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Alpesh Patel 12/31/2018MIAMIBEACH 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) 673-741 1, Fax: (305) 673-7254 Email CityClerk@miamibeach.gov January 17, 2017 Mr. Alpesh Patel 2665 SW 37th Avenue Unit 501 Miami, FL 33133 SUBJECT: Art in Public Places Committee Dear Mr. Alpesh Patel: Congratulations! You have been appointed by the City Commission to the agency, board or committee named above for a term ending: 12/31/2018. 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 Gra— .do City Clerk cc: Saul Frances, Parking Director Dennis Leyva, 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 Email CityClerk@miamibeach.gov TO: Mr. Alpesh Patel RE: Art in Public Places 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: 12/31/2018. 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 closing of the calendar year on which I have served. al -A - Mr. Alpesh Patel Sworn to and subscribed before me this /v day of R -G6 , 2017. Ramon Quezada 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. CA- MIAMIBEACH NAME: Patel CITY OF MIAMI BEACH BOARD AND COMMITTEE APPLICATION FORM Alpesh K Last Name First Name Middle Initial HOME ADDRESS: 2665 SW 37th Avenue Unit 501 Miami FL 33133 Apt No. Home No./Street PHONE: 7865318433 City State Zip Code alpeshkantipatel@gmail.com Home Work Business Name: Miami Beach Urban Studios Address: 420 Lincoln Road Email Address Position: Assistant Professor/Director of MFA program Miami Florida 33139 Street City State Zip Code Pursuant to City Code section 2-22(4) a and 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. • Resident of Miami Beach for a minimum of six (6) months No • Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six (6) months: Yes • Are you a registered voter in Miami Beach: No • (Please circle one): I am now a resident of: • I am applying for an appointment because I have special abilities, knowledge and experience. Please list below: contemporary art scholar • Are you presently a registered lobbyist with the City of Miami Beach'? 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. (Regular Boards of City) Choice 1: Art in Public Places Committee Choice 2: Choice 3: • 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 Note: If applying for Youth Advisory Board, please indicate your affiliation with the Scott Rakow Youth Center: 1. Past service on the Youth Center Advisory Board: No Years of Service: 2. Present participation in Youth Center activities by your children No if yes, please list the names of your children, their ages, and which programs. List below: • Have you ever been convicted of a felony: No If yes, please explain in detail: • Do you currently have a violation(s) of City of Miami Beach codes: 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: • Are you currently serving on any City Boards or Committees: No If yes, which board? • What organizations in the City of Miami Beach do you currently hold membership in? • I am now employed by the city of Miami Beach: No Which department? • List all properties owned or have an interest in, which are located within the City of Miami Beach: Gender: Male 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 federal equal opportunity reporting requirements. Race/Ethnic Categories What is your race? Mark one or more races to indicate what you consider yourself to be. Asian or Pacific Islander Other Description: Are you Spanish/Hispanic/ Latino? Mark the "No" box if not Spanish / Hispanic / Latino. No Physically Challenged: No NOTE: If appointed, you will be required to follow certain laws which apply to city board/committee members. These laws include, but are not limited to, the following: 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 board/committee you have served on for period of one year after leaving office (Miami Beach Code section 2-26). o Requirement to disclose certain financial interests and gifts (Miami -Dade County Code section 2-11.1). (re: 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). 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 have received, read and will abide by Chapter 2, Article VII — of the City Code "Standards of Conduct for City Officers, Employees and Agency Members." I Alpesh Patel agreed to the following terms on 1/4/2017 12:21:29 AM Received in the City Clerk's Office by: Name of Deputy Clerk Control No. Date ACADEMIC POSITIONS Aug 2011 -present Jul 2012 -present Sep 2010 -May 2011 EDUCATION Apr 2009 ALPESH KANTILAL PATEL CURRICULUM VITAE Telephone: 1-786-531-8433 • Email: alpesh.patel@fiu.edu MIAMI BEACH URBAN STUDIOS, FIU, Miami Beach, Asst. Professor, Contemporary Art & Theory MIAMI BEACH URBAN STUDIOS, FIU, Miami Beach, Director, Master in Fine Art in Visual Arts NEW YORK UNIVERSITY, New York City Visiting Scholar, Center for Study of Gender and Sexuality UNIVERSITY OF MANCHESTER, England PhD, Art History