Spencer Hennings 10/31/22MIAMI BEACH
BOARD AND COMMITTEE CHECKLIST
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• /or@ an@ Cof itée Apicavon (completed on±L <I<e ,20 [
o Résumé/Curriculum Vitae 9
o Diversity Statistics Reporting (Completed on_z II' ! w- CO»
o Oath
DATE OF APPoNrMNr: _\/'1/hà
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RECEIVED
JAN 12 2022
CITY OF MIAMI BEA CH
OFFICE OF THE CITY CLERK
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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
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
o Source of Income Statement
o Acknowledgment of Financial Disclosure Requirement
O DIVERSITY STATISTICS REPORTING Keep COPY in file and ORIGINAL for Annual Report.
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CONCLUDED & RESIGNATION LETTERS
Term Expired Letter Date Processed Initials Scan o
Rosignation Letter Date Processed Initials Scan O
Removal Letter due to absences Date processed Initials Scan o
F:ICLERIBOARD AND COMMITTIES DATABASEICHECKLIST MASTER\B&C Checklist 2015 MASTER.docX
We oo co uted to povidg excellent put'kc servce and safety to al wto le, wok ond play in u vbant topcoat, hustouc community
M IA M I BEACH
City o f M ia m i B e a ch , /OO Convonlion Cantor Dri vo, Miami Boach, Eorida 33 139 yyw._miamibca chll.go
OF FICE OF THE CITY CL ERK , Rof0ol E. Gr an ad o, City Cl erk
Tel: 305.673.7411, Fax. 305.673.7254
Email: CityClerk@miamibeachll.gov
Ja nu a ry 04 , 20 22
M r. Spencer H ennings
5055 C O L LI N S A V E. A P T 12C
MIAMI BE A C H , F L 33 14 0
RE: Ad Hoc Neighborhood Resiliency Projects Advisory Committee
D e ar M r. Spencer H e nnings:
C o ng ratula tio ns! Y o u ha ve be e n ap p o in ted by Commissioner David Richardson to the ab ove -
referenced Bo ard or C o m m itt ee , fo r a term ending: 10/31/2022.
Pursua nt to C ity of M ia m i Be ach C ode Section 2-22 (5)a:
N otw ithstanding any othe r provisio n of the C ity C ode or of any R esolution, com m encing w ith
term s beginning on or aft er Ja nua ry 1, 2007, the term of every board m em ber w ho is directly
appointed by a m em ber of the C ity C om m ission shall autom atically expire upon the latter of:
D ecem b er 31 of the yea r the appointing C ity C om m issioner leaves office or upon the
ap po intm e nt/ele ction of the successor C ity C om m ission m em ber.
If yo u are una b le to acce pt this ap p ointm ent, or have any questions, please call the Of fice of the C ity
C le rk at 305 .6 7 3.7 411.
P le a se re a d th e e n close d m ateria ls carefully as the y concern your dutie s, respo nsib ilities, and
req uirem ents as a board or com m itt ee m em ber.
C o ngratulatio ns aga in and good luck.
a
il Granado
C ity C le rk
cc: M o nica Beltran, Pa rking D irector
A m y Know le s, C ity Li a iso n
ENCLOSURES:
O ath of O ffi ce/O ath of C ivility/A cknow ledgem ents
C ity C o de/O rdina nce sectio n ap plicable to agency, board or com m ittee
C ity C o de S ectio ns 2-22 , 2-23, 2-24 , 2-25, 2-26, 2-458 and 2-459
O rdina nce N o . 2006-354 3 - Am en dm en t to C ity C ode Section 2-22
M ia m i-D ade C o unty C o de S ection 2-11.1 - C on fli ct of Interest and C ode of Ethics
C ity Wi de Pe rm it Ap pl ication - (Par ki ng D epart m ent Form )
Boo kl et - G uid e to the Sunshine A m e nd m ent and C ode of Ethics fo r Public O ffi cers and Em ployees
M IA M I B EA C H
City of Miam i Beach, I/0o Convonlon Contor D vo, Mart oa h , Tor d a 33139 www._mlambcachll. gay
OHKCE O IH CIIY CILRK, Rolol E. Granado, Ciy Cloid
I6l 305 .6/3 .7411, f0 305.673.7254
L mal CIN/Clot l om iam ibxooch ll go v
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Mr. Spencer Hennings
RE: Ad Hoc Neighborhood Resiliency Projects Advisory 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: 10/31/2022.
