Chris Rollins 12/31/18t g A
BOARD ND COMMITTEE CHECKLIST
APPOINTEE:__��� TS d (1 �S DATE OF APPOI TMENT: l l l
BOARD/COMMITTEE: V C/+ Appointedby:
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FOR SCANNER FOR CLERK STAFF
Scan o c Letter of Appointment TERM END: TERM LIMIT:
Scan o o Letter of Reappointment
0 7oly/4 ette of Appointment/Reappointment mailed to Committee Liaison on
Scan o o B and and Committee Application (Completed in )
Scan o o Resume/Curriculum Vitae
o Diversity Statistics Reporting (Completed on
Scan o c Oath
IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
U7 W ✓ City Code Ordinance Section applicable to the agency, board or committee
c�t �- ✓ City Code Sections 2-21, 2-22, 2-23, 2-24, 2-25, 2-26, 2-458 and 2-459
may. ✓ 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)
s ✓ Highlights of the Miami -Dade County Ethics Code
m Sunshine Law and Public Records — Frequently Asked Questions
><i.e ✓ Memorandum - Solicitation by City Board and Committee Members
i C
a 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
r� /O DIVERSITY STATISTICS 9 Y REE/PORTI G Keep COPY in file an ORIG/I-NAL for Annual Report.
Received on: Signed b /���0"'�
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Processed on: � (� By Employee:
a Xy 's Office Staff Initials
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Scanned on: / / B Em to ee:
Date Cit I rk's Office Staff Initials
h1kIED
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
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17, AWAwwwail go - MENEM- E I
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 331 39 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 19, 2018
Mr. Christopher Rollins
1717 N. Bayshore Drive, Apt 3238
Miami, Florida 33132
RE: Visitor and Convention Authoritv
Dear Mr. Christopher Rollins:
Congratulations! You have been appointed by the City Commission to the agency, board or committee
named above for a term ending: 1213112018.
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,
Ra/fel do
Cit
cc: Saul Frances, Parking Director
Grisette Roque, 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: 305.673.741 1, Fax: 305.673.7254
Email: CityClerk@miamibeachfl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Mr. Christopher Rollins
RE: Visitor and Convention Authority
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. Christopher Rollins
Sworn to and subscribed before me this , day of �"2018
s D'Agostin
Deputy 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.
"'®DADE SOURCE OF INCOME 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 Las ame
Mailing Address — Street Number, S beet Name, or P.O. Box
l 712 & 62V:�W.&-Or,
City, State, Zip
#1(4441, r 3-� /3 9
First Name Middle Name/initial
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 Employee (check are)
Public Health Trust [7 Municipal:
Department
Position or Title
Work address
Filing as a Board Member (check ane)
Employee ID Number
Work telephone �Imlloymlllil
an on/ended an
0 County )0`Municipai: (_'.PA-;rr C%
(Municipality)
Board where serving
V CA
Alternate address (i) home address is exempt) Work telephone Term began on/ended on
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
Q izd,i ", Wil,_ 331d-
i I
r
I hereby swear (or affirm) that the information above is a true and correct statement.
-0 t - - t7
Signature of Person Disclosing `
02 ! (f'
Date signed
OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/Initials:
138 SP -14 COE 2016
RECEIVED BY ELECTIONS DEPARTMENT:
❑ Hardcopy
fE-Electronic-Eopy----- --- - - - - -
Scanned Date/Initials:
M I A/0 I BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfl.aov
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 Provision Code Section 2-11.1(i) (2)
Board Member's Name: Xk—fr5 kc / 1 'Ai S
1 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.
0/" K/y
Signature
Updated: Thursday, December 28, 2017
Page 4 of 4
F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 06022014.docx
Date
D'Agostin, Charles
From:
Sent:
To:
Cc:
Subject:
Attachments:
Dear Mr. Rollins,
D'Agostin, Charles
Tuesday, January 30, 2018 1:05 PM
'Chris Rollins'
Hatfield, Liliam; Wong, Claudia; Roque, Grisette
Visitor and Convention Authority
Christopher Rollins Appt.pdf
Congratulations! You have been appointed to the above board by City Commission.
Please stop by the Office of the City Clerk to be sworn in, sign your board paperwork and pick up your package.
I am copying Grisette Roque committee liaison, for the schedule of the Committee meetings.
If you need additional information, do not hesitate to contact me at any time.
Regards,
I MA A11
Charles D'Agostin, Office Associate !ll
OFFICE OF THE CITY CLERK
1700 Convention Center Drive, Miami Beach, FL 33139
Tel: 305-673-7411 Fax: 305-673-7254 / Ext. 6465 www.miamibeachfl.gov
We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic
community.