Steven Adkins 12.31.24fv11ANA I B EAC H
BOARD AND COMMITTEE CHECKLIST
APPOINTEE: Steven Adkns
DATE OF APPOINTMENT: 1/10/2023
BOARD/COMMITTEE: LGBTQIA Advisory Committee Appointed by: Commissioner Ricky Arriloa
FOR SCANNER
Scan o
Scan o
FOR CLERK STAFF 12/31/2024
o Letter of Appointment TERM END:
o Letter of Reappointment
TERM LIMIT+ 2/ 3
o Cop of Letter of Appointment/Reappointment e-mailed to Committee Liaison on
1/10723 1/30/23
Scan o o Board and Committee Application (Completed on
Scan o o Resume/Curriculum Vitae 1/30/23
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
✓ County Code Section 2-11.1 - Conflict of Interest and Code of Ethics Ordinance (as
RECEIVED amended through December 2010)
✓ Amendments to the Code of Ethics Ordinance (September 2009 through July 2012)
JAN 30 2023 ✓ Highlights of the Miami -Dade County Ethics Code
✓ Sunshine Law and Public Records - Frequently Asked Questions
CIT"" OF MIAMI BEACH
✓ Memorandum - Solicitation by City Board and Committee Members
OFI=I("- ^.,.. -HE CITY CLE R6 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 Resoonsibilities
• �
Received on: 1/10/2023
Date
Processed on: 1/10/2023
Date
Scanned on: 1/10/2023
Date
Signed by
By Employee:
By Employee:
or
Office Staff Initials
Staff Initials
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:\CLER\BOARD AND COMMITTIES DATABASE\CHECKLIST MASTER\B&C Checklist 2015 MASTER.docx
We are committed to providing excellent public senlice and safety to all who live, work, and play in our vibrant, tropical, historic community.
MIAMIBEACH
City of Miami Beach, 1/00 Convention Cantor [Xivo, hemi Beach, Fladda 33139www.mirami! achfl.aaw
OFFK'I OF THE CRY C:LFRK, Rafaal E. Oram&, City C.lork
Tel.. 305A73.741 1, Fax: 305,673.72.54
.Emil: C; iyCIwk. miamIb hfl.Wy
January 09, 2023
Steven Adkins
1756 N Bayshore Dr. 37G
Miami, FL 33132
RE: LGBTQIA+ Advisory Committee
Dear Steven Adkins:
Congratulations! You have been appointed by Commissioner Ricky Arriola to 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,
fael Granado
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
M'B.E AC H
ll Ati
I
City of Miami Beach, 1700 Convarilbn Contof hive, d rimi k oad , Flat .3'3139 www. ch1l j
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Steven Adkins
RE: LGBTQIA+ Advisory Committee
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: 12/31/2024.
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.
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 1 s lowing the closing
of the calendar year on which I have served.
Sworn to and subscribed before me this 30 day ofJ , 2023
Char 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: BC &miamibeachfl.pov
Telephone: 305.$73.7411
RECEIVED
JAN 30 2023
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):
❑ 1 am a resident of the City of Miami Beach for six months or longer.
Home Address
❑ 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 Busines
Business Add
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 Miami -Dade Gay & Lesbian Chamber of Commerce
Business Address 1130 Washington Ave - 1st FL N Miami Beach, FL 331
"Ownership Interest" means the ownership of ten percent (1091o) 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.
Undeg document and that the facts stated in it
are tr �Idehat I have read the foregoing
1/10/2023
Signature Date
Steven Adkns
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means o ysical presence or o online notarization,
this f o day of .20 23 byy� Alf)
Produced ID
(City of Miami Beach Board/C mmittee
/1 /0 'Cle-1
Form of Identification
Per nally nown
Signaty e �Ny P c
Name of Notary, Typed, Printed, or Stamped
CHARLES J.DAGOSIIN
*; MY COMMISSION # HH 165705
,�a ? EXPIRES: Docember 14, 2025
Bonded Thru Notary Public Underwriters
(NOTARY SEAL)
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www. m io m i beachfl, gov
OFFICE OF THE CITY CLERK
Email: BC(a)miamibeachfl.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(1) (2)
Adkins Steven N
Last Name
First Name
Middle Initial
understand that no later than July 1. of 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.
