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Perry Weitz 12/31/22NA I A NA I BE AC, H f' BOARD AND COMMITTEE CHECKLIST r APPOINTEE. (EQ }� oc/Tz, DATE OF APPOINTMENT: BOARD/COMMITTEE: /14 WP/`"7 Appointed by: ll6�'t'L4/ ?e FOR SCANNER FOR CLERK STAFF .�% Scan o o Letter of Appointment TERM END:4 ERM LIMIT: /c;� Scan o o Letter of Reappointment v Cyr o L tt �of Appointment/Reappoin#ment Qe'-m filed to ommittee Liaison on Scan o o Boar an ommittee�A`p/plication (Completed on U �� Scan o o Resume/Curriculum Vitae Q j o Diversity Statistics Reporting (Completed on Scan o o Oath 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 VRTHC'EIV�'.'i.,! ✓ County Code Section 2-11.1 — Conflict of Interest and Code of Ethics Ordinance (as amended through December 2010) G� , ioz1 ✓ Amendments to the Code of Ethics Ordinance (September 2009 through July 2012) AUG 2' ✓ Highlights of the Miami -Dade County Ethics Code ✓ Sunshine Law and Public Records — Frequently Asked Questions CITY OF MIAMI BEACH ✓ Memorandum - Solicitation by City Board and Committee Members O Citywide Permit Application (Parking Department Form) O Booklet — Guide to Sunshine Amendment & Code of Ethics for Public Officers and Employees Scan o O Source of Income Statement � Scan o o Acknowledgment of Financial Disclosure RpquirP, eni: 11 O DIVERSITY STATISTICS REPPORTING ; •f Received on: �� �� � Signed by X Date Processed on: -By Employee: Date I �// 04, Scanned on: 6/ lal By Employee: Date City in file and Staff Initials Annual Report. 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:\CL.ER\BOARD AND COMMITTIES DATABASE\CHECKLIST MASTER\B&C Checklist 2015 MASTER.docx VVo a cc.1m i�tr d� rn pra"iding excellk,nt pul'A' service) anef solery to ;ill who two. vvoxk irrGa play in qur vibrrulf, Iropreerl, hilunc res^tmua,i'I MIAMIBEACH City of Miami Beach, 1700 Convention Cancer Drive, Miami Boach, Florida 33139 vnvw.miamiboachfl.aov OFFICE OF THE CITY CLERK, Rafael E. Granodo, City Clerk Tel: 305.673.7411, Fax: 305.673.7254 Email: C#yClerk@niiamibeaa:hll.gov August 25, 2021 Mr. Perry Weitz 111 Palm Avenue Miami Beach, Florida 33139 RE: Marine and Waterfront Protection Authority Dear Mr. Perry Weitz: Congratulations! You have been appointed by Mayor Dan Gelberto 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 305.673.7411. 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 Gran do City Clerk cc: Monica Beltran, Parking Director Jacqueline Caicedo, 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 r1 raj A`�,. I A I V } I r' H City of Miami Beach, 1700 Convonlion C'onler [hive, Miami beach, Florida 3;1139 wvyw rTiiarnibwchll.aav OFFICE (X TFC C111 CIERK, Ralad E. Grancxio, City Ckrk Tei: 305.673.7411, fax: 305.673.7254 Entail: Ci►yCtork@miornibwchfl.gov Oath of Office Oath of Civility and Acknowledgements TO: Mr. Perry Weitz 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 J 0/ st, following th� closing of the calendar year on which I have served. / 1 __— i Mr. P rry Weitz Sworn to and subscribed befor a this day of / / tIn, 2021 C les 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. fVli/_\lWi C5t:A�, " City of Miami Beach 1700 Convention Center Drive Miami Beach, Florida 33139 OFFICE OF THE CITY CLERK Email: BC(n)miamibeachfLgov Telephone: 305.673.741 1 �1�BU1�11ttil;�I��I�I�>fI� ► _-_..�d�t�L�73ulLTi'iT[3�T STATE OF FLORI A M COUNTY OF �, —A41:� I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4), as (check (J) all that apply): T( I am a resident of the City of Miami Beach for six months or longer. L"J 1 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). ❑ 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 e ' or busines association. Under pen es of perjury, I d clare t ve read the foregoing document and that the facts stated in ' a e true. S'ignatldre �j ` Date NOTARY Sworn to (or affirmed) and subscribed before me, by means of ❑ physical presence or�nline )n, thiS9� day of, )CL -7 Well Produced ID Form of Identification P r� now / 7 Signature of Not ublic Name of Notary, Typed, Printed, or Stamped 20 1? by of Miami Beach Board/Committee Member). (elzs (NOTARY SEAL) Charles J. DAgostin NOTARY PUBLIC _STATE OF FLORIDA Comm# GG168171 ,siNC 190 Expires 12/14/2021 MIAMI BEACH City of Miami Beach 1700 Convention Center Drive Miami Beach, Florida 33139 www.miamibeachfl.gov OFFICE OF THE CITY CLERK Email: BC(@miamibeachfl.aov Telephone: 305.673.741 1 1)E-110140diiiII1114A ► ► ..