Ronald Starkman 1231212020/11/20 09.07:46 2 17
M IAM I BEACH
BOARD AND COMMITTEE CHECKLIST
APPOINTEE.. /f 42)%/ ta c'kraA DATE OF APPONTMeNT:. [Ly4 /e
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socorre u!2 / hl vía, té.ar Aromes o. _te,aes;
FOR SCANNER FOR CLERK STAFF
Scan o c Letter of Appointment TERM END:T ERM!iMIT:
Scan o o Letter of Reappointment
co Copy of Letter of Appointment/Reappoinirent e-mailed to Committee Liaison on
Scan o
Scan c
Scan
Scan 2
Scan 9
Received on;
o Board and Committee pplication (Completed on'
o Résumé/Curriculum Vitae
o Diversity Statistics Reporting (Completed on
o Oath
IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
City Cods Ordinances Section applicable to the agency, board or committee
t City Code Sections 2-21, 2-22, 2-23, 2-24, 2-25, 2-26, 2458 and 2-459
« County Code Section 2-11.1 - Conflict of interest and Code of Ethics Ordinance (as
amended through December 2010)
Y Amendments to the Code of Eth:cs 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 Comrittee Members
O Citywide Permit Ap plication (Parking Department Form)
O ocket - Guide to Sunshine Amendment & Code of Ethics for Public Officers an Employees
0 Source of Income Statement
O Acknowledgment oi Finencia! Disclosure Requirement
O DIVE RSITY STATISTICS REPOR'U,!;7 ~I• and ORI GINAL far Annual Report,
siaeay X_ 9/4 ____
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Processed on:
Date
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City Clerk's Office Staif Initials
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City Clerk's Office Staff Initials Date
CONCLUDED & RESIGNATION LETTERS
} Te:m Expired Letter Date Processed ]Initials Scan
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'1wiles Resignation Letter Date Processed Scan O
-1 initials --1 Removal Letter due to absences Data processed Scan O
I
F:CLER'BOARD AND COMMIT TIES DATABASECHECKL'ST MASERS&C Checklist 2C15 MASTER.dox
12/31/21 12/31/21
11/23/2020 11/20/2020
11/23/2020
11/23/2020
11/23/2020
11/23/2020
2020/11/20 09 07:.46 7 1"Y
I I I
MIAMI BEACH
City of Miami Beach, IZ Co rwnlis Cont Do, Miam i each, Hlonia 33:39 w.miamibeachl go:
OFFKCF OF IHE CITY CLERK, Rafael E. Grando, Coy Clari
Tel: 305.673.7411, F. 305.673.725a
±mai l: Ct/lsk@r'albeochll.gov
Oath of Office
Oath of Ctility
and
Acknowledgements
TO: Mr. Ronald Starkman
RE: Budget Advisory Committee
I do solemnly swear ar affirm to bear true faith, loyalty and allegiance to the Government at the United
States, the State of Florida, anc the City of Miami Beach and to perform all the duties of a memb er of the
above-mentioned board or committee of the City of Miami Beach to which ! have bsen appointed for a
term ending: 12/31/2021.
To my colleagues and to all of those l represent and serve, l pledge fairness, integrity ena civility, in ail
actons taken and al communications made by me as a public servant.
I have been issued a copy of section Z-11.1 of the Miami-Dade County Code (Conflict of Interest and
Cods of Ethics Ordinance}, as weli as Florida Com mission on Ethics Guide to the Sunshine Amendment
and Code of Ethics far Public Officers and understand that as a memer of a City of Miami Beach Board
an/or Committee. I rust com ply with the financial disclosure requirements of Miami-Dade County or the
State of Florida {depending on the bcard or committee on which ! serve) on July 1st, following the closing
of the calendar year on which I have served.
a,l_ hp" ! ..
Mr. Ronald Starkman
Swom to and subscribed before me tis.day of 2020
Charles D'Agostin
Deputy Clerk
Please visit tne Gty of Miami Beach website at www.miamibeacnfl.gov unaer City Clerk/oarc and
Commitiees for additional information regarding tho Financial Disclosure Requirements.
