Stuart Schikora 12/31/19MIAMIBEACH
BOARD AND COMMITTEE CHECKLIST
APPOINTEE: DATE OF APPOINTMENT: IvIal
BOARD/COMMITTEE: _ Afl �?f te-6)AQpointed by: 1
FOR SCANNER FOR CLERK STAFF
Scan o o Letter of Appointment TERM END: / / / I l TERM LIMIT/)_8/0
Scan o o Letter of Reappointment
o Co f r of Appointment/ReappointW/e-mail,to Committee Liaison on
Scan o o Bard and Committee Application (Completed onScan o o Resume/Curriculum Vitae
o Diversity Statistics Reporting (Completed on
Scan o o Oath
Ci�Alerk's Office Staff Initials z
/ma i V II
CONCLUDED & RESIGNATION LETTERS
Term Expired Letter Date Processed Initials Scan O
Resignation Letter
Date Processed
Initials Scan O
Removal Letter due to absences Date processed Initials Scan O
F:\CLER\BOARD AND COMMITTIES DATABASE\CHECKLIST MASTER\B&C Checklist 2015 MASTER.docx
We ore committed to providing excellent public service and safety to all who live, work, and play in our vibrant, tropical, historic community.
IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
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✓ City Code Ordinance Section applicable to the agency, board or committee
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✓ City Code Sections 2-21, 2-22, 2-23, 2-24, 2-25, 2-26, 2-458 and 2-459
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✓ County Code Section 2-11.1 – Conflict of Interest and Code of Ethics Ordinance (as
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amended through December 2010)
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✓ Amendments to the Code of Ethics Ordinance (September 2009 through July 2012)
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✓ Highlights of the Miami -Dade County Ethics Code
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✓ Sunshine Law and Public Records – Frequently Asked Questions
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✓ Memorandum - Solicitation by City Board and Committee Members
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O Citywide Permit Application (Parking Department Form)
O Booklet – Guide to Sunshine Amendment & Code of Ethics for Public Officers and Employees
Scan O
O Source of Income Statement
Scan O
O Acknowledgment of Financial Disclosure Requirement
O DIVr-rTY STATISTICS n'Um i iNG Keep COPYyin file and ORIGINAL for Annual Report.
S:&— X I — 9 — 2_UQ
Received on:
9 YERSI
Signed b U
Dat ar Member
Processed on:
By Employee:
ate Cle 's i�itials
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Scanned on:
(
By Employee:
Ci�Alerk's Office Staff Initials z
/ma i V II
CONCLUDED & RESIGNATION LETTERS
Term Expired Letter Date Processed Initials Scan O
Resignation Letter
Date Processed
Initials Scan O
Removal Letter due to absences Date processed Initials Scan O
F:\CLER\BOARD AND COMMITTIES DATABASE\CHECKLIST MASTER\B&C Checklist 2015 MASTER.docx
We ore 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.00v
OFFICE OF THE CITY CLERK, Rafael Granado, City Clerk
Tel: (305) 673-7411, Fax: (305) 673-7254
January 04, 2018
Mr. Stuart Schikora
RE: Police/Citizens Relations Committee
Dear Mr. Stuart Schikora:
Congratulations! You have been appointed by Mayor Dan Gelberto the above -referenced Board or
Committee, for a term ending: 12/31/2019.
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,
i
RACelp,ado
C
cc: Saul Frances, Parking Director
Chief Daniel Oates, 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 -. ui a to the SunSkine aqmendment and Cod? of Ethics for Public Officers and Emplo ees
We are comm) ed o providing excellent public service and safety to alt who live, work and play in our vibrant, tropic Dl, historic community.
MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139 vvww.miamibeachfl.aov
OFFICE OF THE CITY CLERK, Rafael E. Granada, City Clerk
Tel: 305.673.7411, Fax: 305.673.7254
Email: CiyClerk@miamibeachfl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Mr. Stuart Schikora
RE: Police/Citizens Relations 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: 12/31/2019.
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 1 st, following the closing
of the calendar year on which I have served.
4A 'S�
Mr. Stuart Schikora
Sworn to and subscribed before me this day ofJ / "' 2018
Char D'Agostin
uty 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
—Se-, 1A t V01A
Last Name
6S f4tP 1 hl AN%
Home Address
I~4OARD AND COMMITTEE APPLICATIOM FORT i
QUA O +
First Name Middle Initial
Ave naN,` mil f -T 3039
City State Zip Code
Home Tel hone CL Wor Telephone Cellular Tele hone Email address
Business Name Occupation
GSS K-@^I'.)r.1l.t1 /eve mecftJ t&�
Business Address City State
Professional License (describe): Expires:
Please attach a copy of currently effective professional license.