and Visual Studies MPhil, Drama/Screen studies (upgraded to PhD in 2006) Sep 1997 YALE UNIVERSITY, New Haven, Connecticut BA in History of Art with distinction in major ARTS ADMINISTRATION Jan 2002 -Jul 2005 Dec 1998 -Aug 2000 Summer 1998 NEW MUSEUM OF CONTEMPORARY ART, New York City Executive Assistant to Lisa Phillips, director WHITNEY MUSEUM OF AMERICAN ART, New York City Project -based Curatorial and Research Assistant Curator SOLOMON R. GUGGENHEIM MUSEUM, New York City Curatorial Intern HONORS, GRANTS, AND OTHER AWARDS 2016 Cranbrook Academy of Art, Bloomfield Hills, Michigan, Critical Studies Fellow 2015-16 Fulbright Foundation, Fulbright Fellowship, for research on contemporary art in Eastern Europe 2012 National Endowment of Humanities (NEH), Summer Institute Scholar 2008 College Art Association (CAA), Professional Development Fellowship finalist DOCTORAL AWARDS University of Manchester, England 2006-8 School of Arts, Histories and Cultures 2006-8 Art History and Visual Studies 2006-8 Art Gallery and Museum Studies UNDERGRADUATE AWARDS Yale University, New Haven, Connecticut 1995-7 Werner F. Gossels Scholarship 1996 Richter Summer Fellowship 1995 Mellon Undergraduate Research Grant SELECTED INVITED LECTURES 2016 2015 2014 2013 2010 2009 Centre de Cultura Contemporania de Barcelona, Spain. Adam Mickiewicz University, Poznan, Poland. School of Art Institute of Chicago, Illinois. New York University, New York City, New York. University of Cambridge, England. University of Oxford, England. MIAMI -DM COUNTY SOURCE OF INCOME STATEMENT Section 2-11.10) of the County Ethics Code requires that certain employees and public officials file a financial disclosure Statement on a yearly basis by July 1st of every year. Disclosure for Tax Year Ending 2016• Last orne , First Name Middle Name/Initial Mailing Address — Street Number Street Name, OrP.O. Box 266( SQ.)3 /We- /41-s`o? City, State, Zip yv!: 6%w1.. L 33 )33 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 (check one) Filing as a Board Member (check one) fl County Municipal: (cl kvt,(- cyt Q -P) (Municipality) Board where serving I �} f n r , al- . (V) U b r 1~ t e S 0_..01/1 Alternate address (if home address is exempt) Work telephone Term began on/ended 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. Examples of sources of income include: compensation for services, income from business, gains from property dealings, interest, rents, dividends, pensions, IRA distributions, and social security payments. 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 ■ County ■ Public Health Trust ■ Municipal: (Municipality) Department Position or Title Employee ID Number Work address Work telephone Employment began on/ended on Filing as a Board Member (check one) fl County Municipal: (cl kvt,(- cyt Q -P) (Municipality) Board where serving I �} f n r , al- . (V) U b r 1~ t e S 0_..01/1 Alternate address (if home address is exempt) Work telephone Term began on/ended 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. Examples of sources of income include: compensation for services, income from business, gains from property dealings, interest, rents, dividends, pensions, IRA distributions, and social security payments. 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 54aV;4044N iNtI( 0'6 v6,51jy 1I'Le G V 1 8'iziS4-- v IA 235 Mi ; r r53191 pro-rrJoy- I hereby swear (or affirm) that the information above is a true and correct statement. Signature of Person Disclosing ,� I6 sig g ed lll RECEIVED BY ELECTIONS DEPARTMENT: ❑ Hardcopy ❑ Electronic Copy OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/Initials: 138 SP -14 COE 2016 Scanned Date/Initials: City of Miami Beach 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov CITY CLERK'S OFFICE Telephone: 305.673.741 1 Fax: 305.673.7254 CityClerk@miamibeachfl.gov 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:A\ e-Pod,Q._. 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 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 6500, 60 days in jail or both. Signature Date Updated: Monday, April 20, 2015 Page 4 of 4 F:\CLER\BALL\aFORMS\BOARD AND COMMITTEES\SO APPLICATION REVISED 06022014.docx MIOA1 BEACH DIVERSITY STATISTICS REPORTING Name: a p e-.411 rot 4 -e -i Board / Committee: 1 r\- itn hf �iie, Appointment Date: 1 1 Pursuant to City of Miami Be ch 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: MaleD Female 0 Race/Ethnic Categories What is your race? D African-American/Black casian/White Asian or Pacific Islander t-11 Native-American/American Indian ED Other – Print Race: Do you consider yourself to be Spanish, Hispanic or Latino/a? Mark the "No" box if not Spanish, Hispanic, Latina/a, CI 0- 0 Yes Do yo onsider yourself Physically Disabled? No Yes C,:\Users\CENTFraN\AppData\Locg,Mitt:ttryte,w,r,orc../rs\TterraiorFtry int:erne, .• . information form 05-.20-13 FINAL.doc Updated: Monday, January 26, 2015