Johann Moore 12/31/23M IA M I BEACH
BO ARD AND COMM ITTEE CHECKLIST
APPOINTEE: ""N""""""° ATE OF APPOINTMENT: 'UU?"!
sooncorreEe """""" """ """" Asome4 r_co"oer"me co"
FOR SCANNER
Scan o
Scan o
FOR CLERK STAFF
o Letter of Appointment
o Letter of Reappointment
o Copy of Letter of Appointm ent/R eappointmen t e-m ailed to
121 14/2021
o oar@ an @ Committee Application (completed on ""07?O'
o Résumé/Curriculum Vitae 12/16/2021
o Diversity Statistics Reporting (Completed on. _
o Oath
reo avo. "" verro. """
Committee Liaison on
Scan o
Scan o
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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 RECEIVED amended through December 2010 )
✓Amendments to the Code of Ethics Ordinance (September 2009 through July 2012)
[ 2 0 2021 ✓Highlights of the Miami-Dade County Ethics Code DE ✓Sunshine Law and Public Records- Frequently Asked Questions
✓Mem orandum - Solicitation by City Board and Committee Members
CITY OF MIAMI BEACH
OF FI CE OF THE CITY CLER 3t/wide Permit Application (Par king Departm ent Form)
o Booklet - Guide to Sunshine Amendment & Code of Ethics for Public Officers and Employees
Scan o
Scan o
o Source of Income Statement
Scanned on:
o Acknowledgment of Financial Disclosure Requirement
O DIVERSITY STATISTICS REPORTING Keep COPY in file and ORIGINAL for Annual Report.
1 D E 20 21_sones»y X 1ola. M ooyc
Date Board or Committee Member
12/16/2021 Cuaba D'Aaeatz Processed on:_ B y Em ployee: 4
City Clerk's Office Staff Initials
a so ._ acere
City Clerk's Office Staff Initials
Received on:
Date
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 COMMITT IES DATABASE\CHECKLIST MASTER\B&C Checklist 2015 MASTER.docx
We are committed to providing excellent public service and safety to all who live, work, and play in our vibrant, topical histonic community
M IA M I BEACH
City of Miami Beach, I/OO Convention Canter Drivo, Miami Bo ach , Florida 33 139 yyw._miaIiboachllgov
OF FICE OF THE CITY CI ERK, Raf0ol E. Gr an ad o, Cy Cl erk
Tel: 305.673.7411, Fax. 305.673.7254
Email: CiyClerk@mi amibeach tl.gov
December 14, 2021
Mr. Johann Moore
717 Jefferson A ve . Apt 8
Miami Beach, Florida 33139
RE: Com mi tt ee on th e Hom eless
Dear Mr. Johann Moore:
Congratulations! You have been appointed by Com m issioner Kristen Rosen Gonzalez to the above-
referenced Board or Committee, for a term ending: 12/31/2023.
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. R~l)fi
Rafael Granado
City Clerk
cc: Monica Beltran, Parking Director
Janay Guerrero, City Liaison
ENCLO SURES:
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 - Am en dmen t to City Code Section 2-22
Miami-Dade County Code Section 2-11.1- Con flict of Interest and Code of Ethics
City Wi de Permit Application - (Parking Department Form)
Booklet - Guide to the Sunshine Amendment and Code of Ethics for Public Officers and Employees
M IA M I BEACH
City of M iam i Beach, 1/O0 C on von lion Conter Drive, Miami Boach, Eorida 33 13 9 yNyyw.m iam i bca ch l]goy
OFFICE OF THE CITY CL ERK, Rafaol E. Granado, City Clerk
Tol: 305.673.7411, Fax. 305.673.7254
Email: CiyClotk@miamibeachll.gov
Oath of Office
Oath of Civility
and
Acknowledgements
T O : M r. Jo hann M oo re
R E : C o m m itt ee on the H om e le ss
I do so le m n ly sw ea r or affi rm to be a r true fa ith, loyalty and allegiance to the G overn m ent of the U nited
States, the State of Florida, and the C ity of M iam i Beach, and to perform all the duties of a m em ber of the
above-m e ntio n e d bo a rd or com m itt e e of the C ity of M iam i Beach to w hich I have been appointed for a
term en din g: 12/31/2023.
