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James Rodgers 12.31.24� BOARD AND COMMITTEE CHECKLIST APPOINTEE: James Rodgers DATE OFAPPOINTMENT: January10\ Animal VVe|fGrG <�Ornmnift8e David ��BOARD/COMMITTEE:�ppmimted �� 'vd R FOR SCANNER FOR CLERK STAFF 31 ) 2, de -'l Scan oLetter ofAppointment TER1110 END: _1^'/,m,��,"'TERNYL|KII|T:��1��.�_~`_^ Scan o n Letter of Reappointment o Coor of Appointment/Reappointment o'moi|ad to Committee Liaison on 0111112-3 Scan o oBoard and Committee Application (Completed nn w Scan u o R6avm6/CurricuiumV|tae oDiversity Statistics Reporting (Completed onw^ Scan v0ath Received on: January 10,2023 Date Processed on: 6 �� c� D t Scanned on: - � " --By Employee: X If Signed by A P�1� or Committee Member By Employee: _ KA City Clerk's Office Staff Initials K,4/1 City Clerk's Office Staff Initials Term Expired Letter IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK Initials Scan 0 / City Code Ordinance Section applicable 0othe agency, board orcommittee ��l\/��[� RECEIVED ` ~-- / City Code Sections 2-21, �22. 2-23, 2-24, 2-25, 2'26, 2-458 and 24bS Removal Letter due to absences / County Code Section 2-111 - Conflict of Interest and Code of Ethics Ordinance (os Initials Scan 0 amended through December 201O) JAN 1 � ?87� / Amendments to the Code of Ethics Ordinance (September 2009 through July 2012) - V Highlights ofthe Miami -Dade County Ethics Code / Sunshine Law and Public Records - Frequently Asked Questions CITY [lFMIAMI BEACH / Memorandum ' Solicitation byCity Board and Committee Members OFFICE OFTHE CITY CLERK oCitywide Permit Application (Parking Department Form) 0 Booklet - Guide to Sunshine Amendment & Code of Ethics for Public Officers and Employees Scan o Source ofIncome Statement Scan oAcknowledgment ofFinancial Disclosure Requirement o Board and Committees Liaison Responsibilities o DIVERSITY STATISTICS REPORTING KdenCOPY ivfile and ORIGINAL for Annual Report. Received on: January 10,2023 Date Processed on: 6 �� c� D t Scanned on: - � " --By Employee: X If Signed by A P�1� or Committee Member By Employee: _ KA City Clerk's Office Staff Initials K,4/1 City Clerk's Office Staff Initials Term Expired Letter Date Processed Initials Scan 0 Resignation Letter Date Processed Initials Scan 0 Removal Letter due to absences Date processed Initials Scan 0 pmLEnWOAnAND oOMmm/ss wASTEMB&onhecmist 2015mASTER.docx ��;,�,�;�� N/dAMBEAU City of Miami Reach, 1 AX) (� t nvonjbn f: onkw DJvo, hk amij l3ooch, 1 Ic)Ma 33139 ��:.rrEi �r€�ib: chf3.ea€ne OFFICE OF THF CITY tw IEK, Raf wl E. Crcanaddo, City Clerk Tek 305.67,37A A 11, Fax: 305.6,73.725,A ,A remail: Q0mk,@mbamIb9mhfl.9oy January 11, 2023 Mr. James Rodgers 947 Lenoz Avenue, Apt 504 Miami Beach, FL 33139 SUBJECT: Animal Welfare Committee Congratulations! You have been reappointed by Commissioner David Richardson to the above referenced, board or committee named above, for a term ending: 12/31/2024. 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, Rafa Granado City Clerk cc: Monica Beltran, Parking Director Julio Rodriguez, 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 City of Nam! Beach, 1700 Convonhon Conker Drive, "(1mi Bond). Florida 33139 tivurrr-rniamii�a cacl�fl.c�. r OFFICE OF THE CITY C[ERK, Rafael F. Gmnodo, City Cbm' Tel: 305.673.7411, fax: 30S.673.725A Email: CiVAerka-Waniboachtf.yov Oath of Office Oath of Civility and Acknowledgements TO: Mr. James Rodgers RE: Animal Welfare 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: 12131/2024. 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. rk9 Mr. James Rodgers Sworn to and subscribed before me this 13 day of -J6''N , 2023 zlj__2� Charles D'Agostin Deputy Clerk *Please visit the City of Miami Beach website at www.miamibeachfi.gov under City Clerk/Board and Committees for additional information regarding the Financial Disclosure Requirements. City of Miami Beach 1700 Convention Center Drive Miami Beach, Florida 33139 OFFICE OF THE CITY CLERK Email: 13CfWmiamlbeachfi.gov Telephone: 3 05.673.7411 AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH STATE OF FLORIDA COUNTY OF MIAMI -DADS I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4), as (check (✓) all that apply): CZ] 1 am a resident of the City of Miami Beach for six months or longer. Home Address 947 Lenox Ave, Apt 504, Miami Beach FL 33139 ❑ I have an ownership interest (fpr 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 p 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 (90f) or more (including the ownership of 90% 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 penaiti s of perjury, I declare that I have read the foregoing document and that the facts stated in it are true. -- January 1Y2023 Signature Date / Lgers James Printed Name NOTARY Sworn to (or affirmed) and subscribed before me, by means of',• physical presence or ❑ online notarization, this 133 da of .��+11�3A-Q, 20 •� � .r Y —_ � `.�by I l� [W$ iLRrol1A (City of Miami Beach Board/Committee Member). Form of Identification Personally Known 1 Signature of Notary Public Name of Notary, Typed, Printed, or Stamped (ftl�SEdLnXl��iP0. u'., TALITACHI°; lir, Notary Public St`` Commission E,ol My Comm. ExpireBonded through Nationa City of Miami Beach 1700 Convenfion Center Drive Miami Beach, Florida 33139 www,miamibecachI`I. _Q OFFICE OF THE CITY CLERK Email: I�iDmiamibeachfl,gov Telephone: 305.673.741 1 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) Rodgers James A Last Name First Name Middle Initial 1 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. QU 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 771than $500, 60 days in jail, or both. //a/, Sign -, • �` Date Members of the Planning Board and Board of Adjustment will be notified directly by the State of Florida, pursuant to F.S. §112.3145(1)(a), to file a Statement of Financial Interests (Form 1) with the Miami -Dade County Supervisor of Elections by 12:00 noon, July 1. Planning Board and Board of Adjustment members who file their Form 1 with the County Supervisor of Elections automatically satisfy the County's financial disclosure requirement as a Miami Beach City Board/Committee member and need not file an additional form with the Office of the City Clerk. However, compliance with the County disclosure requirement does not satisfy the State requirement. Page 5 of 6 F:\CLER\$ALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx Updated: June 2020 A City of Miami Beach 1700 Convention Center Drive Miami Beach, Florida 33139 www.rrdamibeaqLfl,qvLv OFFICE OF THE CITY CLERK Email: ag 0_miamibe@chfl.gov Telephone: 305,673.7411 Rodgers Last Name James A First Name Middle Initial The following information is voluntary and has no bearing on your consideration for appointment. It is being asked to comply with City diversity reporting requirements. Gender: zMale Female Other I prefer not to answer. Race/Ethnic Categories: What is your race? ED, African American/Black Caucasian/White sian or Pacific Islander Native American/American Indian Other - Print Race: E)i I prefer not to answer. Do you consider yourself to be Spanish, Hispanic, or Latina/a? EQ Yes 56 N—o- El 1 prefer not to answer. Do you consider yourself Physically Disabled? Yes No I prefer not to answer this question. Page 6 of 6 FXLERk$ALLVREGWARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL,docx Updated: June 2020 N�' 2*4IAMI'E1ME SOURCE INCOME STATEMENT 9 Section 2-11.1(i) of the County Ethics Code requires that certain employees and public officials file a financial disclosure Statement an a yearly basis by July 1st of every year. Disclosure for Tax Year Ending East Name _ First Name Middle Name/initial 2021 Rodgers James A Mailing Address - Street Number, street Name, or P.O. Bax 947 Lenox Ave, Apt 504 Miami Beach, FL 33139 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. ❑ Ficaria an an Employee (check orae) Q County [] Public Health 'gust _ � Municipal: __•_ �— (Municipality) Department Stryder Eyewear, lic Position or Title ��— Employee ID Number Work address Work telephone Employment began on/ended on Filing as a Board Member (check one) Q County E Municipal. Miami Beach (Municipality) Board where serving Alternate address (if home address is exempt) I Work telephone ITerm began on/ended on 423-4781 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 Stryder Eyewear, lic 1680 Michigan Ave, Ste 700 Miami Beach, FL 33139 Eyewear Design Firm Skymarc Properties, ilc 1445 West Ave, Ste 9, Miami Beach, FL 33139 Real Estate Brokerage I hereby swear (of,affirm) that the Information above is a true and correct statement. Date signed OFFICE USE ONLY Accepted: Y / N 136_SP-14 GOE2e1e RECEIVED BY ELECTIONS DEPARTMENT: Hardcopy 17 Electronic Copy Processed Date/Initials:- ,___ Scanned Date/Initials: t CITYWIDE (CW) BOARD & COMMITTEES City o'f Miami Beach, PARKING DEPARTMENT PARKING APPLICATION 1755 Meridian Avenue, Suite 200/Miorni Beach, FL 33139/Ph: (3051673-7505 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 lowing 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 of 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. Date of Application: January 10,2023 Applicant Name: James Rodgers Board/Committee____Na_me*_: Animal Welfare Committee Address: 947 Lenox Ave, Apt 504, Miami Beach, FL 33139 E -Mail Address: jrgmiamibeachsrealtor,com ---.' _Phone:-__ Work h o ne Home Phone Cell Phone: 347-423-5781 Preferred Contact Method: Vehicle Information Tag: 32BRQR Color: Black State: FL Year: 2013 Make: Lexus Model: IS250 Applicant Signature: -e —Wo _ Please provide signed form to Ihe Parking Department located of 1755 Meridian Avenue, 2-1 floor. Working hours are 8:30 to 5:00 p.m. or email to: ParkinqR pftqnCq_rniqmibeachf1. e-mail subject: BOARD & COMMITTEE PARKING APPLICATION — APPLICANT NAME Parkina Department Section PERMIT SYSTEM GARAGE ACXES5 Expiration Date: ID Card Serial Issued By Print Name: Print Name: Signature: -e Signature: -9 Dale Issued: Date Completed: a