Daniel Balk 12/31/22- MIAMI BEACH
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B O A R D A N D C O M M IT T E E C H E C K L IS T
APPOINTEE: Daniel Balk ---------------- DATE OF APPOINTMENT: 12/21/2020
BOARD/COMMITTEE: Audit Committee Appointed by: Steven Meiner
FOR SCANNER
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FOR CLERK STAFF
o Letter of Appointment
o Letter of Reappointment [j13%]$$5$ "von«rewreesmon ·-mates o carne-.
o Board and Committee Application (Completed on 12/22/20 _)
Résumé/curriculum vitae /_ -[9.
o Diversity Statistics Reporting (Completed on [/2, à O
o Oath
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Liaison on
R E C E IV E D
0EC 23 2020
CITY OF MIA M I BEACH
OFFICE OF THE OTTY CLERK
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 201 O)
✓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
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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
Received on:
o Acknowledgment of Financial Disclosure Requirement
O DIVERSITY STATISTICS REPORTING Keep COPY in file 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 COMMITT IES DATABASE\CHECKLIST MA STER\B&C Checklist 2015 MASTER.docx
We are com mitted to poroviding excellent public service and safety to all who live, work, and play in our vibrant, tropical, historic community
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M IAM I BEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Bach, Florida 33139 yyNyy_miamibachflgg
OFFICE OF THE CITY CLERK, Rafel E. Granado, Ciy Clerk
Tel: 305.673.711, Fax€ 305.673.7254
Email: CiNyClerk @mi amibeach fl.gov
December 21, 2020
Mr. Daniel Balk
4101 Pine Tree Drive, apt 1025
Miami Beach, FL 33140
RE: Audit Committee
Dear Mr. Daniel Balk:
Congratulations! You have been appointed by Commissioner Steven Meinerto the above-referenced
Board or Committee, 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. 7 411.
Please read the enclosed materials carefully as they concern your duties, responsibilities, and
requirements as a board or committee member.
Congratulations again and good luck.
Regards,
Rafael Granado
City Clerk
cc: Saul Frances, Parking Director
Mark Coolidge, City Liaison
ENCLOSURES:
Oath of Office/Oath of Civility/Acknowledgements
City Code/Ordinance section applicable to agency, board or committee
City Code Sections 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
City Wide Permit Application - (Parking Department Form)
Booklet - Guide to the Sunshine Amendment and Code of Ethics for Public Officers and Employees
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MI AMI BEACH
City of Miami Beach, 17OO Convention Center Drive, Miami Beach, Florida 33139 yywy _miamnibea chf]_gay
OFFICE OF THE CITY CLERK, Rafel E. Granado, Cay Clerk
Tel: 305.673.7411, Fax. 305.673.7254
Email: CiNyClerk @miamibeachfl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Mr. Daniel Balk
RE: Audit Committee
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 requirem ents 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. a<t
Mr. Daniel Balk
Sworn to and subscribed before me this 22
pl ease 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.
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MIAMI BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Emai l: BC@miamibeachfl_go
Telephone: 305.673.7411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
STATE OF FLORIDA
COUNTY OF Miami-Dade
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (check (/) all that apply):
i;zJ 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.
2.la 12/22/20
Signature
Daniel Balk
Date
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of□physical presence or□online
notarzaton, a? aa«[)tcelo-r? _,a022y
[A/el [/f// city or Mam each Boararcommittee Member).
X eo f D-er> Lycoye
Form of Identification
Name of Notary, Typed, Printed, or Stamped
(NOT ARY SEAL)
1A!o,, Charles J. DAgostin m~ Ill NOTARY PUBLIC
l STATE OF FLORIDA
° Comm# GG168171
s7 {8 TS" Expires 12/14/2021
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MIAM I BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeach[l.gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
DIVERSITY STATISTICS REPORT
Balk Daniel M
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:
Zl Male
Elremale
O Other
O I prefer not to answer.
Race/Ethnic Categories:
What is your race?
O African American/Black
O Asian or Pacific Islander
El Caucasian/white
O Native American/American Indian
O Other - Print Race: ------------ □I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
Tves
o
O I prefer not to answer.
Do you consider yourself Physically Disabled?
Tves
h No
O I prefer not to answer this question.
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F:\CLER\$ALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRA FTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
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MIAMI BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibegchf]_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)
Balk Daniel M
Last Name First Name Middle Initial
l 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. 2., 1zoo
---------------- Signature Date
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.
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F:\CLER\$ALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRA FTS\BOARD AND COMMITT EE APPLICATION REG FINAL.dccx
Updated: June 2020
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MIAMI BEACH CITYWIDE (CW) BOARD & COMMITTEES Ia City of Miami Beach, PARKING DEPARTMENT PARKING APPLICATION
1755 Meridian Avenue, Suite 200/Miami Beach, FL 33139/Ph: (305) 673-7505 or (305) 673-7000 ext. 6200 PARKING
A cityw ide (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: 12/22/20
Applicant Name: Daniel Balk
Board/Committee Name: Audit Committee
Address: 4101 Pine Tree Drive, apt 1025
E-Mail Address: dbalk128@gmail.com
Work Phone: Home Phone
Cell Phone: 201-983-9585 Preferred Contact Method: Cell
Vehicle Information
Tag: PZDB41 Color: Black
State: FL Year: '2020
Make: Honda Model: Civic
Applicant Signature: .é
Please provide signed form to the Parking Department located at 1755 Meridian Avenue, 2d floor. Working
hours are 8:30 to 5:00 p.m. or email to: ParkingReception@miamibeachfl.gov
e-mail subject: BOARD & COMMITTEE PARKING APPLICATION - APPLICANT NAME
Park ing Departm ent Section
PERMIT SYSTEM GARAGE ACCESS
Expiration Date: ID Card Serial #:
Issued By Print Name: Print Name:
Signature: es Signature: es
Date Issued: Date Completed:
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