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. a fJge «. Soencel Reining
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 informnalion regarding the Financlal Disclosure Requirements.
M IA M I BEACH
City of Miami Beach
1700 Convention Center Drive
Miomi Beach, Florido 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachll qoy
Telephone: 305.673.7411
ECE IVED
JAN 12 2022
CIT OF MIAMI BEACH
OFFICE OF THE CITY CLERK
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):
ti:( I am a resident of the City of Miami Beach for six months or longer.
Home Address s5 ottias Du .LÀ. Di a , baa E.33«o
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 _
y[[Pe,S (]fe S S
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).
[panne tf P1[[eSi-
P1y/mes, J (]f@ S S -
"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. ,f Sa.. f: l/a= O\/e/A A Sijräure T Date'
Prin ed
NOTARY
Swor to (or affirmed) and subscribed before me, by means of o physical presence or~line notarization,
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$$ $"f} wcouitero w 1osos ¿ji,¿ exPIRES: Decombor 14, 2025
·8} Bonded 'Thu Notary Publi c Underwrit ers
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M IA M I B E A C H
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 & COMMITT EE 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 Fir Name Middle Initial
I understan d that no later than July.1, of each year all members of Boards 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 Convention 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 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 $~0/,60 days in jail, or both. <, •/., O'/6/ àà st t we
' Members of the Planning Board and Board of djustmont will bo 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 ACLERISALLIRE GBOARD AND COMMIT TEE APPLICATIONS FINAL DRAF TS\BOARD AND COMMIT TEE APPLICATION REG FINAL doc
Updated: Jun e 2020
MIAMI BEACH
City of Miami Beach
1700 Convention Center Drive
Miomi Beach, Florido 33139
www .miamibeachfl.goy
OFFICE OF THE CITY CLERK
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.
Gender:
íae
L remale
O Other
O I prefer not to answer.
Race/Ethnic Categories:
What is your race?
O African American/Black
LlAei an or Pacific Islander
[I 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 Latinola?
##
O I prefer not to answer.
Do you consider yourself Physically Disabled?
ca e1i o I prefer not to answer this question.
Page 6 of 6
F ICL E RISAL L R EGB OARD AND COMM I T T EE APPLIC ATI ON S FINAL DR AF T S\B O AR D AND CO M MI T T EE APPLI CATION REG FINAL docx
U p da ted : Ju n e 20 20
/\l/A/\/BEACH CT w p (Cw) BOARD & COM E Es a c y et torr ses±, PARKING PAR7 Nr PARKING APP[[CATION
1755 Meridian Avenue, Suite 200/Miami Beoch, FL 33139/Ph (305) 6737505 or (305) 673-7000 4. 6200 PARKING
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 lo avoid
any unnecessary enforcement actions, il is important thai our records reflect the most current and
accurate information regarding your vehicle license plate. Inaccurate and/or outdated vehicle
information may lead lo the issuance of parking citation(s) and/or the towing of your vehicle.
Please noie 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
lo try the other side of the card. Please ensure you hold the entire surface of the card against the reader
until the gale opens.
ACKNOW LEDGEMENT: 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: /6/2
Applicant Nome: S@en e • Heon 4
Board/Committee Name' pA [\ p c 4,, ' 0«, 7...I Ras,o,, on,#. O @4h , o
Address: v • 1 ) ._J
OS et Nu . I• p ino "-ad [. tt
E-Moil Address: S.e ho 4 , (P) Ant o
work Phone: qçq à, o» 3234
~ Home Phone
Cell Phone: 159 )o qq4 Preferred Contact Method: e
Vehicle Information
Tog: HYNS33 Color: old>
State: t ) Year: \017
Make: Pos0 Model: \\NA
Applican! Sianature: 6
Please provide signed form to the Parking Department located at 1755 Meridian Avenue, 2d floor. Working
hours are 8:30 1o 5:00 p.m. or email to: Parkin gRe ception@mi amibeachfl.gov
e-mail subject: BOARD & COMMITTEE PARKING APPLICATION - APPLICANT NAME
Park ina Department Section
PERMIT SYSTEM GARAGE ACCESS
Expiration Date: ID Card Serial#:
Issued By Prinl Nome: Print Nome:
Signature: Signature.
Date Issued: Date Completed:
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