Marc Gidney 12/31/23t t
BOARO ANO COMMITTEE CHECKLIST
APPOINTEE: /11.Al'lC. G-/.P/V 'é 7" DATE OF APPOINTMENT: //-a... z__ -------------------- / ,•
BOARD/COMMITTEE:_rec,,7 _Appointed by: Karcz fseGooeAa&
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Scan o o Letter of Reappointment " [Y)y5'7"°,om ore-nono, e"ye! y.c9mines uaso o
Scan o o Boarâand Committee Application (CompletedVi k} // 5 :J.,/)
Scan o o Résumé/Curriculum Vitae '7 / '1 /l _J.. "'\
o Diversity Statistics Reporting (Completed on//(2_, _do7l
o Oath Scan o
RECE IVED
JAN -6 2022
IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
✓
✓
✓
CITY OF MIAMI BEACH
OF FICE OF TH E CITY CLERK /
✓
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
Scan o
Scan o
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
DIVE SITY STATISTICS REPORTINy
Received on:/t r Signed by /_.<cs !
IGINAL for Annual Report.
[ressed On.
Date
Scanned on: [\/ [[n?Dl/},,
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 Checklisí 2015 MASTER.docx
+e are conifed to providing excellent pubic service and safety to all who live. work, od ploy in cur vibrant, trcpicol, historic coruniy.
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City of Miami Beach, 1700 Convention Canter Drive, Miami Beach, Florida 33139 yw._miamibgachll.gov
OFFICE OF THE CITY CIERK, Rafaal E. Granado, Cy Clark
Tel: 305.673.741, Fax: 305.673.7254
Email: CilyClerk@miamibeachfl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Mr. Marc Gidney
RE: Audit 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 o Miami-Dade County or the
State of Florida (depending on the board or committee on which I se uly 1st, following the closing
of the calendar year on which I have served.
Mr. Marc Gidney
Sworn to and subscribed before me this ~~-
*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.
MI AM \BE
City of Miami Beach
1 700 Convention Center Drive
Miami Beach, Florida 33139
O FF ICE O F TH E C IT Y C LERK
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):
o I am a resident of the City of Miami Beach for six months or longer.
tr9 [(]rs3
¡Have an ownership interest (for a minim um of six months) in a business established in the City of
Miami Beach (for a minimum of six months).
Name of Business 6yo2z.y gC @2et et
. Po », S7. , / Business Address.ii t & et %g z% >e«$c)
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).
[]a[no f [[y[[eSS
[[1[fess J(]re8S
"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.
, I declare that I have read the foregoing document a e th the facts stated in it • ??
Date
@
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of o physical presence or o online notarization, ...w12. cl-j
Produced ID
(Ci~ of Mia~ Beach Board/Czmittee Member).
/ /a'vers 2
Form of Identification
Signat r
i, CHARLES J. DAGOSTIN f~·~•"·~b MY COMMISSION# HH 165705 ii, ¿j EXPIRES: December 14, 2025
;¿5 onded Tr u Nota ry Public Underwrtors
i i »
(NOT ARY SEAL)
Name of Notary, Typed, Printed, or Stamped
M/A MIBE
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
RECEIVED
JAN -6 2027
CIT OF MIAMI BEACH
-Ir OE THE CITY CLER K
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7 411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
I am in compliance with the affiliation requirement of Miami Beach City Code Section s 2-22 (4),
as (check(✓) all that apply):
D I am a resident of the City of Miami Beach for six months or longer.
Home Address: ---------------------------
n a ve 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).
t
Name of Business: 6pry yr Coot'y, CO#_,
snes Aware. >oo-2,°r ,,2, „,,,z r , 7
D 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.
CI„Z,„", "/9".' declare that !have read th e for egoing docum ent,and that the facts 226
Printed Name
Date
M IA M I BE
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachll.gov
O FF IC E O F TH E C ITY C LE R K
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)
Grover
La st N a m e F irst N a m e Middle Initial
I un d e rsta n d th a t no la te r th a n July. 1, of each year a ll m e m b e rs of B o a rds a n d C o m m itt e e s of the C ity of M ia m i
B e a c h , in cl u d in g th o se of a p u re ly ad v iso ry na tu re , are re q u ire d to co m p ly w ith M ia m i-D a d e C o u n ty F in a n c ia l
D is cl o s u re R e q u irem en ts .
One of th e fo llo w in g fo rm s must be filed w ith th e C ity C le rk of M ia m i B e a ch , 17 0 0 C o n v e ntio n C e nte r D riv e ,
M ia m i B e a c h , 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 C opy of your latest Federal Income Tax Return.
Failure to file one of J ese forms, pursuant to the Miami-Dade County Code, may su! iect the person to a fine
of no more tl pouu, 6l days in jail, or both.
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
S u p e rv iso r of E le c tio n s by 12 :0 0 noon, July 1. Plan ning Board and Board of Adjustment members who file their
F o rm 1 w ith the C o u n ty S u p e rv is o r of E le ctions 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
requireme nt.
Page 5 of 6
F:ICLER\$ALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
MIAMl·L f'
EEDE 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
2020 G-)DNUEy
First Name Middle Name/Initial
}
Mailing Address - Street Number, Street Name, or P.O. Box
oo->47°rssT Sore 6eo 4
City, State, Zip
):: 03 / /JI Ctr Y-
r
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 Hele.
Filing as an Employee {check one)
□County □Public Health Trust [] Municipal: f
,,.,/' (Municipality)
Department
~
Position or Title - Employee ID Number
Work address / I Work telephone Employment began on/ended on
Filing as a Board Member (check one)
D County E] Municipal:
(Municipality)
Board where serving
l Dt 7 Cou1
Alternate address (if home address is exempt) I.Work telephone ¡Term began on/ended º0
23oo-27''Tass7 3o-&£-6?4 < Te/e,'
r r
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
6)too r=Coyt> de4- o2ye fr, PacoaT %( o . r -
err> t, a S touss É - L- fac»2»el70 tD
RECEIVED BY ELECTIONS DEPARTMENT:
ar doECEIVED
D Electronic Copy
JAN -6 2022
CITY OF MIAMI BEACH
E OF THE CITY CLERK
REMEMBER TO PRINT, SIGN, AND SUBMIT TO THE OFFICE OF TH E CITY CLERK VIA EMAIL OR HARDCOPY.
M/AIBE
C ity o f Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfl.gov
O FFIC E O F TH E C IT Y C LER K
Email: BC@miamibeachfl.gov
Telephone: 305.673.7 411
DIVERSITY STATISTICS REPORT
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.
G e n d e r:
tez
O Female
O Other
O I prefer not to answer.
R a c e /E th n ic C a te g o rie s :
W h a t is y o u r ra c e ?
O African American/Black
O Asian or Pacific Islander
Li 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?
.a □I prefer not to answer.
Do you consider yourself Physically Disabled?
2ya»
lo
O I prefer not to answer this question.
Page 6 of6
F:ICLER\$ALL\REGIBOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
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