Arthur Unger 12/31/24M IA M I BEACH
BOARD AND COMMITTEE CHECKLIST
Liaison on
Scan o
APPOINTEE: £,UM:1,V, aíl&Ge.- Cf'IJ, DATE OF APPOINTMENT: / ¡¿~~dr I
BOARO/COMMITTEE: C fY>' /jJ ,, fl r /J, Appointed by: e,,, t-J . , 55 ,oV
FOR SCANNER FOR CLERK STAFF 4 /
scan Letter of Appointment TERM END: 123l2029 TERM LuMrr:. [UQ) C
Scan o o Letter of Reappointment
0 ~r;}):;J f /~ºi Appointment/Reappointment 2-mailed
scan ·~an~commie Application (competes 1 1)o/ )}f
Scan o o Résumé/Curriculum Vitae ,
- Diversity Statistics Reporting (Completed on_pt_=O}]
o Oath
IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
✓City Code Ordinance Section applicable to the agency, board or committee
RECEIVED ✓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
a amended through December 2010)
J/\N 29 29Q1 Y Amendments to the Code of Ethics Ordinance (September 2009 through July 2012)
✓Highlights of the Miami-Dade County Ethics Code
CITY OF MIAMI BEACH ' Sunshine Law and Public Records - Frequently Asked Questions
OFFICE OF THE O?TY CLERK Memorandum - Solicitation by City Board and Committee Members
Scan o
Scan o
Received on:
Processed on:
Scanned on:
o Citywide Pennit Application (Parking Department Fonn}
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
O DIVERSITY STATISTICS REPORTINGeep çQPY in file and ORIGINAL for Annual Report.
1h8/2e sores,e=
25 / 9--7at ~/By Employee: f ~.;,'%:1. 7ç L,_ __ .
f P 1~/ By Employee: b c.6:é. /L ~- ,. ~
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
WVe are commined to providing excellent public service and saey to all who live, work, and play in our vibrant, topical, historic community
MI A MI BE A C H
City of Miami Beach, 17OO Convent ion Center Drive, Miami Beach, Florida 33139 yyNy_micmibachíi_gay
OFFICE OF THE CITY CLERK, Rafael E. Granado, Cay Clerk
Tel: 305.673.7411, Fac 305.673.7254
Emal: CayClerk@miamibeachll.gov
January 14, 2021
Mr. Arthur Unger
4565 North Bay Road
Miami Beach, Florida 33140
SUBJECT: Health Facilities Authority Board
Dear Mr. Arthur Unger:
Congratulations! You have been reappointed by the City Commission to the above referenced board or
committee, for a term ending: 12/31/2024.
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.
Respectfully,
Rafael Granado
City Clerk
cc: Monica Beltran, Parking Director
Allison Williams, 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
M IA M I BEACH
City of Miami Beach, 17O Convention Center Drive, Miami Beach, Florida 33139 yyywy_miamibeachf]_gay
OFFICE OF THE CITY CLERK, Rafael E. Granado, Cay Clerk
Tel: 305.6737411, Fax 305.673.72 54
Email: Ci Clerk@miamibeach!l.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Mr. Arthur Unger
RE: Health Facilities Authority 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: 12/31/2024.
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.
of»
swom to and subscribed etore me u2Tl„,)-„a,
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.
M IAM I BEACH
City of Miami Bea ch
1700 Convention Center Drive
Miomi Beach, Florido 33139
OFFICE OF THE CITY CLERK
Em ail: BC@miamibeachf_gov
Telephone: 305.673.7411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
STATE OF FLORIDA
COUNTY OF Pu» Po
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (ch eck (/) all that apply):
• 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 month s).
"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 ZJ are true. of A / /_v_~ ..... J_w __ H _
Sign✓uiê~ Date
4er oe S. 00et p
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of□physical presence or k6 n e
otaraavo. a2 a„, )/(7_ao2ley rar e la.'
X eeauca }_
(City of Miami,B each Board/Committee Member ).
ucreS 4 Se
Sign
Name of Notary, Typed, Printed, or Stamped
(NOT ARY SEAL)
tl)Charies J. DAgostin
NOTARY PUBLIC
: STATE OF FLORIDA
Comm# GG168171 es Epres 12/14/2021
M IAM I BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachhl.aov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
BOARD & COMMITTE E FINANCIAL ACKN OWL EDGEME NT STATEM ENT
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)
lg harala- 5.
Last Name 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 Req uirements.
One of the following forms must be filed with the City Clerk of Miami Be ach, 17 00 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.
ne of these form s, pursuant to the Miami-Dade County Code, may subject the person to a fine
$590, 60 days in jail, or both.
