Alan B Fishman 12.31.24BOARD AND COMMITTEE CHECKLIST
Alan B, Fishm,-in 01124!20 ,
APPOINTEE, ..,,—,— _w [TATE OF APPOINTMENT
ROAROtCOMMITTEE: LGBTGI+ Appointed by Mayor #a l 1
t CiFt SCANNER FOR CLERK STAFF 1 a I I 114 fV
Scan I etterufAppointment Tl�RaNI L'tq = �.. 1 -...._ aER LIMIT
Scan Letter of Reappointment
�Cc y , i, of AppointrnentiReappointment e-mailid to Gon olitz, .
�j. ► I z�113
Scan Board and Co imittee Application {t. onapleted ort
Scan Ri6surne.tCurrictilurn Vitae �� `1p }
Diversity Statistics Reporting (Completed on
Scan Cath
IMPORTANT INFORMATION FOR BOARD AND COMMITTEE PAEMBERS BOOK
City Corte Ordsnance Section tappiica ale to the agen ,? 1. a : fJ E!i .`,•:?
RECEIVED
cc ✓ City Code Sections 2-21.2-22.2-23,2-24, 2-25 2.26, 2 t 3 and 2,46"'4
•
N 1�VE�000� County Code Section 2-11 t -� Conflict of Interest and Code of r i€ ins � ; .
amended t,arcangh Deceniber 2010
* Amendments to the Code of Ethics Ordinance (September 2009 throtic�r) utY 2' 12 3
JAN 25 2023 f Highlights of the Mianv-Cradle County Ethics Code
Sunshine Law and Public Recofals _ Asked Queaions
v Memo? aridtinal - aolicitatioit tsy a pity Czoaru and Coraaraia#ee fi9emt�ers
"."ITY OF MIAMI BEACH
iFFICE OP THE CITY CLERK Ctty wade Permit Application {Parking Department Form)
0 Booklet — Guide to Sunshine Amendment & Code of Ethics for Public Officef S "I Id, t
Scan 0 Source* of income Statement
Scan C., Acknowledgment of Financial Disclosure Requirement
Board and Committees Liaison Responsibilities
DIVERSITY STATISTICS REPORTING Keep C Py it a1, , i.uhGRICINAL for Ararival Repeat,
01/24/23 Signed by x� X
Received on
Date Hoard or Committee Member
Processed on 01124123 By Employee:
Date City Clerk s�ffi �Ytaff lraiti its
01124 23 k—� ' 1.
Scanned on By Employee
Date City Clerk n is4fice Staff I -',Ils
CONCLUDq N L S
_
"!f E xI t i ii h-turf �nflwji
...... _,_....�..� __ ...... Resignation LOWalp_ I .. Scan
_i?r,tnoval Letter due to absences Initials Scan
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girl;fs'L1Af?i)AtVtii;;;Cir.�PvSiTi€����1lirA[5ss�il'd.:iii.;iC3.iriik�rf�ST£,i�if4:�{ ht,rR;i<saiGrrit;3As_�t::t'2;itzt:�
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City of Miami Reach, I AYJConvenlion C onlaf Drive, /'a'kimi Mach, Florida 33 1
fi�� � ^,�.rrti�rrr la chit ae: z
OFF ;F OF THIF CITY CLERK, Rakml.F. Gran+ado, City Clerk
Tel: 305, 73.7411, Fax: .673,725A
Email: 00, k@micrmfly_h grav
January 24, 2023
Mr. Alan Fishman
4640 Post Ave
Miami Beach, Florida 33140
RE: LGBTQIA+ Advisory Committee
Dear Mr. Alan Fishman:
Congratulations! You have been appointed by Mayor Dan Gelberto the above -referenced Board or
Committee, 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 as they concern your duties, responsibilities, and
requirements as a board or committee member.
