Paul Stein 12/31/18MIAMIBEACH
BOARD AND COMMITTEE CHECKLIST
APPOINTEE: A-7, / s.�� DATE OF APPOINTMENT: I l
BOARD/COMMITTEE: f4eKs ,,t- A(f Appointed by:
FOR SCANNER FOR CLERK STAFF
Scan o o Letter of Appointment TERM END: TERM LIMIT:
Scan o o Letter of Reappointment
o rqpy,.DJ/Lrer of Appointment/Reappointment e-mailpd to Committee Liaison on
Scan o o Bo rd an p Committee Application (Completed on �/
)
Scan o o Resum6/Curriculum Vitae
o Diversity Statistics Reporting (Completed on a
Scan o o Oath
o zuj IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
"- E-) ✓ City Code Ordinance Section applicable to the agency, board or committee
et 13;": ✓ 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
kart cn e amended through December 2010)
0 � �` � ✓ Amendments to the Code of Ethics Ordinance (September 2009 through July 2012)
LLJ LLJ✓ Highlights of the Miami -Dade County Ethics Code
co ✓ Sunshine Law and Public Records - Frequently Asked Questions
a',` ✓ Memorandum - Solicitation by City Board and Committee Members
0 Citywide Permit Application (Parking Department Form)
0 Booklet - Guide to Sunshine Amendment & Code of Ethics for Public Officers and Employees
Scan 0 0 Source of Income Statement
Scan 0 0 Acknowl edgmen ncial Disclosure Requirement
0 DIVERITY STATISTICS REP in file and ORIGINAL for Annual Report.
Received on: z�J2-_� J Si ned b
:1 g y —
Date v �rd r m to e r
Processed on: By Employee:
DateuC' Office Staff Initials
Scanned on: By Employee:
Date ity C r ' Office Staff Initials;
ED
CONCLUDED & RESIGNATION LETT S
Term Expired Letter Date Processed
Initials Scan o
Resignation Letter Date Processed
Initials Scan o
Removal Letter due to absences I Date processed Initials Scan 0
F:\CLER\$ALL\BOARD AND COMMITTIES DATABASE\CHECKLIST MASTER\B&C Checklist 2015 MASTER.docx
We circa committed to providing excellent pubic 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: 305.673.715.01
Email: CityClerk@rniamibeachfl.gov
January 04, 2018
Mr. Paul Stein
510 W 50th St
Miami Beach, Florida 33140
SUBJECT: Parks and Recreational Facilities Board
Congratulations! You have beer 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 directy 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.
Regards,
R fael ranado
91iCity Clerk
" cc: Saul Frances, Parking Director
Cynthia Casanova, 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 s wovice 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. Paul Stein
RE: Parks and Recreational Facilities Board
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 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. Paul Stein
Sworn to and subscribed before me this ;_1 day o 2018
4ChsU9D'Agostin2
ty 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.
a
M !AN\IAk"'
DIVERSITY STATISTICS REPORTING
Narne: 1/" �T�► �� ,�
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 che k the appropriate box for each category:
Gender: Male Female
Race/Ethnic Categories
What is your race?
—�� k
African-American0ac
Caucasian/White
Asian or Pacific Islander J
NaLive-Amcrican/;'.merican Indian
L Other — Print Race:
Do you consider yourself to be Spanish, Hispanic or Latino/a? .'`ark the J110" bo.- no
Span sh, Hispanic, Latinc,a.
No
Yes
Do you consider yourself Physically Disabled?
No
Yes
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information fcrm 05-20' 1 S FINALAO'c
upd_tad: Nlomvav, January 26, 2010
MI1jal E SOURCE Or INCOME STATEMENT
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 Name First Name) Middle Name/Initial
Mailing Address — Street Number, Streef Name, or P.O. Box
City, State, Zip ^ � 1 3 �
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 Ernplayee (check orae)
CDun Public Health Trust Q Municipal:
(Municipality)
Department
Position or Title
Work address
Filing as a Board Member (check one)
county it Municipal
Boar�There servin;
Employee ID Number
Ngo? hone Employment began on/ended on
(Municipality)
I
Alternate address (if home address is exempt) Work telephone j Term bega on/e. ed on
List below every source of income you received, along with the address and the principal activity of each source. Include your pubNc 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, IRP. 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
00de, is Avg e
S c kucr 1( tVl f l
I her y swea r affirm) that the information above is a true and correct statement.
Signature of Person Disclosing
_� -3-3- I(�J( Y
Daze signed
RECEIVED BY ELECTIONS DEPARTMENT:
❑ Hardcopy
❑ Electronic Copy
nce10E US=. ONLY Accented: Y ; N De i_ielcy, Processed Date/Initials: Scanned Date/Initials:
138 SP -14 C0E-2013
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 Provision Code Section 2-11.1(1) (2)
Board Member's Name: PAII 1 S�e,'A_)
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 28, 2017
Page 4 of 4
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Date