James Rodgers 12/31/22BOARD AND COMMITTEE CHECKLIST
James Rodgers
APPOINTEE. 9 DATE OF APPOINTMENT:___7'
BOARD/COMMITTEE: Animal Welfare CommitteeAPpainted by:
` M44
FOR SCANNER FOR CLERK STAFF d 1316-2.
Scan o o Letter of Appointment E i�, :t .'.tt;._ / _._ _ . _.......ERi� L€M17
Scan o
o Letter of Reappointment
Initials Scan 0
o Copy of Letter pointmentJReappointment e -mai ed CJDMI e Liaison on
Zi 3 / /
Scan o
o B d and Compplication (Completed on
Scan o
o Resum6/Curriculum Vitae
Id
Initials Scan o
o Diversity Statistics Reporting (Completed on/2/6 /
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, 226, 2-458 and 2-459
RECEIVED
✓ County Code Section 2-11.1 - Conflict of Interest and Code of Ethics Ordinance (as
amended through December 2010)
Y' Amendments to the Code of Ethics Ordinance (September 2009 through July 2012)
DEC 06 2021
V Highlights of the Miami -Dade County Ethics Code
* Sunshine Law and Public Records - Frequently Asked Questions
✓ Memorandum - Solicitation by City Board and Committee Members
CITY OF M MI BEACH
ir CLERK
OFFICE 0 (1) Citywide Permit Application (Parking Department Form)
0 Booklet - Guide to Sunshine Amendment & Code of Ethics for Public Officers and Employees
Scan o 4D Source of Income Statement
Scan o G'Acknowledgment of Financial Disclosure Requirement
0 DIVERSITY STATISTICS REPORTING N
Received on:---- J l E�//
Signed by Ai 2
as
Processed on: By Employee: _
_ Dat City
�j
Scanned on: _/� " /_-,? / By Employee:
Date City
COPY in file and ORIGINAL for Annual Report.
Staff Initials
� �i`°=� r�f t�? 1►.. M`s �.... es i s � � ;� S'.." � � ��
Term Expired Letter
Date Processed
Initials Scan 0
Resignation Letter
Date Processed
Initials Scan o
Removal Letter due to absences
Date processed
Initials Scan o
F:ICLERIBOARD AND COMMITTIES DATABASEICHECKLIST MASTERIB&C Checklist 2015 MASTER.docr,
!
ify of W0111i Beath, T AY0("<.��: tiniit�n (a�r.,:v t. iv,., I `cc,xn i',..,.,;h, ((ur:�:i 3:1131 :^.^r :�r.micsr,:il��rhll.c�cv
OFFU OF THE CTTYCtERY, Rafml E_ Grmcdo, Citi Ctark
Tal: 305.673.741 1, fax: 305.673.725x.
E�'cil: Ci'.;4";+?rk=�msrsmil-k.�.htt.g:�r
November 30, 2021
Mr. James Rodgers
401 Ocean Drive, Apt 1103
Miami Beach, FL 33139
RE: Animal Welfare Committee
Dear Mr. James Rodgers:
Congratulations! You have been appointed by Commissioner David Richardson to the above -
referenced Board or Committee, for a term ending: 12/3112022.
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.
Re as,
fael Gr ado
City Clerk
cc: Monica Beltran, Parking Director
Julio Rodriguez, 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
City of Miaini Beach, 170 Ccmvc.nii�r, C,:rnl:,T D'K"'4, Mi;i;ni e`=h, Florio 33139 rra.minn�il»chtl_�ry
GFFtCi' OF, THE CITY CLERK, Rafael E. Grmado, City i. PA
Tel: 305.673.7411, Fax: 305.673.7254
Entail: C9iy�Ic�kinl€� ,itachfi.gat
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Mr. James Rodgers
RE: Animal Welfare 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: 12131/2022.
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.
Mr. James Rodgers
}
Sworn to and subscribed before me th1§171—/ day 0_e ( 021
Agostin
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.
e
City of Miami Reach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: 6Cmiamibeachfl.00v
Telephone: 305.673.741 1
STATE OF FLORIDA
COUNTY OF Miami -Dade
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (check (J) all that apply):
0 1 am a resident of the City of Miami Beach for six months or longer.
I;havp:,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 (109/6) 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 1 have read the foregoing document and that the facts
stated " it are true.
Sig ture Date
James A Rodgers
Printed Name
Sworn to (or affirmed) and subscribed before me, by means of kphysical presence or ❑ online
notarization, this VG day of k'Y� ` 204 by S r SCA A -
Produced ID
Form of Identification
Personally Known
A7:L--\ �
Signature 6TNotary Public
Name of Notary, Typed, Printed, or Stamped
(City of Miami Beach Board/Committee Member).
�s m NOTARY SEAL)
TALRA HIARELLI
Notary public -State of Florida
`
Commission N GG 967309
or rt
My Comm, Expires Mar 9, 2024
Bonded through National Notary Assn.