Congratulations again and good luck
Regards,
iv
Rafa I Gra ado
City Clerk
cc: Monica Beltran, Parking Director
Brian Garces, 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
City of Miami Beach, iI'M (Aw'mx)m� Uxth'
0ffKItI Ilf0lYS::ICIi>,i:etftialf tri t.xk
ia+x' 1056/1Ta11, fax 30!, 03 715s1
tmat Ctr t*Wkthiksrn&AXj 9(W
Oath of Office
Oath of Civility
and
Acknowledgements
TO Mr Alan Fishman
RE LGBTOIAk Advisory Committee
I do solemnly swear or affirm to bear true faith: loyalty and allegiance to the Government of tine United
States, the State of Florida, and the City of Miami Beach, and to perforn) all tine 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
tears end;ng 1213912024,
TO my colleagues and to all of those; I iep e•<wnt and serve; I pledge fairness, integrity and civitity, it, all
actions taken arid all coinmunicatlons made by tali; as a public servan#
I have been issued a copy of section 2-11 1 of the Miami -Gude County Code (Conflict of Intero.st and
Code of Ethics Ordinance), as well as Honda Commission on Ethics Guide tca the Sunshine Airs ridn"ient
and Code of Ethics for Public Officers and understand that as a member of a City of Miami Beach Loaro
and or Committee. I must coitrpty with the financial disclosure* requstements of Msemi•CJade County of thO
State of Florida (depending or the:. board or committee on which I sc rve) on July 9 st, following the: closing
of the calendar year on which I have served
Mr, Alan Fishman
Sworn to and sut)scrlbed before me this j� day of
�Y�' 2023
Keila en res
Deputy Clerk
`Please visit the City of Miami; f3i�ach V absite at www.intamrbeachff gov under City CleWBorard arlid
Committees for additional infornl3lion regarding the Financial Disclosure Requirements
City 01P, Miami Beach
11;):"t wni,on Dr"p
-V1 10 M 1 C�INV b
OFKI' 10F rilff- Ory Ctl"RK
Email
741 1
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
STATE OF FLORIDA
COUNTY OF MIAMI-DADE
I ary) In compliance with the affiliation requirerrient of Miami Beach City Code Sections 2-22 (4). as (check
(,/) all that apply)
o I am a resident of the City of Miarini Beach for six months or longer.
Home Address 4640 Post Avenue, Miami Beach, FL 33140
0 1 have an ownership interest (for a minimum of six months) in a business established if) the City of
Miami Beach (for a minimum of six months)
Name of Business—_ ---
Business Address—,--
[3 1 am a full-time employee of a business (fof a minirrium 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 ownersbip of fen pewent (10%) or more (including the ownarship of
10% or more of thio otilstanding capital stock) in a business
'Busmess 'fneans atty sole Imopnelorshii), sponsorship, corporation, limited habildy company, or other
entity of husiness association
Under penalties of penury. that I have read the foregoing document and that the facts stated in it
are, true 01/24/23
Siignatjl_e Date
Alan B. Fishman
NOTARY
Sworn to (or affirined) and subscribed before me, by rilearis ol`�. physical presence or,., online notarization
this ),.j7day'of`,..2023 by
..........
(City of Miami Beach BoardiCommittee Member)
Produced ID
Form of Identification
jlsonaljy�Kna,
siqnaw;qooN lary public ARY SFAI
11 ........... .. ..
Manic of Mot afy r�fioteo "Jampe<1
k
City of Miami Beach
s.{tc>er' en'±Or Oliva
Off ICE Of `HE CITY CL;:RK
Finnan B`;riE,
lelephotne 305 673 741 1
UIV_EBSlI STASIS ICS .PzEPQRf
Fishman Abri
Last Name first Name t0iddle lnitia'
The following information is voluntary and has no beating on your consideration for appointment It Is vel-,
asked to comply with City diversity reporting requirements
Gender:
t`v9ate
F F�;male
E ether
1 prefer not to answer
Race/Ethnic Categories.
What is your race?
( African American/Black
0 Asian or Pacific, Islander
i541C
Native Aitierican/Americian Indian
( tither — Print mace
1 prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
Q Yes
;•f+lo
I prefer riot to answer.
Do you consider yourself Physically Disabled?
Yf-s
Pio
I prefer not to answer this question.
Page G or 6
i's"AW) AN' i C. A.Wi tt El" APPLi., t- f :t: _,. " kAr-; -Z'QIA 2U- AW; .'.:s.` . .. . .
City of A ionii Scoc:h
� r11' i„;3'•<S4 ;?ri{^,,i`� .sFe,,t' l.)rsvt4
is : -.TY I.ERK
COMMITTEEBOARD & FINANCIAL ACKINIQWLEP-9EMENIATIATLEM&I
Acknowledgement of fines/suspension for Board/Committee Members for failure to comply with Mic1mi-
Dade County Financial Disclosure Code Provision Code Section 2-11,1(i) (2)
Fishman At in B
Last Game First Nance � Middle mitral
I understand that no later than July 1 of each vear all rnembers of Boards and Committees of the City of Miami
Beach, including those of a purely advisory nature, are required to cornply with Mianu-Dade County Financial
Disclosure Requirements,
of the following forms Frust 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)”" or
3. A Copy of your latest Federal Income Tax Return.
Failure to file one of these fornix; pursuant to the Miami -Dade County Code, ntay subject the person to a fine:
of no more than $500, 60 days i�rboth
_a
;signature Date
fv embeis of the Planning Board and Board of Adjustrrrent avid be notified directly by the State of Florida
pursuant to F.S §112.3145(1 )(a): to file a Statement of Finaricial Interests (Farm 11 with they Miami -Dade. County
supervisor of Flections by 12'00 noon, July 't Planning Board and Board of Adjustment nicinbers who file thee!
Form 1 with the County Supervisor of Elections automatically satitity the County's lirranc,al dis lcisure,
requirement as a Miami Reach City BoardlCommittee member and need not file an additional fora) with the, Office
of the City Clerk_ However, compliance; with they County disclosure rcquirerrient doe, -s not s311,4 the `>lato
requirement
Page 5 of a
•SFa'vii3r;'��-`fit}i;i'�l5.4� ..t:: :, i��>h? t .. ,..-� _ ��t . , t,t : a , -
i,1.Q
M,iA I'll CA
Ell I SOURCE OF INCOME STATEMENT
Of tfvi,r'y y"I"r
..........
DYsctaaureforTax Year EndingLast Nime First Name flifinuvlwkil
202.2 Alan B.
Strad Numbvi-, Sifeel Nilintf, (it 110 Uiw�
4Q445 S;ief idari Avonue,
.. .. ....... ... ... . .....
NY, State, Zip
..
Nfiarni Beach. R 33140
.... . ...... .......... ... . ... . ............. .................. . . . ..... ...........
It your home address is your mailing address. and your honle address is exempt from public records pursuant to Fla. Stat §119
inslylictions on the following page and check here.
Filing as an Employee (check one)
11.1 ......................... .......... ....... -1- ............... ... . . . ....... ...............
❑
County 0 Public Health Trust Municipal: ............._m......_...._ .......... ..
(Munlrapality)
Departnnant
.. ................. ........ .... ... ... ... ......... ... . . .......... . . . . ............ - . . . . ....... . ....................... .
Pomilion or Title
Work address
Filing as a Board Member (check one)
... .............
County
Board Whem serving
Work lulphono
f -,j Municipal: Miami Beach
(Municipality)
Employers ID Number
began onlended oil
Alterozi address pf'ho-m- c address is -e'x'ernplj 4Vark tcirphone— Term be I gan onlendva on
1. 1fst bt"Iow ery
alow) Inst):t VIC 'ddresr"z and Ifie pr ilcqwt aclivily Q1 t"ach wuice i0oluoeyouf pufuhi;
'vome, in dtscmwln", 131 -"ict ii"SW lm� Lirge'st , oufi"e li*! E yainfArs (,it scllitle' of "rualp' w"lude 'orflPinf"'atj""t1 for w iiwe".
",opriv dee ..,gs, inItio-,M, rfmls, ftiden.oi;: penr>iotls. MA d;
lf'd <ol,;1111� Security pavtliz7r&, ANo, -ti,%idk, amy �mur(:e iY iv,
ict 1 w if, „� =r t ^of w of oul rpwise a 'Inir Niwws pziftivf nul not G �'C i'.A.^ It continued on a separate sttba.f, rht , n lu,fll
Njille of Sour" of Incomr.
Address Deswptioj) (it Ilia l)
v Pwic,,11 &fiv;ii
..... ..... .. .........
Nan B FishiM'311
4045 Sheridan AvenUe Legal Serves ,
Miami each. FL 33140
.............. . ...... ... .............. .. .... . . . ........... ................ - — ------ ............. .... ............... — . .. . ............. .
I I Swear (0( 11fit in). that the to RECEIVED BY ELECIIONS DEPARTMENT
'Hardcopy
7
Electronic Copy
. . . . ........ ....... ---- .. ...........
signature of person closing
Date signed
(14 CIO WA a'Nt f 14 Dr' ..cf�!". 10-511,
CITYWIDE (CW) BOARD & � Mtv117pTF-Ey
City of Mmmi fie udi, PARKING DEPARTMENT PARKING V A PPI A ION Pj4a
A citywide (CW) parking permit is honored at metered parking spaces and restricted residential zone,
parking spaces A CW parking permit 15 NOT honored in prohibited areas. An Access Card will be
provided to you for, City gall Garage (G7) access
IMPORTANT NOTE Your vehicle license date serves as your "parking permit". In order to avo, d
any unnecessary enforcement actions, it is important that our records reflect the most current an;.l
accurate information regarding your vehicle license plate. Inaccurate and/or outdated vehi<r
information may lead to the issuance of parking cilation(s) and/or the towing of your vehicle.
Please note that this new access card CANNOT I)e hole punched or perforated in any manner. To i
the new card please hold the card at close proximity to the reader until the gate opens, You may
to try the other side of the card. Please ensure you hold the entire surface of the carol against the readee
until the gate opens.
ACKNOWLEDGEMENT: 1 acknowledge that should my access card be lost, stolen or
damage, i will be responsible to prey a $10.00 replacement fee.
Boa1.rA.. kp*gr Inforr gfl.q. ................
Dole of Application 01/24123
............ ...... .._...._.__............
Applicant Name, Alan B. Fishman
�...._.
Board/Committee Name LGBTQI+
_
..... -- ___ ..... .... _.......... _____ _._...._
.. � _______ _........
Aci3ress`5' 4640 Post Avenue, Miami Beach,FL
E rrlail Address abfesq@aol.com
Work Phone- 305 532 2810
Momo Poona
A p
€ , honQ 305 951-18G0
..
Preferred Contact Method.
Vele In..#ranateon _ ..._._..__......
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Tog, LNNW72
Color lWhite
.... _.........
Slate. Florida
.............. ..,.. .._..........................�...........
Year 2013
..................... _ _._..........,....... _.................._ _,....._..
Make' Testa
............. m.. _ .,. ..,,,.._._.....,.......................... ._._........_...........
Model: S
_.__......_.....,._ .._...__ _ ._........ _..._:. __
..........
_.__ ............ _. _......__...............— — — __.._...___........_.._.......
i Applicant
I Pease provide signed form to ►fi' rking
department located at 1755 Meridian Avenue, ' tlocyr: VJc�rk3�
r
J hours arca 8:30 to 5 00 p.m. or email to parl�trtg �,��pti tt�tt�tTtt. �.S��hfl.#g�w
e-mail subject BOARD & COMMITTEE PARKING APPLICATION - APPLICANTNAME
._._...... ....... ......._ _.
P.arlshag- -----------
_...., ......
PERMIT SYSIEm
GARAGE ACCESS
;ssve-d by Print Name ...._.__.�.__�..__�_......._...�. __
Pant Name
. ......... __ .: ....... _ �_.__ w..,.__. � ...._.._...
gsiatuie3
Signature ex
.... ..�.._.__ . _ w _._.....
laic issvr,d
Date Completed