Davron Banks 12/31/22MI A M[BE A CH
BOARD AND COMMITTEE CHECKLIST
APPorE eEe:_L eo < lreaio.a lo{., _Are or APoInr: 2.[1l[2J
soAR rcoMMrrreE:_bd,cl ln ds4e , 0boite@ y.(a.sson Dasud Ki±erdso
FOR SCANNER FOR CLE RK ST AFF , ì / ?¡ I -ì e
scan ·Letter of App ointm en t TERM END: A]3\[022 reRM LIMIT:/ml> /h'/
Scan o o Letter of Reappointment '
o 9PPf Jf¡ ~e/ ;l--fppointment/Reappointment e_-mailedtto Committee Liaison on
san .sá4 en€e loe-avo corees a ?[/_/2o /
Scan o o Résumé/Curriculum Vitae ¡ 1 / e-
Diversity Statistics Reporting (completed on_/d, /_ Jo ]
Scan o o Oath T 1 "
IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
✓City Code Ordinance Section applicable to the agency, board or committee
O ✓City Code Sections 2-21, 2-22, 2-23, 2-24, 2-25, 2-26, 2-458 and 2-459 [ECE[VEl Y county Code Section 2-11.1- Conflict of Interest and Code of Ethics Ordinance (as
amended through December 2010)
JAN 2 6 2022 ✓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
[Ty OF MIAMI BEACH_ Memorandum - Solicitation by City Board and Committee Members
O FF I C E OF TH E CI T Y CLERK
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 Scan o
Scan o o Acknowledgment of Financial Disclosure Requirement
O DIVERSITY STATISTICS REPORTING Keep COPY in file and ORIGINAL for Annual Report.
Received on. I?-[y 5_/] signed by
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ff Date 2.,6,,,,/,,,z.,,y--
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:ICLERIBOARD AND COMMITTIES DATABASEICHECKLIST MASTERIB&C Checklist 2015 MASTER.docx
M IA #I B E A CH
City of Miami Beach, 1700 Convention Cantor Divo, Miam i Boach, Florid a 33 139 www.miamibaachllgo
OFFKCF OF THE CITY CLERK, Ralool E. Granado, City Clot
Tol 305.673 7411, Fax. 305.673 7254
Email. CiyClol @miamiboochfl. gov
December 14, 2021
Mr. Davron Banks
11254 SW 236th LN
Homestead, FL 33032
RE: Production Industry Council
Dear Mr. Davron Banks:
Congratulations! You have been appointed by Commissioner David Richardson to 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.
Regards,
Rafael Granado
City Clerk
cc: Monica Beltran, Parking Director
Veronica Hennig, City Liaison
ENCLOSURES:
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
MIAM I BEACH
City of Miami Beach, 17OO Conven tion Cantor Divo, Miam i Boach, Florida 33 139 yy._miamibgachfl gov
OFF ICE OF THE CITY CIERK, Rofool E. Gr an do, C y Cdork
Tol 305 673 74I1, Fax. 305.673.7254
Email. C iyClord @ml oam ibooch fl gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Mr. Davron Banks
R E: P ro d u ctio n In d u stry C o u n cil
I do so le m n ly swear or affirm to bear true faith. loyalty and allegiance to the Government of the United
S ta te s, th e S ta te o f Fl o rid a , a n d th e C ity o f M ia m i B e a ch , a n d to perform all the duties of a member of the
a b o ve -m e n tio n e d bo a rd o r co m m itt e e o f th e C ity o f M ia m i B e ach to which I have been appointed for a
te rm e n d in g : 12/31/2022.
T o m y co lle a g u e s a n d to a ll of th o se I re p re se n t a n d se rve , I p le d g e fa irn e ss, in te g rity a n d civility. in all
actio n s ta ke n an d all co m m un ica tio n s m a d e b y m e a s.a p u b lic se rv a n t.
1 have been issued a copy of section 2-11.1 of the Miami-Dade County Code (Conflict of Interest and
C o d e of E th ics O rd in a n ce ), as w e ll a s F lo rid a C o m m issio n o n E th ics G uide to the Sunshine Amendment
a n d C o d e o f E th ics fo r P u b lic Officers and understand that as a member of a City of Miami Beach Board
a n d/or Com mittee, I must comply with the finan cial 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.
h---.
Sworn to and subs cribed before me this:.4-
*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 /A MIBE A CH
City of Miami Beach
1700 Convention Center Drive
Miomi Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email. BC@mlambeachfl gov
Telephone: 305. 673.7411
RECEIVED
JAN 26 2022
CITY OF MIAM I BEA CH
OFFICE OF THE CITY CL ERK
A FF ID A V IT O F A F FILI A T IO N W IT H TH E CIT Y O F M IA M I B EA C H
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.
ptfmP% J([[fesi»
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).
[}arò tf P[[[eSi
P1y[mes,S H(](]fes3-
..,( 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).
Business Address
Name of Business__.~'--'-¡' --'-\\-'-'(Y\'--'-"'o ... r-'--'"e __ M----'-'-,_.Ç""-'b'('Y)"-----'--·,..___'ß....,......,.E ... O.,......,C.._. Y"'\ _
Loo Losh9po0 Dye, H ors. (ach 3139
"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 "a» s 2a Il-[i6/d!
