Robert Schwartz 123122MIAMI BEACH
BOARD AND COMMITTEE CHECKLIST
APPOINTEE: & �leen..\--�c...k�rL DATEOFAPPOINTMENT: til<s'l@;>O
BOARD/COMMITTEE: Vi1drttu<)l., (1,...f"'1Gt2, & Appointed by:(b;uu,i l�ttJ..u.el> kf r lol ,1-
FOR SCANNER
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Received on:
FOR CLERK STAFF
o Letter of Appointment TERM END: ______ TERM LIMIT: _____ _
o Letter of Reappointment
o Copy of Letter of Appointment/Reappointment e-mailed to Committee Liaison on
o Board and Committee Application (Completed on _______ _
o Resume/Curriculum Vitae
o Diversity Statistics Reporting (Completed on ______ _
o Oath
IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK ✓City Code Ordinance Section applicable to the agency, board or committee✓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 Ethics Ordinance (as
amended through December 20 10)✓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✓Memorandum -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
0 DIVERSITY STATISTICS REPORTING Keep COPY in file and ORIGINAL for Annual Report. \ \ \ '5 \ 1,-o '1> I)s;gned by X jZJ Jtt. ·-?,,st -Date Board or Committee Memb r
Processed on: __________ By Employee:-------------,-,------------Date City Clerk's Office Staff Initials
Scanned on: __________ By Employee: _____________________ _ Date City Clerk's Office Staff Initials
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 MASTER\B&C Checklist 2015 MASTER.docx
We ore commiffed to providinq excellent public service and safety to oil who live, work, ond play in our vibrant, tropical, historic community.
12/31/2022 12/31/2026
11/5/2020
11/05/2020
11/05/2020
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11/05/2020
5th Nov
'A A\[RE hr/' ID
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email:. BC@m iamibeachf.gov
Telephon e: 305.673.7411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
STATE OF FLORIDA
COUNTY OF (/A0¢
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (check (<) all that apply):
[g 1„ a resident of the City of Miami Beach for six months or longer.
[m7 ¡have an ownership interest (for a minimum of six months) in a business established in the
City of Miami Beach (for a minimum of six months).
D I am a full-time employee of a business (for a minimum of six months) and [ am based in an
office or other location of the business that is physically located in Miami Beach (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,
or other entity or business association.
Under penalties of perjury, I declare that! have read the foregoing document and that the facts
#2,'752.<„4 JI
Signature
[Z A2a É bcat,
Printed Name
NOTARY
Date
Sworn to (or affirmed) and subscribed before me, by means of Dl physical presence or 9 online
notarization, this 5th day of November ,20 20 by _
Robert Schwartz (City of Miami Beach Board/Committee Member).
X Produced ID FL Driver's License ---------------- Form of Identification
Personally Known
Ciao D'Art
Signature of Notary PuE
Charles J D'Agostin
Name of Notary, Typed, Printed, or Stamped
(NOTARY SEAL)
®Y Charles J. DAgostin
NOTARY PUBLIC
STATE OF FLORIDA
Comm# GG168171
Nef6 .poires 12/14/2021
X
Received 5 November 2020Office of the City Clerk