Alan Nieder 12/31/22E
BOARD AND COMMITTEE CHECKLIST
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FOR CLERK ST AFF
o Letter of Appointment
o Letter of Reappointment
o ' of lt r "I AppointmenUReappointment e~ailed J. Committee
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o esumetcumc@tam vtáé 3/4j j3
o Diversity Statistics Reporting (Completed on. g /_ A>
o Oath
Liaison on
IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
✓City Code Ordinance Section applicable to the agency, board or committee
D ✓City Code Sections 2-21, 2-22, 2-23, 2-24, 2-25, 2-26, 2-458 and 2-459
RECEIVE ✓County Code Section 2-11.1 -- Conflict of Interest and Code of Ethics Ordinance (as
amended through December 201 O)
MAR -9 2022 Amendments to the Code of Ethics Ordinance (September 2009 through July 2012)
✓Highlights of the Miami-Dade County Ethics Code
[T OF MIAMI BEACH ' Sunshine Law and Public Records - Frequently Asked Questions
OFFICE OF THE CITY CLERK ✓Memorandum - Solicitation by City Board and Committee Members
o Citywide Permit Application (Parking Department Form)
o Booklet - Guide to Sunshine Amendment & Code of Ethics for Public Officers and Employees
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Received on:
Processed on:
Scanned on:
o Source of Income Statement
o Acknowledgment of Financial Disclosure Re
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O DIVERSITY STATISTICS REPORTING
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CONCLUDED & RESIGNATION LETTERS
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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
WVe ore committed to providing excellent public service and safety to all who live, work, and play in our vibrant, tropical, historic community.
MI A M I BE
City of Miami Beach, 1700 Convention Conter Divo, Miami Boach, Elorida 33139 yyywy_miarIihaachl]goy
OFFICE OF THE CITY CLERK, Raf0al E. Gran ado, City Clerk Tel. 305.673.74I1, Fax: 305.673.7254
Email: CilyClerk@miamibeachll.gov
February 28, 2022
Dr. Alan Nieder
6340 PINETREE DR
MIAMI BEACH, FL 33141
RE: Disability Access Committee
Dear Dr. Alan Nieder:
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. 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.
Regards,
Rafael Granado
City Clerk
cc: Monica Beltran, Parking Director
Valeria Mejia, 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 , .MI BE
City of Miami Beach, N/0O Convention Conler Divo, Miami Boach, Florida 33139 yyywyy_miaIIihoachÍl.goy · ,
OFFICE OF THE CITY CLERK, Raf0al E. Granado, City Clerk
Tel: 305.673.741, Fa. 305.673.7254
Email: CilyClerk@miamibeochfl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Dr. Alan Nieder
RE: Disability Access Committee
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 requirements of Miami-Dade County or the
State of Florida (depending on the board or committee on which I serve) on J Vy 1st, following the closing
of the calendar year on which I have served.
)
Dr. Alan Nieder
Sworn to and subscribed before me this I-
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 MI BE
City of Miami Beach
1 700 C onventio n C enter Drive
M iam i Beach, Florida 33 13 9
OFFICE OF THE CITY CLERK
RECEIVED
MAR -9 2022
Email: BC@miamibeachf].gov
Telephone: 30 5.6 7 3.7 4 11 CITY OF MIAMI BEACH
OFFICE O E THE CITY CLERK
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
ST A T E O F FLO R ID A
C O U N T Y O F M IA M I-D A D E
I am in co m p lia nce w ith the aff ilia tio n req uirem e nt of M iam i Beach C ity C ode S ections 2-22 (4), as (check
(),al th at apply):
~ I am a resid e nt of the C ity of M iam i Beach fo r six m onths or longer.
ore ... Go Pr ore 2 M._8 2/
□I ha ve an ow nership in te re st (for a m inim um of six m onths) in a business established in the City of
M ia m i Be a ch (for a m in im u m of six m o nths).
[[3[]9 f [[JS[[eSS-
[[JS[[@,S, (][eS..-
□I am a full-tim e em plo ye e of a busin ess (fo r a m inim um of six m onths) and I am based in an office or
othe r lo ca tio n of the busin ess that is physically located in M iam i B each (for a m inim um of six m o nths).
[qr) (f 1][Si-
1JS[[es,S, (]][eS-
"Ownership lnte est" means the ownership of ten percent (10%) or more (including the ownership of
10% or more oft e outstanding capital stock) in a business.
"Business" mean any sole proprietorship, sponsorship, corporation, limited liability company, or other
entity a business association.
jury, I de clare tha t I have read the forego ing docum ent and that the facts stated in it
3,22
A u D ate
P rinted N a m e
NO TARY
S w orn to (o r affi rm e d ) an d su b scrib e d be fore m e, by m ean s ot(phy sic al pre sen ce or online not ariz ation ,
?a H_., h hwu /celere
Prod u ce d ID
iii., CHARLES J. DAGOSTIN !~·A·~-,, MY COMMISSION# HH 165705 z4e ·1
3%j, is; EXPIRES: December 14, 2025
jg"" Bonded Tru Notary Public Underwriters
S ig n at
(N O T A RY S E A L)
M IA M IB E C
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miami beach fl.g ov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.741 l
DIVERSITY STATISTICS REPQRT
A/ M
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:
a e
O Female
O Other
O I prefer not to answer.
