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BOARD AND COMMITTEE CHECKLIST
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ArP NTEE: .t DATE OF APPOINTMENT:
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BOARD/COMMITTEE: " :- Appointed 1 : --O , .
FOR SCANNER FOR CLERK STAFF
Can �3 TERM LIMIT�(
Letter of Appointment TERM END:
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Scan o o Letter of Reappointment
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Scan<; ^ and Committee Application (Completed on �
Scan- ResumdfCurriculum Vitae
w Diversity Statistics Reporting (Completed on
Scan : Oath
IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
City Code Ordinance Section apl:slicable to the agency, board or committee
� i I Y E L e " City Code Sections 2-21 22, 2-23, 2-24, 2-25 2-26, 2-458 and 2-459
County Code Section 2-11.1 -- Conflict of Interest and Coda of Ethics Ordinance (as
amended through December 2010)
O C r 112022 V Amendments to the Code of Ethics Ordinance (September 20119 through July 2012)
✓ Highlights of the Miami -Dade County Ethics Code
✓' Sunshine Law and Public Records - Frequently Asked Questions
CITY OF MIAMI BEACH V Memorandum - Solicitation by City Board and Committee Members
OFFICE OF THE CITY CLERK
'D Citywide Permit Application (Parking Department F=orm)
O Booklet - Guide to Sunshine Amendment ode of Ethics for .lie Officers and Employees
Scan 0 0 Source of Income Statement
Scan C, Acknowledgment of Financial DiscloG re Req , rent
Board and Committees Liais'F espo sibiliti
* DIVERSITY STATISTICS R p6h—n G X C F it� ' n ORI INAL for Annual Report.
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Processed on: By Employee,
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Scanned on: l By Employe;:
Date Cit-fCle,66 Office Staff Initials
CONCLUDED & RESIGNATION LETTERS
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Term Expired Letter Date Processed _ .._.
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Designation Letter µmmµ....__......._;__.._. _ Date Processed Initials Scan c}
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Removal Letter due to al serrtoes Date processed Initials Scan 0
F:\CLEMBOARp AND COMMITTiES DATABASEtCHECKLIST MASTER1,B&C Checklist 2015 MASTER,docx
MIAMIBEACH
City of Miami Beach, 1700 Convention Conter lhivo, Miami Noach, I lotida 33139 www.miamibeachlLaov
OFFICE OF THE CITY CLERK, Rafoel E. Granada, City Clerk
T491:305.671741 1, Fax: 305.673.7254
Email.: CityClefWaiiamibewhfl.gov
September 28, 2022
Mr. Michael Band
5735 LAGORCE DR
MIAMI BEACH, Florida 33140
RE: Ad Hoc Advisory Charter Review and Revision Board
Dear Mr. Michael Band:
Congratulations! You have been appointed by Commissioner Kristen Rosen Gonzalezto 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.
Regards,
RafI 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
I A /k
City of Mianni Beach, IA' (,onl I D"' t_,'*h F,>f,, i ; I l_.r d,l '_<. i
t FFI C Iff CITY CLERK, Rofool t (;rfmdo,GjyCLeA
Tel-, G5,67-1 7411, F€ 3rl,r� €73 725A
Frfo& C.fir .,lpi- iiam1hemli`, gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Mr, Michael Band
FSE: Ad Hoo 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 Miarni Beach to which I have been appointed for a
terra ending: 08/01/2023.
To my colleagues and to all of those l 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"",uide to the Vin's ine Amendment
and Code of Ethics for Public Officers and understand that as a me. ler of a City f is, i Beach Board
and/or Committee, I must comply with the financial disclosure* requi 'en, f Mi i- County or the.
State of Florida (depending on the board or committee on which i s) carr,iy f- I ing the closing
of the calendar year on which I have served.
Sworn to and subscribed before me this day of d1h, 2022
a
'Please visit the City of Miami Beach website at www,rr3iamibeachfl.gov under City Clerk/Board and
Committees for additional Information regarding the Financial Disclosure Requirements.
