Matthew Salom 12/31/18MIAMIBEACH
BOARD AND COMMITTEE CHECKLIST
APPOINTEE: �� I"� 'SA
- Lavl DATE OF APPOINTMENT:
BOARD/COMMITTEE: Ion I(Ce /(J Appointed by: � (— B44\
FOR SCANNER FOR CLERK STAFF f J 3
Scan o o Letter of Appointment TERM END:/ %2 �� I � TERM LIMIT:!/ (
Scan o o Let er of Reappointment
o�gf�a,.Letter of Appointment/Reappointment e-mailed to Committee Liaiison on
Scan o o Board andCommitteeApplication (Completed on /10 )
Scan o o Resume/Curriculum Vitae
o Diversity Statistics Reporting (Completed on 4)
Scan o o Oath
03 IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
✓ City Code Ordinance Section applicable to the agency, board or committee
'!;`_a ✓ City Code Sections 2-21, 2-22, 2-23, 2-24, 2-25, 2-26, 2-458 and 2-459
✓ County Code Section 2-11.1 — Conflict of Interest and Code of Ethics Ordinance (as
amended through December 2010)
" ✓ Amendments to the Code of Ethics Ordinance (September 2009 through July 2012)
iz, Cn ✓ Highlights of the Miami -Dade County Ethics Code
.L- ✓ Sunshine Law and Public Records — Frequently Asked Questions
Lai �t `�' ✓ Memorandum - Solicitation by City Board and Committee Members
)U.
cv Lc"> 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 DIVERSITY STATISTICS REPORTING Keep COPY in file and ORIGINAL for Annual Report.
Received on: Qi 1� Im Signed by X
f DQatq B y�'i'd r m ember
Processed on: [ O / 1 B Employee:
Y��
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De 's Office Staff Initials
Scanned on: By Employee:
Date City C k's Office Staff rn 'alb`
Nil I Pr)
CONCLUDED & RESIGNATION LETTERS
Term Expired Letter I Date Processed Initials Scan o
Resignation Letter I Date Processed Initials Scan o
Removal Letter due to absences I Date processed Initials Scan o
F:\CLER\BOARD AND COMMITTIES DATABASE\CHECKLIST MASTER\B&C Checklist 2015 MASTER.docx
We are committed to providing excellent public service and safety to all who live, work, and play in our vibrant, tropical, historic community.
/01AMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139 www.miamibeachfl.aov
OFFICE OF THE CITY CLERK, Rafael E. Granada, City Clerk
Tel: 305.673.7411, Fax: 305.673.7254
Email: CityClerk@miamibeachfl.gov
January 04, 2018
Mr. Matthew Salom
815 N. Shore Dr.
Miami Beach, Florida 33141
SUBJECT: Police/Citizens Relations Committee
Congratulations! You have been reappointed by Mayor Dan Gelberto 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.
Regar
(/� /R f el Granado
" Cit Clerk
cc: Saul Frances, Parking Director
Chief Daniel Oates, 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.aov
OFFICE OF THE CITY CLERK, Rafael E. Granada, City Clerk
Tel: 305.673.741 1, Fax: 305.673.7254
Email: CityClerk@miamibeachfl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Mr. Matthew Salom
RE: Police/Citizens Relations Committee
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.
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.
Mr. marthm-S-alclr
Sworn to and subscribed before me thi day of �, 2018
C es D'Agostin
eputy Clerk
*Please visit the City of Miami Beach website at www.miamibeachfi.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•DADE SOURCE OF INCOME STATEMENT
i
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 Last me First Name Middle Name/initial
Mailluo Address— Street Number, Str t Name, or P.O. Box
City, State, Zip
?aA 'I -L. 331q
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 Emplayee (check one)
County F PuT�>te4ipalth Trust F� Municipal:
Department
(Municip
Position or Title Employee ID Number
Work address Work telephoneployment beg�onlended on
Filing as a Board Member (check one)
nt/f
Gounty Fj Municipal:
(Municipality) �
Board where servin/�g—//1 I, Ce
Alternate address (if home address is exempt) Work telephone Term hega on/ended an
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
%bs
& P�ulI ILL
I hereby swear (or affirm) that the " ion above is a true and correct statement.
2 Sig a
of fr&lig
Date signed
OFFICE USE F ON Y Accepted: V / N Deficiency:
133 SP -14 00E2016
RECEIVED BY ELECTIONS DEPARTMENT:
❑ Hardcopy
❑ Electronic Copy
Processed Date/Initials: Scanned Date/Initials:
M1AN\1'BFA(_"H
DIVERSITY STATISTICS REPORTING
Narne: 114, t 6Nl
Board /Committee: Pobcc / ` CIYL�7e4s
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 �iFemale 01
Race/Ethnic Categories
What is your race?
African-American/Black
Caucasian/White
Asian or Pacific Islander
1:3 . alive-American/Ami iican Indian
Other — Print Race: rn1�ni c,
Doyou consider yourself to be Spanish, Hispanic or Latino/a? Mark the `'No" box if not
Spanish, Hispanic, Latinole.
1__j o
Yes
Do you consider yourself Physically Disabled?
CS No
ED Yes
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information form 05-20-13 F1NAL.doc
Updated: Monday, Januan/ 26. 201.5