Johann Moore 12/31/22M IAM I BEACH
BOARD AND COMMITTEE CHECKLIST_ /
AP PorE e£e. Joan t w oor o ATE or APPon rwer. /// 2)
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scan o o Letter of Appointment TERM END:/I-. TERM LIMIT:• /
Scan o o Letter of Reappointment
o (:} fe e~ f AppointmenUReappointment. e-mayed/to C~mmittee Liaison on
Scan o o ard and Committee Application (Completed on~ ft, , J--/J
scans ·sum6i@uric@iomi vé 2, ,7)5
o Diversity Statistics Reporting (Completed on. LL_t?_ ? >
Scan o o Oath 7
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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 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
Scan o o Acknowledgment of Financial Disclosure Requirement
O DIVERSITY STATISTICS REPORTING Keep COPY in file and ORIGINAL for Annual Report.
Received or:. 1 Feb 2¡22 Signed by X
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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 COMMITT IES DATABASE\CHECKLIST MASTER\B&C Checklist 2015 MASTER.docx
WVe ore committed to providing excellent public service and safety to all who live, work and play in our vibrant, topical histonc community.
MI
City of Miami Beach, ZOO Convonlion Conter Driva, Miami Booch, Horida 33139 y¿ywy_IiaIribgachf]_goy
OFFICE OF THE CITY CLERK, Rofool E. Granado, City Clerk Tel: 305.673.7411, Fax 305.673.7254
Email: Cit/Clerk@miamibeochfl.gov
February 16, 2022
Mr. Johann Moore
717 Jefferson Ave. Apt 8
Miami Beach, Florida 33139
RE: Sustainability Committee
Dear Mr. Johann Moore:
Congratulations! You have been appointed by Commissioner Mark Samuelian 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 305.673.7 411.
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.
e
City Clerk
cc: Monica Beltran, Parking Director
Alyssia Berthoumieux, 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
M IA M I BEACH
City o f M ia m i Bea ch , 1ZOO Convention Conter Drive, Miam i Boo ch , Eorida 33 139 wywy_miamibachll.goy
OF FICE OF THE CITY CLERK, Rafool E. Granado, City Clerk
Tol: 305.673.7411, Fax. 305.673.7254
Email: CiNyClerk@miamibeachll.gov
Oath of Office
Oath of Civility
and
Acknowledgements
T O : M r. Jo hann M o ore
R E : S ustaina bility C om m itt ee
I do so le m n ly sw ear or affirm to bear true faith, loyalty and allegiance to the G overn m ent of the United
States, the State of Florida, and the C ity of M iam i Beach, and to perform all the duties of a m em ber of the
ab o ve-m entioned board or com m ittee of the C ity of M iam i Beach to w hich I have been appointed fo r a
term ending: 12/31/2022.
To m y co llea gu es and to all of those I represent and serve, I pledge fairn ess, integrity and civility, in all
actions taken and all com m unications m ade by m e as a public serv ant.
I ha ve be e n issued a copy of section 2-11.1 of the M iam i-D ade C ounty C ode (C onflict of Interest and
C o de of Ethics O rdinance), as w ell as Florida C om m ission on Ethics G uide to the Sunshine Am endm ent
and C o de of Ethics for Public O ffi cers and understand that as a m em ber of a C ity of M iam i Beach Board
and/or C om m ittee , I m ust com ply w ith the financial discl osure* requirem ents of M iam i-Dade C ounty or the
State of Flo rid a (d e pending on the board or com m ittee on w hich I serve) on July 1st, fo llow ing the closing
of the cale nda r yea r on w hich I have serv ed.
M r. Jo6nannloore
Sw orn to and subscribed before m e thi✓-~-..- day ~. 2022
*P lease visit th e C ity of M iam i Beach w ebsite at w w w .m iam ibeachfl.gov under City Clerk/Board and
C o m m itt ees fo r additional info rm ation regarding the Financial Discl osure R equirem ents.
G
FPL.
FPL.com Page 1 E0O1
Hello Johann Moore,
Here's what you owe for this billing period.
Electric Bill Statem ent
For: Dec 16, 2021 to Jan 18, 2022 (33 days)
Statem ent D ate: Jan 18, 2022
A ccount Num ber: 47368-10260
Service Address:
717 JEFFERSON AVE APT 8
MIAMI BEACH, FL 33139
CURRENT BILL
$80.82
TOTAL AM O UNT YOU OW E
Feb 8, 2022
NEW CHARG ES DUE BY
ENERGY USAGE HISTORY
800 kW#
640 kWh?
