Daniel Smith 12/31/20t
f t
/\/1
3 5 A# r- j j H¡ £3{ 4# L21./i\>1 1
Scan o
Scan o
BOARD AND COMMITTEE CHECKLIST
[Jgurel S3/ »re or eorwear._/2/ygl/%
BOARD/COMMITTEE: AJ eKf- ~ - . Appointed by: (!ó,M;/1/1. Sler'Jbee.)
ge-sw sea»re «l [9/3y/ p//5>
scan o ·Letter of Appoi ntm ent TERM END: ldL_ f9 TERM LIMrr: /, í/
Scan o o Letter of Reappointm en t
o ÇJ¿PYJ, o,t., f¡eti~/ of Appointment/Reappointment e-m ailed to Committee Liaison on
• orín conree Aste=o cometa o»./2[/y/y9
Résumé/Curriculum Vitae A / ¿
o Diversity Statistics Reporting (Completed on /L 1//
o Oath
APPOINTEE:
Scan o
IMPORTAN T INFORM ATION FOR BOARD AND COMMITTE E MEMBERS BOOK
/LETu
/
Su L,
City Code Ordinance Section applica ble to the agency, board or committee
City Code Section s 2-21,2-22, 2-23, 2-24, 2-25, 2-26, 2-458 an d 2-459
County Code Section 2-11.1 - Conflict of Interest an d Code of Ethics Ordinance (as
amended through December 2010)
mendments to the Code of Ethics Ordinance (September 2009 through July 2012)
Highlights of the Miami-Da de County Ethics Code
Sunsh ine Law and Public Records - Frequen tly Asked Questions
/ Memorandum - Solicitation by City Board an d Committee Member s
Scan O
Scan O
Received on:
Processed on:
Scanned on:
O Citywi de Perm it Ap plication (Parking Department Form)
o Booklet - Guide to Sunshine Am end ment & Code of Ethics for Public Officers and Employees
o Source of Income Statement
o Acknowledgment of Financial Disclosure Requirement
O DIVERSITY STATISTICS REPORTING Keep çQPy in file and ORIGINAL for Annual Report.
Signe d by X·------,--------~-~------- h a Employee -·· '-,"$. LL _ __ - =- ,
{p I/
0
[7 )é})-O sy Employee: _ -· ff. _L r _ .
ae
CO NCLUDED & RESIG NATION LETTERS
Term Expired Letter Date Processed Initials Scan O
Resignation Letter Date Processed Initials Scan O
Rem oval Letter due to absen ces Date processed Initials Scan O
c
FICLERBOARD AND COMMIT TIES DATABASE\CHECKLIST MASTERB&C Checklist 2015 MASTER.docx
W/e are committed to oroviding excellent oublic service ad scíeiy to all who live. work, and icy in our vibrant troical historic community.
/\/A MA /BEA(CH cw pE (cw o AR D & co»wrtes .g
or -riversi e .iv, +sii@e sie+i«cv«or PAR KIN G APPLICATION E.uI#9
1755 Merdian Avenue, Suite 200/Mi mi Beach, FL 33139/Ph: (305) 673-7505 or (305) 673-2. <35 PARKING
A citywide (C W ) parking permit is honored at m et er e d parking spaces and restricted residential zones
parking spaces. A C W parking permit IS N O T honored in proh ibited areas. An Access Card will be
provided to you for City Hall Garage (G7] access.
IM P O RTA N T N O TE : Your veh icle license plate serves as your "parking per mit". In ord er to avoid
any unnecessary enforcement actions, it is important that our records reflect the most curren t and
accurat e information regarding your vehicle license plate. Ina ccura te and/or outdated vehicle
info rm ation may lead to th e issuance of parking citation [s) and/or th e towing of your vehic le.
Please note that this new access card C A N N O T be hole-punched or perforated in any manner. To use
the new card please hold the card a close pro xim ity to the reader until the gate opens. You may need
to try the other side of the card. Please ensure you hold the entire surface of the card against the reader
until the gate open s.
A C K N O WL ED G E M EN T: I acknowledge that should my a ccess ca rd be lo st, sto len o r
d am a g e , I will b e resp o n sible to pay a $10 .00 rep la ce m en t fee .
