Max Gelber Application PackageMIAIBEACH
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B8OARD AND COMMITTEE APPLICATION
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Last Name
Mas
519-
Hom e Address
age O
First Name
Mi each l
Middle Initial
330
7- 9q9-<503
Cellular Telep hon e
N)/A
City
305-15- S10
Work Teleph one
Business Nam e
Home Telephone
<Stwt
State Zip Code
o_lle [232cm6\
Email address
Occ upation
N/A
Business Addres s City State Zio Code
Please list your preferen ce s in order of ranking : [1] first choice, [2] secon d ch oice, and [3] third choice Plgasenote_that
only three (3) choices will be observed by the Office of the City Clerk.
Ad Hoc An ti-Bullying Task Force Health Advisory Committee Norm andy Shores Loca l Government
Neighb orhoo d Improvem ent District
Advisor Coun cil
Affordab le Housing Advisory Health Facilities Authority Board Parks and Recr eation al Facilities Comm ittee Board
An imal Welfare Committee Hispa nic Affairs Committee Personnel Board
Art in Public Places Committee Historic Preservation Board * Planning Board
Audit Committee Housina Authoritv Police /Citizens Relations Committee
Board of Adjustm ent Human Riahts Committee Production Ind ustry Counci l
Budget Advisory Committee LGBTQ Advisory Committee Program for Public Inform ation
Committee
Committee for Quality Education in Marine & Waterfront Protection Senior Affairs Committee
Miami Beach Authoritv
Committee on the Homeless Mavor's 41st Street Committee Sustainability Committee
Convention Center Advisory Board Mayor's General Obligation Bond Transpor tati on, Parking . an d Bicycle-
Oversiaht Committee Pedestrian Facilities Committee
Cultural Art s Council Mavor's Pan el on Ocea n Drive Visitor and Conv ention Authority
Desian Review Board Miami Beach Commission for Women Youth Commission I
Disability Acce ss Committee Next Generation Council I
1.
2.
3.
loo 6o0o
M,
Ml
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Type of Professional Licen se Licen se Numb er
Ah A/. ta
Stat e of Issuan ce Licen se Issuan ce Date License Expiration Date
Note: If you are see king appointment to a professional seat (e.g. attorney, architect, etc.), you must attach a cop y of your
currently effective corresponding professional license.
Page 1of6
F\CLERSALLIREGBOARD AND COMMIT TEE APPLICATIONS FINAL DRAFTSBOARD AND COMMITTEE APPLICATION REG FINAL 0cx
Updated: June 2020
AFFI LI A TI ON WI TH THE CI TY OF MIAMI BEACH
Pursuant to City Code section 2-22(4) a, b, and e: Members of Agencies, Boards, and Committees shall be affiliated
with the City. This requirement shall be fulfilled in the following ways:
a. Resident of the City for a minimum ot sx months: Dü Lh o
• lam a resident ot south Beach l Middle eaen I Norn BeacnLl
Or
b. Demonstrates an ownership_interest (for a minimum of six months) in a business established in the City (for a minimum
of sx months) Yes M or h o
Ownership Interest' shall mean the ownership often percent (10%) or more (including the ownership of 10% or more
of the outstanding capital stock) in a business.
Business" shall mean any sole proprietorship, sponsorship, corporation, limited liability company, or other entity or
business association.
Or
c. Full-time employee of such a business (for a minimum of six months); and I am based in an office or other location of
the business that is physically located in Miami Beach (for a minimum of six months): Yes O ro
Notwithstanding the requirements set forth herein, the qualified full-time employee of a business must be approved by
a 417th vote of the Mayor and City Commission.
NO TE: Members of Agencies, Boards, and Committees shall be required to demonstrate compliance with the City affiliation
requirements of sections 2-22 (4) a and b of the Miami Beach City Code by executing an affidavit, stipulating that they
have met either (or both) of said affiliation requirements. The original affidavit shall be filed with the Office of the City Clerk
prior to being swom in as a member.
