Paul Thomas 12/31/23M IA M I BEACH
FOR SCANNER
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RECEIVED
4PR - 4 2022
FOR CLERK ST AFF
o Letter of Appointment
e-Letter of Reappointment
o Cpp of, efter of Appointment/Reappointment e-mailed to Committee Liaison on
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o' ar n mmittee Application (Completed on . , )
o Resume/curriculum vitae ff/ )3
o Diversity Statistics Reporting (Completed on_/_, [_/__j/a A
o Oath
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
• sosi e ta%J,p22,PK;{"sggg- euony A«ka4 ovestons
V Memorandum -Soli 5n by @i/B6ard and Committee Members CITY OF MIAM I BEACH
OFFICE OF THE CITY CLERK
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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 REPORT~eep COPY in file and IGINAL for Annual Repo .
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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
We are committed to providing excellent public service and safety to all who live, work, and play in our vibrant, tropical, historic community.
M IA M I BEACH
City of Miami Beach, /OO Convention Conlor Drive, Miami Boach, Florida 33 139 yyw_Iiamibcachll.go
OFFICE OF THE CITY CL ERK , Raf0al E. Granado, City Clerk
ol: 305.673.7411, Fax. 305.673.7254
Email: CityClerk@miamibeachfl.gov
Ja nu a ry 24, 2022
M r. Paul T ho m as
800 W est A venue A pt. 302
M ia m i Bea ch, F lo rida 3313 9
SUBJECT: LGBTQIA+ Advisory Committee
C o ng ratulatio ns! Y ou have been reappointed by Commissioner Steven Meiner to the above referenced,
board or com m itt ee nam ed above, fo r a term ending: 12/31/2023.
Pursuant to C ity of M iam i Beach C ode Section 2-22 (5) a, "N otw ithstanding any other pro vision of the
C ity C ode or of any resolution, com m encing w ith term s beginning on or after Jan uary 1, 2007, the term of
eve ry bo a rd m em b er w ho is directly appointed by a m em ber of the C ity C om m ission shall autom atically
exp ire up o n the la tter of: D ecem ber 31 of the year the appointing C ity C om m issioner leaves offi ce or
upo n the appointm enUelection of the successor C ity C om m ission m em ber."
If you are un a ble to accept this appointm ent, or have any que stions, please call the Office of the City
C le rk at 305.6 7 3.7411. Please read the encl osed m aterials carefully.
C o ng ratulatio ns and good luck.
Regaiz1
R afae l G ranado
C ity C le rk
cc: M onica Be ltran , Parking D irector
N a tt a ly C ue rv o , C ity Li aison
ATTACHMENTS:
Letter of A ppo intm e nt
O ath
C ity C od e/O rdina nce section applicable to agency, board or com m ittee
C ity C o d e Se ction 2-22, 2-23, 2-24, 2-25, 2-26, 2-458 an d 2-459
O rdinance N o. 2006-3543 - Am en dm en t to C ity C ode Section 2-22
M ia m i-D a d e C o unty C ode Section 2-11.1 - C on fli ct of Interest and C ode of Ethics O rdinance
C ity Wi d e Pe rm it Ap p lication - (Par ki ng D epartm ent Form )
Boo kl et - G ui de to the S unshine A m endm ent and C ode of Ethics for Public Officers and Em ployees
M IA M I BEACH
City of Miami Beach, 1/OO Convonlion Conter Drivo, Miami Boach, Horida 33 139 yyw_miamiboachl].go
OF FICE OF THE CITY CIERK, Rlool E. Granado, Ciy Clerk
Tol: 305.673.7411, Fax. 305.673.7254
Email: CiNyClerk@miamiboochfl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Mr. Paul Thomas
RE: LGBTQIA+ Advisory 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: 12/31/2023.
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.
eo--
#
Sworn to and subscribed before me this ........--1 .......... - day o_K , 2022
pl ease 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
1 700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
RECEIVED
APR -4 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):
vÍ am a resident of the City of Miami Beach f r six months or longer.
Home Aaar,o \H c 2o2
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 an
2g-
Signature
A ( (A 1loas #ha -
that the facts stated in it
NOTARY
Swom to (or affirmed) an~ subscribed before me, by means o~ysic~~esence or o on~ine notarization,
st/a•hp, h 2 Pal'A. 1ho s
(City of liami Beach Board/Committee Member). ppseeeeeeesteem-eeemees t L,' „„g#ji#;. cvtEes i. owoosm i i'4Se [$Ä; wrcounsso»o isrs
Form of Identification l?gads? ExPREs: Decambor 14, 2025 jg" Bonded Tu Notar y Public Underwriters
Produced ID
(NOTARY SEAL)
Signat r
M IA M I BEA 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: 305.673.7 411
Last Name
DIVERSITY STATISTICS REPORT
+Rs
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;
e
Llremale
O Other
O I prefer not to answer.
Race/Ethnic Categories:
What is your race?
LAfrican Am erican/Black
O Asian or Pacific Islander
Ll Caucasian/white
O Native Am erican/Am erican Indian
O Other - Print Race: ------------- □I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
Jves
o
O I prefer not to answer.
Do you consider yourself Physically Disabled?
ves
AG
O I prefer not to answer this question.
Page 6 of 6
F:IC LE R \$A L L\R E G IB O A R D A N D C O M M ITT E E A P P LI C A T IO N S FIN A L D R A FT SIBO A R D A N D CO M M ITT EE A PPLI C A TIO N REG FIN A L.dccx
Updated: June 2020
MIAMI BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miami beach(l.gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachf.gov
Telephone: 305. 673 .7 4 11
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)
Last Name #.I- First Name Mddle 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 ays in jail, or both.
?a
Signature Date T t
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
MIAMl·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
2021
First Name = ~iddle Name/Initial
Mailing Address - Street Number, Street Name, or P.O. Box
€ )es
City, State, Zip
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 D 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 riot WA,ca,I<; L-
(Municipality)
Board where serving # Ap urso
Alternate address (if home address is exempt) Work telepho e on/ended on
0o2O
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.[]
Name of Source of Income Address Description of the Principal Business Activity
s>-o 'w) 1}-
• nw«e k Lb .A
I hereby swear (or affirm) that the information above is a true and correct statement. RECEIVED BY ELECTIONS DEPARTMENT: cs0it O Hardcopy
tectonic ca3ECEIVED
Signature of Person Disclosing APR -4 2022 tlsl -,__ ì.__
CITY OF MIAMI BEACH
i, i ---· ·- - - . • I lfl. ll I al.E. I
REMEMBER TO PRINT, SIGN, AND SUBMIT TO THE OFFICE OF THE CITY CLERK VIA EMAIL OR HARDCOPY.
±94 .4 47 +$2 Ia
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: _A
Applicant Name: \.
Board/Committee Name; [_o 1 4
Address:
E-Mail Address: >
l
Work Phone:
Cell Phone' 35
Home Phone
Preferred Contact Method: es
Vehicle Information
tea IC>
State:
Make:
Color:
Year:
Model: I<
Applicant S¡unature: 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 ·i D S · ar' mna epartment ection
PERMIT SYSTEM GARAGE ACCESS
Expiration Date: ID Card Serial #:
Issued By Print Name: Print Name:
Signature: Signature:
Date Issued: Date Completed:
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