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Scott Diffenderfer 12/31/22BOARD AND COMMITTEE CHECKLIST APPOINTEE: Scott Diffenderfer DATE OF APPOINTMENT. 12/16/2021 ------------------ BOARD/COMMITTEE: Program for Public Information (PPI) Appointed by: Mayor Dan Gelber FOR SCANNER Scan o Scan o Scan o Scan o Scan o FOR CLERK STAFF o Letter of Appointment o Lett r of Reappointment o pc}y e! /$',$'9PP%tmenvReappointment, e,eyed to committee o /oar@ an @ omittee Aplication (completed o_= '/ JO) / o Résumé/Curriculum Vitae ' o Diversity Statistics Reporting (Completed onz_ t o Oath re« avo.//3//2aro. y2/3// Liaison on REC EIV ED JAN 2 0 2022 C ITY O F 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 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 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 IVERSITY STATISTICS REPORTING Q0, soneay '1les" ·7 V%f Processed on: lu 1 [Q-/""'J)... By Employee: ---J'--T''-Tc;r---:,,-,,-------------- Sca nned one ! /¡ <j Ïe é)--;;}- By Employee --=---h£---7"'á,C--__.__=-------- Date Scan o Received on: 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 Ve are committed to excelfnt publc service and safety to all whs live, work, and in ou vibrant, tropical historic cmmanity. M IA M I BEACH City of Miami Beach, 1/OO Convention Conter Divo, Miami Boa ch, Hlorida 33 139 yywy.miamibgachll.goy OFFICE OF IHE CITY CI ERK , Rof0ol E. Gran ado, City Clerk Tel: 305.673.7411, Fax. 305.673.7254 Emal l: Cit/Cl erk @m i am i beach ll.gov D ecem be r 16 , 202 1 M r. Scott D iff enderf er 20 Isla nd A ve. #402 M ia m i Bea ch, F lorida 33 13 9 SUBJECT; Program for Public Information (PPI) Committee C o ngratulations! Y ou have be e n reappointed by Mayor Dan Gelberto the above referenced, board or com m itt ee na m e d above, fo r a term end ing: 12/31/2022. Pursua nt to C ity of M iam i Be a ch C o de Section 2-22 (5) a, "N otw ithstanding any other pro vision of the C ity C ode or of any resolutio n , com m encing w ith term s beginning on or aft er Jan uary 1, 2007, the term of eve ry bo a rd m e m b e r w ho is directly appointed by a m em ber of the C ity C om m ission shall autom atically expire up o n the la tt er of: D ecem b er 31 of the year the appointing C ity C om m issioner leaves offi ce or upo n th e app ointm e nt/el ection 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 Offi ce of the C ity C le rk at 305.6 7 3.7411. Please read the encl osed m aterials carefully. C o ngratulations and good luck. R egarpd R afae l G ranado C ity C le rk cc: M o nica Be ltran, Pa rking D irector A m y Know le s, C ity Li a ison ATTACHMENTS: Lett er of A ppointm e nt O ath C ity C o de/O rdina nce sectio n ap plicable to agency, board or com m ittee C ity C o de Section 2-22 , 2-2 3 , 2-24, 2-2 5, 2-26, 2-458 and 2-459 O rdina nce N o . 20 06-354 3 - Am en dmen t to C ity C ode S ection 2-22 M ia m i-D a de C o unty C ode Sectio n 2-11.1 - C onfli ct of Interest and C ode of Ethics O rdinance C ity Wi de Perm it A pplicatio n - (P a rking D epart m ent Form ) Boo klet - G uide to the S unshine A m endm ent and C ode of Ethics for Public O fficers and Em ployees MIAMIB City of Miami Beach, ZOO Convontion Conter Divo, Muami oach, Hlorida 33139 y¿_miomibgachll_goy OF FICE OF THE CITY CIERK, Rafool E. Granado, City Clerk Tol: 305.673.7411, Fax. 305.673.7254 Email: Ci/Clerk@miamibeachfl.gov Oath of Office Oath of Civility and Acknowledgements TO : Mr. Scott Diffenderfer R E: Progra m for Public Inform ation (PPI) Committee I do solem nly swear or affi rm to bear true faith, loyalty and allegiance to the Govern ment of the United States, the State of Florida, and the City of M iami Beach, and to perform all the duties of a member of the above-m entioned board or com m ittee of the City of M iami Beach to which I have been appointed for a term ending: 12/31/2022. To m y colleagues and to all of those I represent and serve, I pledge fairn ess, integrity and civility, in all actions taken and all com munications m ade by m e as a public servant. I have been issued a copy of section 2-11.1 of the M iami-Dade County Code (Conflict of Interest and Code of Ethics O rdinance), as well as Florida Commission on Ethics Guide to the Sunshine Amendment and C ode of Ethics for Public Officers and understand that as a m ember of a City of Miami Beach Board and/or C omm ittee, I m ust com ply 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 closi g of the calendar year on which I have served. Sworn to and subscribed before me this :f7 day ·0e *Please visit the City of Miam i Beach website at www .miamibeachfl.gov under City Clerk/Board and C om m ittees fo r additional info rmation regarding the Financial Disclosure Requirements. MIAMIBEA City of Miami Beach 1700 Convention Center Drive Miami Beach, Florida 33139 OFFICE OF THE CITY CLERK RECEIVED JAN 20 2022 Email: BC@miamibeachfl.gov Telephone: 305 .673 741 CITY 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): r/ I am a resident of the City of Miami Beach for six months or longer. H Add 9 Island Ave. #1501, Miami Beach, FL 33139 [)[]]à l]? 