Michael Sherman 12/31/22+
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BOARD AND COMMITTEE CHECKLIST .
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o Letter of Reappointment
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o esumo/curriculum vtae )/'/)33/
o Diversity Statistics Reporting (Completed on zy O, -37
o Oath '
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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.
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·Dat/ 8Ji<;,¡r Committee Member
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Date
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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
)