William Warren 12/31/18MIAMIBEACH
BOARD AND COMMITTEE CHECKLIST
APPOINTEE: vv ! c j / r " '" ►' `f\ !�v DATE OF APPOINTMENT: / 71a-
BOARD/COMMITTEE:
(, / ` %L .S Appointed by: Ave4 tS_'5'o'L/
FOR SCANNER FOR CLERK STAFF C -��(f
Scan o o Letter of Appointment TERM END: / ! Q TERM LIMIT/ -)-/-3r
Scan o o Letter of Reappointment
o Letter of Appointment/Reappointment-mail,d
to Committee Liaison on
Scan o 0 goArd and ommittee Application (Completed on
Scan o o Resume/Curriculum Vitae
o Diversity Statistics Reporting (Completed on
Scan o 0 {- o Oath
N cc
�•�, IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
�- ✓ City Code Ordinance Section applicable to the agency, board or committee
C-- ✓ City Code Sections 2-21, 2-22, 2-23, 2-24, 2-25, 2-26, 2-458 and 2-459
Lo _ - W ✓ County Code Section 2-11.1 - Conflict of Interest and Code of Ethics Ordinance (as
t"?=i amended through December 2010)
>r�ti� ✓ Amendments to the Code of Ethics Ordinance (September 2009 through July 2012)
>_W ✓ Highlights of the Miami -Dade County Ethics Code
°�' c� ✓ Sunshine Law and Public Records - Frequently Asked Questions
r� ✓ Memorandum - Solicitation by City Board and Committee Members
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 Require nt
/ o/DIVERSITY STATISTICS REPO, PY in file and ORIGINAL for Annual Report.
Received on: //Wz0Signed b
9 Y
oar Committe
Processed on:
By Employee:
j / 71t
ity k's Office Staff InW13Scanned on: / BY Employee: Em to ee: _ a M a.
_
Date Cit erk's Office Staff Initials'"!
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\$ALL\BOARD AND COMMITTIES DATABASE\CHECKLIST MASTER\B&C Checklist 2015 MASTER.docx
0/e ace committed fo providing excellent public service and sofety to all who live. work, and play in our vibrant, trapical, historic community.
Immomalm
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
January 19, 2018
Mr. William Warren Jr.
810 11 th Street #202
Miami Beach, Florida 33139
RE: Human Riqhts Committee
Dear Mr. William Warren Jr.:
Congratulations! You have been reappointed by the City Commission to the agency, board or committee
named above for a term ending: 12/31/2018.
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,
Rafael Granado
City Clerk
cc: Saul Frances, Parking Director
Lana Hernandez, City Liaison
ENCLOSURES:
Oath of Office/Oath of Civility/Acknowledgements
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
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: 305.673.7411, Fax: 305.673.7254
Email: City0erk@miamibeachfl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Mr. William Warren Jr.
RE: Human Rights 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: 12/31/2018.
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 gounty or the
State of Florida (depending on the board or committee on which I serve) on July 1st,,ollow' g the closing
of the calendar year on which I have served. „
Sworn to and subscribed before me this ( day of J �� , 2018
/Veputy
*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
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfl.gov
CITY CLERK'S OFFICE
Telephone: 305.673.7411 Fax: 305.673.7254
CityClerk@miamibeachfl.gov
Acknowledgement of fines/suspension for Board/Committee Members for failure to comply with Miami -
Dade County Financial Disclosure Code Pro ision Code Section 2-11.1(i) (2)
Board Member's Name:
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 thg6e forms, pursuant to the Miami -Dade County Code, may subject the person to a fine
of no more than $500, days in jail or both.
nature /� % Date
Updated: Thursday, December 28, 2017
Page 4 of 4
F:ICLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 06022014.dccx
MIAFIMDADE
'LZ.11ia.! SOURCE OFINCOME 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.
Disclosure for Tax Year Ending L t Name Fi t Name fiddle Name/Initial
Mailing Address — Stree Numbe Street me or P 0, Bax
C � � �-
Cit te, Zip` '
Kz
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 9&AnEmpioyee (check ane)
El County 11 PuT�fTrust F Municipal: �
(Munic'
Department
Position or Title Employee 10 Number
Work add rzss I Work telephone Emp o began on/ended on
i
Filinq as a Burd Priember (check oriel
0 County
Ermunicipal
Boar where serving
9j4( c�,. '44 -t, r. Ile- e
Alternate address (if home a dress is exempt)
Chi
(Municipality)
Work telephone — Term began on/ended on
List below every source cf income you received, along with the address and t he 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 Tor 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 ° Source of Income Address I Description of the Principal Business Activity
'C "s- It -f
C. f e�c z3 P"4.1 C'- � l/
date sigrled
iformation above is a true and correct statement.
ncE;rE USE ONLY Arc=nt=d: Y I N ria='sc;_. cy
13S -SP -14 00-=201E
RECEIVED BY ELECTIONS DEPARTMENT:
❑ Hardcopy
- Electronic Copy
Processed Date/Initials: Scanned Date/Initials:
M, I AM , b r -AC H
DIVERSITY STATISTICS REPORTING
Board /Committee:
Appointment Date:
r
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 ON Female 0
Race/Ethnic Categories
What is is your race?
�C�'A.trican-American/Eiacr:
CaucasianhVhite
Asian or Pacific Islander
l.. Native-American/American Indian
al Other — Print Race: _
Do you consider yourself to be Spanish, Hispanic or Latino/a? +✓'ar-': the "No" box if not
Spanish Hispanic, Lafinoia.
Na
Yes
Do you consider yourself Physically Disabled?
'.2 No
0 Yes
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information form 05-20-13 FIN,'-,L.doc
1 ,dated: Mond;aV, Januar'/ ?6. 9015