Jason Salvatore 12/31/18BOARD AND COMMITTEE CHECKLIST
APPOINTEE: -4 S. vM�fE DATE OF APPOINTMENT: O 1-0 3-
BOARD/COMMITTEE:
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BOARD/COMMITTEE: 151V- CI T1 E-5 Appointed by: Mibi°- Diw GGA
FOR SCANNER
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FOR CLERK STAFF
o Letter of Appointment TERM END: (2/S % /4Q TERM LIMIT: / 2 3/
o Letter of Reappointment
o Co.y . -t - of Appointment/Reappointment e-mailed t Committee Liaison on
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o Board and ommittee Application (Completed on / )
o Resume/Curriculum Vitae 41/d?//�
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 REPORTING Keep COPY in file and ORIGINAL for Annual Report.
O3, 1<6 Signed by X
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" By Employee:
Date
r Committee Member
City rk's Office Staff Initials
City C kJ• ice Staff Initials
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CONCLUDED & RESIGNATION LETTERS" NED
Term Expired Letter Date Processed
Resignation Letter Date Processed
Removal Letter due to absences Date processed
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F:\CLER\$ALL\BOARD AND COMMITTIES DATABASE\CHECKLIST MASTER\B&C Checklist 2015 MASTER.docx
Ale roe cornmiited to providing exceIent pubirc service and safety to ail who live work. and play in our vibrant tropical historic community
D'Agostin, Charles
From: D'Agostin, Charles
Sent: Tuesday, April 03, 2018 3:55 PM
To: jason81.us@gmail.com'
Cc: Hatfield, Liliam; Granado, Rafael; Wong, Claudia; Burger, Michele
Subject: Sister Cities Program
Attachments: Jason Salvatore Appt.pdf
Dear Mr. Salvatore,
Congratulations! You have been re -appointed to the above board by Mayor Dan Gelber.
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 Michele Burger committee liaison, for the schedule of the Committee meetings.
If you need additional information, do not hesitate to contact me at any time.
Regards,
,I1AMIBEACH
Charles D'Agostin, Office Associate III
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.
1
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
April 03, 2018
Mr. Jason Salvatore
641 Espanola Way # 32
Miami Beach, Florida 33139
RE: Sister Cities Proaram
Dear Mr. Jason Salvatore:
Congratulations! You have been appointed by Mayor Dan Gelberto the above -referenced Board or
Committee, 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 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 as they concern your duties, responsibilities, and
requirements as a board or committee member.
Congratulations again and good luck.
Regards,
Rafael Gr
City Clerk
cc: Saul Frances, Parking Director
Michele Burger, City Liaison
ENCLOSURES:
Oath of Office/Oath of Civility/Acknowledgements
City Code/Ordinance section applicable to agency, board or committee
City Code Sections 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. Jason Salvatore
RE: Sister Cities Program
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 1st, following the closing
of the calendar year on which I have served.
Mr. Jason Salvatore
3
Sworn to and subscribed before me this day of'' , 2018
Cr ds,4�ostin
eputy 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.iov
CITY CLERK'S OFFICE CityClerk@miamibeachfl.gov
Telephone: 305.673.741 1 Fax: 305.673.7254
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:
S uAls-olt-C�
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 than $500, 60 days in jail or both.
Sig re
Updated: Thursday, December 28, 2017
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Date
/\AlA/V\I BEACH
Name:
DIVERSITY STATISTICS REPORTING
Board / Committee: SIST6,— Cin 6,5"
Appointment Date:
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
Race/Ethnic Categories
What is your race?
�1
African-American/Black
IA Caucasian/White
EDAsian or Pacific Islander
E Native-American/American Indian
CD Other — Print Race:
Do you consider yourself to be Spanish, Hispanic or Latino/a? Mark the "No" box i; not
Spanish, Hispanic, Latino/a.
CA No
Yes
Do you consider yourself Physically Disabled?
IA No
[ Yes
C:AUsers\OENTFre&AppDa_ta\Loco(\Micrnsott\WindOWsvTemporary Internet FilesvvContent.outioo:k\NP4J9CN) vSC minorify
information form 05-20-13 FINAL.doc
Updated: Monday, January 26. 2015