Laurence Herrup 12/31/22~ ~ .•·1BF } ji [} '2 À NA/VE- c
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BOARD îº COMMITTEE CHECKLIST
APPOINTEE: Ì-fµ..)t-e1' U2 A~ ~VfLP DA TE OF APPOINTMENT: Í~l!,"O;,,;;
BOARD/COMMITTEE: ~ l'-tf\,6~ ~ A- f3_ Appointed by: ~
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scan > -Letter of Apointment TERM END: '2[3/7-Y TERM LIMrr: ]?J 2+2
Scan o o Letter of Re_a¡¡¡¡;;;ent [2]-7/2j553\00roves»snrer -=ts,ts creme- us s
o Board and Committee Application (Completed on ft!J:.::)._é) ;)-o
Résumé/Curriculum Vitae j2 · -,3
- Dversty statistics Reos (competes on /<y h)O> O
o Oath z
IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
✓City Code Ordinance Section applicable to the agency, board or committee
RECEIVED cry code Sections 2-21,2-22, 2-23, 2-24, 2-25, 2-26. 245 a 2459
✓County Code Section 2-11.1 -- Conflict of Interest and Code of Ethics Ordinance (as
o amended through December 2010)
0EC -8 2020 Amendments to the Code of Ethics Ordinance (September 2009 through July 2012)
✓Highlights of the Miami-Dade County Ethics Code
CITY OF M!AM! BEACH " Sunshine Law and Public Records - Frequently Asked Questions
OFEÇoéjnfp Memorandum - Solicitation by City Board and Committee Members
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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
Scan o o Acknowledgment of Financial Disclosure Requirement
O DIVERSITY STATISTICS REPORTING Keep COB'Jpfile and ORIGINAL for Annual Report.
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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
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MAIA MIBEACH V !! t i,
City of Miami Beach, !700 Convention Center Die, Miami Each, Florida 33139 yNy w_mimnita chflge
OFFKCE OF THE CITY CLERK, Rafael E. Granado, Cay Clerk
Tel: 305.673.7411, Fax 305.673.7254
Email: Ciylerk@mi amibeochfl.gov
December 03, 2020
Mr. Laurence Herrup
326 71 st Street
Miami Beach, Florida 33141
SUBJECT: Convention Center Advisory Board
Congratulations! You have been reappointed by Commissioner Michael Góngora to the above
referenced, board or committee named above, 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 appointment/election 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.
Congratulations and good luck.
Regards,
Rafael Granado
City Clerk
cc: Saul Frances, Parking Director
Heather Shaw, City Liaison
ATTACHMENTS:
Letter of Appointment
Oath
City Code/Ordinance section applicable to agency, board or committee
City Code Section 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 Ordinance
City Wide Permit Application - (Parking Department Form)
Booklet - Guide to the Sunshine Amendment and Code of Ethics for Public Officers and Employees
\_,, -
AA[AMA+BEACH 5 V lii Ml il t ·f s
City of Miami Beach, 7OO Convention Center Drie, Miami Beach, flarida 33139 ¿ywy_miamnibacrílga
OFFICE OF THE CITY CLERK, Rafasl E. Granado, Cay Clerk
Tel: 305.673.7411, Fax 305.673.7254
Emil: Ci/Clerk@miamibeachfl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Mr. Laurence Herrup
RE: Convention Center Advisory Board
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
State of Florida (depending on the board or committee on which I serve) on July 1st, following the closing
of the calendar year on which I have served.
e__ %a±2 Mr. Lauren ce
Sworn to and subscribed before me this
T •
*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.
\_,
MIAMI BEACH
.._)
City of Miami Beach
1700 Convention Cenier Drive
Miami Beach, Florido 33139
OFFICE OF THE CITY CLERK
Email. BC@miamibeachf_goy
Telephone: 305 .673 7411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
sATEFL@RIA- 1,Le
COUNTY OF Jc"h led<-
1 am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4)
as ( check ( ✓) all that apply):
O I am a resident of the City of Miami Beach for six months or longer.
