Gus Briand 12/31/22MI A MIBEA CH
BOARD AND COM MITTEE CH ECKLIST
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OARDrcoMMrrrEE:_[l'5@ 8p, ArÜAI, COMM\yd4pointed oy. Keg»eo) Al.
voe.l/22o»//3//9 FOR SCANNER
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FOR CLERK STAFF
o Letter of Appointment
o Letter of Reappointment
o f/:J!l/~1f ~r Appointment/Reappointment e_:ailed to Committee Liaison on
o3oar 'and Committee Application (Completed on_. )
• esumerçorcom vtié //[,] o3j
o Diversity Statistics Reporting (Completed on. , LO 3$HT>
º Oath
RECEIVED
JAN -6 2022
CITY OF MIAMI BEACH
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 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
Scan o
Scan o
Processed on:
Scanned on:
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
y ODIVERSITY STATISTICS REPORTING _Keep !¿OP Y in file and ORIGINAL for Annual Report.
Received o:_p,_ 'Lt Q7_sea »y IM!Ml"I
//7)o22a»» od
)ate
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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, tropical, historic community.
M IA M I BEACH
City of M ia m i B e a ch , 1/O0 Convention Conter Drive, Miami Boa ch, Horida 33 139 yyyw_miam ibca chl].go
OF FICE OF THE CITY CLERK, Raf0ol E. Gr an ado, City Cl erk
Tel: 305.673.74 11, Fax. 305.673.7254
Emai l: CiNyCl erk @mi am i beach fl.gov
December 14, 2021
Mr. Gustavo Briand
947 Lenox Ave. Apt 503
Miami Beach, Florida 33139
RE: Hispanic Affairs C om m ittee
Dear Mr. Gustavo Briand:
Congratulations! You have been appointed by Com m issioner Kristen Rosen Gonzalezto 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.
; .cs-.
City Clerk
cc: Monica Beltran, Parking Director
Leonor Hernandez, City Liaison
ENC LO 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 - 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, 1/OO Convention Conter Drivo, Miam i Boach, Forida 33 139 wyw_miamIibcachl]goy
OFFICE OF THE CITY CLERK, Rafa»l E. Granado, City Clerk
Tal 305.673.7411, Fox. 305.673.7254
Email: CityClerk@miamibeachfl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Mr. Gustavo Briand
RE: Hispanic Affairs Committee
l 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: 12/31/2022.
To my colleagues and to all of those I represent and serve, I pledge fairness, integrity and civility, in all
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. · ' ¡pìì)
Mr.~Brianá
Sworn to and subscribed before me this o
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.
M IAM I BEACH
City of Miami Beach
1 700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305 .673 .7 411
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 Aaares _9hl La)o pué A _0 Ml 4FL33134
'(f 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 ot Business éßSny o ß2up Sn/1O
Business Address I7O1 _UNSg [2_ o ¿ß- DR. n [C MA3y 1 33136
'if 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 M iam i Beach (for a minimum of six months).
Name ot Business ( v Sn 9 2u A y 6rV ]O
Business Address _$4 _AS y2
"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 p JU , declare that I have read the foregoing document and that the facts stated in it
are true. ]-4-2027
Signature Date
Printed Name
N O T A R Y
Sworn to (or affirmed) and subscribed before me, py means of u physical presence or online notarization,
o,_00U88,22M.6u S/U 3 4
(Cit of Miami eac~ Board/Comze Member). ,..~ ... !.! .... ~ .. !!!!!!!!!!!!!!!~~!!!!!!!~!!!!!!!!!!!!!!~ X eco - J u> -co i4 #%fe .fzizz.
orm of Identification [Éj,„gdiÉ ExPREs: Docomtor 14, 2025
OW, > í#;jji&' Bonded Thru Notary Public Underwriters
(NOTARY SEAL)
N a m e o f N t a r; T u n e r{ printer or S tamn e rd
MIAMI. EM 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 Last Name First Name Middle Name/Initial
2020 4 ' O097ANO M.
"#r G %so»
City, State, Zip
@ck& t 3313 M tom {
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 Employee (check one)
D County D Public Health Trust D Municipal:
(Municipality)
Department
Position or Title Employee ID Number
Work address Work telephone Employment began on/ended on
Filing as a Board Member (check one)
D County L] Municipal: 1An DB,LE
(Municipality)
Board where serving
HkmJv- [4es Cot T
Alternate address (if home address is exempt) Work telephone Term began on/ended on
18 $54 245d
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. O
Name of Source of Income Address Description of the Principal Business Activity
u5165
6037UA D2A/9 5T00u0 [?O( 0Use +#04o?- oves 0 N-
0e-. S Ou MA 3CP Hh101 $1L15,5
I hereby swear (or affirm) that the information above is a true and correct statement.
Slg"81ure~sing
1- 4-10
Date signed
ctv sr Eco"8 P9ENTENT
J Hardcopy IECEIVED
D Electronic Copy JAN 6 - 2022
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
REMEMBER TO PRINT, SIGN, AND SUBMIT TO THE OFFICE OF THE CITY CLERK VIA EMAIL OR HARDCOPY.
M IAM I BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfl.gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
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)
Last Name First Name Middle Initial
I un d er s ta n d th a t no la ter th an July 1,of each vear all member s of Bo ards and Comm ittees 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 Con vention Center Drive,
Miami Beach, Florida, no later than 12:00 noon of July 1, of each year:
1. A "Source of Incom e Statemen t;" or
2. A "Statement of Financial Interests (Form 1 )1 ;" or
3. A Copy of your latest Federal Incom e 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, lays in jail, or both.
l-d- 02
Sign a tur e 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 Adjustm ent members wh o file their
Form 1 with the County Super visor 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:ICLERISALLIREGBOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.dox
Updated: June 2020
M IA M I BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfl.gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
DIVERSI TY STATISTI CS REPOR T
GUG1HAO MA
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:
E2 Male
lremale
O Other
O I prefer not to answer.
Race/Ethnic Categories:
What is your race?
O African American/Black
O Asian or Pacific Islander
[<l Caucasian/white
O Native American/American Indian
l oner -Print Race: _sr1
O I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or .Latino/a?
6i ve
No
O I prefer not to answer.
Do you consider yourself Physically Disabled?
Oves
23
D I prefer not to answer this question.
Page 6 of6
F:CLER\SALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL .docx
Updated: June 2020
M IA M I BEACH CITYWIDE (CW) BOARD & COMMITTEES
cy oit t a ri se«di, Primo iRrwr PARKING APPLICATION iúñí
1755 Meridian Avenue, Suite 200/Miami Beach, FL 33139/Ph: (305) 673-7505 or (305) 673-7000 ext. 6200
A cilywide (CW) parking permit is honored at metered parking spaces and restricted residential zones
parking spac es. A CW parking permit IS NOT honored in prohibited areas. An Access Card will be
provided to you for City Hall Garage (G7J 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
info rm ation m ay lead to. the issuance of parking ci tation(s} and/or the tow ing of your vehicl e.
Please note that this new access cord CANNOT be hole-punched or perfo rated in any manner. To use
the new card please hold the card at dose proximity to the reader until the gate opens. You may need
to try the other side of the cord. 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, l will be responsible to pay a $10.00 replacement fee.
Board Member Information
Date of Application: /- 4-22¿
Applicant Name: ()/3510J0 • €1AD
Address: q } ENOX AW 5: Mt ) N4 @ 3313
Work Phone: Home Phone
coll Phone: 73 -8- 244 Preferred Contact Method: L
Vehicle lnf - 1ation
Tag: NH LO Color:
State: Year:
Make: LI/oL1 Model:
UH It
201a
M
Applicant S¡mnature: e
Please provide signed form fo' the Parking Department located at 1755 Meridian Avenue, 2" floor. Working
hours are 8:30 to 5:00 p.m. or em ail to: Park ingRecept ion@miamibeachfl.gov
e-mail sub ject: BOARD & COMMITTEE PARKING APPLICATION - APPLICANT NAME
Parkina Department Section
PERMIT SYSTEM GARAGE ACCESS
„
Expiration Date: ID Card Serial #:
Issued By Prinf Name: Print Name:
Signature: e Signature: e5
Date Issued: