David New 12/31/19\IBEA
BOARD AND COMMITTEE CHECKLIST
APPOINTEE: D'9i/vl A4c-i DATE OF APPOINTMENT: 3 / �/ l b
BOARD/COMMITTEE: 1)4 _ Appointed by: itiA/9-41404 ' o-die
FOR SCANNER FOR CLERK STAFF ��
Scan o o Letter of Appointment TERM END, /%5 / ' TERM LIMIT -2/N/
Scan o o Letter of Reappointment
o py of ett of Appointment/Reappointment e-mailed to Committee Liaison on
Scan o o Board and ommittee Application (Completed on 2 /// )
Scan o o Resume/Curriculum Vitae --LGA-y
o Diversity Statistics Reporting (Completed on Pr-
Scan
o o Oath
IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
✓ City Code Ordinance Section applicable to the agency, board or committee
co ✓
City Code Sections 2-21, 2-22, 2-23, 2-24, 2-25, 2-26, 2-458 and 2-459
4r4 f-3 ✓ 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)
E,, ✓ Highlights of the Miami Dade County Ethics Code
cp
cv ,-- Sunshine Law and Public Records — Frequently Asked Questions
✓ Memorandum - Solicitation by City Board and Committee Members
La
Ce
.0 0 Citywide Permit Application (Parking Department Form)
C`'' `' 0 Booklet — Guide to Sunshine Amendment & Code of Ethics for Public Officers and Employees
Scan 0 0 Source of Income Statement
Scan 0 0 Acknowledgment of Financial Disclosure Requirement
G DIVERSITY STATISTICS REPORTING Keep COPY in file and ORIGINAL fo,�� R ort.
Received on: 1-265-14( Signed by X c✓�
Processed on:
Scanned on:
ate /
Date
/�// vv By Employee:
Date ity C;�i"s Office Staff Initials
mkiED
CONCLUDED & RESIGNATION LETTERS
By Employee:
Bird or C
mitte
Office Staff Initials
Term Expired Letter Date Processed
Resignation Letter Date Processed
Removal Letter due to absences Date processed
Initials Scan 0
Initials Scan 0
Initials Scan 0
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 331 39 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
March 02, 2018
Mr. David New
1616 Michigan Ave. Apt#1
Miami Beach, Florida 33139
SUBJECT: Disability_Access Committee
Congratulations! You have been reappointed by Mayor Dan Gelberto 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,
Raf el Gr
Ci, Clerk
(i)
c: Saul Frances, Parking Director
Valeria Mejia, 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. David New
RE: Disability Access 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: 12/31/2019.
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 New
day ofA ,2018
merles gostin
De 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.
/\AA/\/\ BEACH
DIVERSITY STATISTICS REPORTING
Name:
Board / Committee:
Appointment Date:
/)4--wd Ain/,1
1)A -C
/ ?-7//:(
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 Female X11
Race/Ethnic Categories
Wh t is your race?
African-American/Black
Caucasian/white
0 Asian or Pacific Islander
0 Native-American/American Indian
0 Other — Print Race:
Do you consider yourself to be Spanish, Hispanic or Latino/a? Mark the "No" box if not
Spapish, Hispanic, Latino/a.
No
0 Yes
Do you consider yourself Physically Disabled?
8:No
Yes
.CAUse.ra\C` N-T'i rafT,Ap.pData\ o a':`,Microsot`WIT:ac.?
information form 05.20.10 FINA',L.doc
Updated: Monday, January 26. 2015
SOURCE OF 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 ayearly basis by July 1st
of every year.
Disclosure for Tax Year Ending
—2-10/_7
Last Na7)..c First Nam
Mailing Address — Street Number, Street Nam , or P.D. Boxt.).7-A./ A--vc._ -__
City, State, ZipCI
'
/ Q r /30-a, �& 33 /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. ❑
Middle Name/Initial
Filinn Employee (check one)
0 County Public Health Trust fl Municipal:
Department
Position or Title
Work address
Filing as a Board Member (check one)
0 County
Board where serving
Alternate address (if horse address is exempt)
(Municipality)
Work telep a
Xf-Municipal: -141 0 /_ liiff""
Work telephone
(Municipality)
Employee ID Number
Employment began on/ended an
Term bega on/ended on
.3.,;. a/r
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, rent, 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 I Address Description of the Principal Business Activity
SOC/it l Secv-i
I hereby swear (or affirm) that the information above is a true and correct statement.
Signature of Person Disclosing
go-/fY
Date signed
OFFICE USE ONLY Accepted: Y / N Deficiency:
139 SP -14 C0E 2016
N/4 -
RECEIVED BY ELECTIONS DEPARTMENT:
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