QM 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 o Lq4 these forTs, pursuant to the Miami -Dade County Code, may subject the person to a fine
of no 0, 60 n jail, or both.
Siqnature 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
I.
�.�
Tj SOURCE OF INCOME STATEMENI
Section 2-11.1(i) 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.
Disclosure for Tax Year Ending Last Name First Name Middle Name/Initial
2021 jAdkins Steven Noel
Mailing Address — Street Number, Street Name, or P.O. Box
1756 N Bayshore Dr. #37G
City, State, Zip
Miami, FL 33132
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)
County E] Public Health Trust Municipal:
(Municipality)
Department
Position or Title
Employee ID Number
Work address
Work telephone
Employment began on/ended on
Filing as a Board Member (check one)
® County
Board where serving
E] Municipal: Miami Beach
(Municipality)
LGBTQIA+Advisory Committee
Alternate address (if home address is exempt) Work telephone Term began on/ended on
1130 WashingtonAve 1st FL N Miami Beach, FL 33139 (305) 673-4440 1/10/2023
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 anoth r
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
MDGLCC
1130 Washington Ave 1st FL N
Miami Beach, FL 33139
Chamber of Commerce
the information above is a true and correct statement.
Signature of Perso isclo
Date signed
RECEIVED BY ELECTIONS DEPARTMENT:
❑ Hardcopy RE E jj/`t=-LD'
❑ Electronic Copy
,JAN 30 2023
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/Initials: Scanned Date/Initials:
138_SP-14 OOE 2016
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www. rn is rn i beac hfl. Ut�v
OFFICE OF THE CITY CLERK
Email: BCl_miamibeachfl.gov
Telephone: 345.673,7411
Adkins
Last Name
Steven
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•
Male
Female
Other
I prefer not to answer.
Race/Ethnic Categories:
What is your race?
African American/Black
2 an or Pacific Islander
Caucasian/White
Native American/American Indian
Other — Print Race:
1 prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
9 ID Y
No
I prefer not to answer.
Do you consider yourself Physically Disabled?
B>Neo!""
1:11 prefer not to answer this question.
Page 6 of 6
F:\CLER\$ALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
CITYWIDE (CW) BOARD & COMMITTEES
N/\ I AM I BEAC 1-1
City of Miami Beach, PARKING DEPARTMENT PARKING APPLICATION
1755 Meridian Avenue, Suite 200/Miami Beach, FL 331 39/Piv (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 out, 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.
RnnrA Mamhow 1nfnrmnA'nn
Date of Application: 1/10/2023
Applicant Name-, Steven Adkns
Board/Committee Name: LGBTQIA Advisory Committee
Address: 1130 Washington Ave - 1st FL N Miami Beach, FL 33139
E -Mail Address: steve@gaybizmiami.com
Work Phone: 3056734440
Home Phone N/A
Cell Phone: 3058070595
Preferred Contact Method: cell
Valkirlsa 1nfnrmn#;nn
Tag:
ICU Y10
Color:
Navy
State:
FL
Year:
2016
Make:
Hyundai
Model:
Sante Fe Sport
Applicant Signature: -e
Please provide signed form _tothaaqFring Department located at 1755 Meridian Avenue, 2nd floor. Working
hours are 8:30 to 5:00 p.m. or email to:.ParkingReception@miamibeachfi.90
e-mail subject: BOARD & COMMITTEE PARKING APPLICATION — APPLICANT NAME
Pr2rVinn n^nrvr*md%n# V&akr#m*e%n
PERMITSYSTEMGARAGE
ACCESS
Expiration Date-,
ID Card Serial #:
Issued By Print Name:
Print Name:
Signature: As
Signature: -e
Date Issued:
Date Completed:
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