Brian Ehrlich 12.31.24M I A MI BE H
APPOINTEE:
FOR SCANNER
BOARD AND COMMITTEE CHECKLIST
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TERM END: r- ' IMIT: Ill-- Scan o
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023
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FOR CLERK STAFF
o Letter of Appointment
o Letter of Reappointment
o c_z,Jy-=t r~-ietter of AppointmenUReappointment ~e-mailed to Committee
o Board and Committee Application (Completed on f '2[ _)
o R~sum~/Curriculum Vitae ] 2
o Diversity Statistics Reporting (Completed on )4 kl 9
o Oath
Liaison on
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
pEE[WED Y County Code Section 2-11.1 - Conflict of Interest and Code of Ethics Ordinance (as
amended through December 2010)
(pp 1420l3 V Amendments to the Code of Ethics Ordinance (September 2009 through July 2012)
✓Highlights of the Miami-Dade County Ethics Code
ACH ' Sunshine Law and Public Records - Frequently Asked Questions QA@,9£5,"!hp},$Gk • iemorandom- s6iciaion by ciy Board and ~~mrite6 Merers
o Citywide Permit Application (Parking Department Form)
o Booklet - Guide to Sunshine Amendment & Code of Ethics for Public Officers and Employees
Scan o
Scan o
o Source of Income Statement
o Acknowledgment of Financial Disclosure Requirement
o Board and Committees Liaison Re onsibilities
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Received on:
Scanned on:
O DIVERSITY STATISTICS REPORTING,,
2.]]}[Z22 sea j. $i, m a
Processed on: [.l.-' By Employee: t«ff2 ca»rosy of9ma
_________ By Employee: -------''}-/'---_V_ « _
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
.,
F:\CLER\BOARD AND COMMITTIES DATABASE\CHECKLIST MASTER\B&C Checklist 2015 MASTER.docx
MIA MIB
City of Miami Beach, I/OO Convention Can ter Drive, Miami Beach, Florida 33 139 yyywy._miamibaachllg
OFFICE OF THE CITY CLERK, Raf0l E. Granado, City Clerk
Tel: 305.673.7411, Fax. 305.673.7254
Email: Ci#yCl erk@miamibooch fl.gov
February 03, 2023
Mr. Brian Ehrlich
4520 North Bay Road
Miami Beach, FL 33140
RE: Historic Preser vation Board
Dear Mr. Brian Ehrlich:
Congratulations! You have been appointed by the City Commission to the agency, board or committee
named above for a term ending: 12/31/2024.
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.
Re::;;/
•• City Clerk
cc: Monica Beltran, Parking Director
Deborah Tackett, City Liaison
ENCLOSURES:
Oath of Office/Oath of Civility/Acknowledgements
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
City Wide Permit Application - (Parking Department Form)
Booklet - Guide to the Sunshine Amendment and Code of Ethics for Public Officers and Employees
MI AMI E CH
City of Miami Beach, /OO Convention Coner Drivo, Miami Boach, Florida 33 139 yww.miamihgachll.gov
OFFICE OF THE CITY CLERK, Ralaol E. Granado, City Clark
Tel: 305.673.7411, Fax. 305.673.7254
Email: Ci/Clerk@miamibeachfl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Mr. Brian Ehrlich
RE: Historic Preservation Board
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: 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.
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. Brian Ehrlich
sworn to and subscribed before me hi]4 day or l0,__, 2023
.±
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.
M IAM I BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
RECEIVED
FEB 14 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): K ' am a resident of the City of Miami Beach for six months or longer.
ore. ow .. 5 16lual Neg Agr, IIH Hui Be-lpf7,
1have an own ership interest (tor a minimum ot sx months) in a business established in 4. 41~] f' Miami Beach (for a minimum of six months).
Name of Business .J?iu:aJ ~
ens .. '±zo Rd Mad Beal 331yo
□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 ------------------------
Py[[es,S (]]fess
"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" means any sole proprietorship, sponsorship, corporation, limited liability company, or other
entity or business association.