Sign Date
Do to Te,olea 'f,ot o
Printed Name
NOTARY
Sworn to ( o, alfi & and subscribed ?•fore m e] means ot){physical J!!:•sence o, o online notarization , $5.. e .2l, )Au d! [eto pats
________ ('" · Beach Board/Co
P a > Produced ID
Form of Identification
ee Member).
(NOTARY SEAL)
Signal
M IA M I BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeochtl.gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
DIVERSITY STATISTICS REPORT
hats st Name
we
l
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:
fíí
N remale
O Other
O I prefer not to answer.
Race/Ethnic Categories:
What is your race?
IZll African American/Black
O Asian or Pacific Islander
O 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?
NYes
ni
O I prefer not to answer.
Do you consider yourself Physically Disabled?
y es
i
O I prefer not to answer this question.
Page 6 of 6
F \CLER\$ALLIREG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTSIBOARD AND COMMITTEE APPLICATION REG FINAL docx
Updated. June 2020
M IAMI BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeochtl.goy
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
BOARD & COMMITTEE FINANCIAL ACKNOWLEDGEMENT STATEMENI
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)
lAlison irst ame
T
Last Name Middle Initial
l understand that no later than July1,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 Requiremènts. · ·
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 forms, pursuant to the Miami-Dade County Code, may subject the person to a fine
of no more than $500, 60 days in jail, or both.
d2u . va Date t 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 ICLER\$ALLIREGIBOARO AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL docx
Updated: June 2020
MIAMI-. EMI
Clear From Print Form
SOURCE OF INCOME STATEMENT
Sect ion 2-111() of the County Ethics Cod e requires that ce rtain employees and public officials file a financial disclosure Statement on a yearly basis by July 1st
of every year.
Disclosure for Tax Vear Ending Last Name
a0o oo First Name
o
Middle Name/Initial e
Mailing Address - Street Number, Street Nam e, or P.O. Box
2. +o LN) 25
City, State, Zip
Ho re F L 33 0 2 8
If your hom e 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 tele.
Filing as an Employee (check one)
O County O Public Health Trust D Municipal:
(Municipality)
Departm ent
Position or Title Employee ID Number
W ork address " telephone Employment began on/ended on
Filing as a Board Member (ch eck one)
O County íwonewt: [,lg, of [asi
(M unicipality )
Board where serving
% \o
Alternate address (if home address is exempt) telephone Term began on/ended on
I l\ r2 1z
List below every source of inco me you recei ved, alon g w th the address and the principal activity of each source Include your public salary Place the sources of
incom e in descen ding order, with the largest so urce first Examp les of source s of inco me incl ude com pen sation for servces, inco me from business, gains from
property dealing s, inter est rents, drd en ds, pen sions, IRA dustnbut ion s, and social secunty paymen ts Also, incl ude any source of incom e recei ved by another
person for your ben efit However, the incom e of your sp ouse or any business partn er need not be disclosed If continued on a separate sheet, check here. []
Name of Source of Income Address Description of the Principal Business Activity
L¡e «J alo uoldo,de G6 u)es+ h e o c, S60€ 120 ?ace of Erlor e)
LN . Hoos06,T, ))00 o
I hereby swear (or affi rm ) that the inform ation above 1s a true and correct statement.
a?
Signature of Person Disclosing
1116la \
o6 lkl '
RECEIVED BY ELECTIONS DEPARTMENT:
/Harteo" RECEIVE-t
\Electronic copy' :/VEE}
JAN 26 r .2 J.
CI TY OF MI AMI SEA CH
REMEMBER TO PRINT SIGN
n t Jhl tl E: CTlY ,Alls#
AND SUBMIT TO THE OFFICE OF THE. CITY CLERK VIA EMAIL OR HARDCOPY =i
.4...."#%22%41 la
1755 Meridian Avenue, Suite 200/Miami Beach, FL 33139/Ph. (305) 673-7505 or (305) 673-7000 ext. 6200 PARKING
A cityw ide (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
Date of Application: I,2 15'2
Applicant Name:
Os r
Board/Committee Name:
Address; 11254 S00 37
E-Moil Address:4, rcn+robo HS
Work Phone:
Coq
Cell Phone a(0-6866-2)\ Preferred Contact Method:
Vehicle Information
Tag: Color:
State:
Make:
FL Year:
Model: - IS0
Applicant S¡+nature: e6
Please provide signed rm to the Parking Deportment located at 1755 Meridian Avenue, 2 floor. Working
hours are 8:30 to 5:.00 p.m. or email to: ParkingR eception@m iamibeachfl.gov
e-mail subject: BOARD & COMMITTEE PARKING APPLICATION - APPLICANT NAME
P ·ki D s ar' na epartment ection
PERMIT SYSTEM GARAGE ACCESS
Expiration Dote: ID Cord Serial #:
Issued By Print Name: Print Name:
Signature: Signature. e6
Date Issued. Date Completed.