Mike Gibaldi 12/31/22M IA M I BEACH
BOARD AND COMMITTEE CHECKLIST
APPoreEe:_Mo @at Ar or APorweNr. ?_"
FOR SCANNER
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BOARD/COMMIT TE.arine & Waterfront Protection Auto}pointed by. Commissioner Ricky Arriola
rei avo.d]3L/son. /2/3//j
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RECEIVED
MAR -7 2022
FOR CLERK STAFF
o Letter of Appointment
o Letter of Reappointment 9r of er ;:i, ~pointment/Reappointment e-mailed to Committee
o Bo rd an Committee Application (Completed on • - )
• Resomercmreuum vie /TT
o Diversity Statistics Reporting (Completed on. g_?_p ah>
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
g2,9%,ß25g?lle coso«os erro« Aron«oto tea«o o»ro»ns roro»
o Booklet - Guide to Sunshine Amendment & Code of Ethics for Public Officers and Employees
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Received on:
o Source of Income Statement
o Acknowledgment of Financial Disclosure Requirement
O DIVERSITY STATISTICS REPORTING Keep COPY in file and ORIGINAL for Annual Report.
3-1-22 stoned syX ')le bald ------------------------ Date
ros•-7-22
Date
su. 3-7- 2)
Date
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[3y [m[O/ee. J
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 DATABASE\CHECKLIST MASTERIB&C Checklist 2015 MASTER.docx
Ve are committed to roding excellent public serce and safety to oll who live work and olay in our vibrant tcpcal histonc commun.Ny
/ MIAM/BEACH
City of Miami Beach, 1/00 Convention Conter Drive, Miami Beach, Hlorida 33 139 yNyw._miamnibachll_go
OFFICE OF THE CITY CLERK, Rof0ol E. Granado, City Clerk
Tel: 305.673.7411, Fax. 305.673.7254
Email: CityClerk@miamibeachfl.gov
February 24, 2022
Mr. Mike Gibaldi
4780 Pine Tree Dr., Apt 1
MIAMI BEACH, FL 33140
RE: Marine and Waterfront Protection Authority
Dear Mr. Mike Gibaldi:
Congratulations! You have been appointed by Commissioner Ricky Arriola 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.
Regar~ .- City Clerk
cc: Monica Beltran, Parking Director
Kenneth Varela, 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
MI AMI BEACH
City of Miami Beach, I/OO Convention Center Drive, Miami Bach, Florida 33139 www_miamibeachll_gov
OFFICE OF THE CITY CLERK, Rafael E. Gran ado, Ciy Clerk
Tl: 305.673.7411, Fax. 305.673.7254
Email: Cit Clerk @mi amibeach fl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO : M r. M ike G ibaldi
R E : M arine and W aterfront Protection A uthority
I do solem nly sw ear or affirm to bear true faith, loyalty and allegiance to the G overn m ent of the U nited
States, the State of Florida, and the C ity of M iam i Beach, and to perf orm all the duties of a m em ber of the
above-m entioned board or com m ittee of the C ity of M iam i B each to w hich I have been appointed fo r 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 ci vility, in all
actions taken and all com m unications m ade by m e 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
C ode of Ethics O rdinance), as well as Florida Commission on Ethics Guide to the Sunshine Amendment
and C ode of Ethics fo r P ublic Officers and understand that as a member of a City of Miami Beach Board
and/or C om m ittee, I m ust com ply w ith the finan ci al discl osure requirements of Miami-Dade County or the
S tate of Florida (depending on the board or com mittee on which I serve) on July 1st, following the closing
of the calendar year on which I have served.
Sworn to and subscribed before me this
Mr. Mike Gibaldi
7.a0e
please visit the City of Miami Beach website at ww w.miamibeachfl.gov under City Clerk/Board and
Committees for additional information regarding the Financial Disclosure Requirements.
MIAM I BEACH
City of Miami Beach
1 700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
RECEIVED
MAR -7 2022
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
!"3\ata» V I am a resident of the City of Miami Beach for six months or longer.