~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).
O 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 ip it are true><
Date
tal4/wc
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of O physical presence o.Ko"nline
oaraaon a 'ha. a )ceAbra 2c22 y
LAakeeerty? .cry st amt Beach soar/committee Memen
X cae [6 p),yes -ue Se
· Form of Identification
Pérsonally Known
Tr%j.9$2123 9% shy
Name of Notary, Typed, Printed, ~amped
(NOTARY SEAL)
12!A,, Charles J. DAgostin
00.s; NOTARY PUBLIC
e
sl STATE OF FLORIDA
Comm# GG168171
e Expires 12/14/2021
\_,, ./
MIAM!BEA CH
C ity o f M ia m i B e a ch
1 700 Convention Center Drive
Miami Beach, Florida 33139
www ._miamibeachtl._gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Tel ep h on e : 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)
luttr laca
Last Name First Name Middle Initial
I understand that no later than July1,_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 rms, pursuant to the Miami-Dade County Code, may subject the person to a fine "ii"Ysinial, or both.
Date
Bfbr · y
' 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:ICLERISALLIREGIBOARD AND COMMITTEE AP PLICATION S FINAL DRAFïS\BOARD AND COMMITTEE APPLICATION REG FINAL.dccx
Updated: June 2020
h /
M1AM/BEACH IVA #V\i .. \i
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
ww_miamibeachfl_gov
OFFICE OF THE CITY CLERK
Email: BC@mniamibeachfl_gov
Telephone: 305.673.7 411
DIVERSITY STATISTICS REPORT
Las~
kdä A.
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:
Zh Mae
O Female
D Other
O I prefer not to answer.
Race/Ethnic Categories:
What is your race?
~
frican American/Black
Asian or Pacific Islander
Caucasian/White
O Native American/American Indian
Lother - Print Race.
D I prefer not to answer.
~ consider yourself to be Spanish, Hispanic, or Latino/a?
:
LlIprefer not to answer.
Do you consider yourself Physically Disabled?
5. 5
O I prefer not to answer this question.
Page 6 of 6
ACLERISALLIREGIOARD AND COMMITTE E APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTE APPLICATION REG INAL. docx
Updated: June 2020
a /
A\[AM\/BEA(CH CIWIDE (CW) BOARD & COMTEeEs a k iai cadi, é@si@e oeisrior PARKING APPLICATION
1755 Meridian Avenue, Suite 200/Miami Beach, FL 33139/Ph: (305) ó73-7505 or (305) ó73-7000 ext. 6200
u
MA
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.
ACKNOW LEDGEM ENT: I acknow ledge that should my access card be lost, stolen or
damage, I will be responsible to pay a $10.00 replacement fee.
Date of Application:
Applicant Name:
Board/Committee Name.
-- •• , ---- - - f
Address: 2%p2, 1)2f • 4 (2
E-Mail Address: /he /lt.Cu
work Phone: 35 -S- ebl] Home Phone 2,5-77 4 9&3G
cell Phone: %5'7/- 83& Preferred Contact Method: Cd[
Vehicle Information
Tag: n o Color: Beel
State: L Year: 20
Make: B¢ Model: S3i
Applicant Signature: s
Please provide signed form to the Parking Department located at 1755 Meridian Avenue, Qi floor. Working
hours are 8:30 to 5:00 p.m. or email to: ParkingReception@mniamibegchfl.gov
e-mail subiect: BOARD & COMMITTEE PARKING APPLICATION - APPLICANT NAME
kina D
PERMIT SYSTEM I GARAGE ACCESS
Expiration Date: ID Card Serial #:
Issued By Print Name: Print Name:
Signature: s Signature: es
Date Issued: Date Completed:
Secti
:\ping \$man \rar\íoms\cw bocras&committees parkingíorm.doc orm updated 9/26/2017
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