Roger Baumann 4/1/19AIBEACH
APPOINTEE: I
BOARD AND COMMITTEE CHECKLIST
O'5 P' 134- tA1 *'J,u DATE OF APPOINTMENT:
BOARD/COMMITTEE: 03 f*(f F4' 1r Appointed by: ! it 6OA4 4 ,5512y✓
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FOR CLERK STA / C � �j
o Letter of Appointment TERM END: `7j/ ` / TERM LIMIT: (I ( r
o Letter of Reappointment
o �llpy of /Letter of Appointrnent/Reappointment e-mailed to Committee Liaison on
V/7//r
FOR SCANNER
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Processed on:
Scanned on:
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o Boar and Committee Application (Completed on
o Resume/Curriculum Vitae
o Diversity Statistics Reporting (Completed on
o Oath
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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 Et
o Source of Income Statement
o Acknowledgment of Financial Disclosure
o VERSITY STATISTICS REPORT!
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Signed by X
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/ By Employee:
blic Officers and Employees
RIGINAL for Annual Report.
ommittee Member
tyy l 's Office Sta
nitials
y
Cler
Office Staff Initials
CONCLUDED & RESIGNATION LETTERS
Term Expired Letter
Resignation Letter
Removal Letter due to absences
Date Processed
Date Processed
Date processed
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F:\CLER\SALL\BOARD AND COMMITTIES DATABASE\CHECKLIST MASTER\B&C Checklist 2015 MASTER.docx
ta svrr, "lye v,/ork and p!c,; rn our vibrant trop c. ,
'Or' COM i"n r ay
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
May 17, 2018
Mr. Roger Baumann
5025 North Bay Road
Miami Beach, FL 33140
RE: Miami Beach Hall of Fame Selection Committee
Dear Mr. Roger Baumann:
Congratulations! You have been appointed by the City Commission to the agency, board or committee
named above for a term ending: 04/01/2019.
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,
Rjffael Granado
City Clerk
cc: Saul Frances, Parking Director
Eva Silverstein, 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.
MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139 w w.miamibeachfl.aov
OFFICE OF THE CITY CLERK, Rafael E. Granath), City Clerk
Tel: 305.673.741 1, Fax: 305.673.7254
Email: CilyClerk@miamibeachfl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Mr. Roger Baumann
RE: Miami Beach Hall of Fame Selection 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: 04/01/2019.
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
Code of Ethics Ordinance), as well as Florida Commission on Ethics Guide to the shine Am- dm
and Code of Ethics for Public Officers and understand that as a member of -0' Miami 6)2ch B
and/or Committee, I must comply with the financial disclosure* requirem •f ami-Dad9,County o
State of Florida (depending on the board or committee on which I s- 0,e •n . ly 1 foiling the c
of the calendar year on which I have served.
Sworn to and subscribed before me this
Mr/Roger Bauman
v
rd
the
sing
day oOTIti‘j
018
D'Agostin
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.gov
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 Disclosure Code Provision Code Section 2-11.1(i) (2)
f\
a'! (`)e
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 for , pursu to the Mi. ► 1 •ade County Code, may subject the person to a fine
of no more than $500, 60 d i ail • oth.
Signatu
Updated: Thursday, December 28, 2017
Page 4 of 4
F:\CLER\$ALL1aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 06022014.docx
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Date
MIAM3
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 a yearly basis by July 1st
of every year.
Disclosure for Tax Year Ending Las e First fe A Middle/Name/Initial
2017
Mailing Address - Street Number Stre am , or�,Q :
City, State, Zi
yo
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If your home address is our 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. 0
Filing as an Employee (check one)
Couh Public Health Trust E] Municipal:
Department
Position or Title
Work address
(Municipality
Employee ID Number
Work telephone Employment began on/ended on
Filing as a Bo ember (check one)
D County unicipal: � � �� % 4701
(Municipality)
Board where serving
44 /8 ()1\ F414. Comivvrilee
Alternate address (if home address is exempt) Work telephone Term began 9n/ended on
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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, rents, 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 he disclosed. If continued on a separate sheet, check here.D
Description of the Principal Business Activity
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Name of Source of Income _ Address
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09 -2t - f
I hereby swear (or affirm) tha
Si�gnaattoff Perso
'T Ij �It
Date signed
ation above is a ue : nd Correct statement.
isclosing
OFFICE USE ONLY Accepted: Y / N Deficiency:
138 SP -14 COE 2016
RECEIVED BY ELECTIONS DEPAIITMEN1
❑ Hardcopy
❑ Electronic Copy
Processed Date/Initials: Scanned Date/Initials:
MIAMI BEACH
Name:
DIVERSITY STATIST 5 REPORTING
Ex -
Board / Committee:
PI- ��
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.
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6447e 044. eg,„,
Please check the appropriate box for each category:
Gender: Male
Female RJ
Race/Ethnic Categories
What is your race?
P African-American/Black
Caucasian/VVhite
Li Asian or Pacific Islander
Native-American/American Indian
LJ Other — Print Race:
Do you consider yourself to be Spanish, Hispanic or Latino/a? . lark the "No" box if not
Spanish, Hispanic, Latino/a,
No
I Yes
Do you consider yourself Physically Disabled?
No
Yes
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information form 05-20-13 FINAL.doc
Updated: Monday, Januanj 26, 2015