Cameron McLain 12/31/22DocuSign Envelope ID: 1 BC53A72-A49C-4439-9560-4B7D30064288
1AMIBE
BOARD AND COMMITT EE CHECKLIST / ~ . ¡,
APPOINTEE: Cameron McLain DATE OF APPOINTMENT: / gs a)_.
BOARD/COM MITTEE._ "ext Generation council _Appoi nted • 9 . ]ejvjC
res e//y/25a/2/3//
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FOR SCANNER FOR CLERK STAFF
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o Letter of Appointment
o Lett r of Reappointment
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dad6 ad torvíié6 Aootcaon t«corea a,/y7/2
• esumecoumrteutoum váe )/7/ ,),,
o Diversity statistics Reporting (Completed ond, , _'0)_}
o Oath
Liaison on
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
RECEIVED
FEB -7 2022
CITY OF MIAMI BEACH
öF+ICE OF THE CITY CLER'
Scan o
Scan o
Received 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
O DIVERSITY STATISTICS REPORTING Keep COPY in file and ORIGINAL for Annual Report.
2/6/2022 Signed o X ------,..,;.---------------- •. /5722
... 375E»
Date
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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 oroviding excellent public service and safety to al who live, wok, and play in our vibrant, topical, historic community.
D o c u S ig n E n v e lo p e ID : 1 B C 5 3 A 72 -A4 9 C -4 4 3 9 -9 5 6 0 -4 B 7 D 3 0 0 6 4 2 8 8
MI MIBE
City of Miami Beach, 1ZOO Convention Center Drive, Miami Boach, Florida 33 139 yywy_miamibeachll.go
OFFICE OF THE CITY CLERK, Rofool E. Granado, Ciy Clerk
Tel: 305.673.7411, Fax. 305.673.7254
Email: City Clerk@miamibeachll.gov
January 25, 2022
Ms. Cameron McLain
5900 COLLINS AVE APT 407
Miami Beach, FL 33140
SUBJECT: Next Generation Council
Congratulations! You have been reappointed by Commissioner Steven Meiner to the above referenced,
board or committee named above, 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 305.673.7 411. Please read the enclosed materials carefully.
Congratulations and good luck.
Regards,
Rafael Granado
City Clerk
cc: Monica Beltran, Parking Director
Erick Chiroles, City Liaison
ATTACHMENTS:
Letter of Appointment
Oath
City Code/Ordinance section applicable to agency, board or committee
City Code Section 2-22, 2-23, 2-24, 2-25, 2-26, 2-458 and 2-459
Ordinance No. 2006-3543 - Am endment to City Code Section 2-22
Miami-Dade County Code Section 2-11.1 - Conflict of Interest and Code of Ethics Ordinance
City Wide Permit Application - (Parking Department Form)
Booklet - Guide to the Sunshine Amendment and Code of Ethics for Public Officers and Employees
D o c u S ig n E n v e lo p e ID : 1 B C 5 3 A 72 -A4 9 C -4 4 3 9 -9 5 6 0 -4 B 7 D 3 0 0 6 4 2 8 8
Ml MIBE
City of Miami Beach, I/OO Convention Center Drive, Miami Bouch, Florida 33 139 yyy._Iiamibgachfl_go
OFFICE OF THE CITY CLERK, Rofaol E. Granado, Cly Clerk
Tl: 305.673.7411, Fax. 305.673.7254
Emal: CityClerk@miamiboachll.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Ms. Cameron McLain
RE: Next Generation Council
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: 12/31/2022.
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 requirem ents 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.
1/DocuSigned by:
LE±
Ms. Cameron McLain
Sworn to and subscribed before me thi~?
Deputy Clerk
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.
D ocuS ign Envelope ID : 1 BC53A72-A49C-4439-9560-4B7D30064288
M IA M I H
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Em ail: BC@m iamibe achfl.gov
Telephone: 305.673.7411
ECEIVED
FEB -7 2022
T OF MIAMI BEACH ker or iécrvcin
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):
k I am a resident of the City of Miami Beach for six months or longer.
Home Address -------------------------
5900 Collins Ave Apt 407 Miami Beach FL 33140
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 ------------------------
[yS[/es,S (r@SS
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).
[]qr9 (f [1[9S
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.