23 Nov
2 0 2 0 /1 1 /2 0 0 9 :0 7 :4 6 6 7
MIAMI BEACF@Two cw e@go a cow@í@Es ggq
sii»ii iww si·si» PARKING APPLICATION #figi#f@g
755 Me idiaa Avenue, $oh 2CC/Mtemi 6 a:. FL 33139/1: (305) 7 37 505 or (305) 573-70C0 oz4. 6200
A citywide [CW) parking permit is honored at metered parking spaces and restricted residential zones
parking spa ces. A CW parking permit IS NOT honored in prohibited areas. Ar Access Card will be
provided to you for City Hall Garage {G7] access.
IM P O RTA N T N O TE : Your vehicle license plate serves as your "parking permit". In order to avoid
any unnecessary enf orc em en t actio ns, it is important th at our records rellact the most current an d
accurat e information regarding your vehicle license plate. {accurate and/or outdated vehicle
infor m ation m ay lead to th e issuance of parking citation{s} and/or the towing of your vehicle.
Please note that th is new access card CA N N O T be hol e-p unched or perfor ated in any man ner . To use
the new card please hol d the card at close proximity to the reader unti l ihe gate op en s. You may need
to try the other side of the card. Please ensure you hold the entire surfa ce of the card against the reader
until the gate opens.
ACKNOWLEDGEMENT: I acknowledge that should my access card be lost, stolen or
damage, I wilt be responsible to pay a $10.00 replacement fee.
Board Member In fo rm a tion
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8oard/Cor.mitee Ncme:„9 t„} )fyz éd2" Fe vif o r
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E-Mail Adoress. /'¡¡_?[;:/-a. I' )c.. l/1-? "'-"'!_ __ Q -!J-rt-1 4, /. ~-~-------~---·--·------~
w ok Ph on e: ' Hom e P"°2>s /94-{02/
ClfPhone: 4, • [rlerre 3 Coi f 6i d », j t ,.__ ,_1_7_& '6' 7 3 ~ _5"j -~-------·--·---~:- __,
Vehicle information ---·--------~----------,
Tag: ~::rJç /i.. 0 2 z.. Color: ¡ lv h1 i-e.., J
:_ª...,te_-: __ ,..___.______________ Year~·-t -Zo ¡ y _
Mcke: Moat: g
r------'----'----------...., ; ,o ~--: -~-- S'O -----------~
2,A 2f d I [Ppliccnt Sigature:es_ " '„. ............ ---I
Please pro vi de signed form to the Parking Deportment located at 1755 Meridian Avenue, 2"" floor. Working
hours are 8:30 to 5:C0 p.m. or email to: PakingRe ception@ n igmi beach fl.gov
email subject: BOARD & COMMITTEE PAR KI N G APPLICATION - AP PL IC A N T NAME
Parking Deportment See:ticon
Fii SY5i • 15ü@¿ g@@@ss 1
iration ate: 17cGa s..a 7 I--...__ -----+----·- ------~--·---------i
Issued By Print Name: 'Print Nlame: ' -------1-- --------------
Signature: : Signature: as -]
patessuwed;'ate Compl et ed . •
2 0 2 0 /1 1 /2 0 0 9 0 7:4 6 5 {7
MIAM1BE ACH
City of Miami Beach
17Q0 Ccnvontion Center Drive
Miami Beach, Florida 33139
www.migrribeachf.go
OFFICE OF THE CITY CLERK
Email: BC@miamihcachfi,gov
Telephone: 305.673.7411
80ARD & C O M MI TTEE FI NANCIAL ACKNOWLEDGEMENT STATEMENT
Acknowledgement of fines/suspension for Board/Committee Members for failure to comply with Mlaml-
Dada County Financial Disclosure Code Provision Code Section 2-11.1{1) (2)
n4 1 { /oaa!e? 7
First Name Middle Initial
l understand that no later than July 1, of each ygar all m em ber s cf 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.
