Scott Robins 12/31/22M IA M I BEACH
APPOINTEE:
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BOARD AND COMMITTEE CHECKLIST . .
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RE C E IV E D
FOR CLERK STAFF
o Letter of Appoíntment
o Letter of Reapp ointm ent
o ~ Îppoíntment/Reappoíntment e.maílej to Committee
-· ~osi6 Gnu6or i c e Aveano cor e ea a,_2//9-2à]
• Resume/curriculum vtáe 3/ / 2o> ]
o Díversíty Statistics Reporting (Completed on / ' )
o Oath
Liaíson on
IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
✓Cíty Code Ordinance Section applicable to the agency, board or committee
Y City Code Sections 2-2 1, 2-22, 2-23, 2-24, 2-25, 2-26, 2-4 58 and 2-4 59
✓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
C ITY O F M IA M I BEA C H ✓Sunshine Law and Public Records - Frequently Asked Questions
O FFICE AE CITY CL E R K Y Memorandum - Solicitation by City Board and Committee Members
MAR 1 2021
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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
Annual Report.
Received on:
Processed on:
Scanned on:
o Acknowledgment of Financial Disclosure Requirement
_ o DIVERSITY STATISTICS R~eep .... --W
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Date 3l- 91acore.
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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.dccx
We are committed to providing excellent public service and satey to all who live, work, and play in our vibrant, tropical, historic community.
MI AMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139 yyy_miamibeachflgo
OFFICE OF THE CITY CLERK, Rafcal E. Granado, City Clerk
Tel: 305.673.7411, Fax 305.673.7254
Email: Ci/Clerk@miamibeachfl.gov
February 03, 2021
Mr. Scott Robins
1800 W. 24th St
Miami Beach, Florida 33140
SUBJECT: Marine and Waterfront Protection Authority
Congratulations! You have been reappointed by Mayor Dan Gelber 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. 7 411. Please read the enclosed materials carefully.
Congratulations and good luck.
Regards,
Rafael Granado
City Clerk
cc: Monica Beltran, Parking Director
Jacqueline Caicedo, 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
MIA MI BEACH
City of Miami Beach, 1700 Convention Center Drive, Mia mi Beach, Florida 33139 yyyy_miamnibeachi_gay
OF FICE OF THE CITY CL ERK , Rafel E. Granado, Cly Clerk
Tel: 305.673.7411, Fax 305.673.7254
Email: Ci/Clerk@miamibecchll.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Mr. Scott Robins
RE: Marine and Waterfront Protection Authority
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 fol low in g the closing
of the calendar year on which I have served. -
Mr. Scott Robins
Sworn to and subscribed before me this Z iy y
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 IAMI BEA CH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
STATE OF FLO RIDA (9 ,l
COUNTY OF DINI 'd.dz
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (check (/) all that apply):
D. I am a resident of the City of Miam i Beach for six months or lon ger.
~ 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).
f/:J. 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.
ii:i.,,,""@_OC Pej,] declare th at I have read the foregoing documen t an i th at the facts
z jfret[ye
3- 11
Signature
6ola 2bias Date
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of O physical presence or O online
notarization , this _[ day ot J]
po li ka914S (cy of Miami Beach Board/committee Memben).
, 201}1 by _
Produced ID
X
Form of Identification
Personally Known
é <
Ziê caim»sin + GG 33731 ?=if wy Com m. Expires Mar 30, 20
onded through Nation al Notary As
M IA M I BEACH
C ity o f M ia m i B e a ch
1 700 Convention Center Drive
M iam i Beach, Florida 33139
www.m iami be ach fl._gov
O FFIC E O F THE CITY CL ERK
Em ail: BC@ m iam ibeachfl.gov
Telephone: 305.673.7 411
B O A R D & C O M M IT T E E FIN A N C IA L A C K N O W L E D G E M E N T S T A T E M E N T
A c k n o w le d g e m e n t of fi n e s/s us p e ns io n fo r B o ard /C o m m itt ee M em b e rs fo r fa ilu re to co m p ly w ith M iam i-
D a d e C o u n ty Fin a n c ia l D is c lo s u re C o d e P ro visio n C o d e S ection 2-11 .1(i ) (2)
loi5 Í2
Last Name
{eri
(Nam e Middle Initial
I understand that no later than Ju ly 1,_o f eac h y e a r 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.
O n e of the following forms m u s t be fil e d with the City Clerk of Miami Beach, 1700 Convention Center Drive,
Miami Beach, Florida, no later than 12:00 noon of J u ly 1, of e a ch ye ar:
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 Torris, pursuant to the Miami-Dade County Code, may subject the person to a fin e
more thag_$500,60 day5 FJ ail, Gr Gr
3 12 ]
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.
Page 5 of 6
F:\CLER\$ALLIREG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTSIBOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
MIAMl·DADE-
EIE 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.
Disclosure for Tax Year Ending I Last Na~ \,.. •
2020 I50OAS " ora Middle Name/Initial
Mailing Address - street yr2y8, Stree
30 >-
7 33134
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. D
Filing as an Employee (check one)
D County [ Public Health Trust [] Municipal:
(Municipality)
Department
Position or Title
Work address Work telephone
Employee ID Number
Employment began on/ended on
Filing as a Board Member (check one)
2am AMowt Dad 75woe: Ho of 2gg1 a«lA
(Municipality)
Alternate 0o Term began on/ended on
(j)
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.D
Name of Source of Income Address Description of the Principal Business Activity
M Kcal Slal
9205°% 9ce kcal slC
Signature öf osmg
2-12\
Date signed
RECEIVED BY ELECTIONS DEPARTMENT:
Jare/RECEIVED
O Electronic Copy
M4AR 12021
CITY OF MIAMI BEA CH
OFFICE u O/TY CLERK
OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/Initials: Scanned Date/initiais.
138_SP-14 COE 2016
MIAMI BEACH
C ity o f M ia m i B e a ch
1700 Convention Center Drive
Miami Beach, Florido 33139
www._miamibeach fl_gov
O FF IC E O F TH E C ITY C LERK
Email: BC@miamibeachfl_gov
Telephone: 305.673.7411
DIVERSITY STATISTICS REPO RT
&0i s 3et B
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.
G e n d er:
gf ae
O Female
Cloner
O I prefer not to answer.
R a c e/E th n ic C a teg o ries:
W ha t is yo u r rac e?
O African American/Black
O Asian or Pacific Islander
SS±k caucasianwhite
O Native American/American Indian
O Other - Print Race: _
D I prefer not to answer.
D o yo u co nsid er yo u rself to be S panish , H isp anic, o r Latino/a?
ves d-o
O I prefer not to answer.
D o yo u co n sid e r yo u rse lf P hysically D isab led?
ves
o
O I prefer not to answer this question.
Page 6 of6
F:ICLER\$ALLIREGIBOARD AND COMMITTEE APPLICATIONS FINAL DRAFTSIBOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
±.A.l."##2% Ia
1755 Merdian Avenue, Suite 200/Miami Beach, FL 33139/Ph: (305) 673-7505 or (305) 6737000 ex4. 6200 PARKING
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
Date of Application: 3-Il-2l
Applicant Name:
Board/Committee Name:
Address: 1Z00
E-Mail Address: Ssh+
Work Phone: 6 674-0o6
Cell Phone: 3 <5- 0OO Preferred Contact Method: coll
Vehicle Information
Tag: Dr 04a Color:
State: rt Year:
Make: Model:
Applicant Signature: es
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 subiet: BOARD & COMMITTEE PARKING APPLICATION - APPLICANT NAME
kinq Department S
PERMIT SYSTEM GARAGE ACCESS
Expiration Date: ID Card Serial #:
Issued By Print Name: Print Name:
Signature: es Signature: es
Date Issued: Date Completed:
:\ping\$man\raríorms \cw boards&committees parkingform.doc rm updated 9/26/2017