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Jeremy Wachtel 04/30/23.....+pauwt_. ., f .i• � , . nor. £ n"J .. ... MIAMIBEACH BOARD AND COMMITTEE CHECKLIST APPOINTEE: &IN.A11-11 (oa"114 DATE OF APPOINTMENT: � i�(C/ �' BOARDICOMMITTEE: l'lan"I . _VP,01 (dA Afrfr��Appointed by: ; / Gil 6,/` FOR SCANNER FOR CLERK STAFF TERM LIMIT: " V /�� Scan o o Letter of Appointment TERM END: Scan o o Letter of Reappointment f etter of Appointment/Reappointment e-mailed to Committee Liaison on s Scan o f' Board and Committee Application (Completed on ) Scan o o R6sum6/Curriculum Vitae / o Diversity Statistics Reporting (Completed on Scan o 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 RECEIVED ✓ 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) DEC 27 2022 ✓ Highlights of the Miami -Dade County Ethics Code ✓ Sunshine Law and Public Records - Frequently Asked Questions CITY OF MIAMI BEACH ✓ Memorandum - Solicitation by City Board and Committee Members OFFICE OF THE CITY CLER Citywide Permit Application (Parking Department Form) O Booklet - Guide to Sunshine Amendment & Code of Ethics for Public Officers and Employees Scan O O Source of Income Statement Scan O O Acknowledgment of Financial Disclosure Requirement O Board and Committees Liaison Responsibilities Received on t O DIVERSITY STATISTICS REPORTING Keep COPY in file and ORIGINAL for Annual Report. ! Z `2-1 - YLZ Signed by X -� — Date /,� Bo, -0 oucommittee Member Processed on: /-�/�' __ By Employee: Date Scanned on: /-')� /';� /� By Employee: 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:ICLERIBOARD AND COMMITTIES DATABASEICHECKLIST MASTERIB&C Checklist 2015 MASTER.docx i `> _ ra r� cc���^!#1 m �vt�c�»�q �eelt�rr? �wta?rc �ia.nc:9 or,d salerp• tc a4 rfic� hve, work. er�f flay in c�,r vsixont, r;cprca;; hrstc,ic common+v M.IAMIBEACH City of Mia :ini Beach, 1700 Owenflon Cenica Dfivo, Nva mi Bryn h, Florida 3313 wrvmmigmi chil_gov OFFICF OF TFTF CFTY CLERK, RafaelF. Granado, City Fleck Tel: 305.673.7-411, t, Fax: 305.673.7254 Fail: �:1hj°l�rkr�ra�imifir-;tifl..ga� December 14, 2022 Mr. Jeremy Wachtel 6000 Collins avenue apt 530 Miami Beach , Florida 33140 SUBJECT: Mayor's 41st Street Committee Congratulations! You have been reappointed by Mayor Dan Gelberto the above referenced, board or committee named above, for a term ending: 04/30/2023. 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. Congratulations and good luck. Regards, ;N Rafael Granado City Clerk cc: Monica Beltran, Parking Director Diana Fontani, City Liaison ATTACHMENTS: Letter of Appointment Oath City Code/Ordinance section applicable to agency, board or committee City Code Section 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 Ordinance City Wide Permit Application - (Parking Department Form) Booklet - Guide to the Sunshine Amendment and Code of Ethics for Public Officers and Employees MIAMIBEACH City of Miami Beach, 1700 f`;mvonfim ConlaT Gta w, Alarm 1100th, floodo 33133 wwwxtfamrx_xid .c�c OFTICE of 11# CITY CIFRK, Rofool F. Granada, City Mork lel: :105.&73.7411, Fax 305.673.775A Enmil: CtiyCl QmiamiboaNlr qm Oath of Office Oath of Civility and Acknowledgements TO: Mr. Jeremy Wachtel RE: Mayor's 41 st Street 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: 04/30/2023. 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. Mr. Jeremy Wachtel Sworn to and subscribed before me this day of +ZL. , 2022 C es D'Agostin Deputy Clerk "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, I P-,iBEACH 'CitY Of Mianii each 1700 Convention Center Drive Miami Beach, Florida 33139 YML�' rn�m�lohEl = OFFICE OF THE CITY CLERK Email: BCamiamibeacbfi.gov Telephone: 305,673,7411 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) a C Jk1-01 IS e, � 0_1 11+1 6 Last Name First Name Middie initial I understand that no later than July 1. -of each yea 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. Q= 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 $500, 60 days in jail, or both. 1,2 ...... . .... S Date I Members of the Planning Board and Board of Adjustment will be notified directly by the State of Florida, pursuant to F.S. §112.3145(1)(a), to file a Statement of Financial Interests (Form 1) with the Miami -Dade County Supervisor of Elections by 12:00 noon, July 1. Planning Board and Board of Adjustment members who file their Form I with the County Supervisor of Elections automatically satisfy the County's financial disclosure requirement as a Miami Beach City Board/Committee member and need not file an additional form with the Office of the City Clerk. However, compliance