Christopher Rollins 12.31.23IA Al
BOARD AND COMMITTEE CHECKLIST
AP Po rE Ee:. [h nl be r Po tlin
sororcowwrree Vieth 1 89p29??2,Po Arotear
FOR SCANNER FOR CLERK STAFF . (l hi / '
Scan o o Letter of Appointm ent TERM END: 12 '3 /2&
Scan o o Letter of Reappointment
o G9Py y 9 f_ Letter of Appointment/Reappointm en t e-mailed to Committee Liaison on
3131 3 ]
o Board and Committee Application (Completed on I/Ql2l
o R6sum~/curriculum Vitae ] J
o Diversity Statistics Reporting (Completed on 2 303
o Oath
TERM LIrr: 12/31]23
Scan o
Scan o
Scan o
DATE OF APPOINTM Nr. 2[l 2 3
a«hq to m mu @oo
RECEIVED
FEB 7 2023
CIT Y O F MIAMI BEACH
OFFICE OF TIE CI TY CL ER K
IMPORTANT INFORM ATION FOR BOARD AND COMMITTEE MEM BERS BOOK
t City Code Ordinance Section applicable to the agen cy, board or committee
Y City Code Sections 2-21, 2-22, 2-23, 2-24, 2-25, 2-26, 2-458 an d 2-459
County Code Section 2-11.1 -- Conflict of Interest and Code of Ethics Ordinan ce (as
amended through December 2010)
Y Amendments to the Code of Ethics Ordinance (September 2009 through July 2012)
Highlights of the Miami-Dade County Ethics Code
Sunshine Law and Public Records -- Frequen tly Asked Questions
Memorandum - Solicitation by City Board and Committee Members
Scan o
Scan o
Received on:
Processed on:
Scanned on:
O Citywide Permit Application (Parking Departm ent Form)
O Booklet - Guide to Sunshine Amendment & Code of Ethics for Public Officers and Employees
O Source of Income Statement
O Acknowledgment of Fina ncial Disclosure Requirement
O Board and Committees Liaison Responsibilities
O DIVERSITY STATISTICS REPORTING Keep COPY in file and ORIGINAL for Annual Report.
0 //a3 so»X [!hgt @ lu, £Los
Date Board or Committee Member
]3 /23 ytenors k/'
Date City Clerk's Office Staff Initials
_/lL? rower !1
City Clerk's Office Staff Initials 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
E\CLER\BOARD AND COM MIT TIES DATABASE\CHECKLIST MASTER\B&C Checklist 2015 MASTER.docx
We ore committed to providing excellent public service and safety to oll who live, work, and play in our vibrant, tropical, historic commun.ty.
1B
City of M iami Beach , 1700 Convention Cantor Drivo, Miami Booch, Florida 33139 yyyy._miamibachll.gov
OFFICE OF THE CITY CLERK, Rafaal E. Granado, City Clerk
Tel: 305.673.741, Fax:. 305.673.7254
Emai l: CilyClerk@miamibeachll.gov
February 06, 2023
Mr. Christopher Rollins
650 NE 32nd Street, Unit 3003
Miami, Florida 33137
SUBJECT: Visitor and Convention Authority
Dear Mr. Christopher Rollins:
Congratulations! You have been reappointed by the City Commission to the above referenced board or
committee, for a term ending: 12/31/2023.
If you are unable to accept this appointment or have any questions, please call the Office of the City Clerk
at 305.673. 7 411.
Please read the enclosed materials carefully. Congratulations and good luck.
Resp1!1'
Rafael Granado
City Clerk
cc: Monica Beltran, Parking Director
Grisette Roque, 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
MIB
C ity of M iam i Beach, LOO Corvan/on Coner Drivo, Miami Bach, Florida 33 139 gwwy.IiaIilachllgoy
OFFICE OF THE CITY CLERK, Rafael E. Granado, City Clerk
Tel: 305.673.7411, Fax: 305.673.7254
Email: CilyCl erk@mi am ibeach fl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Mr. Christopher Rollins
RE: Visitor and Convention Authority
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 m emb er of the
above-mentioned board or committee of the City of Miami Beach to which I have been appointed for a
term ending: 12/31/2023.
