Matthew Gultanoff 12/31/23M IA M I BEACH
B O A R D A N D C O M M IT T EE C H E C K L IST
APPOINTEE: Matthew Gultanoff
oARDcoMMrrr.lPBPF Aromntea by: Commissioner Rosen Gonzalez
sep2/3/%. 12/31/7
DATE OF APPOINTMENT: 12/14/2021
FOR SCANNER
Scan o
Scan o
FOR CLERK STAFF
Scan o
Scan o
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o Letter of Appointment
o Letter of Reappointment
o p /º~8/er of ~rntmenUReappointment e-maile~tto Committee Liaison on
·'s6a an d corrftes 6oicao comtetes a/h//_S_/ o)/
o Résumé/Curriculum Vitae )) /)-5 ,
o Diversity Statistics Reporting (Completed on_' „O) f
o Oath
RECEIVED
DEC 20 2021
CITY OF M IAM I BEA CH
O F FIC E O F TH E C ITY C LER K
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
✓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 Requirement
O DIVERSITY STATISTICS REPORTING Keep COPY in file and ORIGINAL for Annual Report.
Received on: 12/17/2021 Signed by X /s/ Mat ew Gultanoff
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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:\C LER\BO ARD AND CO M M ITT IES DATABASE\CHECKLI ST MASTER\B&C Checklist 2015 MASTER.dccx
WVe are committed to ro d in g excelle nt public senwce and sa fety to all who le work and olay n our vbwart tcpcal historc communy
M IAMI BEACH
City of Miami Beach, I/OO Convention Cen ter Drive, Miami Booch, Florida 33 139 yaw _miaIiba chllgo
OFFICE OF THE CITY CLERK, Rafool E. Granado, City Clerk
Tel: 305.673.7411, Fax. 305.673.7254
Emal: CiNyClerk@miamibeachfl.gov
December 14, 2021
Mr. Matthew Gultanoff
125 JEFFERSON AVE #122
MIAMI BEACH, FL 33139
RE: Transportation, Parking and Bicycle-Pedestrian Facilities Committee
Dear Mr. Matthew Gultanoff:
Congratulations! You have been appointed by Commissioner Kristen Rosen Gonzalezto 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.
Rega~
Rafal ran ado
City Clerk
cc: Monica Beltran, Parking Director
Monica Beltran, 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 BEACH
City of Miami Beach, 1ZOO Convention Conter Drive, Miami Boach, Horida 33139 yyw_miamibachll_go
OFFICE OF THE CITY CLERK , Rofool E. Gronodo, CiNy Clerk
Tel: 305.673.7411, Fac 305.673.7254
Email: CityClerk@miamibeachfl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Mr. Matthew Gultanoff
RE: Transportation, Parking and Bicycle-Pedestrian Facilities 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: 12/31/2023.
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.
ls Matthew Guttanof_-
Mr. Matthew Gultan off T
Sworn to and subscribed before me thisl7(J ¡)c:=t:_ 1
*Please visit the City of Miami Beach website at ww w.miamibeachfl.gov under City Clerk/Board and
Committees for additional information regarding the Financial Disclosure Requirements.
M IA M I BEACH
City of Miami Beach
l 700 Convention Center Drive
Miami Beach, Florida 33139
OF H CE O F IH E CI IY CL ERK
Em ai l: 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):
oc I am a resident of the City of Miami Beach for six months or longer.
Home Address 125 Jefferson Ave #122, Miami Beach, FL 33139
o 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 _
o 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 l h3y e read the foregoing document and that the facts stated in it
are true/s/ Matthew Gultanof/ a 12/17/2021
Signature ~ -□-a-te _
Matthew Gultanoff
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means o~ysical presence or o online notarization, e'_ab)e..re?{
k Produced ID " 7E SST Form of Identification
Signat
Name of Notary, Typed, Printed, or Stamped
sggié,, CRIE@
: <:'~~- o ~•"' -nQV;;, JIN rJ ¿;; ¿. MY COMMISSION # HH 16s7os
3; EXPIRES; pa- ";;55' rt3:v0comber 14, 2025 , 'FF's° Dyda4 r ..
¿.5° 90ed Ihu Notary Public Underwriter
M IA M I BEACH
City of Miami Beach
17 0 0 C onvention C enter Drive
M iam i Beach, Florida 33139
www.miamibegchfl, goy
O FFICE O F TH E CI TY CL ERK
Email: BC@miamibeachfl.gov
Telephone: 305 .673.7 41 l
DIVERSITY STATISTICS REPORI
Gultanoff Matthew
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:
Male
O Female
O Other
[Xl t prefer not to ans w er.
Race/Ethnic Categories:
What is your race?
O African American/Black
O Asian or Pacific Islander
O Caucasian/White
O Native American/American Indian
O Other- Print Race: _
[l I prefer not to ans w er.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
lyes
Lo
[U 1 prefer not to ans w er.
Do you consider yourself Physically Disabled?
lves
No
Ll ¡pr e fer not to ans w er this question.
Page 6 of 6
F:ICLER\$ALLIREG \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
M IA M I BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeach[l.gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
BOARD & COM MIIIEE FINAN CIAL 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)
G u ltanoff M atthew
Last Name First Name Middle Initial
I understand that no later than July1of 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.
/s/ M atth ew G ultanoff 12/1 7/2021
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:IC LER \$ALLIREG \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
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