Paul Stein 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) 673-7411, Fax: (305) 673-7254
Email CifyClerk@miamibeach.gov
February 07, 2017
Mr. Paul Stein
510 W 50th St
Miami Beach, Florida 33140
SUBJECT: Parks and Recreational Facilities Board
Congratulations! You have been reappointed by Mayor Philip Levine to the above referenced, board or
committee named above, for a term ending: 12/31/2018.
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 and good luck.
Regards,
Ra l el Granado
City Clerk
cc: Saul Frances, Parking Director
Cynthia Casanova, 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. Paul Stein
RE: Parks and Recreational Facilities 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: 12/31/2018.
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 • Miami -Dade County or the
State of Florida (depending on the board or committee on which I se - o, 1st, following the closing
of the calendar year on which I have served.
Mr. Paul stein
Sworn to and subscribed before me this : -y of -t • 117
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.
MIAMI BEACH
BOARD AND COMMITTEE APPLICATION FORM
Last Name + d l
Sk' 1
Home Address
tName
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Home Telephone Work Telephone
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Business Name
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Business Address Ci
Middle Initial
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State
Zip Code
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Cellular Tele one" Email address
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Occupation
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Professional License (describe):
Please attach a copy of currently effective pro
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 indivi ual shall have been a resident of the City for
a minimum of six months; or b. An individual shall demonstrate owne hip/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) mont s: Yes or No
• Demonstrates ownership/interest in a business in mi Beach for a minimum of six months: Yes .i or No
• Are you a registered voter in Miami Beach: Yes or No ILZI
• 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:
• 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 Office of the City Clerk.
❑ Affordable Housing Advisory Committee
0 Health Advisory Committee
O'Parks and Recreation Facilities Board °O
❑ Art in Public Places Committee
0 Health Facilities Authority Board
0 Personnel Board
❑ Audit Committee
0 Hispanic Affairs Committee
0 Planning Board**
❑ Board of Adjustment **
0 Historic Preservation Board*
0 Police Citizens Relations Committee
❑ Budget Advisory Committee
0 Housing Authority
0 Production Industry Council
❑ Committee on the Homeless
❑ uman Rights Committee
0 Sister Cities Program
❑ committee for Quality Education in MB
-Convention
GBT Advisory Committee
0 Sustainability Committee
di Center Advisory Board - x
arine & Waterfront Protection Authority
0 Transportation, Parking, & Bicycle -Pedestrian
Fac'lities Committee
❑ Cultural Arts Council
0 Miami Beach Commission for Women
❑ isitor and Convention Authority
❑ Design Review Board*
0 Normandy Shores Local Government
Neighborhood Improvement
Youth Commission ,_3
❑ Disability Access 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:
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 06142016.docx
oO Note: If applying for the Youth Center positions of the Parks and Recreations F �iliti Bo�.d, please indicate your affiliation with
the Scott Rakow Youth Center and/or the North Shore Parks Youth Center: 47%% I r ft? 6061,
• Please describe your past service with the City's Youth Centers (include dates of service): V1)4,i'1�u! 041
• Present participation in Youth Center activities by your children: Yes 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 or No Ij If yes, please explain in detail:
• Do you currently have a violation(s) of City of Miami Beach Code? Yes or No E If yes, please explain in detail:
• Do you currently owe the City of Miami Beach any money? Yes IZ1 or No
If yes, explain in detail:
• Are you currently serving on any City Board or Committee? Yes or No yes, which board/committee? et,(k,1 _ P; t l'!c
• In what organization(s) in the City of Miami Beach do you currently hold membership?
Name
Position
Name Position
• List all properties owned or in which you have an interest within the City of Miami Beach:
• Are you now employed by the City of Miami Beach? Yes or No
Which department and title?
• Pursuant to City Code Section 2-25 (b): Do you have parent La, spouse IZ), child Zi brother or sister Ej who is
employed by the City of Miami Beach? Yes Eior No
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 beipg asked to comply with City diversity reporting requirements.