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 ------------------------ [1IS[[eS [\(]]feS5 J 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 Compass Florida LLC Business Address 605 Lincoln Road, 7th Floor, Miami Beach, FL 33139 "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 have read the foregoing document and that the facts stated in it L/9/a02a Date Printed Name NOTARY Sworn to (or affirmed) and subscribed before me, by means of a physical presence or Xonline notarization, «/1a0sea23, Sour pi9ale Re (9.!Y of Miam( Beach Board/Commizte Member). ro s o / pre'5 (o s.) Form of Identification Fe9fsop illy_Known, ) Sign Name of Notary, Typed, Printed, or Stamped ¿gijüi#;z., + :SJ.DAG0sTN ¿f" j"%; wrcou ussoN 1sros %j,„J9a.&; xREs: pecan r 14, 2025 ;j? Bonded Thu Notary Public Underwriters M IA M IB E H City of Miami Beach 1700 Convention Center Drive Miami Beach, Florida 33139 www.migmibeachl] goy 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) Diffenderfer Glenn Scott 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. Failure to file one of these form , ursuant to the Miami-Dade County Code, may subject the person to a fine of no more an $5 daßs i · il, or th. J/;? /,p {J) ¿J. :;J._ 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:\CLER\$ALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.dccx Updated: June 2020 M IA M I BE 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 Diffenderfer Glenn Scott 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: i nae O Female O Other O I prefer not to answer. Race/Ethnic Categories: What is your race? O African American/Black LJ Asan or Pacific Islander [Cl Caucasian/white LI 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? Jves Lü No O I prefer not to answer. Do you consider yourself Physically Disabled? Eves ad0Ro O I prefer not to answer this question. Page 6 of 6 F:\CLER\$ALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION RE G FINAL.docx Updated: June 2020 MIAMl·DAD E- EI 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 I Last Name First Name Middle Name/Initial 2021 Diffenderfer Glenn Scott M ailing Address - Street Number, Street Name, or P.O. Box 9 Isl a nd A ve. #15 01 City, S tate, Zip M ia m i B e a c h , FL 33139 If your hom e address is your m ailing address, and your home address is exempt from public records pursuant to Fla. Stat. $119.07, read instructions on the follow ing page and check here. □ Fili ng as an Em ployee (ch eck on e) [] County [] Public Health Trust [] Municipal: (Municipality) Departm ent Position or Titl e Employee ID Number W ork address I W ork telephone Em p loym ent began on/ended on Fili ng as a Board M em ber (check one) [] County rd Municipal: Miami Beach (Municipality) Board w here serving P ro g ra m fo r P u blic Information (PPI) Altern ate address (if hom e addre ss is exempt) I Work telephone P3%% 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 Nam e of S ource of Income Address Description of the Principal Business Activity Compass Florida LLC 605 Lincoln Road, 7th Floor Real Estate Miami Beach FL 33139 I hereby sw e r (or affi rm ) that the information above is a true and correct statement. gn iisclos 1/0o la0aa Dat e si@a 7 RECEIVED BY ELECTIONS DEPARTMENT: □Hardcopy RECEIVED D Electronic Copy JAN 20 2022 CITY OF MIAMI BEACH } 1- OFFICE USE ONLY A ccepted: Y / N Deficiency: Processed Date/Initials: Scanned Date/initials:; 13 8 _S P -14 C OE 20 16 /\/\//\/\/\/ CI w DE (C W) BO AR D & COMMITTEES City of Miami Beach, PARKING DEPARTMENT PARKING APPLICATION 17 55 Meridian Avenue, Suite 200/Miami Beach, FL 33 139 /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: )/9/2092 Applicant Name: Z",J, e _ 7I€n Sco u' 'nlere( Board/Committee Name: o4ro kr lie hoe»nu f Address: 9 one4, FL 3 E-Mail Address: Work Phone: Home Phone col Pones: gs-58-333/ Preferred Contact Method: Vehicle Information Tag: o98Ly Color: & State: FL Year: 7013 Make: KY/co Model: Hifi#y U I Applicant Sianature: e Please provide signed form to the Parking Department located at 1755 Meridian Avenue, 2" floor. Working hours are 8:30 to 5:00 p.m. or email to: PgrkingReception@miamibeachfl.gov e-mail subject: BOARD & COMMITTEE PARKING APPLICATION -- APPLICANT NAME p ·ki D ar Ina epartment ection PERMIT SYSTEM GARAGE ACCESS Expiration Date: ID Card Serial #: Issued By Print Name: Print Name: Signature: Signature: e Date Issued: Date Completed: 5 :p2mg ·man rar torms cw oars«commntees pat'angtorm,+toc orm up tate