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Daniel Veitia 11/30/17�� i `� � ; � l�i �� a 0 �.-� �� c^-.�--..--� � � '� � 3 a �F � 'v. � '�'—�� ``z� � : � �OA�D �� f�i�iTTEE CHEC�LI�� APPOfNT�E: ��^��"� v P� ��r� DAI E OF APPOINTMENT; l/� �� n�-7 �/� S� S ,�n ///., r BOARD/COMMI i TEE: �� pv'�Z�✓ ;�N� � Appointed by: !V �� !C� � � FOR SCANNER FOR CLERK STAFF Scan c c Leiie� OT /�ppo(nime*It Scan o o Lei��r of Reappointment o.�py- of_ �� of Appoiniment/Re2ppoiniment e-mailed io Corr�mii�ee Liaison ��n o � oar Gnd Commi«ee A lic��ion Com leted on pp � p ) Scar c o Rcsum�/Curriculum Vitae o Diversi'ry Siatisiics ReaoRing (Compieied on ) Scan o o OGth Ii41PORTANT Ii�FORMATION FOR BOARD AND C01�J[MITTEE MENISERS BOOK ✓ Ciiy Cod2 Ordinance Section aoplicabf� 'to the Ga�ncy, board or commi?�e ✓ Ci"ty Cod� Sec�ions 2-21, 2-22, 2-23, 2-24, 2-25, 2-20, 2-458 Gnd 2—^.59 ✓ County Coda S�ciion 2-11. i— Conrlict oi Int�res"t �nd Cod� oT Ethics Ordin2nce amended tnrougn December 2010) ✓ F�mendmencs to the Cod� of E'thics Ordin�nce (S�p�emb�r 2009 'throuah July 2Q12) ✓ Highlighis o� the P�liami-D2de Coun'ty Ethics Code ✓ Sunshine La�v and Public Records — Freauently Asked Qu�siions ✓ Memorandum - Solici�a�ion by Ci�y Board Gnd Commi� �a Me.mb�rs � Cii��ride Perrr�i't Applica�ion (Parkina Deparmen't Form) O F_�r�Oli��— �=U1�� iG �Ull��l!(': n!"1^��r"1^c�l: �. C0�8 Oi �ii`l,�S �Oi 1='ii�'IC �.'i'ii�::(� c�� Fti1C;OV��. Scar o o Source o� lncom� S�_at�m�n� S�an o o �ckne��r,�l�dgmen� oi Financi�f Disclosure Requiremeni � Q[�'�RSI i Y ST"�T(STICS RcPO?Tf�vG ' ee� COPY in fi!� snd ORIG{�;AL `er Anrua[ Repor. P,ec�ived on: I d�/ i�/ � � Signed by � G�:e rd or Co�r�mi��e �41e��b�r Frecess�d or: /�/l �/� � B�� Em lo��ee: . , J P > �^�c Cli� fif�S �iilC� Si�` �Ill�l :!S Scanned on: /�/( /�/ � B� EmoloS ee: ,I � , 1 L�?ic Iy C�cf� � �ilCc s aii illiiai5 �� i T�rm Expired Le �er j Dai� Proc�s�ed � Ini�i=!s Scan o i I I � i � -- ��esignaiion L�'ti�i dc�c �iOCcSScd if1lilaiS SCail 0 I R�mov�l Let�er due to ab�e.nces I D�'t� proc2jScd � Initial� Scar o � � � �:1 .LF. \c P.RD AN;7 CO��i�AI�I�S DATAB�S�`.CH=�KLIST F',=:ST��=�lS�C Cr��cklis? 20 � 5 Ih.�'oc: ',�'. c. � , -,�, -� � �-. , . � �-..... _ - - Mi��/11 BEACH City of Miami Beach, 1700 Comention Center Drive, Miami Beach, Florida 33139 www.miamibeachfl.aov OFFICE OF THE CITY CLERK, Rafael E. Granado, City Clerk Tel: 305.673.7411, Fax: 305.673.7254 Email: CityClerk@miamibeachfl.gov October 03, 2017 Mr. Daniel Veitia 1525 Normandy Drive Miami Beach, Florida 33141 RE: Mavor's IT Svstems Review Blue Ribbon Panel Dear Mr. Daniel Veitia: Congratulationsl You have been appointed by Mayor Philip Levineto the above-referenced Board or Committee, for a term ending: 11/30/2017. 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 as they concern your duties, responsibilities, and requirements as a board or committee member. Congratulations again and good luck. Re rds, ; �`!c Rafae ranado City Clerk � cc: Saul Frances, Parking Director Eva Silverstein, City Liaison � � ,�� . �' .� '�� ENCLOSURES: Oath of Office/Oath of Civility/Acknowledgements City Code/Ordinance section applicable to agency, board or committee City Code Sections 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. M��ifBEACH City of Miami Beach, 1700 Convention Center Drive, Miomi Beach, Florida 33139 www.miamibeachfl.aov OFFICE OF THE CITY CLERK, Rafael E. Granado, City Clerk Tel: 305.673.7411, Fax: 305.673.7254 Email: CilyClerk@miamibeachfl.gov Oath of Office Oath of Civility and Acknowledgements TO: Mr. Daniel Veitia RE: Mayor's IT Systems Review B�ue Ribbon Panel 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: 11/30/2017. To my colleagues and to all of those I represent and serve, I pledge fairness, integrity and civility, in all actions taken and all communications made by me as a public servant. 