2ng of the following forms mgsg_pg fligg with the City Clerk of Miami Beach, 1700 Convention Center Drive,
Miami Beach, Florida, no later than 12:00 noon of July 1, f each year.
1. A"Source of Income Statement;" or
2. AStatement at Financial Interests (Form 1)':" or
3. A Copy of your latest Federal Income Tax Return.
Faliure 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. ? \°:>--J - ..
2e«y i¿/z/z>
Signature Date 7
Members of the Planning Board and Board of Adjustmnent will be notified directly by the State of Florida,
pursuant to F .S . $112.3145(1)(a), to file a Statement of Financial Interests (Form 1) with the Miami-Dade County
Supervisor of Elections by 12:00 noon, July 1. Planring Boerd and Beard of Adjustment members who file their
Form 1 with the County Supervisor af Elections automatically satisfy the County's financial disclosure
requirem ent as a Miami Beach City Baara/Committee m em ber and nead not file an addition al form with the Office
of the City Clerk. However, compliance with the County disclosure requirement does not satisfy the State
requirement.
Page 5 cf6
FACLERSALL'REG3OARD AND COMMITTEE APPLICATIONS INAL DRAFTS\3OARD AND OHMIT TEE APLICATION REG FINAL.do
Updated: June 2020
2020/11/20 09.07.46 4 /7
MIAMI BEACH
City of Miami Beach
700 Convention Center Drive
Miomi Beach, Florida 33139
w9:.miam jb.eachfl.g2y
OFFICE OF THE CITY CLERK
Email: BCG@miarnibeachf.goy
Telephone. 305.673.7411
DIVERSITY STATISTICS REPOR T
Last Name
l ho•l
First Name Middle initial
The following information is voluntary and has no bearing on your consideration for appointment. It is being
asked to comply with City diversity reporting requirements.
Gonder:
E~uae üfeae
Jome:
}prefer not to answer.
Race/Ethn!c Categories:
What is your race?
LJ African American'lack
(l Asian or Pacific Islander
Szd caucasianvite
L} Native American!American Indian
oner- Print Race:
ll] refer rot to ans
Do you consider yourself to be Spanish, Hispantc, or Latinola?
CJves er
Llt refer not to answer.
Do you conslder yourseif Physically Disabled?
.lves
gäo
Ll prefer not to answer this question.
Page 6 of6
F:CLER$ALL'EGBOAR AND CCMMIITEE APPLICATE'N S FINA! DRAFTS\OAR AND COMMITTEE APPLICATION PG F NL.4ox
Updated: June 220
2020/11/20 09.07:46 3 /7
MIAMIBEACH
City of Miami Beach
\700 Ccrvertion Center Drive
Miami Beach, Florida 33139
OFFICE CF THE CTY CLE?K
Emait: 3G@mnamiheachl go
Teephon: 305.673.7411
AFFIDAVIT 9E AFFILIATLQNy I+ TE gay gE MLAML BEAcH
STATE OF FLORIDA
COUNTY OF
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (check () al that apply):
X lam a resident of the City of Miami each for six months or longer.
[ [have an ownership interest (tor a minimum of six months) in a business established in the
City of Miami Beach (tor a minimum of six months).
[] lama ful-time employee of a business {for a minimum ct six months) and I am based in an
office or other location of the business that is physically located in Miami Beach (for a
mninimum 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 scle proprietorship, sponsorship, corporation, limited liability company,
or cther entity or business association.
Under penaities of perjury, I declare that l have read the foregoing document and that the facts
stated in it are true._ ]
A S. lz.ls.
Signature Dale _Kall _Sp»zl a
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of D) physical presence or ] online
notarization, this _day of.ZC Y-
_(City of Miami Beach Board/Committee Member).
Produced ID
Form of Identification
Personally Known
«NOTARY SEAL)
Signature of Notary Public
Name of Notary, Typed. Printed, or Stamped
23 November 20
Ronald Starkman
X FL Drivers License
Charles J. D'Agostin