MIAMI�CZAUE SOURCE OF INCOME STATEMENT Clear From Print Form
RM
Section 2-11.1(1) 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 Namelinitial
2020 [Rodgers James A
Mailing Address - Street Number, Sfreet Name, or P.O. Sox i
401 Ocean Drive, Apt 1103
.._.._...--.......... -....... .... _.._...-_
City, State, Zip ----._...._.__........._._..... ---_-.._ �_._.�
Miami Beach, FL 33139
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 h2e.
Filinq as an Employee (check one)
County ID Public Health Trust E] Municipal:
(Municipality)
_
Department
Position or Title
Employee ID Number
Work address
--
Work telephone '----
(
Employment began onlended on
— ----
Filing as a Board Member (check one)
County fMunicipal:
(Municipality)
Alternate address (if home address is exempt) I Work telephone ITerm began onlended 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
1680 Michigan Ave, Ste 700,
I
Stryder Eyewear, Ile
Skymarc Properties, IIc
Miami Beach, FL 33139
1445 West Ave Ste 9,
Miami Beach, FL 33139
Eyewear Design Firm
i
Real Estate Brokerage
! TD Bank USAA Robin Hood
i—
Assorted Websites _ I
Online Savings/Brokerage accts.
Total interest income for all acct
Less than $300 ver year f
I hereby swear (or affirm) that the information above is a true and correct statement.
Sig Ore of Person Disclosing
4M------
Date signed
RECEIVED®N&VFkl TDENT:
Hardcopy
CJ Electr06E`Eop0 6 2021
CITY OF MIAMI BEACH
OFFICF ("-E: THF CITY CLERK
rREMENIFlf R F0 PRINT, SIGN, AND SUBMIT TO THE Of-FICE OF THE CITY CLERK VIA EMAIL OR HARDCOPY.
CITYWIDE (CW) BOARD & COMMITTEES
City of Miami Beach, PARKING DEPARTMENT PARKING APPLICATION
1755 Meridian Avenue, Suite 200/Miami Beach, F! 33139/Ph: (3051673-7505 or (305) 673-7000 ext. 6200 PARKING
A citywide (CW) parking permit is honored at metered parking spaces and restricted residential zones
parking spaces. A CW parking permit I5 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 of 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.
gnnrri Momkor 1nfnrmntsnn
Date of Application:
Applicant Name:
James Rodgers
_
Board/Committee Name:
Animal Welfare Committee
Address: 401 Ocean Drive, Apt 1103, Miami Beach, FL 33139
E -Mail Address: Jr@miamibeachsrealtor.com
Work Phone:
Home Phone n/a
347-423-5781
Cell Phone: 347-423-5781
Preferred Contact Method: call/text/Email all fine
Tag: AWE M21 Color: Black
State: – — FL Year: 2013
Make: Lexus Model: IS250
Applicant Signature: es/.U`" '-_�
Please provide signeqrm to the Parking Department located at 1755 Meridian Avenue, 2,18 floor. Working
hours are 8:30 to 5:00 p.m. or email to:arkingRec jiggCvatiqlrealibecach
e-mail subjects BOARD & COMMITTEE PARKING APPLICATION — APPLICANT NAME
K9r.rliinn r},arar.r9man4 R,�rtinn
PERMIT SYSTEM
GARAGE ACCESS
Expiralion Date:
ID Card Serial #:
Issued By Print Name:
Print Name:
Signature: XS
Signature: d
Date Issued:
Date Completed:
City of Miami Beach
I r'00 Convention Center Drive
Miami Beach, Florida 33139
vnvw.miarnibecc ;fl.00v
OFFICE OF 1FIE CITY CLERK
Email: I3Q@Miamibeachf1.ggv
Telephone: 305,673,7411
BOARD & COMMITTEE FINANCIAL ACI{NQWt_EDGEMENT 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(1) (2)
Rodgers James A
Last Name u First Name Middle Initial
I understand that no later than duly 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.
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) or
3. A Copy of your latest Federal Income -fax 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 tha 500, 60 days in jail, or both.
Signature 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
FXLERI$ALUREGIBOARD AND COMMITTEE APPLICATIONS FINAL DRAFTSWARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
Cis, of fAianii Beach
1700 Convention Center Drive
Miami Beach. Florida 33139
wo/w..m.iamiheachfL.gov
OFFICE OF THE CITY CLERK
Email: jQ.@.miamibeachfl.gov
Telephone: 305.673.741 1
Rodgers
Last Name
DIVERSITY STATISTICS REPORT
James
First Name
A
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:
Male
Female
Other
' 1 prefer not to answer.
Race/Ethnic Categories:
What is your race?
African American/Black
Q` Asian or Pacific Islander
I Caucasian/White
I--:1 Native American/American Indian
Other — Print Race:
I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
Yes
No
I prefer not to answer.
Do you consider yourself Physically Disabled?
�` Yes
ONo
I prefer not to answer this question.
Page 6 of 6
F:\CLER\$ALLIREG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020