► • 1 _ ! a _. i� _ 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) lVeI rz- l> -16-19-1V Last Name First Name U 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-E,ederal Income Tax Return. Failure to file one df tYiese forms, purJuant to the of no more than $,5O',60 days in jpil, cl boll f `r County Code, may subject the person to a fine Date 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 COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx Updated: June 2020 Clear From Print Form MIAMF 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 last Name First Name Middle Nametinitial 2020 /J& F/L/v Mailing Address -- Street Number, Street Name, or P.O. Box T 4 D 61LOl� d 40-1- City, State, Zip Alexi off rads3 If vour home address is vour mailina address, dnd vour home address is exempt from public records oursuant to Fla. Stat. &119.07. read instructions on the following page and check h®e. Filing as an Employee (check one) E] County [j Public Health Trust 0 Municipal: (Municipality) Department Position or Title Employee ID Number Work address Work telephone w Employment began onlended on Filing as a Board Member (check one) ® County Iunicipal: L i � ©y (Municipality) Board where serving Alternate address (if home address is exempt) -,13/-I% Work telephon Term began ontended on //' 4e ii, f /-" h ' ✓ 5 v 3 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 ano fj e 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. U Name of Source of Income Address Description of the Principal Business Activity t{i-/F-7-l' yr �Pi''7 C° 704 AxAl gall, /T 1"r /0 Z-r'714.4-i"/viJ 4�1- (ir6 r T VA! 0 c[ S r-itf%t L L EsTA T� D/el A" 1741 S Mtir-�-rC. I hereby §hear,(or affirm) that re of Person I above is a true and correct statement, RECEIVED BY ELECTIONS DEPARTMENT: ❑ Hardcopy RECEM70 C_7 Electronic Copy AUG 26 2021 CITY OF I IA,MI REACH REMEMBER TO PRINT, SIGN, AND SUBMIT TO THE OFFICE OF THE CITY CLERK VIA EMAIL OR HARDCOPY. .1;AM I BEACH City of Miami Beach 1700 Convention Center Drive Miami Beach, Florida 33139 www.rniarnibeachfi.gov OFFICE OF THE CITY CLERK Email: BC@rniamibeachfl.gov Telephone: 305.673.741 1 z / r -17--z- Last Name DIVERSITY STATISTICS REPORT 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. Gen r: ,Ven aj Female Other 1 I prefer not to answer. Race/Ethnic Categories: What is your race? ED African American/Black Caian or Pacific Islander ucasian/White Native American/American Indian Other — Print Race: prefer not to answer. Do you consider yourself to be Spanish, Hispanic, or Latino/a? es No I prefer not to answer. Do you consider yourself Physically Disabled? s No I prefer not to answer this question. Page 6 of 6 F\CLER\$ALI_\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx Updated: June 2020 CITYWIDE (CW) BOARD & COMMITTEES 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 exl. 6200 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: 1 acknowledge that should my access card be lost, stolen or damage, I will be responsible to pay a $10.00 replacement fee. Rnnrd Mamhar Infnrmrn#inn Date of Application:35/�� Applicant Name: Board/Committee Name: ��✓ �dN . /l��tG���� Address: E -Mail Address:`'1,/,./T Wo. Phone: j Home Phone Cell hone: / .7 y= j f5 Preferred Contact Method: e u Vahmeha, Infnrmn#inn Tag: %/`n V 1�6 3V GARAGE ACCESS Calor: Gr State: Al Print Name: Year:� Signature: % Make: -' I Date Completed: Model: Applicant Signature: A Please provide signed form to e Park+ hours are 8:30 to 5:00 p.m. r email to e-mail subject: ARD & C g epartment luted at 1755 Meridian Avenue, 2°1 floor. Working arkingReceptiion@miamibeachfi.gov MMITTEE PARKING APPLICATION — APPLICANT NAME Perrleinn FlAnnrtmAnt Scertinn PERMIT SYSTEM GARAGE ACCESS Expiration Date: ID Card Serial #: Issued By Print Name: Print Name: Signature: AK Signature: % Date Issued: I Date Completed: