John Lee 12/31/23MI MIBE
BOARD AND COMMITTEE CHECKLIST
APPOINTEE:::::--,,\ D\--vf\ \ ft DATE OF APPOINTMENT: 12/9/2021
BOARD/COMMITTEE . D)/>(\ _Appoi nted by. 'n o.-. \clot
FOR SCANNER
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FOR CLERK STAFF
o Letter of Appointment
o Letter of Reappointment
o P9%o ketter of Appointment/Reappointment e-mailed
o Board and Committee Application (Completed on "?""?0'
o Résumé/Curriculum Vitae 1/4/2022
o Diversity Statistics Reporting (Completed on _
o Oath
TERM END: TERM LIMIT: _ 12/31/23 12/31/23
to Committee Liaison on
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Received January 5, 2022
Office of the City Clerk
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 201 O)
✓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
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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
o Acknowledgment of Financial Disclosure Requirement
O DIVERSITY STATISTICS REPORTING Keep COPY in file and ORIGINAL for Annual Report.
12/22/2021 X John LeelJL
Received on: Signed by ---------------------
Scanned on:
Date Board or Committee Member
14n2022 Caaba 'Aaeut Pressed on.[3yE_mpl0fee. (/
City Clerk's Office Staff Initials ca«pg [\y l [)]/g},
City Clerk's Office taff Initials
Date
1/4/2022
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 COMMITTIES DATABASE\CHECKLIST MASTER\B&C Checklist 2015 MASTER.docx
to are commuted to providing excellent public service and to all who five, work, and play in our vibrant, topical, historic community.
M IA M I BEACH
City of Miami Beach, ZOO Convention Cantor Drivo, Miami Boa ch, Florida 33 139 ywyw._miamnibeachll.gov
OF FICE OF THE CITY CIERK, Raf0ol E. Gr an ad o, City Cl erk
Tol: 305.673.74 1, Fax. 305.673.7254
Email: CiyClerk@miamibeachll.gov
December 20, 2021
Mr. John Lee
20 Island Avenue #402
Miami Beach, Florida 33139
SUBJECT: M arine and W aterfront Protection Authority
Congratulations! You have been reappointed by Com m issioner David Richardson to the above
referenced, board or committee named above, 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.
Congratulations and good luck. Reg721
Raf¿Granado
City Clerk
cc: Monica Beltran, Parking Director
Kenneth Varela, City Liaison
ATT A CHM ENTS:
Letter of Appointment
Oath
City Code/Ordinance section applicable to agency, board or committee
City Code Section 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 Ordinance
City Wide Permit Application - (Parking Department Form)
Booklet - Guide to the Sunshine Amendment and Code of Ethics for Public Officers and Employees
MI
City of Miami Beach, 1/OO Convention Coner Drive, Miam i Boach, Horida 33 139 gs¿yy_miaribgachfl_go
OFFICE OF THE CITY CLERK, Rafael E. Granado, City Clerk
Tel: 305.673.7411, Fax. 305.673.7254
Emai l: CityCl erk@miamibeach fl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Mr. John Lee
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: 12/31/2023.
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)~
of the calendar year on wh ich I have served.
(___ /------- -· /4 Mr. GAA-t'.èe
Sworn to and subscribed before me this ¿ L day of~, 2021
Charles 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.
MIA\tB
City of Miami Beach
1700 Convention Center Drive
M iami 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
() a/fat apply):
/ I am a resident of e City of Miami Beach for six months or longer.
tore A«aress I Itou- 'tit" V'si
□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).
[]qr (f [/1 [P S S
p1[,[n,, J (}]F ,bi.