T o m y colle ag ue s and to all of tho se I represent and serve, I pledge fairn ess, integrity and civility, in all
actio ns taken and all com m unicatio ns m ade by m e as a public serv ant.
I ha ve be e n issued a co p y of se ction 2-11.1 of the M iam i-D ade C ounty C ode (C onflict of Interest and
C o de of Ethics O rdin a nce), as w ell as Florida C om m ission on Ethics G uide to the Sunshine A m endm ent
and C o de of Ethics fo r Pub lic 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 u st com p ly w ith the financi al di scl osure require m ents of M iam i-D ade C ounty or the
State of F lo rida (d epe nding on the board or com m itt ee on w hich I serv e) on July 1st, fo llow ing the cl osing
of the cale nda r yea r on w hich I have se rv ed.
)ola M oove
? M r. Johann M oore
16th Dec
Sw orn to and subscribed befo re m e thi s day of 2 021
Charles D'Agostin
Deputy Clerk
*P le a se visit the C ity of M ia m i Bea ch w ebsite at w w w .m iam ibeachfl.gov under C ity C lerk/B oard and
C o m m itt ee s fo r add itional info rm atio n regarding the Financi al Di sclosure R equirem ents.
MIAMl·DADE- EI SOURCE OF INCOME STATEMENT
Section 2-11.1() of the County Ethics Code requires that certain em ployees and public officials file a financial disclosure Statem ent on a yearly basis by July 1st
of every year.
Disclosure fo r Tax Year Ending ¡ Last Nam e First Nam e Middle Name/Initial
2020 Moore Johan n
M ailing Address - Street Num ber, Street Nam e, or P.O . Box
717 Jefferson Ave. Apt 8
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 follow ing page and check Hel e.
Filing as an E m ployee (check one)
□County □Public Health Tru st D Municipal:
(Municipality)
De p art m e n t
Position or Title Employee ID Num ber
W ork address I W ork telephone Employment began on/ended on
Filing as a Board M em ber (check one)
O County D M unicipal:
(Municipality)
Board w here serv ing
Altern ate address (if hom e address is exem pt) I W ork telephone I Term began on/ended on
List below every source of incom e you rece ived, along with the address and the principal activity of each source. Include your public salary . Place the sources of
incom e in descending order, with the largest source first. Exam ples of source s of inco m e include: com pensation for serv ices, income from business, gains from
propert y dealings, interest, rents, dividends, pensions, IRA distributions, and social security paym ents. Also, include any source of income received by another
person fo r your benefit. However, the incom e of your spouse or any business partner need not be disclosed. If continued on a separate sheet, check here. []
Nam e of Source of Incom e Address Description of the Principal Business Activity
Robert Goldring, Spouse 717 Jefferson Ave. SGS North America
Mia.m¡ Pea.oh PT, 33139
I hereby swear (or affi rm) that the info rmation above is a true and correct statement.
Joav M oove
Signature of Person Disclosing
16 D E C 2 0 2 1
Date signed
RECEIVED BY ELECTIONS DEPARTMENT:
O Hardcopy
{/ Electron ic Copy
Received December 16, 2021
Office of the City Clerk
REMEMBER TO PRINT, SIGN, AND SUBMIT TO THE OFFICE OF THE CITY CLERK VIA EMAIL OR HARDCOPY.
M IA M I 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):
~ I am a resident of the City of Miami Beach for six months or longer.
Home Address 717 Jefferson Avenue, Apt 8, 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 penalties of perjury, I declare that I have read the foregoing document and that the facts stated in it
are true. Jolavv Moore 16 D& 2O21
Signature Date
Jo han n M oore
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of o physical presence or online notarization,
_________ (City of Miami Beach Board/Committee Member).
this 16thuay or December ,2o21_y Johann Moore acccccccacccccecceeeen$
ii%., CHARLES J. DAGOSTIN
¿?% À"? wcowIssoN 4 +H 165705
è, 2%,a.¿sé ExIREs: Docom ber 14, 2025
$;3$" ponded Tru Notary Public Underwriters
i i »
X Produced ID
Form of Identification
Personally Known
Caal. D'A, cut,
Signature of Notary Pubtc6
(NOTARY SEAL)
Name of Notary, Typed, Printed, or Stamped
MIAMI BEACH
City of Miami Beach
1 700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfl.gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7 411
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)
Moore Johann L
Last Name First Name Middle Initial
I understand that no later than July 1, of each vear 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.
ne 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.