City of Miami Beath
1700 Convention Cotter Drive
MR �ani Beo h, Florida 3,1139
OFFICE OF THE CITY C:I El'K
Email: E3C f?�miamilrr (ice{a
Telephone: 305,673.7411
STATE OF FLORIDA
COUNTY OF MIAMI-DADE
RECEIVED
0 C T 112022
CITY OF MIAMI BEACH
OFFICE or -'THE CITY CLERK
I am in compliancy: with the affiliation requirement of Miami Beach City Code Sections 2-22 (4), as (check
(J) all that apply):
-- 1 am a resident of the City of Miami Beach for six months or longer.
Nome Address � � 1
gfft
rro 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
0 1 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 busit iess.
tonsorship, corporation, limited liability company, or other
-ad the foregoing document and that the facts stated in it
[,
Date
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of physical presence or ci online notarization,
this day of C ,JZI&t" , 20by r. J�
(City of Miami Beach Board/Committee Member),
Produced ID
Farm of Identification
Personally known
PSUSM CA.
(Z WiGe
Signature of Notary Public,, �i
,. ES: Menh 7,
Name of Notary, Typed; Printed, or Stamped
/\/�/���\��[ ��
' ` ^", " � w BEAC.n "
City of Miami Beach
i7OOConvention Center Drive
Miami Beach, Florida 33139
Am .zoicilmibc-�1q68.ggu
OFR[OF TFiE CITY CLERK
Email:
305,b73.74||
Acknowledgement of fines1suspension for Board/Committee Members for failure to comply with Miami.
Dade County Financial Disclosure Code Provision Code Section 2-11.1(1) (2)
LA 6 n) K (, QAAKEt ej
Last Name First Name Middle Initial
| understand that nolater than all members ofBoards and Committees cfthe City o/Miami
Beach, including those nfa purely advisory nature, are required to comply with Miami -Dade County Financial
Disclosure Requirements.
One ofthe following forms mgst b2 file with the City Clerk ofMiami Bmoch, 1700 Convention Center Drive,
Miami Beach, Florida, nolater than 12:OOnoon ofJuly 1'mfeach year:
1. A"Source ofIncome Statement" or
2. A"SbabmrnentofFinancial Interests (Form V;" or
3, A[bpyoWurlatest Fedeuf-n�bmoTax Return.
Zfile lyb of t ese vlUrSUant to the Miami -Dade County Code, may subject the person to a fine
I ( () CT_ 70
Date
I Members of the Planning Board and Board of Adjustment will be notified directly by the State of Florida,
pursuant bnF.G.§112.3146(1)(o).tofile aStatement nfFinancial 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 Qty Clerk. However, compliance with the County disclosure requirement does not satisfy the State
requirement,
Page 5 of
p:ICLER�$AWREG'SOARmAND COMMITTEE APPLICATIONS FINAL nRAFTIABOARoAND COMMITTEE APPLIC ATION REG FINALAOCX
NA I A/N,A, I B EAC 1-1
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
wyny
- -miarnibeacblaom
OFFICE OF THE CITY CLERK
Email: BQ(a,)miamibeacLfIj
qov
Telephone: 305.673.7411
DIVERTY STATISTICS REPORT
All "L
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,
'..Male
Male
�--Female
Other
I prefer not to answer.
Race/Ethnic Categories:
What is your race?
African American/Black
Asian or Pacific Islander
Caucasian/White
Native American/American Indian
Other - Print Race:
I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
U Yes
No
IZI I prefer not to answer.
Do you consider yourself Physically Disabled?
Yes
No
I prefer not to answer this question.
Page 6 of 6
FACLEMSALLNREMBOARD AND COMMITTEE APPLICATIONS FINAL DRAFMOOARD AND COMN1141TEE APPLICATION REG FINAL.docx
Updated: June 2020
CITYWIDE (CW) BOARD & COMMITTEES
f
City *'f Miami each, PA RKING DEPARTMENT PARKING APPLICATION
175" Meridion Avenue, Soife 200/Womi Bemh, FL 331,39/Ph: (305) 673-75,05,,,,�r (3051673-7000 exi, 6200
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
damage, I vvi If be responsible to pay a $ 10.00 replacement fee. I
venLcie invormanon
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hours are 8:30 to 5:00 p.m, o
e-mail subiect: BOA
Expiration Date:
Eby Print (�Ic�m
Signature:
faate1-11U11d7 m.
Year:
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& COMMITTEE PARKING APPLICATION - APPLICANT NAME
GARAGE ACCESS
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