Home Address 4780 Pine Tree Dr, Apt 1, 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 Da
Business Address ------------------------
□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 n_l_a _
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 ru e. ')like <bald; 3-5-22
-------------- Signature
Mike Gibaldi
Date
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means o~hysical presence or o online notarization, o.> o» ore&H a-2 , M L!e AlantL "
_________ (City of Miami Beach Board/Committee Member).
K eso Y D ux > loe
], Form of Identification
ally Known
zz.. CHARLES J, DAGOSTIN ·is1,, ·vw. ê" j "; w cou u ss o n HH 1os7os
¿i ,è,$i ExPREs: December 14, 2025
3..$ on ded Tru Notary Pub ic Undenwriters %E.%°
(NOTARY SEAL)
Signature o
M IA M I BEACH
City of Miami Beach
1 700 Convention Center Drive
Miami Beach, Florida 33139
www._miamibeachl]_gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7 411
DIVERSITY STATISTICS REPORI
G ib a ldi M ichae l J
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.
%» Me
O Female
O Other
O I prefer not to answer.
Race/Ethnic Categories:
What is your race?
LI-African American/Black
lAsit or Pacific Islander
[SiCa ucasian/wh ite
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?
et
O I prefer not to answer.
Do you consider yourself Physically Disabled? :
O I prefer not to answer this question.
Page 6 of 6
F:\CLER\$ALLIREG\BOARD AND COMMITT EE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION RE G FINAL .docx
Updated: June 2020
MIAMI B E A C H
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
BOARD & COMMITTEE FINANCIAL ACKN OWLEDGE MEN I STATEM EN T
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)
Gibaldi Michael J
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 Mi am i
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. '/he Gibaldi 3-5 22
Signature Date
' 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\$ALLIREG \BO ARD AND CO M M ITT EE APPLICATIO NS FINAL DRA FTS\BOARD AND COMMITT EE APPLICATION RE G FINAL.docx
Updated: June 2020
MIAMl·DAD E-
EEMI 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.
Di sclosure fo r Tax Year Ending I Last Nam e First Nam e M iddle Nam e/Initial
2021 Gibaldi Michael J
M aili ng Add ress - Stre et Num ber, Street Nam e, or P.O. Box
4780 Pine Tree Drive, Apt 1
City, State, Zip
Miami Beach, FL 33140
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 here. D
Filing as an Employee (check one)
[] county □Public Health Trust [] Municipal:
(M unicipality)
Dep artm ent
Positi on or Title Em ployee ID Num ber
W ork add ress I W ork telephone Em ploym ent began on/ended on
Filing as a Boa rd Member (check one)
[] county City of Miami Beach
(M unicipality )
Board w here serving
Marine & Waterfront Protection Authority
Altern ate address (if hom e address is exem pt) W ork telephone
305-389-4615
Term began on/ended on
3-1-2022
List below every source of incom 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. Examples of sources of income include: compensation for services, income from business, gains from
pro perty 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 incom e of your spouse or any business partner need not be disclosed. If continued on a separate sheet, ch eck her e.[]
Nam e of Source of Incom e Address Description of the Principal Business Activity
Brickell Energy 1951 NW 7 Ave, Suite 600 Sales, installation, management
Miami, FL 33136 of Electric Vehicle chargers
I hereby sw ear (or affir m) that the information above is a true and correct statement.
mid &ad d
Signature of Person Disclosing
3-5-2022
Date signed
coas ea9E %%b □Hardcopy
tectonic Pf,-7 2022
CITY OF MIAMI BEACH
OFFICE OF THE CITY CL E RK
OFFICE USE ONLY A ccepted: Y / N Deficiency: Pro cessed Dat e/Initial s: Scann ed Date/initials:
138_SP-14 COE 2016
2\Es£4.£1#%22 £%. I
1755 Meridian Avenue, Suite 200/Miami Beach, FL 33139/Ph: (305) 673-7505 or (305) 673-7000 ext. 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 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 Applicatio' 3-5-2022
Applicant Name:
Board/Committee Name:
Address:
4780 Pine Tree Dr., A t1, Miami Beach, FL 33140
E-Mail Address:
h20mike @ mail.com
Work Phone: 305-389-4615 Home Phone
305-389-4615
Cell Phone:
305-389-4615
Preferred Contact Method:
email
Vehicle Information
Ta g: Color: WHITE ROASC
State: FL Year:
2018
Make: Model: Leaf Nissan
Applicant Sianature: e ida <dad
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, ·ki D ar mna epartment ection
PERMIT SYSTEM GARAGE ACCESS
Expiration Date: ID Card Serial #:
Issued By Print Name: Print Name:
Signature: 6 Signature: e
Date Issued: Date Completed:
s
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