with the County disclosure requirement does not satisfy the State requirement. Page 5 of 6 F:\CLER%$ALLREGIBOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL,dmx Updated, June 2020 MIAMI BEACH City Of mi anti Beach 1700 Convention Center Drive Miami Beach, Florida 33139 w-�j a mi �c i �fy OFFICE OF THE CITY CLERK Email: BC a(" Telephone: 305,673,7411 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: 2 -Male U Female 0-1 Other 0) 1 prefer not to answer. Race/Ethnic Categories: What is your race? Q'African American/Black 0,a,sian or Pacific Islander �31—caucasian/V\/hite Eal Native American/American Indian Other — Print Race: OJI I prefer not to answer. Do you consider yourself to be Spanish, Hispanic, or Latino/a? Q;Ns 0 Q, i prefer not to answer. Do you consider yourself Physically Disabled? Nes No I prefer not to answer this question. Page 6 of 6 F:%CLER\$ALL\REGk6OARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx Updated June 2020 - MIAMI, Clef' From Print Form RZO SOURCE OF INCOME STATEMENT Section 2-11.1(1) 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. 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. ❑ Filing as an Employee (check one) 0 County E] Public Health Trust Municipal: (Municipality) Department u Pasitton or Me � -� �-~ Employee iD Number Work address 7Work telephone Employment began on/ended on Filing as a Dowd Mendw (check one) O`County 401L?" © Municipal: — (Municipality) Board wherervi seng j Aftemate address (if home address Is exempt)Work telephone Term began on/ended on � � �t i,�� ���Q ,lel # 5-)p�2:v�� �310 >>� 'Ion - 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 shoot, check her Name of source of Income / "JQ1( Address e, �7rGlGigl 60. �"G9<��i�(U Description of the Principal Business Activity I hereby swear (or affirm) that the Information above Is a true and correct statement. of Person Disclosing yDate signed RECEIVED BY ELECTIONS PEPAji', MENT: O Hardcopy 0 Electronic Cant 27 2021 CITY OF MIAMI BEACH OFFICE OF 7 H CIT" (-'I c_Ut- REMEMUEA TO PRINT, SIGN, AND SUBMIT TO THE OFF -ICE OF THE CITY CLERK VIA EMAIL OR HARDCOPY. .r: Gita OF Miami Reach 1700 Convention Center Drive Miami Beach, Florida 33139 OFFICE OF THE CITY CLERK Email: BCOmiamibeachfl gov Telephone: 305.673,741 1 RECEIVED DEC 27 2022 CITY OF MIAMI BEACH OFFICE OF THS 7 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): I am a resident of the City of Miami Beach for six months or longer. t >~ ' - FL, Home Address �c�'ry_'f [ tr_' `_'._��i C �L) f J' r t �h t �' `+ ". I have an ownership interest (for a minimum of six months) in a business established in the City of Miami Beach (for a mi`niimmum of six months). �^ Name of Business 1 asi'; GC�C4 t .p. Business Address Q 0 q F� 4��� ��� R A ta,y f- Ajeac(t iF"�' 3 SI N 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 Id 4 C L ,T-1 53 i(10 "Ownership Interest" means the ownership of ten percent (105yo) 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 are true. __,/ � � / — a C) a Sign eDate '� 0 I'qA � Uc, a" Printed Name NOTARY Sworn to (or affirmed) and subscribed before me, by means of o physical presence or o online notarization, this I day of 20 �—ey 7 Produced ID (City of Miami Beach Board/Committee Member). Form of Identification Personally Known Signature of to u icUftN 1\Q Name of Notary, Typed, Printed, or Stamped UNDASCHECHTER MY COMMISSION I HH 066133 EXPIRES: JxwM 30, 2025 Bwded Ttn Notary Pubk Unden Mw% (NOTARY SEAL) MI,LUBEACH CITYWIDE (CW) BOARD a COMMITTEES City of PARKING APPLICATION kPW PARKING DEPARTMENT 1755 Meridian Avenue, Suite 200/Miami Beach, ft 33139/Ph, (305) 673-7505 or (305) 673-7000 ext. 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 or damage, I will be responsible to pay a $ 10.00 replacement fee. Poor Date of Application. Applicant Name: Board/Committee Name: Coll Address: kov (69fl"Ij Avc, i'-)ea,(74 1�>3120 --iw lvlail Address: �a 041f f-40 0^C11 Work Phone: Home Phone Cell Phone: 5a) '026'1" 7S 7 3S7 Preferred Contact Method: Vehicle Information ............. Tog: E A Color: 0 F�9A State: C r A --Ye—ar. 65 3 Make: Model: Applicant Si nature: IK Please provide signed form to the Parking Department located at 1755 Meridian Avenue, 2rtd floor. Working hours are 8:30 to 5-00 p.m. or email to: ParkingReception@miamibeachfi.gov e-mail subject: BOARD & COMM17TEE PARKING APPLICATION — APPLICANT NAME Parkina D000rtment Section PERMIT SYSTEM GARAGE ACCESS Expiration Dote: ID Card Serial #: Issued By Print Name: Print Name: Signature: K Signature: Date Issued: Date Completed: