David Doebler 12/31/22M IA M I B EACH
BO ARD AND COMM ITTEE CHECKLIST
APPOINTEE: David Doebler DATE OF APPOINTMENT: 12/14/2021
FOR SCANNER FOR CLERK STAFF
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BOARD/COMMITTEE: Marine & Waterfront Protection Appointed by: Alex Fernandez
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o Letter of Appointment
o Letter of Reappointment
o 'fJ! of L tt ~~/tment/Reappointment e-o/3iledïto Committee
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o Resumercuricutoum vae )fjj] o j
o Diversity Statistics Reporting (Completed on/z///. 9]
o Oath
Liaison on
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 2010)
✓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
CITY O F MIAM I BEACH ✓Memorandum - Solicitation by City Board and Committee Members
OFFICE O F THE CITY CLERK
RECEIVED
DE C 15 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
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Received on:
o Acknowledgment of Financial Disclosure Requirement
O DIVERSITY STATISTICS REPORTING ='' ORIGINAL for Annual Report.
12/14/2021 Signed by X
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-Date/
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Scanned on: /é}- /J<:[~ / By Employee: --~---r7''--------------- z
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:ICLER\BOARD AND COMMITT IES DATABASEICHECKLIST MASTERIB&C Checklist 2015 MASTER.docx
We are committed to providing excellent public servce and safety to all who le work and olay in cur vbart tcpcal hustnc communNy
MIAMI BEACH
City of Miami Beach, 1/OO Convention Conter Drive, Miami Booch, Horida 33 139 yyw_miamibachllgo
OFFICE OF THE CITY CLERK, Rafael E. Granado, City Clerk
Tl: 305.673.7411, Faxe 305.673.7254
Email: CiNyClerk @miamibeach fl.gov
December 14, 2021
Mr. David Doebler
800 West Ave, #212
Miami Beach, Florida 33139
RE: Marine and Waterfront Protection Authority
Dear Mr. David Doebler:
Congratulations! You have been appointed by Commissioner Alex Fernandez to 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,
R~anado
City Clerk
cc: Monica Beltran, Parking Director
Kenneth Varela, 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
MIAMI BEA CH
C ity o f M ia m i B e a ch , 1ZOO Convention Conter Drive, Miami Boach, Horida 33 139 yyw_miamibachll.goy
OFFICE OF THE CITY CLERK, Rafael E. Granado, City Clerk
Tl:. 305.673.7411, Fax. 305.673.7254
Email: CiNyClerk@miamibeachfl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
T O : M r. D avid D oebler
R E : M a rine and W aterf ront Pro tection A uthority
I do so le m nly sw ea r or affi rm to bear true faith, loyalty and allegiance to the Govern m ent of the U nited
States, the State of Florida, and the C ity of M iam i Beach, and to perf orm all the duties of a m em ber of the
above-m e ntione d board or com m ittee of the C ity of M iam i Beach to w hich I have been appointed fo r a
term ending: 12/3 1/2022.
T o m y colle a gu e s and to all of those I represent and serv e, I pledge fairn ess, integrity and civility, in all
actions taken and all com m unications m ade by m e as a public serv ant.
I ha ve be e n issu ed a copy of section 2-11.1 of the M iam i-D ade C ounty C ode (Conflict of Interest and
C ode of Ethics O rdinance), as w ell as Florida C om m ission on Ethics Guide to the Sunshine Am endm ent
and C ode of Ethics fo r Public O ff icers and understand that as a m em ber of a C ity of M iam i Beach Board
and/or C o m m itt ee , I m ust com ply w ith the financi al di scl osure requirem en t s of M iam i-Dade County or the
State of F lo rida (depending on the board or com m ittee on w hich I serv e) on July 1st, follow ing the closing
of the cale ndar yea r on w hich I have serv ed. 2EE
M r. D avid D oebler
sw om t o ans suoscor ne a »tore n e w //a b)ç,,
pl e a se vi si t the C ity of M iam i Beach w ebsite at www .m ia m ibeachfl.gov under City Clerk/Board and
C om m itt ees fo r add itional info rm ation regarding the Financial D isclosure Requirem ents.
MIAMI BEACH
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 FLORIDA
COUNTY OF MIAMI-DADE
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4), as (check
(✓)all that apply):
'1' I am a resident of the City of Miami Beach for six months or longer.
Home Address 800 West Ave, Apt 212, Miami Beach, FL 33139
□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).
Name of Business _
Business Address -------------------------
□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}.