Jola Moove 1 Dec. 2021
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:ICLEK\$ALL\Kl::G\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
M IA M I B EA C H
City of Miami Beach
1 700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeach[l.gov
OFFICE OF THE CITY CLERK
E m ail: BC @m i ami be ach fl .gov
Telephone: 305.673.741 l
DIVERSITY STATISTICS REPORI
Moore Johann L
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:
XJ Mae
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
LS Caucasian/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?
ves qo
O I prefer not to answer.
Do you consider yourself Physically Disabled?
Cl ves
Jo
O I prefer not to answer this question.
Page 6 of 6
F:\C L E R \$A LL\R E G \B O A R D A N D C O M M ITT E E A P P LI C A T IO N S FIN A L D R A FTS\BO A R D A N D C O M M ITT EE A PP LI C ATIO N REG FIN A L.docx
Updated: June 2020
M IA M I BEACH 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 1305) 673-7000 ext. 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: 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:
Applicant Name: Johann Moore---parking application not needed at this time
Board/Committee Name:
Address:
E-Mail Address:
Work Phone: Home Phone
Cell Phone: Preferred Contact Method:
Vehicle Information
Tag: Color:
State: Year:
Make: Model:
Applicant Sianature: e
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
p ·ki D ar mna epartment ection
PERMIT SYSTEM GARAGE ACCESS
Expiration Date: ID Card Serial #:
Issued By Print Name: Print Name:
Signature: 6 Signature: e
Date Issued: Date Completed:
s
ta
PARKING
:pmg man rar' torms cw oarls«committees pat.angtorm.doc orm up tare
FPL.com Page 1 E001
Hello Johann Moore,
Here's what you owe for this billing period
Electric Bill Statement
For: Oct 18, 2021 to Nov 16, 2021 (29 days)
Statement Date: Nov 16, 2021
Account Number: 47368-10260
Service Address:
717 JEFFERSON AVE APT 8
MIAMI BEACH, FL33139
CURRENT BILL
$57.93
TOTAL AMOUNT YOU OWE
Dec 7, 2021
NEW CHARGES DUE BY
ENERGY USAGE HISTORY
80o kwh
=tliltitll1
OkWh, ······O
N D J F M A M J J A S O N 2020 2021
BILL SUMMARY
Amount of your last bill
Payments received
Balance before new charges
Total amount you owe
71.60
-71.60
o.oò
57.93
$57.93
FPL automatic bill pay - DO NOT PAY
(See page 2 for bill details.)
KEEP IN MIND
• Payments received after December 07, 2021 are considered late; a late
payment charge, the greater of $5.00 or 1.5% of your past due balance will
apply. Your account may also be billed a deposit adjustment.
• The amount due on your account will be drafted automatically on or after
November 27, 2021. If a partial payment is received before this date, only
the remaining balance due on your account will be drafted automatically.
Customer Service:
Outside Florida:
(305) 442-8770
1-800-226-3545
Report Power Outages:
Hearing/Speech Impaired:
1-800-4OUTAGE (468-8243)
711(Relay Service)
G
FPL.
I 3¥ FPL AUTOMATIC BILL PAY - DO NOT PAY ¥
The amount enclosed includes
the following donation:
FPL Care To Share:
Make check payable to FPL
in U.S. funds and mail along with
this coupon to:
JOHANN MOORE
717 JEFFERSON AVE APT 8
MIAMI BEACH FL 33139-8553 FPL
GENERAL MAIL FACILITY
MIAMI FL 33188-0001
Visit FPL.com/PayBill
for ways to pay. 47368-10260 ] ( $57.93 ] ( Dec 7, 2021
'-------~
S Auto pay - DO NOT PAY
ACCOUNT NUMBER TOT AL AMOUNT YOU OWE NEW CHARGES DUE BY AMOUNT ENCLOSED