• I am applying for an appointment because I have special abilities, knowledge, and experience. Please list below:
\a.r agi li ( a]l.2l et beo$& lau llk;all 9A_3 _ts Tef
6a) of ke 3 ely t_yo.A tat si kefe. [ lac
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t t0hl sjeaku havi» 4er soll in sek cl llaf ks G 5eo@
all hy hull..l yis, \ et od o'4k k B 8.ll. Ei,
Si«K s g«@! ko r 3 ye , lie.Mt «? { y sheul a l kg carts
for % kl o Avow} ytiy_ oy ±8ad on &l_ De to Act,
\ ex\ at y'ani <. ol d tats «vM($.
Page 2 of6
F CLERISALLREGBOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS BOARD AND COMMITTEE APPLICATION REG FINAL doc
Upd ate d: June 202 0
• Are you a registered active lobbyist with the City of Miami Beach? Yes O or No~
• Have you ever bee n convicted of a felony? Yes O or zí yes, please explain in detail:
• Do you cu rrently have a viol ation(s) of City of Miami Beach Code? Yes O or oí. please explain in detail:
• Do you cu rrently owe the City of Miami Beach money? Yes O or Nod ff yes, please explain in detail:
• Ar e you cu rrently serv ing on any City Board or Committee? Yes O or No 01f yes, which Board/Committee?
• In what organization(s) in the City of Miami Beach do you currently hold membership?
Name Position
Name Position
• List the address of all properties owned or in which you have an interest within the City of Miami Beach:
/
• Are you now employed by the City of Miami Beach? Yes Lr NL so, which department and title?
• Pursuant to ciy code section 2-25 (): Do you hge a paent l, souse Ll, aa L ouer lo sser L
who is employed by the City of Miami Beach? Yes lor No L]
"Yes." identify persons) and departments)y: [ elbe ,May0 3
Note. If applying for the At-Large position of the Historic Preservation Board, please answer the below questions:
• Have you ever resided in one of the City's Historic Districts for at least one year? Yes Dor No O
If you answered "Yes," please indicate:
From: To
Address Dates
From: To
Address Dates
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FCLERSALLREGBOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS BOARD AND COMMITTEE APPLICATION REG FINAL &&cx
Updated: June 2020
NOTE: IF APPOINTED, YOU WILL BE REQUIRED TO FOLLOW CERTAIN LAWS THAT APPLY TO CITY
BOARD/COMMITTE E MEMBERS. THESE LAWS INCLUDE, BUT ARE NOT LIMITED TO:
o Prohibition from directly or indirectly lobbying City personnel. (Miami Beach City Code Section 2-459)
o Prohibition from contracting with the City. (Miami-Dade County Code Section 2-11.1)
o Prohibition from lobbying before the Board/Committee you have served on for period of one year after leaving office.
(Miami Beach City Code Section 2-26)
o Requirement to disclose certain financial interests and gifts. (Miami-Dade County Code section 2-11.1) _
o Sunshine Law - Florida's Government-in-the-Sunshine Law was enacted in 1967. Today, the Sunshine Law regarding
open government can be found in Chapter 286 of the Florida Statutes. These statutes establish a basic right of access to
most meetings of Boards, Commissions, and other governing bodies of state and local governmental agencies or
authorities.
o Voting conflict -- Form 8B is for use by any person serving at the county, city, or other local level of government on an
appointed or elected Board, Council, Commission, Authority, or Committee. It applies equally to members of advisory and
non-advisory bodies who are presented with a voting conflict of interest under Section 112.3143, Florida Statutes.
I HEREBY ATTEST TO THE ACCURACY AND TRUTHFULNESS OF THE APPLICATION; AND I HAVE RECEIVED,
READ AND WILL ABIDE BY CHAPTER 2, ARTICLE VII, OF THE MIAMI BEACH CITY CODE, ENTITLED "STANDARDS
OF CONDUCT FOR CITY OFFICERS, EMPLOYEES AND AGENCY MEMBERS AND ALL OTHER APPLICABLE
COLIN.TY AND/OR STATE LAWS AND STATUTES ACCORDINGLY."
46-l3 20 Mx 6el «
Applicant's Signature Date Name of Applicant (PLEA SE PRINT)
Board and Committee Application Checklist: Please ensure you have provided all information before applying or
reapplying to any Board and Committee
Inave answered all questions fully.
O I have attached additional sheets, if necessary, to provide required information.