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 com ply 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.
Ck»tla € Rel
Mr. Christopher Rollins
Sworn to and subscribed before me this _!J!!}_ day f ~"-1="----<I 2023
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.
MI B
City of Miami Beach
17 00 Con vention Center Drive
Miami Beach, Flor ida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telep h one: 30 5.6 7 3.7 411
RECEIVED
FEB 7 2023
CI TY OF IAMI BEA CH
OFFICE OF +IE CITY CLERK
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
STATE OF FLORIDA
COUNTY OF MIAMI-DADE
l am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4), as (check
(/) all that apply):
DI lam a resident of the City of Miami Beach for six months or longer.
Home Address _
[] I have an ownership interest (for a m inim um of six months) in a business established in the City of
Miami Beach (for a minimum of six months).
Name of Business _
Business Address _
l am a full-time employee of a business (for a minimum of six months) and l am based in an office or
other location of the business that is ph ysi cal ly located in Miami Beach (for a minimum of six months).
o r s or sure. <'html (gc (sue llt I
sousess Aaorecs 1)~ o%31 1 205 BI)RMI Q6@H« 3 a 139
"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 business.
"Business" m eans any sole proprietorship, sponsorship, corporation , limited liability comp any, or other
entity o r b usin ess associatio n.
Under penalties of perjury, I declare that I have read the foregoing document and that the facts stated in it
"1/1pg.al4du ° ta 2/lz3
Signature Date
(I(Sn 2 /ft £ E L L A
Printed Name
NOTARY
________ (City of Miami Beach Board/Committee Member).
~'Produced ID
sln.1-~ --\--'F"'-"''.:..-\:=-=:;_..-I :..__ _
Sworn to (or affirmed) and subscribed before me, by means of4physical presence or on line notarization ,
o T a, a #baa,,,a0 83»_CHI2(LA+d TZOLLM
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70 .- G,#r,$ ;5 s OF EN
'ii'
Form of Identification
Name of Notary, Typed, Printed, or Stamped
MIAMI
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfl.gov
OFFICE Of THE CITY CLERK
E m ail: B C @m iamibeachfl.go
Telephone: 305.673.7411
DIVERSITY STATISTICS REPORT
p.0+ La mane OH#IP£. Re°
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:
b+at e
@i rate
Ll oner
Ll1prefer not to an sw er.
Race/Ethnic Categories:
What is your race?
[]Af rican Am erican/Black
Asian or Pacific Islander
Caucasian/White
Native American/American Indian 0 Other- Print Race: _
El pr e fer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latinola?
Les Jo
[Fiore ter not to ans w er.
Do you consider yourself Physically Disabled?
es
0
I prefer not to answer this question.
Page 6 of 6
F\CL E R\S A LL \R E G \B O AR D AND C O M M IT TEE A P PL I C A T ION S FIN AL DR AF T S \B O A RD AND C OM M ITT EE AP P L I C A TI ON R E G FI N AL .d 0 cX
Updated: June 2020
MIAMIBE
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.mniamibeachfl.gov
OFFICE OF THE CITY CLERK
Em ail: BC @m i am i be achf.gov
Teleph one: 305.673.7411
BOARD & COMMITTEE FINANCIAL ACKNOWLEDGEMENT STATEMENT
Acknowledgement of fines/suspension for Board/Committee Members for failure to comply with Miam i-
Dade County Financial Disclosure Code Provision Code Section 2-11.1(i) (2)
kt u
Last Name
(4/467//&
First lame' Middle Initial
I understand that no later than July.1 ,o f 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.
One of the following forms mu st 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 Statem ent;" 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 forms, pursuant to the Miami-Dade County Code, may subject the person to a fine
of no more than $500, 60 days in jai l, or both. ltols to iignature Date 7
' 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 th e County disclosure requirement does not satisfy the State
requirement.
