Daniel Davidson 12/31/20MIAMI BEAi.H
BOARD AND COMMITTEE CHECKLIST
APPOINTEE: /);�if!� 64-vleIS6� DATE OF APPOINTMENT: r�
BOARD/COMMITTEE: P_'r( Appointed by: Co Al'KA �� �� �✓
FOR SCANNER FOR CLERK STAFF /
Scan o o Letter of Appointment TERM END: /-)- 3 b- iJ TERM LIMIT: ` 3 .;(
Scan o o Letter of Reappointment
o L tter of Appointment/Reappointment e-mailed to Committee Liaison on
Scan o o Board and Committee Application (Completed on )
Scan o o Resume/Curriculum Vitae
o Diversity Statistics Reporting (Completed on
Scan o o Oath
Received on
Processed on
Scanned on
DIVERSITY STATISTICS REPORTING
l / I / /;r Signed by
j Dat
C C BY Employe
Em to e
Da/ � t
By Employe
Date
Keep COPY in file and ORIGINAL for Annual Report.
CONCLUDED & RESIGNATION LETTERS
Term Expired Letter
IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
Initials Scan o
✓ 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
Removal Letter due to absences
✓ County Code Section 2-11.1 - Conflict of Interest and Code of Ethics Ordinance (as
-T
amended through December 2010)
✓ Amendments to the Code of Ethics Ordinance (September 2009 through July 2012)
✓ Highlights of the Miami -Dade County Ethics Code
U1
✓ Sunshine Law and Public Records - Frequently Asked Questions
;
✓ Memorandum - Solicitation by City Board and Committee Members
0 Citywide Permit Application (Parking Department Form)
0 Booklet - Guide to Sunshine Amendment & Code of Ethics for Public Officers and Employees
Scan o
o Source of Income Statement
Scan o
o Acknowledgment of Financial Disclosure Requirement
Received on
Processed on
Scanned on
DIVERSITY STATISTICS REPORTING
l / I / /;r Signed by
j Dat
C C BY Employe
Em to e
Da/ � t
By Employe
Date
Keep COPY in file and ORIGINAL for Annual Report.
CONCLUDED & RESIGNATION LETTERS
Term Expired Letter
Date Processed
Initials Scan o
Resignation Letter
Date Processed
Initials Scan 0
Removal Letter due to absences
Date processed
Initials Scan 0
CW
F:\CLER\BOARD AND COMMITTIES DATABASE\CHECKLIST MASTER\B&C Checklist 2015 MASTER.docx
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.gov
CITY CLERK'S Office
Telephone: 305.673.741 1 Facsimile: 305.673.7254 Email: CityClerk@miamibeachfl.gov
January 02, 2019
Mr. Daniel Davidson
1415 Euclid Ave.
Miami Beach, Florida 33139
SUBJECT: Production Industry Council
Congratulations! You have been reappointed by Commissioner Mark Samuelian to the above
referenced, board or committee named above, for a term ending: 12/31/2020.
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,
Rafael Granado, City Clerk
cc: Saul Frances, Parking Director
Silvia Royer, 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
MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK'S Office
Telephone: 305.673.7411 Facsimile: 305.673.7254 Email: CityClerk@miamibeachfl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Mr. Daniel Davidson
RE: Production Industry Council
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: 12/31/2020.
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.
-----M r.- Dani ei-D'aV i d s o n
Sworn and subscribed before me this Y day of January 2019
Deputy 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.
'"'®°ADE 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 Lag -Name First Name A Middle/Name/initial
.2— � l V� --)r—
Mailing Address – Street Number, Street Name, or P.O. Box
n
City, State, Z�
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. ❑
Filina as an Emolovee (check one)
County EjPu Health Trust ❑Municipal:
(Municipali
Department
Position or Title
Employee ID Number
Work address
Work telephone
Employment began on/ended on
Filing as a Board Member (check one)
County
Municipal:
0 X12 Ss
(Municipality)
Board where serving
Alternate address (if home address is exempt) Work telephone Term began on/ended on
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
nerson for vour benefit. However. the income of vour spouse or anv business partner need not be disclosed. If continued on a separate sheet, check here.❑
Name of Source of Income
Address
Description of the Principal BusinessActivity
/
I hereby swear (or affirm) that the
Signature of P isc osing
Date signed
OFFICE USE ONLY Accepted: Y / N Deficiency:
138 SP -14 COE 2016
and correct statement.
RECEIVED BY ELECTIONS DEPARTMENT:
❑ Hardcopy
❑ Electronic Copy
Processed Date/Initials: Scanned Date/Initials:
1 � �
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.m iamibeachfl.gov
CITY CLERK'S OFFICE
Telephone: 305.673.7411 Fax: 305.673.7254
CityClerk@miamibeachfl.gov
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: 1JJ,4,_VL6 S 0 t
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.
Updated: Thursday, December 28, 2017
Page 4 of 4
F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 06022014.docx
MIAMI BLACH
DIVERSITY STATISTICS REPORTING
Name: _PrM&-2f_ 1, CDs,
pro a -
) 0 C Dj) S �j
Board / Committee: _�c
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:
I
Gender: Male &4-_F`emale1:)
Race/Ethnic Categories
What is your race?
1 ,
ATric rnerican/Blac"K
[_4�a�jcasian/White
Asian or Pacific Islander
Native-American/American Indian
Other — Print Race:
Do you consider yourself to be Spanish, Hispanic or Latino/a? Ma,k the "No" box i; not
Spanish, Hispanic, Latino/a.
apl_o�'
0 Yes
Do you consider yourself Physically Disabled?
[LrN�o
Z) Yes
information form 05-20.13 FIN" L&C
Updated: Monday, Jnnuarli 26. 2015