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. . niel Veitia Sworn to and subscribed before me this � day oi��C�2017 / � < i C rles D'Agostin 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. �� City of Miami Beach i 700 Convention Center Drive, Miami Beach, Flarida 33139, www. m iam i beachfl.aov OFFICE OF THE CITY CLERK CiryClerk@miamibeachfl.gov Telephone:3Q5.673.7411 Fax:305.673.7254 Acknowledgement of fineslsuspensian for BoardlCommittee Members for failure to comply with Miami- Dade County Financial Disclosure Code Provisian Code Section 2-11.1{i) (2) Board Member's Name: Danief Veitia I unders#and that no later than Julv 1, of each vear all members of Boards and Commit�ees of the City of MEami Beach, including those af a purely advisory nature, are required to comply with Miami-Dade County Financial Disclosure Requirements. This means that the members of City Advisary Boards, whose sale or primary responsibility is to recommend legislation or give advice to the City Commission, must file, even though they may have been recently appoinied. One of the following forms must be filed with the City Clerk of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida, na la#er than 12:00 noon of July 1, of each year. 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 subjec# the person to a fine of no more than $500, 60 days in jai! or both. � Sig re Updated: Thursday, December 22, 2016 Page 4 of 4 C:1Users1CLERQueRlDesktaplBC APPLICATfON.docx 10104l17 Date m MIAMIBEACH NAME: Veitia Last Name HOME ADDRESS: 1525 Normandy Drive Apt No. Home No./Street PHONE: (305) 219-3408 (305) 403-0657 Home Work Business Name: Urban Resource Address: 1193 71st St Street Daniel First Name Miami Beach City CITY OF MIAMI BEACH BOARD AND COMMITTEE APPLICATION FORM Middle Initial Florida 33141 State Zip Code daniel@urbanresource.com Email Address Position: Realtor Property Mgr. Miami Beach Florida 33141- 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 Yes • 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: Yes •(Please circle one): I am now a resident of: North 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? No Please list your preferences in order of ranking [1] first choice [2] second choice, and [3] third choice. Please note that onlv three (31 choices will be observed bv the Citv Clerk's Office. (Regular Boards of City) Choice 1 Choice 2 Choice 3: Planning Board Mayor's IT Systems Review Blue Ribbon Panel * Board members are required to file Form 1—"Statement of Financial InteresY' 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 Issuance Date License Number 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: Child Name Age Program • 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 • Are you currently serving on any City Boards or Committees: No • 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? If yes, please explain in detail: If yes, which board? • List all properties owned or have an interest in, which are located within the City of Miami Beach: Property �....�_.. .. . . .. .. _ _�... � �__.� w..w. W.�� __� �......�.� � �.� 1525 Normandy Dr � � . _.. �. � ._ _ ...._.,_ W.�.�_...��_.. � � _ . . _��_._.�.__.; 117 S Shore Drive ' � � .__� �._��_.�.....�.... ._�__.w_�_...._. 1191-1203 71 st Street . _ . Gender: Male The following information is voluntary and is neither part of your application nor has any bearing o� 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. White Other Description: Are you Spanish/Hispanic/ Latino? Mark the "No" box if not Spanish / Hispanic / Latino. Yes 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. "1 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 Daniel Veitia agreed to the following te ms on i/ „/J � �Li Received in the City Clerk's Office by: Name�f Deputy Clerk Control No. Date � ��,��k �� Di�/�RSIiY STAT15T1C5 REPORTING Name: �� /l�r �� l V �� l �} � /l� � �% �S 5�0��, �z✓/�,�� Board / Gomm�ttee: , � �� A ointment Date: � �� / � 1? p , � Pursuant to City of Miami Be�ch Ordinance 2009-3632, the Ciiy is required to annually prepare and present a repart 'to the City Commission identi'rying the City's diversity statistics. This farm afiows board and committee applicanfs and members to voluntarily self-identify their race, ethnicity, disabled status and gender. Pfease check the appropriate box for each categary: Gencier: Male Female �1 Raczl�thn�c Cafegories 1��1hat is your race? � A' 'ean-Americ�n/Bl�c:�: a�.�c�sian'!Nhi�e Asian or Pacific islane��r � �!a�ive-,�rierican/�m�,�ic�r� ;7di�n � Othe" ._. pCi<<t R�Cc: Do you �onsider yourself `� �e Sp�nish, His��nic or Latin�!a? t�'�rk the "No" box rf not Spanis�=�, H;s��,�ic, Latinoi�. Do you consicfer yourself Phy�sical(y Disabled? ��;� � Yes .�.�,��-'Sti::�l � rrc�`��;�i:�:z�Zl�1�_Ct��_i`° i�Ci �. U;.�, : f3._ ;.>1T2,'t Ci�t�.^,' 11 . .. _ - � _'��.'Gtl;:?^; C1�Yt�}pt��r'��,,i ? .,i� �'�.5� l"`i' _ iiti� i:7`orm2tio.i f�v�rm ��5•�0-?3 �iN,�-`,�.d•�;c iJrs,�; `-:a: P,dorc'r.y, J2.nua;;/ 26. 20t=;