Under penalties of perjury, I declare that I have read the foregoing document and that the facts stated in it
are true. ~W9- __ 2_;6_;_2_0_22 _
Signature Date
Cameron Mclain
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, means of physical presence of online notarization,
sG/.«/Fd1 a92»• fro-' K(Av
_________ (City of Miami Beach Board/Committee Member).
n» 4 6 PAs so n
Form of Identification
P 'sorally Know
Signa
ry, Typed, Printed, or Stamped
DocuSign Envelope ID: 1BC53A72-A49C-4439-9560-47D30064288
M\IA MlB
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www .miamibeach[l,gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
DIVERSITY STATISTICS REPORT
Mclain Cameron E
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:
late
(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
E] 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?
lves
2Jo
O I prefer not to answer.
Do you consider yourself Physically Disabled?
v es
ho
D I prefer not to answer this question.
Page 6 of 6
F:\C LER \$A LL\R E G \BO A RD A N D CO M M ITT E E A P P LI C A TIO NS FIN A L D RA FT S \B O A R D A N D CO M M ITT E E A PP LI C A TIO N RE G FI NAL .docx
Updated: June 2020
DocuSign Envelope ID: 1BC53A72-A49C-4439-9560-47D30064288
MIAMI E
City of Miami Beach
1 700 Convention Center Drive
Mia mi Beach, Florida 33139
www.miamibeachfl,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)
Mclain Cameron E
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 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.
@E. soso
Signa[y#e""r [n
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
DocuSign Envelope ID: 1 BC53A72-A49C-4439-9560-487D30064288
MIAMI-DADE- SOURCE OF INCOME STATEMENT EEII
S ection 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 Mclain Cameron E
M ailing Address - S tre et Num ber, S tre et Nam e, or P.O . Box
5900 Collins Ave Apt 407
City, S tate, Zip
Miami Beach FL 33140
If your hom e address is your mailing address, and your hom e address is exem pt from public records pursuant to Fla. Stat. $119.07, read
instructions on the follow ing page an d ch ec k he re. D
Filing as an Em ployee (ch eck on e)
[] county ] Public Health Trust [] Municipal :
(Municipality)
Departm ent
Positi on or Title Employee ID Number
W ork addre ss I W ork telephone Employment began on/ended on
Filing as a Board Mem ber (ch eck on e)
[] county E] Municipal : Miami Beach
(Municipality)
Board w here serving
Next Generation council
Altern ate address (if hom e address is exempt) Work telephone
Li st below every source of incom e you received, along w ith the address and the principal activity of each source. Include your public salary. Place the sources of
incom e in descending order, w ith the largest source first. Exam ples of sources of income include: compensation for services, income from business, gains from
pro pert y dealings, interest, rents, dividends, pensions, IRA distributions, and social security payments. Also, include any source of income received by another
person fo r your benefit. How ever, the incom e 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
Global Luxury Realty 1688 Meridian Ave Miami Beach FL Real Estate Agent
I hereby swear (or affirm) that the information above is a true and correct statement.
1/0ocuSigned b y :
S ign~~losing
2/6/2022
Date signed
RE CEIV ED BY ELE CTIO NS DE PARTMENT:
D Ha rd c o p y RECEIVED
[] Electronic Copy
FEB -7 2027
CI TY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
OFFICE USE ONLY A ccep t ed: Y / N Defici ency: Processed Dat e/Initials: Scan ned Date/Initials:
138_SP-14 COE 2016
DocuSign Envelope ID: 1 BC53A 72-A49C-4439-9560-4B7D30064288
MIAM! BE CITYWIDE (CW) BOARD & COMMITTEES
City of Miami Beach, PARKING DEPARTMENT PARKING APPLICATION
1755 M eridian Avenue, Suite 200/Miami Bech, FL 33139/Ph: (305) 673-7505 0 (305) 673-7000 ex4. 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
Date of Application: 2/6/2022
Applicant Name: Cameron Mclain
Board/Committee Name: Next Generation council
Address: 5900 Collins Ave Apt 407 Miami Beach FL 33140
E-Mail Address: cameronemclain@gmail.com
Work Phone: Home Phone
Cell Phone: 8135977052 Preferred Contact Method: email
Vehicle Information
Tag: EQKP74 Color: Red
State: FL Year: 2015
Make: Buick Model: Verano
Applicant Sianature: ef Ene.
Please provide signed form to Re Parking'Department located at 1755 Meridian Avenue, 2d floor. Working
hours are 8:30 to 5:00 p.m. or email to: ParkingReception@miamibeachfl.gov
e-mail subject: BOARD & COMMITTEE PARKING APPLICATION - APPLICANT NAME
P ·di D ar una e p a m e n e cto n
PERMIT SYSTEM GARAGE ACCESS
Expiration Date: ID Card Serial #:
Issued By Print Name: Print Name:
Signature: e Signature:
Date Issued: Date Completed:
rt tS ·ti
: .pig man rar forms cw oar is commntees par+ mg'orm, toe