Ron Gerard 12/31/22~-- e
BOARD AND COMMITTEE CHECKLIST
07/28/2020
APPOI NTEE: , • ,,,,,,,=........a..
Animal W elfare Committee Commissioner Meiner
BO RD/COMMITTEE: p pointed by.
Ron Gerard
DATE OF APPOI NTMENT:
FOR SCANNER
Scan o
Scan o
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Scan o
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RECEIVED
2020 AUG
FOR CLERK STAFF
o Letter of Appointment
o Letter of Reappointment
• COB%,/4835er of Appointment/Reappointment e-mailed
. . 07/29/2020 o Board and Committee Application (Completed on I
o Résumé/Curriculum Vitae 07/29/2020
o Diversity Statistics Reporting {Completed on )
o Oath
12/31/27
TERM END: TERM LIMIT: -
12/31/22
to Committee Liaison on
IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS 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
t County Code Section 2-11.1 - Conflict of Interest and Code of Ethics Ordinance (as
amended through December 2010)
Amendments to the Code of Ethics Ordinance (September 2009 through July 2012)
/ Highlights of the Miami-Dade County Ethics Code
t Sunshine Law and Public Records - Frequently Asked Questions
/ Memorandum - Solicitation by City Board and Committee Members OIT OF MIAMI BEACH rra;TCLERK
o Citywide Permit Application {Parking Department Form)
Scan o
Scan o
Received on:
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 Keep COPY in file and ORIGINAL for Annual Report
07/29/2020
Si gned k f,,,{aw
Board or Committee Member
Scanned on:
Date
07/30/2020
Processed on: By Employee: Ciba D' geaton,
Date ity Clerks ORce Sani Initials
07/30/2020 Chou D'goat,
by Employee.
City Clerk's Office Staff Initials Date
CONCLUDED & RESIGNATION LETTERS
Term Expired Letter Date Processed Initials Scan o
Resignation Letter Date Processed Initials Scan o
Removal Letter due to absences Date processed Initials Scan o
F:CLER\BOARD AND COMMITTIES DATABASE\CHECKLIST MA STER\B&C Checklist 2015 MA STE R.docx
gemei k3 5± pi : ve ar c' hz55e, sork, orde a »ba: urca? évstr rema,ity
-- I
'
July 28, 2020
Mr. Ron Gerard
RE: Animal Welfare Committee
Dear Mr. Ron Gerard:
Congratulations! You have been appointed by Commissioner Steven Meinerto the above-referenced
Board or Committee, for a term ending: 12/31/2022.
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
appointmentfelection 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 as they concern your duties, responsibilities, and
requirements as a board or committee member.
Congratulations again and good luck.
Regards,
Rafael Granado
City Clerk
cc: Saul Frances, Parking Director
Elias Gonzalez, City Liaison
ENCLOSURES:
Oath of Office/Oath of Civility/Acknowledgements
City Code/Ordinance section applicable to agency, board or committee
City Code Sections 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
o '
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Mr. Ron Gerard
RE: Animal Welfare 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: 12/31/2022.
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
Stale of Florida (depending on the board or committee on which I serve) on July 1st, following the closing
of the calenda, yea, on which I have sen,ed. . . / ~ a ML Ron Gerard
28 July
Sworn to and subscribed before me this day of.2020
Ciao 'get
Charles D'Agostin
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.
"-' ur
MIAMAIBE
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeach]_gov
OFFICE OF THE CITY CLERK
Email: BQ@miamibeachfl_ goy
Telephone: 305.673.7411
BOARD & COMMITTEE FINANCIAL ACKNOWLEDGEMENT STATEMENT
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)
(aeon
Last Name
T2el>
First Name Middle Initial
l 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.
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;" or
2. A"Statement of Financial Interests (Form 1)';" or
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
~an .$500¡ßg days in jail, or both.
Tos 7zozo
Signature Date /
1 Members of the Planning Board and Board of Adjustment will be notified directly by the State of Florida,
pursuant to F.S. S112.3145(1)(a), to file a Statement of Financial Interests (Form 1) with the Miami-Dade County
Supervisor of Elections by 12:00 noon, July 1. Planning Board and Board of Adjustment members who file their
Form 1 with the County Supervisor of Elections automatically satisfy the County's financial disclosure
requirement as a Miami Beach City Board/Committee member and need not file an additional form with the Office
of the City Clerk. However, compliance with the County disclosure requirement does not satisfy the State
requirement.
Page 5of6
FCLERIS ALLIREGIBOARD AND COMMITT EE APPLICATIONS FINAL DRA FT SIBOARD AND COMMITT EE APPLICATION REG FINAL.dOc x
Updated: June 2020
sr o'
1IAMiB
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Flor ida 33139
www.miamibeachfl.gov
OFFICE OF THE CITY CLERK
Email: BC@miamnibeachf.gov
Telephone: 305.673.7411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
STATE OF FLORIDA
COUNTY OF
I, the undersigned, do hereby state under oath, and under penalty of perjury, that the following
facts are true:
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (check (/) all that apply):
[Resident of the City of Miami Beach for six months or longer.
O Demonstrates an ownership interest {for a minimum of six months) in a business established
in the City {for a minimum of six months).
"Ownership Interest" means the ownership of ten percent (10%) or more (including the
ownership of 10% or more of the outstanding capital stock) in a business.
"Business" means any sole proprietorship, sponsorship, corporation, limited liability company, roer en 9y9 aso / _o-_ ze·zazo
Date
T2ar> ea -I
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of O physical presence or~nline
cauto». o2a,_J -] _o2_y>y SkAeD
(City of Miami Beach Board/Committee Member). Jee Less ¥ Produced ID
Form of Identification
Signature'v""% •
Charles J. DA go sti
NOTARY PUBLIC
STATE OF FLORIDA
(NOTARY SEAL)
- ~
Clear From Print Form
,.,...... ~ ¡
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 I Last Name First Name Middle Name/initial
2019 .f'
Mailing Address - Street Number, Street Name, or P.O. Box
3>e u@- r el G
City, State, Zip
n Z FL 13
lf your home address is your mailing address, and your hom e 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)
[] county 0 Public Health Trust O Municipal:
(Municipality)
Department
Position or Title Employee ID Number
Work address /Work telephone Employment began onlended on
l ¡
Fling as a Board Member (check one)
D County [ Municipal:
{Municipality)
Board where serving
Alternate address {if home address is exempt) /Work telephone /Term began on/ended on
I 1
j
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
]e»r poles 1@ eAile g t
C-4,+
ts- €c r± £e3313%
I hereby swear (or affirm) that the information above is a true and correct statement.
2. ~tore of Pe~,-n-ô.,i!ìs_c_lo-si_n_g----==-----
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RECEIVED BY ELECTIONS DEPARTMENT:
nt;ut;l EL) Hardcopy
J EIectranie Coy ,, U CO
CITY OF M!AMI BEACH
OFFICE OE TE -Ty+p
REMEMBER TO SIGN, AND SUBMIT TO THE OFFICE OF THE CITY CLERK VIA EMAIL OR HARDCOPY.