Date
/a/ozi 7 7
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
Superviser of Elections by 12:00 noon, July 1. Plan ning 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\SALLIEGBOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
st Em SOURCE OF INCOME STATEMENT
Section 2-11.1(l) 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 I Last Name First Name
202o llUGte, herve
Malling Address - Street Number, Street Name, or PO. Box j, 5,2
5oO Cols #fleu fr ó
MIddle Name/initial
5,
City, Stat e, ZIp
F 35/40
lf your home address is your mailing address, and your home äddress is exempt from public records pursuant to Fla. Stat. $119.07, read
instru ctio ns on the following page an d check here.Dl
Fling as an Empl oyee (check one)
D county D] Pubic Health Trust [2íuniciat: Motz%1
Department
Positi on or Title
Work telephone
Employee D Number
Employment began on/ended on
Fling as a Board Member (check one)
□County Juniciat: tty et-
(Municipality)
ssr4wer "eo9 4, - l4542-
Alternate address (If home address Is exempt) Work telephone
5-3,
List below every source of incom e you recei ved, along with the address and the principal activity of each source. Include your public salary. Place the sources of
income in desc ending order, with the largest source first. Exam ples of sources of income include: compensati on 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 incom e of your spouse or any business partner need not be disclosed . tf comtimued on a sepa rate sheet, check here.Ll
Mame of Source of income ] Address [ Description of the Principal Busi ness Activity
anuo.- #hpe-, z?
the information above is a tru e and correct state ment.
}-
Sig
4glee aneT
RECEIVED BY ELECTIONS DEPARTM ENT:
o Hardcopy RECEIVED
[ Electronic Copy
JAN 2 9 2021
CITY OF MIAM I BEA CH
OFFICE OE TF TILED
OFFCE USE ONLY Accepted: Y I N Deficiency.. Processe d Date/initials: Scanned Date/initials:
138_SP-14 COE 2016
M IAM I BEACH
City of Miami Beach
1700 Convention Center Orive
Miami Beach, Florida 33139
www_miamibeach[l_gov
OFFICE OF THE CITY CL ERK
Email: C@miamibeachf]goy
Telephone: 305 .673 .7 41 1
DIVERSITY STATISTICS REPORT
lise lu #rit 6
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
a
Drenale
loner
O I prefer not to answer.
Race/Ethnic Categories:
What is your race?
O African American/Black
l_ Asian or Pacific Islander
Llaucasian/White
O Native American/American Indian
O Other - Print Race: _
O I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
8a
O I prefer not to answer.
Do you consider yourself Physically Disabled?
es
No
O I prefer not to answer this question.
Page 6 of6
FCLERSALL'REGBOARD AND COMMITTEE APPLICATIONS FINAL DRAFTSIBOARD AND COMMITTEE APPLICATION REG FINAL.dOcx
Updated: June 2020
MIAM I BEACH CITYW IDE (CW) BOARD & COMMITTEES Ell
y-ri- --s oie oie+rios PARKING APPLICATION El#A#pep#Eg
1755 Meridian Avenue, Suite 200/Miami Bech, FL 33139/Ph: (305) 673-7505 6r (305) 673-7000 ea. 6200 PRKi ñié
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
Dote of Application: //2012027
Applicant Name: triton 5, head RA
Board/Commitee Name: C9- l,pl
Address: lle puad4 43NI#O
E-Mail Address: erte.. qJ @=7uro#
Work Phone:
Cell Phore:
D0
77
Vehicle Information
Tag:
State:
Make:
Hone Phone 205-51-9/76
Preferred Contact Method: gt.
Color:
Year:
Model:
Applican Signature: es
Please provide signed fo t6th %6rig Department located at 1755 Meridian Avenue, 2° floor. Working
hours are 8:30 to 5:00 p.m. or em6ßl6 : PgrkingReception@miamibeachf].gov
e-mail subiect: BOARD & COMMITTEE PARKING APPLICATION- APPLICANT NAME
ki - .
PERMIT SYSTEM GARAGE ACCESS
Expiration Date: ID Card Serial #:
Issued By Print Name: Print Name:
Signature: e Signature: es
Date Issued: Date Completed:
:\ping\Sman \reforms cw board&committees parkingform.doc rm updated 9/26/2017
.------------- - -
' EsTRICnoNs:
ENDORSEMENTS:
C LA S S : E • Any non+commercial vahicl w ith a GR less than 20,00t lbs. or any RU
REPLA CEMENT LICENSE REQUIRED WI TH IN A0 DAYS OF AD DRESS OR NAME CHANGE
The stat4 ot Florida retains al property rights hwrein. Py(a
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