David Lancz 12/31/19B E Ac
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BOARD AND COMMITTEE CHECKLIST
APPOINTEE: /3-1:c1 DATE OF APPOINTMENT: ;1/-)-1 he-
BOARD/COMMITTEE:
L ( 13 /9'j V� 1 Appointed by: CO/'4/14. / `0S
FOR SCANNER
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FOR CLERK STAFF
4044/21-1-1-6
o Letter of Appointment TERM END: /). 3/. // TERM LIMIT: /d- 31.
9-3
o Letter of Reappointment
o op of ettof Appointment/Reappointment-mailed to Committee Liaison on
o Boa •and ommittee Application (Completed on
...2-• /1e)
o Resume/Curriculum Vitae
o Diversity Statistics Reporting (Completed on
o Oath
IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
✓ City Code Ordinance Section applicable to the agency, board or committee
✓ 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)
✓ Highlights of the Miami -Dade County Ethics Code
✓ Sunshine Law and Public Records — Frequently Asked Questions
✓ 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
o Source of Income Statement
o Acknowledgment of Financial Disclosure Requirement
o DIVERSITY STATISTICS REPON'gep COPY in file and ORIGINAL for Annual Report.
3 --).-
Date
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Date
Date
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By Employee:
By Employee:
ommitta�Dr//lember
Jerk's Office Staff Initials
City .mark's Office Staff Initials
CONCLUDED & RESIGNATION LETTERS
Term Expired Letter
Resignation Letter
Removal Letter due to absences
Date Processed
Date Processed
Date processed
Initials
Initials
Initials
F:\CLER\$ALL\BOARD AND COMMITTIES DATABASE\CHECKLIST MASTER\B&C Checklist 2015 MASTER.docx
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MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139 w w.miamibeachfl.aov
OFFICE OF THE CITY CLERK, Rafael E. Granado, City Clerk
Tel: 305.673.741 1, Fax: 305.673.7254
Email: CityClerk@miamibeachfl.gov
February 21, 2018
Mr. David Lancz
900 Bay Drive # 917
Miami Beach, Florida 33141
SUBJECT: LGBTQ Advisory Committee
Congratulations! You have been reappointed by Commissioner Kristen Rosen Gonzalezto the above
referenced, board or committee named above, 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.
Congratulations and good luck.
Regards,
afae ` anado
cijity Clerk
cc: Saul Frances, Parking Director
Morgan Goldberg, 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. Granado, 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. David Lancz
RE: LGBTQ Advisory 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: 12/31/2019.
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.
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 1st, following the closing
of the calendar year on which I have served.
Sworn to and subscribed before me this
Mr. David Lancz
3 day of/t" f 2018
arle %'Agostin
:
D �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.
MIAMI BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfl.aov
CITY CLERK'S OFFICE 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 Di, losure Code Provision Code Section 2-11.1(i) (2)
g�
L c
Board Member's Name: /
I understand that no later than July 1. of each year 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 t ..4. 00, 60 days in jail or both.
Signature
Updated: Thursday, December 28, 2017
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Date
/\A1AM BEACH
DIVERSITY STATISTICS REPORTING
Name: � U C-2
CBoard / Committee: 1,6 ILR /
A ointment Date: Td) I 2 t)(
Pp
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: MFemale Li
RaceiEthnic Categories
What is your race?
Li] African-American/Black
Caucasian/Vvhite
Asian or Pacific Islander
Native-American/American Indian
Other — Print Race:
3 ctc-e,
Do you consider yourself to be Spanish, Hispanic or Latino./a? Ma . 'r,s ttlo'
Spanish, Hispanic, Latino/a.
`0
IRA Yes
Do you consider yourself Physically Disabled?
Yes
C\Users\CEN`rFraN\AppData\Lacar,Miorosott\Wirdows\Pe r oorary Intz,rn
information form 05.20-13 FINA,L.doc
Updated: Monday, January 26. 2015