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Brad Ugent 12/31/21 t\/\ I A t'' I B E A BOAF7 AND COMMITTEE CHECKLIST • � L APPOINTEE: �/�� f. >� r DATE OF APPOINT ENT: , 0)-0 BOARD/COMMITTEE: i(/1 A/KIAppointed by: l�T— CO 4I'S 5/61. FOR SCANNER FOR CLERK STAFF (- 61144/1 f''/ e / .— Scan J Scan o o Letter of Appointment TERM END: �/ J/ �i TERM LIMIT: 121A Scan o o Letter f711/çe Reapointment o f r Aontment/Rea ointment e mailed to Committee Liaison on iip 0 �pP pp Scan o o Board and Committee Application (Completed o 3 gOcJ Scan o o Resume/Curriculum Vitae AlTavO—OgO o Diversity Statistics Reporting (Completed on Scan o 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 RECEIVED amended through December 2010) ✓ Amendments to the Code of Ethics Ordinance (September 2009 through July 2012) ✓ Highlights of the Miami-Dade County Ethics Code JAN 2 4 2020 ✓ Sunshine Law and Public Records—Frequently Asked Questions ✓ Memorandum - Solicitation by City Board and Committee Members CITY OF MIAMI BEACH OFFICF"'r aP CITY CLERK O Citywide Permit Application (Parking Department Form) 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 0 DIVERSITY STATISTICS REPORTI Keep COPY in file and ORIGINAL for Annual Report. Received on: f /-2—C— / —2— 2P Signed by X / ,, , , 471c7k: Date/ /,, Boar', • o`. puttee 0-- ber Processed on: / C (d--6� By Employee: �� Date*� °1 i'= ri " e Staff Initials Scanned on: t A) c---(7 c1 By Employee: Date y Cler ' * ice Staff Initials kgi tit anneU CONCLUDED & RESIGNATION LETTERS Term Expired Letter Date Processed Initials Scan 0 Resignation Letter Date Processed Initials Scan 0 Removal Letter due to absences Date processed i Initials Scan 0 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 ploy in our vibrant, tropical historic community. MIAMI BEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 331 39 www.miamibeachfl.gov OFFICE OF THE CITY CLERK, Rafael E.Granado, City Clerk Tel: 305.673.741 1, Fax: 305.673.7254 Email: CityClerk@miamilpeachfl.gov January 17, 2020 Mr. Bradley Ugent 5838 Collins Ave#3A Miami Beach, Florida 33140 RE: Human Rights Committee Dear Mr. Bradley Ugent: Congratulations!You have been appointed by the City Commission to the agency, board or committee named above for a term ending: 12/31/2021. 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. Regy.Z Ra ael Granado City Clerk cc: Saul Frances, Parking Director Lana Hernandez, 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. MIAMI BEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139 www.miamibeachfl.gov 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. Bradley Ugent RE: Human Rights 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: 12/31/2021. 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. ..A Bradle i gent Sworn to and subscribed before me this I day of 'u 20 Cha e D'Agostin uty 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) Board Member's Name: hZ'C"CA 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. Cr--3r •f 2 / 9 Si_nature Date Updated:Thursday,December 28,2017 Page 4 of 4 F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 06022014.docx MIAMI BEACH DIVERSITY STATISTICS REPORTING Name: r/ (A0o-, Board / Committee: /4 CA/1/14 A) R( S CE61/144' l t '/---le Appointment Date: / 7 / d--() 0 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 D Race/Ethnic Categories What is your race? African-American/Black liCaucasianNNhite 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 Spanish, Hispanic, Latino/a. 8 Na Yes • Do you consider yourself Physically Disabled? FA No 1a Yes C:1Users\CENTFraN.AppData\Local\Microsoft\Winda'r1s\Temoranr Internet Fi!eslContent.Outlook\NP4J9CNX1BC minority information form 05-20-13 FINAL.doc Updated: Monday,January 26,2015 MIAMI•DADE SOURCE OF INCOME STATEMENT COUNTY Section 2-11.10)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 La t NameFirst Name Middle Name/Initial 2019 V\ , t +— DeGC�(.Q i A Mailing Address—Street Number,Street e,or P.O.Box 5q 4s ( e/r-7 A (--JQ --4 City,State,Zip — �' /14 I C"----\.."--"--N / 8e7 CI L7 (..----- ( 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.❑ Filing as an Employee (check one) El County 11. Public Health Trust ® Municipal: (Municipality) Department Position or Title Employee ID Number Work address Work telepho Employment began on/ended on Filing as a Board Member(check one) &cc,El County fl Municipal: C,,4 i 9 C "(•,�-�-,-• ° (...j (Municipality) Board where serving 4VI-4-" P l' As-s' �4 l -ffee Alternate address(if home address is exempt) Work telephone Term Deg 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 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 Address Description of the Principal Business Activity S M6 r----L_ 33131 I hereby s r(or affirm)that the information above is a true and correct statement. RECEIVED BY ELEpgsCEIVED O Hardcopy 11 ❑Electronic Copy JAN 24 2020 S' ature of Pet Disclosing i 7-2- C-4/.)---c CITY OF MIAMI BEACH OFFICE OF'THE CITY CLERK Date signed OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/Initials: Scanned Date/Initials: 136 SP-14 COE 2016