Brian Harris 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
December 16, 2016
Mr. Brian Harris
1000 South Beach Drive #1002
Miami Beach, Florida 33139
SUBJECT: Budget Advisory Committee
Dear Mr. Brian Harris:
Congratulations! You have been reappointed by the City Commission to the above referenced board or
committee, 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 and good luck.
Respectfully,
Rafael Granado
City Clerk
cc: Saul Frances, Parking Director
Cintya Ramos, 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.
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. Brian Harris
RE: Budget Advisory 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: 12131/2018.
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.
Mr. Brian Harris
Sworn to and subscribed before me this `�� day o 2001
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.
ttA
Cite of Miami Beach Boarc & Committee
Citywide Parking Application
l
DATE OF APPLICATION: 2 iV
LAST NAME: I r ri `o FIRST NAME: ''"/ arc) r
t� kyr /`!'cc
NAME OF BOAR/COMMITTEE: 0 Cipa a 4! SO
ADDRESS:
WORK PHONE:
CELL PHONE:
HOME PHONE:
VEHICLE MAKE 1 VEHICLE MODEL I VEHICLE YEAR
f �
TAG NUMBER
I understand that Board/Committee Citywide Parking entitles me to park at any
parking meter both on -street and off-street (metered parking lots) I further understand
that Citywide Parking is NOT AUTHORIZED AT ATTENDED LOTS OR GARAGES —
EXCEPTION: CITY HALL GARAGE (i 55 MERIDIAN AVE).
NOTE: Your license plate now serves as your "parking permit'. Parking enforcement
specialists are equipped with handheld and mobile LPR devices to confirm your parking
permit status (valid/invaUd).
In order to avoid any unnecessary enforcement actions, it is important that our records
reflect the most current and accurate information regarding your vehicle license plate.
Please provide us with your current Vehicle information (year/make/model/license plate
number). Inaccurate and/or outdated vehicle information may lead to the issuance of
parking citation(s), andlor the towing of your vehicle.
Applicants Signature:
M1C d BEACH
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
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: r Igh
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"
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.
CityClerk@miamibeachfl.gov
Updated: Monday, April 20, 2015
Page 4of4
F:\CLER\SALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 06022014.docx
0 207
Date
MIAMI DADE
COUNTY
SOURCE OF INCOME STATEMENT
Section 2-11.1(i) 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
201
Lasi Name
H G2 r 15
Mailing Address — Street Number Street Name, or P.O. Box
City, State, Zip
First Name
IJ r qh
Middle Name/Initial
Alb
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)
County ] Public Health Trust Municipal:
(Municipality)
Department
Position or Title
Work address
Filing as a Board Member (check one)
n County
Work telephone
Employee ID Number
Employment began on/ended on
Municipal:' ("
Board where serving
UGG J GVi So ri
Alternate add ss Of home address is exempt)
z
& A X61
QD m
(Municipality)
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 o4
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
•H th income of our spouse or any business partner need not be disclosed. If continued on a separate sheet, check here.❑
person for your benefit. oVv, ier, e y
Income
Address
Name of Source of
jam,✓4{'r^043
Description of the Principal Business Activity
I hereby swear (or affirm) that the information above is a true and correct statement.
Signature of Person Disclosing
kei l (
Dat igne
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:
MIAMI BEACH
Name:
DIVERSITY STATISTICS REPORTING
Board / Committee:
Appointment Date:
\.(4 C•r- 1"-/
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 —71 Female L.J1
Race/Ethnic Categories
What is your race?
Ea?eican-American/Black
Caucasian/White
[221 Asian or Pacific Islander
Li Native-American/American Indian
Other — Print Race:
Do you consider yourself to be Spanish, Hispanic cr Latincla? Mark the "No" box if not
Spanish, Hispanic, Latino/a.
Yes
Do you consider yourself Physically Disabled?
1.d\lo
ED Yes
C:\Users\CENTFraN\AppData\Locaf,Iviicrosoft\Windov-is\Ternoorery ntrne:
information form 05-20-13 FINAL.doc
Updated: Monday, January 26,2015