail Address Home Director of Operations Business Name: Winter Music Conference, Inc. Position: 3450 NE 12th Terrace Ft. LauderdaleFL33334 Address: State CityZip Code Street Pursuant to City Code section 2-22(4) a and b: Members of agencies, boards, and committees shall be affiliated requirement shall be fulfilled in the following ways: a) an indi   months; or b) an individual shall demonstrate ownership/interest Yes No Yes circle one): I am now a resident of: North Beach I have lived and worked in Miami Beach since 1998. During that No 123Please note that only three (3) Please list your preferences in order of ranking [] first choice [] second choice, and [] third choice. choices will be observed by the City Clerk’s Office. (Regular Boards of City) Choice 1:Design Review Board Choice 2:Historic Preservation Board Choice 3: Planning Board Note: If applying for Youth Advisory Board, please indicate your aff 1. Past service on the Youth Center Advisory Board: No Years of Service: if yes, please list the names of your children, their No 2. Present participation in Youth Center activities by your chil ages, and which programs. List below: No Have you ever been convicted of a felony:If yes, please explain in detail: Do you currently have a violation(s) of City of Miami Beach code No If yes, please explain in detail: Do you currently owe the City of Miami Beach any money:No If yes, please explain in detail: No Are you currently serving on any City Boards or Committees:If yes, which board? What organizations in the City of Miami Beach do you currently h NameTitle Miami Beach UnitedBoard Member North Shore Historic District Neighborhood President Association North Beach Neighbors AllianceSteering Committee Member List all properties owned or have an interest in, which are loca Property 7915 Crespi Boulevard, Miami Beach, FL 33141 No I am now employed by the city of Miami Beach:Which department? The following information is voluntary and is neither part of yo being asked to comply with federal equal opportunity reporting r Gender:Male Race/Ethnic Categories What is your race?White Mark one or more races to indicate what you consider yourself t Other Description: No Are you Spanish/Hispanic/ Latino? Mark the "No" box if not Spani Physically Challenged:No NOTE:  If appointed, you will be required to follow certain laws which These laws include, but are not limited to, the following:    Prohibition from directly or indirectly lobbying city personnel o    Prohibition from contracting with the city (Miami-Dade County Co o    Prohibition from lobbying before board/committee you have served o Beach Code section 2-26).    Requirement to disclose certain financial interests and gifts (M o (re: CMB Community Development Advisory Committee):  prohibiti from having   any interest in or receiving any benefit from Co or those with whom you have business or immediate family ties Upon request, copies of these laws may be obtained from the “I hereby attest to the accuracy and truthfulness of the applica VII – of the City Code “Standards of Conduct for City Officers, I Kirk Paskal agreed to the following terms on 1/12/2016 9:36:58 Received in the City Clerk's Office by: Name of Deputy Clerk Control No.Date 1 A N f City of Miami Beach 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miarnibeachfl.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: Irk- G, L 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.usiethics/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. 2(21- Signature / Date Updated:Wednesday,April 09,2014 Page 4 of 4 F:\CLER\SALL1aFORMS\BOARD AND COMMITTEES\aC APPLICATION REVISED.docx DIVERSITY STATISTICS REPORTING Name: 41 Et6_ et . Board / Committee: a ©vI s • 6e.0.01) 45/Q_te, P vnt4ese • YY Appointment Date: !Hi i 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: Malel Female Race/Ethnic Categories What is your race? - African-American/Black Caucasian/White La Asian or Pacific Islander LJ1 Native-American/American Indian LD 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 D Yes Do you consider yourself Physically Disabled? 14 No I 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