O I have attached a current resume, photograph, and a copy of any applicable professional license.
O I have completed and attached the Board & Committee Financial Acknowledgement Statement.
K Ihave completed and attached the Diversity Statistics Report.
O Submit complete application package.
Via Email: BC@mniamibeachfl_gov
Via U.S. Mail or in Person:
City of Miami Beach
Office of the City Clerk I Board and Committee Section
1700 Convention Center Drive, 1+ Floor
Miami Beach, FL 33139
If you have any questions, please contact the Office of the City Clerk via email: BC@miamibeachfl.gov or telephone:
305.673. 7411.
Note: Florida Statutes §119.071: The role of the Office of the City Clerk is to receive and maintain forms filed as public
records. If your home address, telephone numbers, and/or photograph are exempt from disclosure and you do not wish
your home address, telephone numbers, and/or photograph to be made public, please: 1) Use your office or other address
for your mailing address, 2) Use your office or other telephone number for your contact number; and 3) Do not attach a
photograph.
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F CLER\SALLREGIBOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS BOARD AND COMMITTEE APPLICATION REG FINAL dcx
Updated: June 2020
MI AMAIBEACH
City of Mi ami Bea ch
1700 Convention Center Drive
Miomi Beach, Florida 33139
www_miamibegchhi_goy
OFFICE OF THE CITY CLERK
Email: C @mniamibea chf _go
Telephone: 305.673.7411
OARD&çQMMI1EE 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)
(Glku
Last Name
MN A
First Name Middle Initial
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.
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
of no more than $500, 60 days in jail, or both.
(lux o- <«-l-2o
Signature Date
' Members of the Planning Board and Board of Adjustment will be notified directly by the State of Florida,
pursuant to F.S. §112.3145(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.
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F CLERSALLREGBOARD AND COMMITTEE APPLICATIONS FINAL DRAFTSIBOARD AND COMMJTTEE APPLICATION REG FINAL dcx
Updated. June 2020
MI A MI BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www_mniamibeach[i_gov
OFFICE OF THE CITY CLERK
Email: BC@rniarnibeachfl.gov
Telephone: 305.673.7411
DIVERSITY ST A TIS TICS REPORT
Gell« Ha MA-
Last Name First Name Middle Initial
The following information is voluntary and has no bearing on your consideration for appointment. It is being
asked to comply with City diversity reporting requirements.
Gender:
zíí
O remal e one
O I prefer not to answer.
Race/Ethnic Categories:
What is your race?
O African American/Black
L_! Asian or Pacific Islander
Li Caucasian/White
O Native American/American Indian O Other- Print Race: _
O I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latinola?
ves ±o
O I prefer not to answer.
Do you consider yourself Physically Disabled?
vs
'5No
O I prefer not to answer this question.
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F ACLERSALLREGLBOARD AND COMMIT TEE APPLICATIONS FINAL DRAFT S BOARD AND COMMITTE APPLICATION REG FINAL &0cx
Updated: June 2020
€)
W ork Experience
Skills
Education
Max Gelber
5445 Lagorce Drive, Miami Beach, Florida, 33140
786-999-5034
max.gelber123@gmail.com
Although I have limited work experience due to my age, I have worked hard in and out
of school and I have a particular interest in public service.
Volunteer fo r Various Political Campaigns
2012 to 2020
N/a
South Florida
Volunteered as a field worker for a number of local campaigns, primarily canvassing
and phone banking.
Camp Counselor
06/2018 to 07/2018
Miami Beach JCC
4221 Pine Tree Drive
Worked as a coach for several 3-5th grade students during a 7 week summer
program.
Big Brothers Big Sisters Club at Miam i Beach Senior High School,
President and Founder
10/2019 to Present
Big Brothers Big Sisters
Miami Beach Senior High School
Founded a Big Brothers Big Sisters Club at my school. Plan, coordinate, and host
mentoring events for unmatched "littles" of the Big Brothers Big Sisters Foundation.
Fluent in Word, Powerpoint, and Excel - 3 years
Intermediate Fluency in Spanish- 2 years
Miami Beach Senior High School
None
C lass of 2022
Hono r R o ll/ Intern ational Baccalaureate
09/2 0 18 to Present
I