~- --- eclare that I have read the foregoing document and that the facts stated in it
211 . 2023 are
Printed Name
Date
________ (City of Miami Beach Board/Committee Member).
l roducedo Tl lo en-&€
)~. f _tifi cation
Personally Knl-1" .,,f/- _
Signat ure of Notary Pub lic
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of o physical presence or o online notarization,
this [lhd ay of }v "_ _, 2o1 _by tl'- t1'' I %".
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M IA MI BEA CH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachf]_gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
DIVERSITY STATISTICS REPORT
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:
tfi
ire»
D Other
D I prefer not to answer.
Race/Ethnic Categories:
What is your race?
Ll Amican American/Black
D Asian or Pacific Islander
[i-ca ucastan/white
0 Native American/American Indian D Other- Print Race: _
D I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
1 a ,
Lo
D I prefer not to answer.
Do you consider yourself Physically Disabled?
ve» Ok
Ll1prefer not to answer this question.
_. -· --·· ... ·---·--. __ .. ·- .. . --· __ ·-·-· ,. ... __ ._P age 6 of 6 .. . --· ·-. -·-·. .....
MIAMI BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachll,gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
BOARD & COMMITTEE FINANCIAL ACKNOWLEDGEMENT STATEMENT
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)
..±m et ..#e Ah Middle Initial
I 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.
One 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.
Fa lure ile one of these forr , pursuant to the Miami-Dade County Code, may subject the person to a fine
of no more th: $500, 60 days in/jail, or both.
2.42s
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
EA(I EI2\Al I \pE\A rn AAn (MAMIT TEE ADDI IOATIONI EINAI Ip?AETIpOADD ANIn (MAMAIT TEE ADDI IOATI(NI DE(: EINAI iv
M IA M I-a &III SOURCE OF INCOME STATEMENT
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.
oiscotosure tor to» var tao [ustame - " ",, A, [
2022 (H \It HU
M iddle Nam e/Initial
M aili ng Address - Street Num ber, Street Nam e, or P.O. Box
5 TS O' AeouC
C ity, State, Zip
If your home address is your mailing address, and your home address is exe pt from public records pursuant to Fla. Stat. $119.07, read
instructions on the following page and check here. D
Fili ng as an Em p loyee (check one)
3
□C ou nty D Public H ealth Tru st [] M unici pal :
(M unicipality)
D epart m ent
Position or Title Em ployee ID Number
W ork address W ork telephone Em ploym ent began on/ended on
Fili n g as a B o ard M em ber (check one)
[] c oun t y nicipal:
(Municipality)
Board w here serving
Ho
Al tern ate address (if hom e address is exem pt) W ork telephone
t0 /
Term be an on/en ded on
2
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.□
Nam e of Source of Incom e Address Description of the Principal Business Activity
I ~ eby swear (or a · ) that the information above is a true and correct statement.
sig nature ot Person Di scl osin g
2,14. 2023
D ate signed
RECEIVED BY ELECTIONS DEPARTMENT:
LJ Hardy.p]/ED
L] Electrohl c6by
FEB 14 2023
CI TY OF MI AM I BE A CH
OFFI CE OF THE CI TY CLERK
M IA M I BEACH CITYWIDE (CW) BOARD & COMMITTEES
City of Miami Beach, PARKING DEPARTMENT PARKING APPLICATION
1755 Meridian Avenue, Suite 200/Miami Beach, FL 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.
Board Member Information
Date of Application:
Applicant Name:
Board/Committee Name:
Address: tH}
E-Mail Address:
wok Phone: 3 7 1
Cell Phone:
Vehicle Information
Preferred Contact Method: Ce
Tag: 8IFkR Color:
State:
Make:
Rt_ Year:
Model:
Applicant Si4nature: e
Please provide signed form to the Parking Department locate' r 1755 Meridian Avenue, 2d floor. Working
hours are 8:30 to 5:00 p.m. or email to: ParkingReception@miamibeachfl.gov
e-mail subiect: BOARD & COMMITTEE PARKING APPLICATION - APPLICANT NAME
P ·ki D S · ar m a epa rtm ent ection
PERMIT SYSTEM G A RA G E ACC ESS
Expiration Date: ID Card Serial #: ;
Issued By Print Name: Print Name:
Signature: e Signature: e
Date Issued: Date Completed:
-
% s a e kiss
Oper ation ot s mot or v»hie con titutes cset ts ry sobriet y test req uired