Board Member information
D ate of Ap pl ication: 06/10/2020 t
A pp licant N ame: Daniel Smith
Board/Committee Name: Next Gen Council
Address: 90 AIton Rd. #1401 Miami Beach, FL 33139
E-Mail Address: daniel@salomonsmith.com
W ork Phone: (305) 297-1018 Home Phone
Cell Phone: Preferred Contact Method:
Vehicle Information
Tag: CQJR62 Color: Black
State: Florida Year: 2020
Make: Jeep Model: Grand Cherokee
Applicant Signature: es
Please provide signed form to the Parking Department located at 1755 Meridian Avenue, 2 fl oor. Working
hours are 8:30 to 5:00 p.m. or email to: PgrkingReception@mnigmibeachfl.gov
e-mail subject: BOARD & COMMITTEE PARKING APPLICATION - APPLICANT NAME
Parkina Department Secti
PERMIT SYSTEM G AR AGE ACCE S S
Expiration Date: ID Card Serial #:
Issued By Print Name: Print Name:
Signature: s Signature: es
Date Issued: Date Completed:
f;ping\$ma iar\arm s cw boards&committees parkingfcrm.doc form updated 9/26/2017
MIAMI-DAD E. EIE . SO URC E OF INCO M E STATE M ENT
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 I Wist Name First Name Middle Name/initial
2 0 19 Smith Daniel s
Mailing Address - Street Number, Street Name, or P.0. Box
90 Al ton R d #14 0 1
City, State, Zip
M ia m i Be a ch , F L 3 3139
lf your home address is your mailing address, an d your hom e address is exemp t from public records pursuant to Fla. Stat. $119.07, read
instructions on the following page and check here. []
Filing as an Employee (check one)
[] Coun ty [] Public Health Trust [] Municipal:
(Municipality)
Departm ent
Position or Title Employee ID Number
Work address I Work telephone Employment began on/ended on
Filing as a Board Member (check one)
[] county E] Municipal: City of M iam i Beach
(Municipality)
Board where serving
Next Generation Council
Alternate address (if home address is exempt) I Work telephone I Term began on/ended on
90 AI ton R d . # 14 0 1, Mi am i Beach , FL 33139 (305) 297-1018
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
Salomon Sm ith PL LC 1111 Brickell Ave. #2200, Mi am i, Law Firm
FL 33 131
I hereby swear (or affirm) that the inform ation above is a true and correct statement.
%€
Signature of Person Disclosing
h[·2o
Date signed
RECEIVED BY ELECTIONS DEPARTMENT:
[ Hardcopy
[ Electronic Copy
OFFICE USE ONLY Accepted: Y / N Deficiency.. Processed Date/Initials: Scanned Date/initials:-
138_SP-14 COE 2016· "
I BEACH
City of M iam i B ea ch
1700 Convention Center Drive,
Miami Beach, Florida33139,
www.miam ibe ach fl .gov
CITY CLERK'S OFFICE
Telephone: 305.673.741 1 Fax.305.673.7254
CityClerk@rniamnibeachi.gov
A ckn o w ledgem ent of fines /suspensio n for B oard/C om m ittee Mem bers for fai lure to com ply w ith Miarni-
Dade County Fin ancial Disclosure Code Provis ion C ode Section 2-11.1(i) (2)
Board Member's Name: .. ~D~·-=·"":__"_' -<_.· _/ _~:__,..__,._J----'-[_---------------"-----'-------
I unders tand that no later th an July 1, of each year all members of Boards and C om m i ttees of th e City of
M iam i Beach , incl uding tho se of a purely advisory nature, are required to com ply with Miam i-Da de County
Fi nancia l Di scl osure Requi rem ents. This m eans that th e members of City Advisory Boards, whose sole or
prim a ry respon sibility is to recomm en d legislation or give advi ce to the Ci ty Comm i ssion , m ust file, even
though they m ay have been recently appoi nt ed.
One of the followi ng forms must be filed with the Ci ty Cl e rk of Miam i Beach, 1700 C onv enti on C enter Drive,
Mi am i B each, Flo rida, no later th an 12:00 noon of July 1, of each year.
1.A "Source of Income Statem ent"
2..A"Statement of Financial Int erest s (Form 1)"
3. A C opy of your latest F eder al Inc om e Tax Ret urn
Failure to file one of these form s, pursuant to the Mi am i-D ade County C ode, may subject the person to a fine
of no more than $500, 60 days in jail or both.
- ===--
Signature Date 6f/.a.
Updated: Monday, April 20, 2015
Page 4 of4
F IC LE RI SALL aF ORM SB O ARD AND COM M ITT EESIB C AP PLI CATI ON REVI SED 06022O14.doc x