Ruban Roberts 11/30/171\ \IA. ‘I t 1 31
RECEIVED
2o1jHO -9 PM 12:44 BOARD AND COMMITTEE CHECKLIST
CITY Of d f x,194-- J PO . 1 -S DATE OF APPOINTMENT: Witi 7
OFFICE OF THE CI filjt wJ%l
BOARD/COMMITTEE: �✓�P�% =�-1 Appointed by: , oR L ev A/e
FOR SCANNER
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FOR CLERK STAFF
o Letter of Appointment
o Letter of Reappointment
o Cop of Letter of Appointment/Reappointment e-mailed to Committee Liaison
• r Carnmitte Application (Completed on a '7)-44/2
o Diversity Statistics Reporting (Completed on %
MIAMIBEACH
City of Miami Beach, 1700 Convention 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
November 03, 2017
Mr. Ruban Roberts
RE: Mayor's Blue Ribbon Panel on Memorial Davjll/eekend
Dear Mr. Ruban Roberts:
Congratulations! You have been appointed by Mayor Philip Levineto the above -referenced Board or
Committee, fora 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.
Regards
fael Granado
City Clerk
cc: Saul Frances, Parking Director
Amy Mehu, 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.
MIAMIBEACH
City of Miami Beach, 1700 Convention 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
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Mr. Ruban Roberts
RE: Mayor's Blue Ribbon Panel on Memorial Day Weekend
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 t, follgwing the closing
of the calendar year on which I have served.
Sworn to and subscribed before me thi
Mr. Ruban Roberts
day ofC v 62017
ries 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.
AAA' B
City of Miami Beach
1700 Convention Center Drive,
Miami Beach, Florida 33139,
www. m iam i beachfl.Qov
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:
vi/4)/ koher-b
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 $ , 60 ys in jail or both.
Signature
Updated: Monday, April 20, 2015
Page 4 of 4
F:\CLER\3ALL\aFORMS\BOARD AND COMMITTEES \BC APPLICATION REVISED 08022014.docx
Date
!\/\IAMBEACH
DIVERSITY STATISTICS REPORTING
Name: kLA. 6r4/0
Board / Committee: AAkhil `-5 PAAJ- r OAJ /14-x,ky- I. -I P
/o /Fe/7
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
Race/Ethnic Categories
What is your race?
Moan-American/Black
CaucasianflNhite
EJ Asian or Pacific Islander
Native-American/American Indian
Other — Print Race:
Do you consider yourself to be Spanish, Hispanic or Latino/a? Mark the "No" box if not
Spanish, Hispanic, Latinola.
Z21-Nic
Yes
Do you consider yourself Physically Disabled?
o
Yes
CAUsers\CENTFreNKAppData\Local\Microsoft\Wihdows\Tei7:D0rary Interne:f-lies\Contert.outiook\NP4J9CNX..BC minority
information form 05-20-13 FINAL.doc
Updated: Monday, January 26. 2015