Gender: Male Female
Race/Ethnic Categories
What is your race?
Pfrican-American/Black
Caucasian/White
Asian or Pacific Islander
Native-American/American Indian
Page 2 of 4
F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 06142016.docx
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 , onsider yourself Physically Disabled?
No
rj 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:
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 the board/committee you have served on for period of one year after leaving office (Miami Beach
City Code section 2-26).
o Requirement to disclose certain financial interests and gifts (Miami -Dade County Code section 2-11.1).
o 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).
o 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.
o 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 OFFICE -RS, PLOYEES AND AGENCY MEMBERS AND ALL OTHER APPLICABLE COUNTY AND/OR STATE LAWS AND
STA E* CCO' .INGLY."
Applicant's Signature
Date Name of Applicant (PLEASE PRINT)
Received in the Office of the City Clerk by:
Name of Deputy Clerk Control No. Date
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:\CLER1$ALL1aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 06142016.docx
MIAMI BEACH
City of Miami Beach
1 700 Convention Center Drive,
Miami Beach, Florida 33139,
www.miamibeachfl.gov
OFFICE OF THE CITY CLERK
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:
Ruf S-1--eAfs\
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.
Signature V Date
Updated: Tuesday, October 04, 2016
Page 4 of 4
F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 06142016.docx
MIAMI.DADE
OVNTY
SOURCE OF INCOME STATEMENT
Section 2-11.1(1) 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.
AO
Disclosure for Tax Year Ending
2014
Las Name fir a Middle Name/Initial
4
Mailing Address — Street Number Street Name, or P.0. Box
‘\c -(Q Uv
City, State, Zip
'R'3 -3/o0
t)MI I
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)
J County
Municipal:
(Municipality)
Board here serving
Alternate address (if home address is exempt)
Work telephone
3of= 99 -t 99S
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 0 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)
J County
Municipal:
(Municipality)
Board here serving
Alternate address (if home address is exempt)
Work telephone
3of= 99 -t 99S
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
rn,gm) ora►, coon'i'`I
Pi) b 1/c, SLioo1J
7G9c)/
I hereby swear (or affirm) that the information above is a true and correct statement.
Signature o Person Disclosing
Dat sign d
RECEIVED BY ELECTIONS DEPARTMENT:
Hardcopy
❑ Electronic Copy
OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/Initials:
1.3E SP -14 COE 201a
Scanned Date/Initials:
City of Miami Beach
1700 Convention Center Drive,
Miami Beach, Florida 33139,
www.miamibeachfl.gov
CITY CLERK'S OFFICE CityClerk@miamibeachfl.gov
Telephone: 305.673.741 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(1) (2)
/q C
Board Members Name: £ y
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 e e
of no more than $5
these forms, pursuant to the Miami -Dade County Code, may subject the person to a fine
0, 60 days in jail or both.
a/ii)
Signature Date
Updated: Monday, April 20, 2015
Page 4 of 4
F:\CLER\SALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 06022014.docx
MIAMI BFACH
Name:
DIVERSITY STATISTICS REPORTING
( D
Board / mmittee: , 1
Appointment Date:
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
Female LA
Race/Ethnic Categories
What is your race?
O ican-American/Black
aucasianNvynite
Asian or Pacific islander
O Native-American/American IndiPn
Other — Print Race:
Do you consider yourself to be Spanish, Hispanic or Latino/a2 Mark the "No" box if not
Spanish, Hispanic, Latino/a.
LJ No
0 Yes
u consider yourself Physically Disabled?
No
0 Yes
CAUSerS\CENTFraMAppDataskLOca!\MiCrOSaft\;d'VindovisViemooraryrtern Fi!es\Gcntent.Outlook\NP4.J9CNXVBC mincrjty
information form 05-20-13 FIRIAL,doc
Updated: Monday, Januar,/ 25. 2015