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Joshua Robins 12/31/22~ MIAMI BEACH BOARD AND COMMITTEE CHECKLIST APPOINTEE: Joshua Robins DATE OF APPOINTMENT: March 30, 2022 --""""--'--"-'-"--'-"""'-........;--~~;...._----- BOARD/COMMITTEE: Next Generation Council FOR SCANNER Scan o Scan o Scan o Scan o Scan o RECEIVED M4AR 31 2022 Appointed by: Commissioner Samuelian reno eo.E2/31b2+enrune./2/3y/2- FOR CLERK STAFF o Letter of Appointment o Letter of Reappointment ° ?P',,/ettper of, Appointment/Reappointment e-railed - sota aorcok«c on cornees a,3 3 '2 o Résumé/Curriculum Vitae 3 3 / ì Ì o Diversity Statistics Reporting (Completed on. ), d> 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 CITY OF MIAMI BEACH OFFICE OF THE CITY CLERK o Citywide Permit Application (Parking Department Form) Scan o Scan o Received on: 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. 3/30/2022 Signed by X -----.,.1J'---------------- I Date¡ Processa 4. .ó) / /)02 emoyee: A / Date Scanned on: 3 31} ~0,),,2_By Employee: ---,-7"----:_.---------- 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 COMMITTIES DATABASE\CHECKLIST MASTER\B&C Checklist 2015 MASTER.docx We are committed to providing excellent public service and safety to all who live, work, and play in our vibrant, tropical, histonc community M IAM I BEACH City of Miami Beach, 1/OO Convention Conter Divo, Miami Boach, Hlorida 33 139 yywwy_miamnibcachll.goy OFFICE OF THE CITY CLERK, Rafaol E. Gran ado, Cly Clerk Tol: 305.673.7411, Fax. 305.673.7254 Email: CiNClerk@miamibeachll.gov March 30, 2022 Mr. Joshua Robins 4316 Nautilus Dr MIAMI BEACH, FL 33140 RE: Next Generation Council Dear Mr. Joshua Robins: 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. 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. Regard72J Rafael Granado City Clerk cc: Monica Beltran, Parking Director Erick Chirales, 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 - Am endm ent to City Code Section 2-22 Miami-Dade County Code Section 2-11.1-Conflict of Interest and Code of Ethics City Wi de Permit Application - (Par king Department Form) Booklet - Guide to the Sunshine Amendment and Code of Ethics for Public Officers and Employees 4 A 84BEA CH t''i i\,j'/i { · + 1 t 'd e 1 + (WH¥ II II IN,, Ratel I arnmnk, fi lel ll. 'J! ± ·AH, +ax. 'Ji,6':3 824 E ms;l. it,kl.iv.subs. hfl #or O ath of O ff ice O ath of C ivili ty and A ckno w ledg em ents TO: Mr. Joshua Robins 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 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. £ Mr. Joshua Robins 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. MIAM I BEACH City of Miami Beach 1700 Convention Center Drive Miami Beach, Florida 33139 OFFICE OF THE CITY CLERK Email: BC@miamibeachfl.gov Telephone: 305 .673 7411 RECEIVED MAR 31 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 (✓)all that apply): o I am a resident of the City of Miami Beach for six months or longer. Home Address 1800 W 24 St, Miami Beach, FL 33140 □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). [[are (f [y5[n%SS [[S[P%SS J\(](]reSS □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 Scott Robins Companies, Inc. Business Address 230 5th St, Miami Beach, Fl 33139 "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 «se 2e 33002022 Signature 7/ Date Joshua Robins Printed Name NOTARY Sworn to (or affirmed) and subscribed before me, by mean, of~ysical P. 6 senfe 1 o_r& o 1 on~ne notarization, oc.ac ut _2 2 JoSa,y2> ~ity of Mi mi Beach Board/2.:~ittee Member). roocea /__ )ve s 1se Form of Identification .sgii;g, CHARLES 4. GosTN f~i:¡':.,\ MY COMMISSION# HH 165705 ±;$, ¿g EXP IRE S: Decem ber 14, 202 5 %% }ij?" Bonded Thr u Notary Public Underwrit ers (NOTARY SEAL) MIAM I BEACH City of Miami Beach 1700 Convention Center Drive Miami Beach, Florida 33139 www.miamibeachll.gov OFFICE OF THE CITY CLERK Email: BC@miamibeachfl.gov Telephone: 305.673.7 411 DIVERSITY STATISTICS REP ORI Robins Joshua p 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: íee LlFemale O Other O I prefer not to answer. Race/Ethnic Categories: What is your race? O African American/Black CJ, Asian or Pacific Islander IX) Caucasian/white LJ 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 XNo O I prefer not to answer. Do you consider yourself Physically Disabled? Jves 0+ O I prefer not to answer this question. Page 6 of 6 F:ICLER\$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 .miamibeachll.gov OFFICE OF THE CITY CLERK Email: BC@miamibeachfl.gov Telephone: 305.673.7411 BOARD & COMMIT IEE 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) Robins Joshua p Last Name First Name Middle Initial I understand that no later than July 1,_of each vear 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 3/30/2022 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:\CLER\$ALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.dccx Updated: June 2020 M IA M l·DAD E- 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 First Name Middle Name/Initial 2021 Robins Joshua Paul Mailing Address - Street Number, Street Name, or P.O. Box 1800 W 24 ST City, State, Zip Miami Beach, Fl, 33140 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. O Filing as an Employee (check one) [] county □Public Health Trust [] Municipal: (Municipality) Department Position or Title Employee ID Number Work address I Work telephone Employment began on/ended on Filing as a Board Member (check one) [] county [] Municipal: Miami Beach (Municipality) Board where serving Next Generation Council Alternate address (if home address is exempt) I Work telephone pp;a 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 Scott Robins Companies, Inc. 230 5th St, Miami Beach, Fl Office on 5th and Washington 33139 I hereby swear (or affirm) that the information above is a true and correct statement. s;,,..,,. or,~,.,;,, 3/30/2022 Date signed av or a-79/8%%//% O Hardcopy J ectroni6 %},R 31 2022 CITY OF MIAMI BEACH OFFICE OF THE CITY CLERK OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/initials: Scanned Date/Initials: 138_SP-14 COE 2016 ±\9£4 .4 07 #±2 .E%: IL 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 Application: 3/30/2022 Applicant Name: Joshua Robins Board/Committee Name: Next Generation Council Address: 230 5th St Miami Beach Fl 33139 E-Mail Address: joshua@robinscompanies.com Work Phone: 305-674-0600 Home Phone Cell Phone: 305-915-34 7 4 Preferred Contact Method: email Vehicle Information Ta g: GGQQ38 Color: Black State: Florida Year: 2019 Make: BMW Model: X5 Applicant Sianature: e e Please provide signed form to4he Parking Department located at 1755 Meridian Avenue, 2" 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: f Signature: Date Issued: Date Completed: s :' pmg man roar' torms cw oarls committees par+.ingtorm.doc HUA PAUL O8/Ns 800 W 24TH ST MAM BCH, FL 331 Mk 09-27-19