James Orlowsky 12/31/21;:,. ..\ i • i , B= r· = ,}. -~ ~ j
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B O A R D A N D C O M M ITT E E C H E C K L IS T
APPOINTEE: S A 5 0 a w-S Y
BOARD/COMMITTEE:
FOR SCANNER
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DATE OF APPOINTMENT: )/7/z>z2
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reau eo.(2131h1 ra n. /2//// FOR CLERK STAFF
o Letter of Appointment
o Letter of Reappointment
o ~¿;.!t!!Jointment/Reappointment
o Board and Committee Application (Completed on y LL Luz-
o Résumé/Curriculum Vitae ' r "
o Diversity Statistics Reporting (Completed on=l )4
o Oath
Committee Liaison on
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Scan O
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Received on:
IM PO RT ANT IN FO RM ATI ON FO R B OARD AND COM MI TT EE MEM BERS BOOK
City Code Ordinance Section applicable to the agency, board or committee
Y 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 Ethi cs Ordinance (as
amended through December 201 O)
✓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
✓l'V1emorandum - 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
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CONCLUDED & RESIGNATION LETTERS
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Resignation Letter Date Processed Initials Scan o
Removal Letter due to absences Date processed Initials Scan o
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F:CLER\BOARD AND COMMIT TIES DATABASE\CHECKLIST MASTER\B&C Checklist 2015 MASTER.dock
FEB 3 2020
CITY OF M IAM I BEACH
O FF ICE OF TH E C ITY C LERK
We are committed to providing excellent public serice and scfey to ali who live, work, and pay in our vibrant, tropical historic community.
1,A MI BE A CH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139 www miamibeachfl.gov
OFFI CE OF THE CITY CLERK, Rafael E. Granado, City Clerk
Tel: 305.673.7411, Fax. 305.673.7254
Email: CityClerk@miamibeachfl.gov
January 17, 2020
RECEIVED
FEB 3 2020
CITY OF MIAMI BEACH
OFFICE OF THE CITY C!ERK
Mr. James Orlowsky
415 FAIRWAY DR
MIAMI BEACH, Florida 33141
SUBJECT: Board of Adjustment
Dear Mr. James Orlowsky:
Congratulations! You have been reappointed by the City Commission to the above referenced board or
committee, 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. 7 411.
Please read the enclosed materials carefully. Congratulations and good luck.
R~ly,
Rafael Granado
City Clerk
cc: Saul Frances, Parking Director
Rogelio Madan, 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
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, Miomi Beach, Florido 33139 www .miomibeochfl gov
O FFIC E OF TH E C ITY C LE RK , Ra fa el E. G ra na d o , C ity C lerk
Tel: 30 5 .6 7 3 .7 4 11, Fa x: 30 5 .6 7 3 .7 2 5 4
Em a il: Ci ty C le rk@ m ia m ib eachfl.g o v
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Mr. James Orlowsky
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 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.
55 ±e Mr. James Orlowsky
Sworn to and subscribed bef°Qe this _3 diiYêi t Ç -
*Please visit the City of Miami Beach website at www.miamibeachfl.gov under City Clerk/Board and
Committees for additional information regarding the Financial Di sclosure Requirements.
RECEIVED
FEB 3 2020
CITY O F M IAM I BEACH
OFFICE OF TE CITY CL E R K
We are com m itted to pro viding excellent public service and safety to all who live, work and play in our vibrant, tropical, historic com m unity.
MIAMIBEA CH
City of Miami Beach
1 700 Convention Center Drive
Miami Beach, Florida 33139
www_miamibeachf]goy
CITY CLERK'S OFFICE
Telephone: 305.673.7411 Fax: 305.673.7254
Ci#yClerk@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)
es.raw-mt-r s Na e..hoc<<s Q,[ash/
I understand that no later than July 1. of each year all members olsoards 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 Finan cial Interests (Form 1)"
3. A Copy of your iatest 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.
e 2l/zoco
Date
Updated: Thursday, Dece mber 28, 2017
Page 4 of 4
F:\CLER\$ALL\aFORMS\BOARD AND COMMIT TEES'BC APPLICATION REVISED 06022014.d0cx
RECEIVED
FEB 3 2020
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
M IA M l·DAD EI EIE SOURCE OF INCOME STATEMENT
Section 2-11.1() 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 I Last Name First Name Middle Name/Initial
2019 O2ojF; )A5 5ro€
Mailing Address - Street Number, Street Name, or P.O. Box
q I5A] 4uuc t± [41
City, State, Zip
4 I 4€AH F- L 3351
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. O
Filing as an Employee (check one)
[] county D Public Health Trust D Municipal:
(Municipality)
Department
Position or Title Employee ID Number
Work address I Work telephone Employment began on/ended on
Filing as a Board Wem ber (check one)
[] county 5 Municipal: H JAR 6AH
(Municipality)
Board where serving
B$04o 3 9557T
Alternate address (if home address is exempt) I Work telephone I Term began on/ended on
305 53705 l [a[zozo / al3lzsu
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.O
Name of Source of Income Address Description of the Principal Business Activity
L4o1- CHA AdC ZY CA 4 4 rs A A S DAI 4tu F55l9>
RECEIVED
FEB 3 2020
y y
l . tir I ll lii
9fElg5 g I GK,##5i norraton aore s ate au cores statement
±5.e==a- f@nae of Person Disclosm¡
z[3/zozo
Date signed
RECEIVED BY ELECTIONS DEPARTMENT:
D Hardcopy
[] Electronic Copy o
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• à <é é
OFFICE USE ONLY Accepted: Y/ N Deficiency: Processed Date/Initials: Scanned Date/Initials: _
138_SP-14 COE 2016
M A[A MM[EACH //1. li?-,i\.. l
DIVERSITY STATISTICS REPORTING
Name: -----------------------------
5A) o4o/7
Board/ Committee: $0A49 A15-77T
Appointment Date: ]ls71zzo
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 enael
Race/Ethnic Categories
What is your race?
Cl African-American/lack
c aucaslawhite
O Asian or Pacific Islander
[¿Native-American/American Indian
Li ther- Print Face.
Do you consider yourself to be Spanish, Hispanic or Latino/a? Mark the "No" box if not
Spanish, Hispanic, Latino/a.
Jo
kves
Do you consider yourself Physically Disabled?
±
ves
C:\Use:sCNTFaNAppData\Loca!Microsoft\idos\Temoray itsrnet iles\Cotent.Out4o ANP4JCNXC miriy
information farm O5-20-13 FINAL.dc
Updated: Monday, January 26. 2015