Page 5of 6
F:ACL ERI SAL L\RE G\B O ARD AN D CO MM I TTE E APPLI CATI O NS FINAL DRAFTS\B O ARD AN D CO MMI TTEE AP PLICATI ON RE G FINAL.docx
Updated: June 2020
M IA M l·DAD E- En SOURCE OF INCOME STATEMENT
Section 2-11.1(i) of the County Ethics Code requires th at certain employees and public of ficials file a financial disclosure Statement on a yearly basis by July 1st
of every year.
Dis cl osure for Tax Year En ding
2022
Middle Name/Initial
Mailing Address - Street Number, Street Name, or P.0. Box
'Ml At
City, State, Zip
COM6A ts
lf your home address is your mailing address, and your home address is exempt from public records pursuant to Fla. Stat. $119.07, read
in str uctions on th e fol lowi n g page and ch eck here . []
Filing as an Employee (check one)
] county [] Public Health Tr ust [] Mun icipal:
(Municipality)
Department
Position or Title Employee ID Number
Work address I Work telephone Employment began on/ended on
Filing as a Board Memb er (check one)
[] county (/'wumntctpat: DIA»tu As4T'
(Municipality)
Board where serving
YA
Alternate address (if home address is exempt) I W ork telephone I Term began on/ended on
305-772-472-1 2016
List bel ow every sourc e of income you recei ved, alon g wi th the address an d th e principal activity of each sour ce. Include your public sal ar y. Place the sourc es of
income in descen din g ord er, with th e lar gest sourc e first. Exam pl es of sourc es of income incl ude: compen sation for servi ces, inc om e from business, gains from
pr o pert y dealings, interest, rents, dividends, pensi o ns, IRA distributions, and social security payments. Al so, include any source of income received by another
person for your ben efit. However, th e income of your sp ouse or any business par tn er need not be disclosed. If continued on a separate sheet, check here.[]
Name of Source of Income Address Description of the Principal Business Activity
/97/ 66et ttzt IMC
to! bur Sve 33 lsnnuy /hsntsew M0l1' &6el\, 33437
I hereb y sw ear (or affirm) that th e information above is a tr ue and correct st at em ent .
(ijnto G u,
Signature or lrsn Disclosing
2/1/%
Date signed
av es 97%, P"9%%%7%P"
L] Hardcopy
tJ ectromis G}, 72023
CITY OF MIAMI BEACH
OF-EE=E Ar Q/Ty%!ERK
O FFIC E USE ON LY Accept ed: Y / N Deficien cy. Pro cessed Date/initials: Scann ed Date/initials:-
138_SP-14 COE 2016
//\], [Bf CITYWIDE (Cw) BOARD & COMMI TTEES
ciwy of Mi er»i ea±», PARKING DEPARTMENT PARKING PP[[CA[[ON
1755 Meridian Avenue, Suite 200/Miami Beach, FL 33139/Ph: (305) 673-7505 or (305) 673-7000 ex4. 6200
A citywide (CW} parking permit is honored at metered parking spa ces 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 action s, 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 ol 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.
Board Member Information
Date of Application:g l [23
Applicant Name: 0j4/510H
Board/Committee Name: ((4
Address: 1}5]
E-Mail Address: j
C, -+'o t + e o
work Phone' 3451)2-'
cell Phone 305772/l
me Pho ne
Preferred Contact Method:,
Vehicle Information
Tag: 4v t Color: 6?
State: @ Year: 002/
Make: TY/A Model: Eu'>
Applicant Sianature: tthe#o €!__, l
Please provide signed form to the Parking Department located at 1755 Meridian Avenue, 2" floor. Working
hours are 8:30 to 5:00 p.m. or email to: Parking~Reception@miamibeachfi.gov
e-mail subject: BOARD & COMMITTEE PARKING APPLICATION -- APPLICANT NAME
P ·kd D rv S ar mna epa ment ection
PERMIT SYSTEM GAR AGE ACCESS
Expiration Date: ID Cord Serial #:
lssued By Print Name: Print Name:
Signature: 6 Signature: 6
Date Issued: Date Completed: