Josh Levy 12/31/22MI A E CH
APPOINTEE:
BOAR D AND COMMITTEE CHECKLIST , ] I..A.._ Le•j Are orAPonwmwe»r. [Q/3 /7o
7 i
BOARDICOMMITTEE: @z.·y__<{z_e· Appointed by: ._ /Ac,oh+
FOR SCANNER
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RECEIVED
NOV 1 2020
res.a m w sa L[3//22, .L2]3//;3 o Letter of Appointment TERM END: l>]_, =ER M LIMIT: Ly_ >
o Letter of Rea~ent
o f fYf:,to ~ r -0~pointment/Reappointmen~ e-mailed_ tQ Committee Liaison on
o Board and Committee Application (Completed on SO, 7
a Résume/curriculum Vitae tu //,9))_,
o Diversiy statistics Reporting (Completed on [_y ))a )
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 2010)
✓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
C ITY O F MI A MI BEACO Citywide Permit Application (Parking Department Form)
O FF I CE OF THE OT:Co Booklet - Guide to Sunshine Amendment & Code of Ethics for Public Officers and Employees
Scan o o Source of Income Statement
Scan o o Acknowledgment of Financial Disclosure Requirement
O DIVERSITY STATISTICS REPORTING Keep çQP in file and ORIGINAL for Annual Report.
Received on: i t./ G. { -:r o>- Ù Signed by X. __ -11+-..,,,...,--+,,c-------------
17
Processed on: /f (./b ~ By Employee: ~,.... __ ~ .... ./;,~-- _ ... _
Scanned on: / I/; ~~2o B y Employee: I ,,..z,.c _._/_. _. '.-=-
CON C LUDED & R ESIGNATION 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 are committed to providing excellent public service and safety to all who live, work, and play in our vibrant, tropical, historic community.
MIAMl·DADE' EEl 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 Last Name First Name Middle Name/Initial
Lav7 -. k / 2019 )e,5 v
Mailing Address - Street Number, Street Name, or P.O. Box
5o 3> N/ 6 ¡( J
City, State, Zip ,
MB Ft 33//0
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. O
Filing as an Employee (check one)
[] county □Public Health Trust [ Municipal:
(Municipality)
Department
Position or Title Employee ID Number
Work address I Work telephone Employment began on/ended on
Filing as a Board Member (check one)
[] county J iamnteia±. / · 62.h t
(Municipality)
Board where serving
ô.f o(r4 E d oc4ro
Alternate address {if home address is exempt) I Work tel~pho~e "'ª I Term began on/ended on
3o-747-0a /1o
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
SL A? +ni e £A 5e33 . 6A (s
6P3>(o /A¿ Ao+rs M.
I hereby swear (or affirm) that the information above is a true and correct statement.
Signature of Person Disclosing
«/c/2er0
Date signed
RECEIVED BY ELECTIONS DEPARTMENT:
J Harto»ECE]VED
[] Electronic Copy -
1727 Yu .U
CITY Or
OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/Initials: Scanned Date/Initials: _
138_SP -14 COE 2016
.±e±A ..\."E 2 2 La
1755 Meridian Avenue, Suite 200/Miami Beach, FL 33139/Ph: (305) 673-7505 or (305) 673-7000 ext. 6200 PARKING
A citywide (CW) parking permit is honored at metered parking spaces and restricted residential zones
parking spaces. A CW parking permit IS NOT honored in prohibited areas. An Access Card will be
provided to you for City Hall Garage (G7) access.
IMPORTANT NOTE: Your vehicle license plate serves as your "parking permit". In order to avoid
any unnecessary enforcement actions, it is important that our records reflect the most current and
accurate information regarding your vehicle license plate. Inaccurate and/or outdated vehicle
information may lead to the issuance of parking citation(s) and/or the towing of your vehicle.
Please note that this new access card CANNOT be hole-punched or perforated in any manner. To use
the new card please hold the card at close proximity 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 opens.
ACKNOWLEDGEMENT: I acknowledge that should my access card be lost, stolen or
damage, I will be responsible to pay a $10.00 replacement fee.
Board Member Information
Date of Application: /oleo>°
Applicant Name: I
Jeskv Levy
Board/Committee Name:
u2hr, :, f Elac+riv
Address: I el 5033 AU BA,
E-Mail Address: TL<., l
5 A L dney . gr
Work Phone: c -74«.o7«1 Home Phone 305- 85-302
Cell Phone: 3o5_ 71- o74( Preferred Contact Method: Cet
Vehicle Information
Tag: JU o A \ Color: -/ State: r Year: I
2018
Make:
Y
Model: £
(
Applicant Signature: e
Please provide signed form to the Parking Department located at 1755 Meridian Avenue, 2" floor. Working
hours are 8:30 to 5:00 p.m. or email to: ParkingReception@miamibeachfl.gov
e-mail subject: BOAR D & COMMITTE E PARKING APPLICATION - APPL ICANT NAM E
kina D s -·
PERMIT SYSTEM GARAGE ACCESS
Expiration Date: ID Card Serial #:
Issued By Print Name: Print Name:
Signature: es Signat ure: es
Date Issued: Date Completed:
f\ping\man\rar\forms \cw boards&committees parkingform.doc form updated 9/26/2017
M IAM I BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Eeach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
STATE OF FLORIDA
COUNTY F
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (9heck (/) all that apply):
12(' I am a resident of the City of Miami Beach for six months or longer.
D I 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 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).
"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 I have read the foregoing document and that the facts
stated in it are true.
ll- wt
Signature
fosl4«
Date
u/]1e2e
Printed Name
!v;
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of□physical presence o~line
notarzation. this _day or /Uouo"ea_ _/sy
)054i '<e-1 „es aver sa solco«mote» e ' D, ] >. a. cu.s sos
~ Produced ID /' t v(./rc_ L.,-. ( Lf:::::/) Se ,~~1,.£'% NOTARY PUBLIC
Form of Identification 2 , STATE OF FLORIDA 2 - Comm# GG168171
ef6° poires 12/14/2021
(NOTARY SEAL)
Name of Notary, Typed, Printed, or Stamped
I - -
MIA M/BEA CH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfl.gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
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)
lzs
Lastan
Tse MA
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 )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 $500, 60 days in jail, or both.
Signa~ Date
I[/e.e
1 Members of the Planning Board and Board of Adjustment will be notified directly by the State of Florida,
pursuant to F.S. §112.3145(1 )(a), to file a Statement of Financial Interests (Form 1) with the Miami-Dade County
Supervisor of Elections by 12:00 noon, July 1. Planning Board and Board of Adjustment members who file their
Form 1 with the County Supervisor of Elections automatically satisfy the County's financial disclosure
requirement as a Miami Beach City Board/Committee member and need not file an additional form with the Office
of the City Clerk. However, compliance with the County disclosure requirement does not satisfy the State
requirement.
Page 5 of 6
F:\CLER\$ALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.dccx
Updated: June 2020
M IA /V\I BEA C H
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeach[],_gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
DIVERSITY STATISTICS REPORT
L.o,
h
L.. isst ' M
y
Last Nari a y t Name Middle Initial
The following information is voluntary and has no bearing on your consideration for appointment. It is being
asked to comply with City diversity reporting requirements.
Gender: vale
O Female
loner
O I prefer not to answer.
Race/Ethnic Categories:
What is your race?
LAAmican American/Black
LI Asian or Pacific Islander
L Caucasian/white
O Native American/American Indian
O Other- Print Race: _
D I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
u$
D I prefer not to answer.
Do you consider yourself Physically Disabled?
9
O I prefer not to answer this question.
Page 6 of6
F:\CLER\$ALL\REG\B:::>ARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
Joshua M . L evy , E sq.
5033 N ort h B ay Road
Mi am i B each, FL 33140
(305) 799-0991
Josh is a highl y experienced litigator w ho has ar gued num erous cases, jury
an d non-jury , in state an d fe deral court s an d before adm ini str ative tr ibun als. H e
concentrates on such are as as com plex business litigation, personal injury , in sur ance
m atters, and genera l liability . Josh has re cently obtain ed hi s C ert ifi cation as a
Florida Suprem e C ourt C ert ifi ed M ediator. A ski llfu l negotiator, Josh also has
expertise in drafting contr acts and resolving disputes. Josh's cl ients have ranged
fr om lar ge corp orations such D enn y's, B ank of Am eri ca, AI G , and Starbucks to
sm all local restaur an ts, bar s, and businesses. H e also has experi ence in the
hospitality in dustry , representin g hotels such as T he Seta i and M arr iott. In Josh's
w ork for corp orate cl ients, he provides strategic legal advice to senior m an agem ent
and identifies proactive solutions to elim in ate or mi tigate risks whi le keepin g in
m ind the busin ess objectives of the com pany.
P r o fe s s io n a l E xp e ri e n c e :
S u p r e m e C o u rt o f F lo ri d a C e rt ifi e d M e d iato r
J a nu ary 2 0 1 9 - Pr e s e nt
F ie s ta R e s tau r a nt G r o u p , In c . VP o f L e g a l
F e br u ar y May 2018
Manages Employment Litigation, American with Disabilities Act
Litigation, Class Actions, General Litigation and Workers
Compensation Claims. Participates in and Instrumental in
Settling High Exposure Cases. Reviewing and Drafting
Contracts, Works with Various Departments including Human
Resource, Marketing, and Real Estate on Various Documents,
Drafting Employee Handbooks, Franchise Agreements and
various other Documents.
Pardo Jackson Gainsburg, PL, Miami, FL
Attorney January 2009 - 2018
Partner
Practice Ar eas :
Em ploym ent Litigation, Fair Labor Sta ndards A ct, Insurance
Litigation, M edical M alpractice, C onstru ction Litigation,
Com plex Business Litigation, G eneral Liability , W orkers'
Com pensation, Prem ises Liability
Silver, Levy , Feldm an, Bass and Braham s, P.A ., M iam i, FL
(Began as Davis, Silver and Levy , P.A .)
Attorn ey Jun e 1996 - Decem ber 2008
Founding Partner
o S e rv e d a s th e F e e d e r P att e rn R e p re se n tativ e fo r th e P T S A fo r a ll
M id d le S c h o o ls a n d E le m e ntary S c h o o ls th at fl o w into M ia m i
B e a c h S e n io r H ig h S c h o o l
S a m p le T ri a l an d A p p e ll a te C a s e s :
Sandra C hapm an v. Nations B ank
Tuck v. B ank of A m erica
D0D X 632006063
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"( rOperation of. nmniotor s consent to ·> law.
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