I I I II I 480 kWh'
I I I II 320 kWh? I I 160 kWh'
0kWh ............ ················O
2021 J F M A M J J A s o N D J 2022
BILL SUMMARY
Am ount of your last bill
Paym ents received
Balance befo re new charges
Total new charges
Tota l am o u n t you ow e
59.65
-59.65
0.00
80.82
$8 0.82
FP L au tom a tic bill pay - D O N O T PA V
(See page 2 for bill details.)
KEEP IN MIND
• Payments received after February 08, 2022 are considered late; a late
payment charge, the greater of $5.00 or 1.5% of your past due balance will
apply. Your account may also be billed a deposit adjustment
• The amount due on your account will be drafted automatically on or after
Jan uary 29, 2022. If a partial payment is received before this date, only the
rem aining balance due on your account will be drafted automatically.
The Public Service Com m ission unanim ously approved FPL's four-year rate
agreem ent, which begins this m onth, to support continued investm ents in
clean energy, the grid and technology. Visit FPL.com/An swer s.
Custom er Service:
Outside Florida:
(305) 442-8770
1-800-226-3545
Report Power Outages:
Hearing/Speech Impaired:
1-800-4OUTAGE (468-8243)
711 (Relay Service)
G
r-EL.
I 3¥ FPL AUTOMATIC BILL PAY - DO NOT PAY ¥
The amount enclosed includes
the fo llowing donation:
FPL Care To Share:
Make check payable to FPL
in U.S. funds and mail along with
this coupon to:
JOHANN MOORE
717 JEFFERSON AVE APT 8
MIAMI BEACH FL 33139-8553 FPL
GENERAL MAIL FACILITY
MIAM I FL 33188-0001
Visit FP L.c om /P ayB ill
fo r ways to pay. «roso-rozo }( "" )[ ea»s.zoo? $ Auto pay - DO NOT PA Y
ACCOUNT NUMBER TOTAL AMOUNT YOU OWE NEW CHARGES DUE BY AMOUNT ENCLOSED
%
F-PL.
Custom er Nam e:
Johann Moore
Account Num ber:
47368-10260
FPL.com Page 2 E001
BILL DETAILS
Amount of your last bill
Payment received - Thank you
Balance before new charges
New Charges
Rate: RS-1 RESIDENTIAL SERVICE
Base charge:
Non-fuel: (First 1000 kWh at $0.073710)
(Over 1000 kWh at $0.083710)
Fuel: (First 1000 kWh at $0.034870)
•..•.........(Qer 10o9 Rh at $0.044870)_.............
Electric service amount
Gross rec. tax/Regulatory fee
Franchise charge
Utility tax
59.65
-59.65
«#tat« a data
$0.00
$8.99
$40.91
$19.35
69.25
1.83
3.82
5.92
Taxes and charges 11.57
Total new charges $80.82
Total amount you owe $80.82
FPL automatic bill pay- DO NOT PAY
METER SUMMARY
Meter reading - Meter ACD5877. Next meter reading Feb 16, 2022.
Usage Type Current Previous Usage
kWh used 69275 68720 555
ENERGY USAGE COMPARISON
This Month Last Month Last Year
Service to Jan 18, 2022 Dec 16, 2021 Jan 15, 2021
kWh Used 555 462 457
Service days 33 30 30
kWh/day 17 15 15
Amount $80.82 $59.65 $57.19
Florida's Energy Future
Our unanimously approved 2022-2025 rate
plan supports investments in clean energy,
the grid and technology.
Find out more
Watch savings add up We're here to help
Receive a monthly bill credit by allowing with If you're experiencing hardship as a result of
FPL On Call to cycle off selected appliances the coronavirus (COVID-19) and need help
when absolutely necessary. with your bill, there are resources available.
See if you qualify , Learn more
When you pay by check, you authorize FPL to process your payment electronically or as a draft. If your payment is processed electronically,
your checking account may be debited on the same day we receive the check and your check will not be returned with your checking account
statement. FPL does not agree to any restrictions, conditions or endorsements placed on any bill statement or payments such as check, money
order or other forms of payment. We will process the payment as if these restrictions or conditions do not exist.
M IA M I BEACH
City of Miami Beach
l 700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
RECEIVED
FEB 1 7 2022
CITY OF MIAM I 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):
:S: I am a resident of the City of Miami Beach for six months or longer.
Home Address 717 J efferson Avenue, Ap t 8, M iam i Beach, 1L 33139
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 _
Business Address _
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).
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.
Under penalties of perjury, I declare that I have read the foregoing document and that the facts stated in it
are true. Joa M oore 1 Feb 2o22
Signature Date
Jo han n M oore
Printed Name
NOTARY
Sworn to (or affirm7e/) and subscribed before me, by means of2physical presence or a online notarization, o/a/a1 2• Jh3u] loo c
x Produced ID
(City of Miami Peach Board/Committee Member). [- [ruer les
form of Identification
., CHARLE S J. DAGOSTIN /f&if.'-~\ MY COMMISSION# HH 16570
" +: ±e, ¡¿S EXPIRES: Decomber 14, 2025
}7'$" ponded Thru Notary Public Undenwrit sassassaasa. ..
(NOTARY SEAL)
Signatur
MIAMI BEACH
City of Miami Beach
1 700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachll.gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
DIVERSITY STATISTICS REPORT
Moore Johann L
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:
XJ Mate
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
LS 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?
Yves
2No
O I prefer not to answer.
Do you consider yourself Physically Disabled?
aves
o
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 REG FINAL.docx
Updated: June 2020
MIAMI BEACH
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: 305.673.7 411
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)
Moore Johann L
Last Name First Name Middle Initial
I 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 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)';" 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.
Jolav Moove 1 Fel 2022
Signature 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:ICLER\$ALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
MIAMI-DADE. EE SOURCE OF INCOME STATEMENT
Section 2-11.1(@) of the County Ethics Code requires that certain em ployees and public officials file a financial disclosure Statement on a yearly basis by July 1st
of every year.
Disclosure fo r Tax Year Ending I Last Nam e First Nam e Middle Name/Initial
2020 Moore Johann
M ailing Address - Street Num ber, Street Nam e, or P.O. Box
717 Jefferson Ave. Apt 8
City, State, Zip
Miami Beach, FL 33139
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 fo llowing page and ch eck Iele.
□County O M unicipal:
De p art m e n t
Position or Title
W ork address
Filing as a Board M em ber (check one)
W ork telephone
O County [ uniciat:
Board w here serv ing or i hee
A ltern ate address (if hom e address is exem pt) Work telephone Ter~an
Li st below every source of inco m e you received, along with the address and the principal activity of each source. Include your public salary . Place the sources of
incom e in descending order, with the largest source first. Exam ples of source s of incom e include: com pensation for serv ices, income from business, gains from
propert y dealings, interest, rents, dividends, pensions, IRA distributions, and social security paym ents. Also, include any source of income received by another
person fo r your benefit. However, the incom e of your spouse or any business partner need not be disclosed. If continued on a separate sheet, check here. D
Nam e of Source of Incom e Address Description of the Principal Business Activity
Robert Goldring, Spouse 717 Jefferson Ave. SGS North America
M/Tia.mi Rea0h HT, 33139
I hereby swear (or affirm) that the info rmation above is a true and correct statement.
Jol a v M oore
Signature of Person Disclosing
16 Feb 2022
Date signed
RECEIVED BY ELECTIONS DEPARTMENT:
O Hardcopy RECEIVED
□Electronic Copy
FEB 1 7 2022
CITY O F M IAMI BEACH
OFFICE OF THE CITY CLERK
REMEMBER TO PRINT, SIGN, AND SUBMIT TO THE OFFICE OF THE CITY CLERK VIA EMAIL OR HARDCOPY.
l ±\9£4 .4 17 ±2.± LO
17 5 5 M eridi a n A venue, Suite 20 0 /M ia m i Bea ch, FL 33 13 9 /P h : (30 5) 67 3-7 50 5 or (305) 673-7 000 ext . 6200 PARKING
A city w ide (CW ) parking perm it is honored at metered par king spaces and restrict ed residential zones
par king spaces. A C W par king perm it IS NOT honored in prohibited ar eas . An Access Car d will be
provided to you for C ity Hall G ar age (G 7) access.
IMPORTANT NOTE: Your vehicle license plate serves as your "parking permit". In order to avoid
any unnecessar y enfo rcem ent actions, it is im portant that our records reflect the most current and
accurate info rm ation regarding your vehicle license plate. Inaccurate and/or outdated vehicle
info rmation m ay lead to the issuance of parking citation(s) and/or the towing of your vehicle.
Please note that this new access car d CANNOT be hole-punched or perforated in any manner. To use
the new card please hold the car d at close proxim ity to the reader until the gate opens. You may need
to try the other side of the car d. Please ensure you hold the entire surface of the car d 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:
Applicant Name: Johan n M oore---par kin g ap plicat ion not needed at this time
Board/Committee Name:
Address:
E-Mail Address:
Work Phone: Home Phone
Cell Phone: Preferred Contact Method:
Vehicle Information
Tag: Color:
State: Year:
Make: Model:
Applicant Sianature: ef
Please provide signed form to the 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 ·kd D ar mna epartment ection
PERMIT SYSTEM GARAGE ACCESS
Expiration Date: ID Card Serial #:
Issued By Print Name: Print Name:
Signature: e Signature:
Date Issued: Date Completed:
s .
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