Name of Business _
Business Address _
"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 enalties of perjury, I declare that I have read the foregoing document and that the facts stated in it
5/true
/ 12/14/2021
Date
David Doebler
Printed Name
NOTARY
E.%"7 76"TEE"
X Produced ID 7 E ". 6i identification
all Known
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Name of Notary, Typed, Printed, or Stamped
ARY SEAL /~A~-:~~\ CHARLES J. DAGOSTIN ~ i;; ¿? MY COMMISSION # HH 165705
%$5 2 EXPIRES: December 14, 2025 •,·i6°· p at a '+ "f,'°" oded Thru Notary Public Underwriens
M IA M I B EA C H
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachll.gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
BOARD & COMMIIIEE 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)
Doebler David J
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 than $500, 60 days in jail, or both.
.2# 12/14/2021
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.
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F:\CLER\$ALL\REG \BO ARD AND CO M M ITT EE APPLI CATIO NS FINAL DRAFT S\BOARD AND COMMITT EE APPLICATION REG FINAL.dccx
Updated: June 2020
MIAMl·DADE- EE
Clear From Print Form
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 Name First Name Middle Name/Initial
2020 Doebler David J
Mailing Address - Street Number, Street Name, or P.O. Box
800 West Ave, Apt 212
City, State, Zip
M ia m i B ea c h , FL 33 13 9
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 che ck Hele.
Filing as an Employee (check one)
□County O Public Health Trust [] M unici pal:
(Municipality)
Department
Position or Title Employee ID Number
W ork address I Work telephone Employment began on/ended on
Filing as a Board Member (check one)
O County J Municipal : City of M iam i Beach
(Municipality)
Board where serving
Marine & Waterfront Protection Authority
Alternate address (if home address is exempt) I Work telephone I Term began on/ended on
954-415-7 434
List below every source of inco m e you rece ived, 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 source s of inco me 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 fo r your benefit. However, the income of your spouse or any business partner need not be disclosed. If continued on a separate sheet, check here. O
Name of Source of Income Address Description of the Principal Business Activity
Mission Critical Systems, Inc 1347 East Sam ple Road, Pom pano Beach 3306 4 Internet Security
Miami-Dade Coastal Cleanup, Inc 800 West Ave, Apt 212, Miami Beach, FL 33139 Marine Debris Non-Profit
Rental Income 833 West Ave, #404, Miami Beach, FL 33139 Rental Income
I hereby swear (or affirm) that the inform ation above is a true and correct statement. RECEIVED BY ELECTIONS DEPARTMENT:
%E "nEçEIVED [] Electronic 'opy
Signature of Person Disclosing DEC 15 2021
12/14/2021
Date signed CITY O F M IAMI BEACH
(I I r /rrr- r - - -~ '
REMEMBER TO PRINT, SIGN, AND SUBMIT TO THE OFFICE OF THE CITY CLERK VIA EMAIL OR HARDCOPY.
M IA M I B EA C H
City of Miami Beach
l 70 0 Convention Center Drive
Miami Beach, Florida 3313 9
www.miamibeach[].gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7 411
DIVERSITY STATISTICS REPORI
Doebler David 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:
Z0 Male
O Female
O Other
O I prefer not to answer.
Race/Ethnic Categories:
What is your race?
O African American/Black
O Asian or Pacific Islander
/I Caucasian/white
O Native American/American Indian
O Other - Print Race: ------------- □I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
ves
Z4No
O I prefer not to answer.
Do you consider yourself Physically Disabled?
aves
o
O I prefer not to answer this question.
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F:\C LER \$ALL\REG\BO ARD AND CO M M ITT EE APPLI CATIO NS FINAL DRAFT S\BOARD AND COMMITT EE APPLICATION REG FINAL.docx
Updated: June 2020
M IA M I BEACH C ITY W ID E {C W ) BO A RD & C O M M ITT EES a City of Miami Beach, PARKING DEPARTMENT PA RKIN G A PPLI CATIO N
1755 Meridian Avenue, Suite 200/Miomi Beach, FL 33139 /Ph: (305) 673-7505 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 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
dam age, I will be responsible to pay a $10.00 replacem ent fee.
Board Member Information
Date of Application: 12/14/2021
Applicant Name: David Doebler
Board/Committee Name: Marine & Waterfront Protection Authority
Address: 800 West Ave, Apt 212, Miami Beach, FL 33139
E-Mail Address: dave.doebler@gmail.com
Work Phone: Home Phone
Cell Phone: 954-415- 7 434 Preferred Contact Method: Cell
Vehicle Information
Tag: KPSJ38 Color: Blue
State: FL Year: 2019
Make: Kia Model: Niro
Applicant Sianature: e 7274
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 subject: BOARD & COMMITTEE PARKING APPLICATION - APPLICANT NAME
Parkina Department Section
PERMIT SYSTEM GARAGE ACCESS
Expiration Date: ID Card Serial #:
Issued By Print Name: Print Name:
Signature: Signature: e
Date Issued: Date Completed:
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DAVID JASON
DOEBLER
800 WES T AVE APT 21 2
MIAMI BEACH, FL 33139-5579
DOB: 08-17
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