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Michael Sherman 12/31/22+ I_, '-._.,/ BOARD AND COMMITTEE CHECKLIST . APPore.._@rl4e]_/e# oArEorAPorENr. /3/ 2a2 f oARcowrree. _/hK//oAeomnea»_((hj : t ±22. "9%%2%.. aso l2,)l2.c» /2/3//4 o Letter of Reappointment o ~ /ppointmenUReappointmen/t e-mailed to Committee Liaison on • oaf@aGcomrte Acavon compotetea »/_,_ 2-7/2o/ o esumo/curriculum vtae )/'/)33/ o Diversity Statistics Reporting (Completed on zy O, -37 o Oath ' Scan o Scan o Scan o Scan o / {ECEIVED ✓ -EB 08 2021 / ✓ ✓ C OF MIAMI BEACH / O! =OF THE CITY 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 Scan o Scan o Received on: 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 O Acknowledgment of Financial Disclosure Requirement I O DJVERSITY ~lATISTICS REPORT!~ -K~e~ COPY in file and~ORIGINAL7for: Ann~al Report. 2Lg/2>l ±sX b5ht, Sp,>1 , A / ·Dat/ 8Ji<;,¡r Committee Member •Y'2ole»» L}2 Scanned on: Date 2 /1 2a l_ _eynotovee l = Date 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 We are committed t providing excellent service and safety o all who hive, wok, and incur vibrant, topical, historic community. • J City of Miami Beach, 1/OO Convention Center Drive, Miami Beach, Florida 33 139 yyw_miamibachf_gw OFFICE OF THE CITY CLERK, Rafael E. Granado, City Clerk Tel: 305.673.7411, Fax 305.673.7254 Email: Ci/Clerk@miamibeachfl.gov January 21, 2021 Mr. Michael Sherman 1573 Pennsylvania Ave, 1 N Miami Beach, FL 33139 SUBJECT: Human Rights Committee Dear Mr. Michael Sherman: Congratulations! You have been reappointed by the City Commission to the above referenced board or committee, for a term ending: 12 /31/202 2 . 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. Congratulations and good luck. Respectfully, Rafael Granado City Clerk cc: Monica Beltran, Parking Director Lana Hernandez, 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 ~ / City of Miami Beach, 1/OO Convention Center Drive, Miami Bea ch, Flor ida 33 139 y_Aw_miamibcachf_go OFFICE OF THE CITY CLERK, Rafael E. Granado, Cly Clerk Tel: 305.673.7411, Fax 305.673.7254 Email: Cit/Clerk@miamibeochfl.gov Oath of Office Oath of Civility and Acknowledgements TO: Mr. Michael Sherman RE: Human Rights 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* 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. %h%sel Mr. Michael Sherman swom to and subscribed before me n b _a,, _[@__,a02+ Ciao 'gei Charles D'Agostin Deputy Clerk *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. - • - MIAM[BEACH City of Miami Beach 1700 Convention Center Drive Miami Beach, Florida 33139 OFFICE OF THE CITY CLERK Email: BC@m iamibe achf_gov Telephone: 305 .673 7411 AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH STATE OF FLORIDA , 1J n. COUNTY OF [w Mt I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4), as (check (/) all that apply): ~m 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 yrtY of Miami Beach (for a minimum of six months). u( 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 stated in i A perjury, I declare that I have read the foregoing document and that the facts Signature cg,1 KM6h 28-ozl Date Printed Name NOTARY Sworn to (or affirmed) and subscribed before me, by means of O physical presence orXonline notarization, this<{_rl,day of_ £e.-&--~=} , 20¿r{by _ /)cl4e f_5/et0_toy on am t each soar@rcommtee Member . ecaoco [ ])Neo Lee Form of Identification Name of Notary, Typed, Printed, or Stamped (NOT ARY SEAL) 1A±!a,, Charles J. DAgostin m~ '\, NOTARY PUBLIC 3 -- & , „ [STATE OF FLORIDA 2-HS comm# GG168171 e Exoires 12/14/2021 \_/ / I City of Miami Beach 1700 Convention Center Drive Miami Beach, Florida 331 39 www.miamibeachfl.gov OFFICE OF THE CITY CLERK Email: BC@miamibeachfl_gov Telephone: 305.673.7411 DIVERSITY STATISTICS REPORT f{4Ad M J~ 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: 9 e únete O Other O I prefer not to answer. Race/Ethnic Categories: What is your race? O African American/Black O Asian or Pacific Islander @g caucastan/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? Llves 2 Ro lreer not to answer. Do you consider yourself Physically Disabled? ks# No O I prefer not to answer this question. Page 6 of 6 F:\CLER\$ALL\REG\BOARD AND COMMITT EE APPLICATIONS FINAL DRAFT S\BOARD AND COMMITT EE APPLICATION REG FINAL.docx Updated: June 2020 \_,, - MIAM\IBEACH City of Miami Beach 1700 Convention Center Drive Miami Beach, Florida 33139 www.miamibeacht]._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) Sly RM00 ! 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 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 khan $500, 6Q days in jail, or both. 02.08.202-l 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. Page 5 of 6 F:\CLER\$ALL\REG\BOARD AND COMMITT EE APPLICATIONS FINAL DRAFT S\BOARD AND COMMITT EE APPLICATION REG FINAL.dccx Updated: June 2020 MIAMI-DADE. ELI / 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. I First Name osso.sr. torr ver ws I2eu0 M el 2020 Y Middle Name/Initial - "E3 +E#TE3," #c, s %a. oÁ , 3sí I 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.Dl 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 [,jMuniciat: Cry 9 B m. Hutu. Alternate address (if home address is exempt) Term began on/ended on 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 4@9L, JN-o I )h«nt€ Lo kct [1 Co-vt C I I hereby swear (or affirm) that the information above is a true and correct statement. .du!! 2.1.0074 Date signed RECEIVED BY ELECTIONS DEPARTMENT: [ Hardcopy RECEIVED [ Electronic Copy FEB O 8 2021 CITY OF MIAM I BEACH OFFICE CF THE CITY CLERK OFFICE USE ONLY Accepted: Y / N Deficiency. Processed Date/initials: Scanned Date/Initials: 138_SP-14 COE 2016 )