□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 -------------------------
],[P S,, J]]FPS,3-
"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.
t I have read the foregoing document and that the f cts stated in it
/ /re? Z 'O
Date s
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of #physical presence or online notarization,
. 22nd, December John Lee this _-aay of , 20~by _
_________ (City of Miami Beach Board/Committee Member).
FL. Driver's License X Produced ID
Form of Identification
Personally Known
Ciao, 'peat
Signature of Notary Pullf
C h a rle s J. D 'A g o stin
9 e s , CHARLE S J. DAGOS TIN ff@,7 wgm±EE#ks
#j¿, ¿$S EXPIRES: December 14, 2025
"·;;{$% Bonded Tu Notary Public Underwriters i»
(NOT ARY SEAL)
Name of Notary, Typed, Printed, or Stamped
M IA M I
EmI SOURCE OF INCOME STATEMENT
Section 2-11.1(@) 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
2020
First ame ovo Middle Namellnitial
City, State, Zip
d3 (
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 Heile.
Filing as an Em ployee (check one)
DJ county [ P ublic Health Tr ust [] M u nicipal :
(Municipality)
Departm ent
Position or Title Employee ID Number
Work address ¡ Work telephone Employment began on/ended on
Filing as a Board Member (check one)
[] county [ Municipal: \t (\o9y 2,€Ac
(Municipality)
Board where serving
wk kon Pool- \«kot/ /\/ \
Alternate address (if home address is exempt) ¡ Work telephone ¡ ·rerm began on/ended 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. D
Name of Source of Income Address Description of the Principal Business Activity
d correct statement.
Signature of Person, iisclosing
!3ilo
RECEIVED BY ELECTIONS DEPARTMENT:
O Hardcopy
/ Electronic Copy
Received January 4, 2022
Office of the City Clerk
REMEMBER TO PRINT, SIGN, AND SUBMIT TO THE OFFICE OF THE CITY CLERK VIA EMAIL OR HARDCOPY.
MI A#I BE H
C ity of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfl.gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Tele phone: 305. 673.741 1
BOARD & COMMITTEE FINANCIAL ACKNOWLEDGEMENT STATEMENT
Acknowledgement of fines/suspension for Board/Committee Members for failure to comply with Miami- \¿ ~ade C oun ty Financial D isclosure C 3 ~ ~e Sectio n 2-11 .1(i) (2)~
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.
e n
Signature
iami-Dade County Code, may subject the person to a fine
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 IBO ARD AND CO M M ITT EE APPLI CATIO NS FINAL DRAFTS\BOARD AND CO MMITT EE APPLICATION REG FINAL .docx
Updated: June 2020
MIA\l
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachl].goy
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
DIVERSITY STATISTICS REPORT
Last Name First Name
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:
l Male
O Female
Lloher
O I prefer not to answer.
Race/Ethnic Categories:
What is your race?
O African American/Black
O Asian or Pacific Islander
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?
L2ves
l1No
Ll prefer not to answer.
Do you consider yourself Physically Disabled?
ayas
Li o
O I prefer not to answer this question.
Page 6 of 6
F:IC LE R \$A LLIRE G \B O A RD A ND C O M M ITT E E A PP LI C A TIO N S FIN A L D R A FTS\B O A RD A N D C O M M ITT E E A PP LI C A TIO N RE G FINAL .docx
Updated: June 2020
MIA CITYWIDE {CW) BOARD & COMMITTEES
City of M iam i B each , PA R K IN G D EP A R T M E N T PARKING APPLICATION
1755 Meridian Avenue, Suite 200/Miami Beach, FL 33139 /Ph: (305) 673-7505 or (305) 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 $10.00 replacement fee.
Board Member Information
Dote of Application: e 07, 26\
Applicant Name: l0ho Leo
Board/Committee Name: wo0 ?¥
Address: 0, \,\o0A \se '1o1 /9\t el {O 33136
E-Mail Address: \11\ ? \ko1 v-al0 C o
Work Phone: Home Phone
Cell Phone: 306 5 Preferred Contact Method:
Vehicle Information
Tag: +45190 Color: w«Mk
State: #L0\ Year: tozo
Make: -0£D0 Model: p$ape
Applicant Sianature: e
Please provide signed form to the Parking Depar tment 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 Ina epar'men ecton
PERMIT SYSTEM GARAGE ACCESS
Expiration Date: ID Card Serial #:
Issued By Print Name: Print Name:
Signature: e Signature: eí
Date Issued: Date Completed:
t tS ·ti
.pmng man rar torms cw oatds!committees parmgorm.doc