Jorge Gonzalez 08/01/23M IA M I BEACH
BOARD AND COMMITTEE CHECKLIST
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APPOINTEE: _Jo@e A._ogle?_ DATE OF APPOINTM ENT:
BOARD/COMMITTEE:/l& lko Sal FAa± Appointed by: CG@so.. /. [a,le
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o Résumé/Curriculum Vitae )_)
o Diversity Statistics Reporting (Completed on! 't "$
o OathScano
RECEIVED
SEP O 2 2022
CITY OF MIAMI BEACH
OFFICE OFTH E CITY CLERK
IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
City Code Ordinance Section applicable to the agency, board or committee
Y 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 Miam i-Dade County Ethics Code
Sunshine Law and Public Records - Frequently Asked Questions
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
o Source of Income Statement
o Acknowledgment of Financial Disclosure Requirement
o Board and Committees Liaison Responsibilities
O DERSITY STATISTICS REPORTING Keep çQPY in file and ORIGINAL for Annual Report. h, //)) soca% l
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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:ICLERIBOARD AND COMMITTIES DATABASEICHECKLIST MASTERIB&C Checklist 2015 MASTER.dccx
Ve ors commined to providing excellent public servce ond sole»y to oll who live, work and play i out vibrant, tropical, histoi; community
M IAM I BEACH
City of Miami Beach, 1/O0 Convention Conter Divo, Miami Boach, Horida 33 139 yyy_miamibachl]goy
OFFICE OF THE CITY CIERK, Rafaol E. Granado, City Clerk
Tel: 305.673.7411, Fax: 305.673.7254
Email: CityClerk@miamiboochll.gov
August 18, 2022
Mr. Jorge Gonzalez
Protected
Miami Beach, FL 33140
RE: Ad Hoc Advisory Charter Review and Revision Board
Dear Mr. Jorge Gonzalez:
Congratulations! You have been appointed by Commissioner Alex Fernandez to the above-referenced
Board or Committee, for a term ending: 08/01/2023.
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.
Rafael Granado
City Clerk
cc: Monica Beltran, Parking Director
Rafael Granado, 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
C ity of Miami Beach, 17OO Conven tion Canter Die, Miami Beach, Florida 33 139 wwv.uiaribeachll.gov
OFFICE OF THE CITY CIERK, Rfol E. Granado, Cy Clerk
Tl: 305.673.7411, Fax 305.673.72.54
Emal: Cülydork@miamioochll.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Mr. Jorge Gonzalez
RE: Ad Hoc Advisory Charter Review and Revision Board
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: 08/01/2023.
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.
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.
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@miamibeachf].gov
Telephon e: 305.673.7411
RECEIVED
SEP 02 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 lam a resident of the City of Miami Beach for six months or longer.
Home Address fro kcled /xE 't fb) Oloac
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).
ar (f [[y [fes.
11 S]Pes,, J(](fes
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).
Qr7] f Hy,[meSS
PS, J([Sf,S
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 #
e o= Date
Jg, • Gezalz
Printed
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of o physical presence or o online notarization,
nts 4 day ot /uqul
City of Miami Beach Board/Committee Member).
Produced ID iiê33. MANON HERNANDOEZépéevotaryPol«- sate of fora
3$t.3g/ com«woo + 7776
i.Se? My Comm. Expires May 24, 2026
8onded through National Notary Assn.
M IA M I BEA C H
City of Miami Beach
l 700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachtl,gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
DIVERSITY STATISTICS REPORT
ao2ale2 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:
ate
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
lÜ 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?
gJ ves
o
O I prefer not to answer.
Do you consider yourself Physically Disabled ?
ves
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.miamibeachfl,gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
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)
Last Name First Name Middle Initial
I understand that no later than July1of 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 days in jail, or both.
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\$ALLIREG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
M IA M l·DAD E-
EE SOURCE OF INCOME STATEMENT
Section 2-11.1(i) of the County Ethics Code requires that certain employees an d public officials file a financial disclosure Statement on a yearly basis by July 1st
of every year.
Disclosure for Tax Year Ending I last Name First Name Middle Name/Initial
2021 Gonzalez Jorge M
Mailing Address - Street Number, Street Name, or P.O. Box
655 96th Street
City, State, Zip
Bal Harbour, FL 33154
If your home address is your mailing address, and your home address is exempt from public records pursuant to Fla. Stat. $119.07, read
instructions on the following page and check here. 0
Filing as an Employee (check one)
O County D Public Health Trust [] Municipal:
Municipality)
Department
Position or Title Employee ID Number
Work address I Work telephone Employment began on/ended on
Filing as a Board Member (check one)
county [] Municipal: City of Miami Beach
Municipality)
Board where serving
Miami Beach
Alternate address (if home address is exempt) ¡ Work telephone ¡ Term began on/ended on
655 96th Street Bal Harbour, FL 33154 (305) 866-4633
List below every source of income you received, along with the address and the principal activity of each source. Include your public salary. Place the sources of
income in descending order, with the largest source first. Examples of sources of income include: compensation for services, income from business, gains from
property dealings, interest, rents, dividends, pensions, IRA distributions, and social security payments. Also, include any source of income received by another
person for your benefit. However, the income of your spouse or any business partner need not be disclosed. If continued on a separate sheet, check here.[]
Name of Source of Income Address Description of the Principal Business Activity
U n iv e rsity o f M ia m i 132 0 S o u th D ixie H w y . U n ive rsity A dju n ct Pro fessor
C o ra l G a b le s , F L
S trate g y M a tt e rs, In c . N/A C onsu lting
I hereby swear (or affirm) that the information above is a true and correct statement.
Date signed
RECEIVED BY ELECTIONS DEPARTMENT:
O Hardcopy
econ¢ , EIVED
EP 02 2022
H
OFFICE USE ONLY Accepted: Y / N Deficiency:
138._SP-14 COE 2016
Processed [ate/initials.
OFGE OF Is GCl.Ell
Scanned Date/Initials:
24.4.7+ 21$% a
1755 Meridian Avenue, Suite 200/Miami Beoch, FL 33139/Ph: (305) 673-7505 or (305) 673-7000 e4. 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 fo 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 cord 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: 5l2al,z2
Applicant Nome: Jove Gr4lez
Board/Committee Name: 4y [lo Cf Té. a r) s), 73ea.ve
Address: 3qo fo. Pf [uta0e
E-Mail Address @TGoz4 /ail.co
Work Phone: 3os 86- ea433 Home Phone 3o 9S 0cs?
Cell Phone: 3os 3og-o3 Preferred Contact Method: ell
Vehicle Information
Tag:
State:
Make:
0
Color:
Year:
Model:
3/we
Applicant St4nature: e5
Please provide signed rm to the Parking D írtment located at 1755 Meridian Avenue, 2" floor. Working
hours are 8:30 to 5:00 p.m. or email to: ParkingReception@m iamibeachfl,gov
e-mail subject: BOARD & COMMITTEE PARKING APPLICATION- APPLICANT NAME
P ·ti D rt ts tiar' una epa men ec'Ion
PERMIT SYSTEM GARAGE ACCESS
Expiration Date: ID Card Serial #:
Issued By Print Nome: Print Nome:
Signature: Signature: €
Date Issued: Dote Completed:
p