GoL[O,� o0y1hdu. C ai
33/3,7
Zip Code
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 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 for a minimum of six months.
• Resident of Miami Beach for a minimum of six (6) months: Yes O or No
• Demonstrates ownership/interest in a business i I Beach for a minimum of six months: Yes 8 or No
• Are you a registered voter in Miami Beach: Yes or No
• I am now a resident of: North Beach South Beach U 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 Za 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 Citv Clerk.
❑ Affordable Housing Advisory Committee
D Art in Public Places Committee
D Audit Committee
D Board of Adjustment "
❑ Budget Advisory Committee
❑ Committee on the Homeless
D Committee for Quality Education in MB
❑ Convention Center Advisory Board
❑ Cultural Arts Council
❑ Design Review Board.`(
❑ Disability Access Committee
❑ Health Advisory Committee
D Health Facilities Authority Board
❑ Hispanic Affairs Committee
I ❑ Historic Preservation Board*
I D Housing Authority
❑ Human Rights Committee
I ❑ LGBT Advisory Committee
D Marine & Waterfront Protection Authority
I D Miami Beach Commission for Women
❑ Normandy Shores Local Government
Neighborhood Improvement
D Parks and Recreation Facilities Board °
❑ Personnel Board
❑ Planning Board's
1 ❑ Police Citizens Relations Committee
1 ❑ Production Industry Council
I ❑ Sister Cities Program
D Sustainability Committee
❑ Transportation, Parking, & Bicycle -Pedestrian
Facilities Committee
❑ Visitor and Convention Authority
0 Youth Commission
" 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 Issuance Date
Page 1 of 4
C:\Users\CLERQueR\Desktop\BC APPLICATION.docx
License Number
License Expiration Date
Note: If applying for the Youth Center positions of the Parks and Recreations Facilities Board, please indicate your affiliation with
the Scott Rakow Youth Center and/or the North Shore Parks Youth Center:
• Please describe your past service with the City's Youth Centers (include dates of service):
• 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:
Child's name:
Age: Program:
Age: Program:
• Have you ever been convicted of a felony? Yes or No-211IIf yes, please explain in detail:
• Do you currently have a violation(s) of City of Miami Beach Code? Yes or Noia If yes, please explain in detail:
• Do you currently owe the City of Miami Beach any money? Yes or No If yes, explain in detail:
• Are you currently serving on any City Board or Committee? Yes or No If yes, which board/committee?
• 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 , spouse Q child U brother or sister IZ3 who is
employed by the City of Miami Beach? Yes Uor No 44
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 bein
Mi asked to comply with City diversity reporting requirements.
Gender: Mmale
Race/Ethnic Categories
What is your race?
2Aan-American/Black
I� Caucasian/White
4 Asian or Pacific Islander
1-1 Native-American/American Indian
Page 2 of 4
C:\Users\CLERQueR\Desktop\BC APPLICATION.docx
Other— Print Race:
Do yo
Do yourself to be Spanish, Hispanic or Latino/a? Mark the "No" box if not Spanish, Hispanic, Latino/a.
No
1-1 Yes
Do you consider yourself Physically Disabled?
No
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 Govemment-in-the-Sunshine Law was enacted in 1967. Today, the Sunshine Law regarding open
government can be found in Chanter 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 OFFICERS, EMPLOYEES AND AGENCY MEMBERS AND ALL OTHER APPLICABLE COUNTY AND/OR STATE LAWS AND
STATUT S ACCORD Y."
S<14;IL'a-W
Applidarf `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
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MIAM BEACH
City of Miami Beach
1700 Convention Center Drive,
Miami Beach, Florida 33139,
www.miamibeachfi.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(1) (2)
Board Member's Name: -S UN2 k <�—:< a "v ."Qj
I understand that no later than July 1, of each vear 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
Updated: Thursday, December 22, 2016
Page 4 of 4
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�1 41- — 2-0
Date
M1AMI B
DIVERSITY STATISTICS REPORTING
Name: St��- Sc(,k2e/1-
Board
/ Committee:
Appointment Date: / l
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 6 /Female ID
Race/Ethnic Categories
What is your race?
glean-American/Black
23 Caucasian/White
ED Asian or Pacific Islander
0 Native-American/American Indian
ID Other — Print Race:
Do you consider yourself to be Spanish, Hispanic or Latino/@-/
Spanish, Hispanic, Latincla,
C� 10
ID Yes
Do you-ronsider yourself Physically Disabled?
Yes
CAUse Intzmei
information form 05-20-13 FINAL.doc
U -P d a te d: Mond _v v, Januar; 26.'20'5