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Barry Klein 12/31/19BOARD AND COMMITTEE CHECKLIST APPOINTEE: )3W/ ae rtJ DATE OF APPOINTMENT: S// 71/ 0 BOARD/COMMITTEE:bre/4.S i e- /T Appointed by: (, l L/ COMM SS, dlv / Sca SCANNER FOR CLERKn o o Letter of A ppoint ent TERM END: /2/ 3/ l I / TERM LIMIT: /472/3 //3 FORSca AFF Scan o o Letter of Reappointment o = •.' q1 e -r of Appointment/Reappointment mail`d to Committee Liaison on JC. ti 16 Scan o o Board and ommittee Application (Completed on Scan o o Resume/Curriculum Vitae iI4)(- '(1:/1/4)C4) o Diversity Statistics Reporting (Completed on Scan o o Oath Lf) 0 >- o r.a Scan 0 Scan 0 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 Require ent O DIVERSITY STATISTICS REP fi G Keep C PY in file aINAL for Annual Report. Received on: rj> 1' It:, Signed l Processedon: 1Dt11 U By Employee: D( /at / Employee: I `pity ' - 's Office Scanned on: /3 1/ 0 ByJ Date City CI v. Office Staff Initials.NNFD itte Member Initials CONCLUDED & RESIGNATION LETTERS 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\SALL\BOARD AND COMMITTIES DATABASE\CHECKLIST MASTER\B&C Checklist 2015 MASTER.docx ^•e :are com„rr?a-, to providing ,xieirent public service and ;e:2!y to oil who live work and play in our vibrant h�GCoi historic corm -2)11;1/1y 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: 305.673.741 1, Fax: 305.673.7254 Email: CityClerk@miamibeachfl.gov Oath of Office Oath of Civility and Acknowledgements TO: Mr. Barry Klein RE: Board of Adjustment 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 1 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. 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 lst, followin• the closing of the calendar year on which I have served. l 4 IMi Barry Klein day o4'' /, 2018 Sworn to and subscribed before me this -€1 arle 'Agostin puty 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 11700 Convention Center Drive Miami Beach, Florida 33139 www.miamibeachfl.aov CITY CLERK'S OFFICE CityClerk@miamibeachfl.gov Telephone: 305.6737411 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: Nick v c-LA1 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. fir7 mature Updated: Thursday, December 28, 2017 Page 4 of 4 F:\CLER\BALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 06022014.docx Datk MIAMI BEACH 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 May 17, 2018 Mr. Barry Klein 6356 Alton Road Miami Beach, FL 33141 RE: Board of Adiustment Dear Mr. Barry Klein: Congratulations! You have been appointed by the City Commission to the agency, board or committee named above for a term ending: 12/31/2019. 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 Granado City Clerk cc: Saul Frances, Parking Director Rogelio Madan, 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.