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BOARD AND COMMITTEE CHECKLIST
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• tenter ot Appoi ntment TERM END: L, }], ] rMLum:[í/, [
T T T r r t
o Letter of Reappointment
o Gpy, of )-~e~ h Appointment/Reappointment e-mailed to Committee Liaison on
o Board and Committee Application (Completed on s:2:iz í::JeJ yJ--0
o Résumé/Curriculum Vitae /
1 1 o Diversity Statistics Reporting (Com plet ed on l »JO)O
o Oath 7 S c a n o
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/ Q /TY OF _MIAM I Ba o
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IMPORT ANT INFORMATION FOR BOARD AND COMMITTE E MEMBERS BOOK
FE;pp} Y City Code Ordinan ce Section applicable to the agen cy, board or committee
IVE[ city Code Section s 2-21, 2-22, 2-23, 2-24, 2-25, 2-26, 2-458 and 2-459
Y County Code Section 2-11.1 - Conflict of Interest and Code of Ethics Ordinance (as
am en ded through Decem ber 2010)
Am en dments to the Code of Ethics Ordinan ce (Septem ber 2009 through July 2012)
Highlights of the Miami-Dade County Ethics Code
Sunshine Law and Public Records - Frequently Asked Questions
Memoran dum - Solicitation by City Board an d Committee Members
S c a n O
S c a n O
Received on:
O Citywi de Permit Application (Parking Department Form)
o Booklet - Guide to Sunshine Am endment & Code of Ethics for Public Officers and Employees
o Source of Income Statement
O Acknowledgmen t of Financial Disclosure Requirement
O DI V E R SI TY S TA TI S TI C S R EP O R 'IN G
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CONCLUDED & RESIGNATION LETTERS
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Resigna tion Letter Date Processed Initials Scan O
Removal Letter due to absen ces Date processed Initials Scan O
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FICLERBOARD AND COMMIT TIES DATABA SE\CHECKLIST MASTER&C Checklist 2015 MASTER.docx
Ve are committed to providing excellent public service and scíeiy to all who live. work and icy in our vibrant, tropical historic community.
M IA M I BEACH
City of Miami Beach, 1700 Convention Center Drive, Miomi Beach, Florido 33139 www.miomibeochfl.gov
OFFICE OF THE CITY CLERK, Rafael E. Granado, City Clerk
Tel: 305.673.7411, Fax: 305.673.7254
Email: CityClerk@m iamibeachfl.gov
February 10, 2020
Mr. Mark Wylie
1340 Lincoln Road, Apt. 202
Miami Beach, Florida 33139
SUBJECT: LGBTQ Advisory Committee
Congratulations! You have been reappointed by Mayor Dan Gelberto the above referenced, board or
committee named above, for a term ending: 12/31/2021.
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,
7¥
,) Rafael Granado
g city clerk
cc: Saul Frances, Parking Director
Morgan Goldberg, 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.
MIAM I BEACH
City of Miami Beach, 170O Convention Center Drive, Miami Beach, Florido 33139 ww_miamibeachfl gov
OF FICE OF THE CITY CLERK, Rafael E. Granado, City Clerk
Tel: 305.673.7411, Fax. 305.673.7254
Email: CityC lerk@miamibeachfl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Mr. Mark Wylie
RE: LGBTQ Advisory 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.
Sworn to and subscribed before me this _2 t
*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.
MI A MIBEA CH
City of Miami Beach
1 700 Convention Center Drive
Miami Beach, Florida 331 39
www._miamibegchf]_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)
essevo-o e._[al N\ u«
I understand that no later than July 1__ of sach_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.
Qne 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.
Date
Updated: Thursday, December 28, 2017
Page 4 of 4
F:\CLER\$ALL\aFORMS\80ARD AND COMMITTEES'BC APPLICATION REVISED 06022014.docx
MIAMI-DADE♦
EI 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
2019 CE "dye, amenmta 0
Mailing Address - Street Num ber, StreefNá me, or P.O. Box
l,4o Lol C. 0
Cit~tate, Zip
« e
NW ci £ 33
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. D
[] county [] Municipal:
Department
Position or Title
Work address Work telephone
Filing as a Board Wember (check one)
[] county ] Municipal:
(Municipality}
Board where serving
Alternate address (if home address is exempt) I Work telephone ¡ Term began on/en ded 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
6+Ao 41200 74. re# 1>,a,46 l/o ? t rvu, " 3,31
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I hèeby swear (or affirm) that the information above is a true and correct statement.
L i
Sign ature of Person Disclosing ±.le loua
RECEIVED BY ELE na...7#"Peer
Electronic Copy #"B 26 2020
1V OF MIAMI BEACH! Grc ii5éi CLERK
OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Daie/lnitials: Scanned Date/lniiials: _
138_SP -14 COE 2016
MIA. J\ A¡ f'rÂ. r , 1 . /V \l b ,i t
DIVERSITY STATISTICS REPORTING
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Pursuant to City of Miami Beach Ordinance 2009-3632, the City is required to ann ual ly
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.
P lea se check th e ap propriate box for each category:
Gender: Male Female O
Wh gti s your race?
A frican -Am er ican /l ack
O Caucasian/White
[!A si an or P a cific Islander
[I Native-American/American Indian
[lther- Print Face.
D o you consider yourself to be Spanish, Hispanic or Latino/a? Mark the "No" box if not
Spanish, Hispanic, Latino/a.
~er yourself Physically Disabled?
lvee
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information form O5-20-13 FINAL.dOc
Updated: Monday, Jan uary 2, 2015