Race/Ethnic Categories:
What is your race?
O African American/Black
O Asian or Pacific Islander
LQ 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?
Jves
~:refer not to answer.
Do you consider yourself Physically Disabled?
Aves ä
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.dccx
Updated: June 2020
M IAM I E
City of Miami Beach
1 700 Convention Center Drive
Miomi Beach, Florido 33139
www.miamibeachfl.gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305. 67 3 7411
BOARD & COMMIIIEE FINANCIAL ACKNOWLEDGEM ENT 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)
Nree Il
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 Miam 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 yd r latest Federal Income Tax Return.
Failure o file on of these forms, pursuant to the Miami-Dade County Code, may subject the person to a fine
of no me than $i00, 60 days in jail, or both. - 2.22
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\REGIBOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
MIAMl·DADE. 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 Last Name ~ y Middl~e/lnitial
2021 /v1)
Mailing Address - Street Number, Street Name, or P.O. Box 3 o NIN NAX
City, State, Zip we BMW+ 6 ]_s/L/¡
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 following page and check here. D
Filing as an Employee (check one)
[] county [] Public Health Trust [] Municipal:
(Municipality)
Department
Position or Title Employee ID Number
Work address Work telephone Employment began on/ended on
Filing as a Board Member (check one)
□County ~unicipal: /tr %0Md
(Municipality)
Board where serving D±sur has4 ow „kc
Alternate address (if home address is exempt) Work telephone "p e 2022
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
Name of Source of Income Address Description of the Principal Business Activity
M 3o h7e/ /lJ) (y
COL0/ l)y\/W ,. kt (s• ht) /ooh a Dy+ ht, (o hr» /) AI
I hereby swear (or affirm) that the information above is a true and correct statement.
)a/
erson Disclosing
, s2
Date signed
RECEIVED BY ELECTIONS DEPARTMENT:
[] Hardcopy RECEIVED
[] Electronic Copy
MAR - 9 2022
CITY OF MI AMI BE A CH
OFFICE OF THE CITY CLERK
CITYW IDE (CW ) BO ARD & COMMITTEES
City of Miami Beach, PARKING DEPARTMENT PARKING APPLICATION
1755 Meridian Avenue, Suite 200/Miami Beach, FL 33139/Ph: (305) 673-7505 or (305) 673-7000 ext. 6200
A ci ty w id e (C W ) p a rkin g p e rm it is ho n o re d a t m e te re d p a rkin g sp a ce s a n d re stricte d re sid e ntia l zo n e s
p ar kin g spa ce s. A C W p ar kin g p e rm it IS NOT ho n o re d in p ro h ib ite d a re a s. A n A cce ss C a rd will b e
p ro vid e d to you for C ity H a ll G ar a ge (G 7 ) a cce ss.
IMPORTANT NOTE: Y o u r ve h icl e lice n se p la te se rve s a s yo u r par ki n g p er mi t". In o rd e r to a vo id
a n y un n e ce ssar y e n fo rce m e n t a ct io n s, it is im po rta n t tha t ou r re co rd s re fle ct the m o st cu rre n t a n d
a ccu ra te in fo rm atio n re gar d in g you r ve h icl e lice n se p late . In a ccu rate an d /o r outdate d ve h icl e
in fo rm atio n m ay le ad to the issu a n c e o f p ar kin g ci ta tio n (s) a n d /o r the to w in g o f you r ve h icl e .
P le a se no te tha t th is ne w a cce ss car d CANNOT b e ho le-p u n c h ed o r p e rfo ra te d in a n y m a n n e r. To use
th e ne w ca rd p le ase ho ld th e ca rd a t cl o se p rox im ity to the re ad er un til th e g a te ope n s. Y ou m ay nee d
to try the o the r sid e o f the ca rd . P le ase e n su re yo u ho ld th e e n tire surfa ce o f th e ca rd a ga in st th e re a d e r
un til the g ate op e n s.
ACKNOWLEDGEMENT: I acknowledge that should my access card be lost, stolen or
damage, I will be responsible to pay a $10.00 replacement fee.
B o a rd M em b e r In fo rm a tio n
Date of Application: M ece I I 222 .
Applicant Name: /$/ VE el
Board/Committee Name: BA2rm» lcat outtee
Address: 7202 2-7 Pp A /ml±± helar Jì_ 3/o
E-Mail Address: 1 red co /afc t a+
Work Phone:(21) q 297 Home Phone
Cell Phone: K - 5//-4407 Preferred Contact Method: el
V eh icl e In fo rm a tio n
Tag: Aß) s5$ Color: Mlck
State: f Year: 2 2=
Make: po It Model: Mt
Applicant Sianature: e
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: ParkingR eception@miamibegchfl.gov
e -m ai l su bj e ct: B O AR D & COMMITTEE PARKING AP PLICATIO N - APPLICANT NAME
P ·i D S ' ar mn a enartment ection
PERMIT SYSTEM GARAGE ACCESS
Exp iration Date: ID Card Serial #:
Issued By Print Name: Print Name:
Signature: 6 Signature: es
Date Issued: Date Completed:
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