William Warren 12.31.23M IAMI BEACH
S c a n o
S c a n o
BOARD AND COMMITTEE CHECKLIST
APPOINTEE. boll«n 'on DATE OF APPOINTMENT. 2[10/2 3
BOARD/COMMITTEE: AL(_Afr_Alu+-Appointed : __(@qy_Mt.
FOR SCANNER FOR CLERK STAFF ( J l ) o
S c an o o Letter of Appointm ent T ER M EN D :[{4 2 TERMLIMrT:2 ') 3
S ca n o o Letter of Reappointment ,]%7[h 59 o Appointment«R eappoi ntm ent e-mailed to committee Liaison on
o Board and Committee Application (Completed on 2] 4) 23
o R~sum~/C urriculum Vitae .] ]
o Diversity Statistics Reporting (Completed on 2. 24 '2,
o Oath S ca n o
RECEIVE D
FEB 24 2023
CI T Y OF MI AM I BE A CH
OFFICE O€ THE CITY CLERK
IM P O R T A N T IN F O R M A T IO N FO R B O A R D A N D C O M M ITT E E M E M B E R S B O O K
✓City Code Ordinance Section applicable to the agency, board or committee
Y 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
amended through December 2010)
✓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 -- Frequently Asked Questions
✓Memoran dum - Solicitation by City Board and Committee Members
S c a n o
S ca n o
o Citywide Permit Application (Parking Departm ent Form)
O Booklet - Guide to Sun shine Am en dment & Code of Ethics for Public Officers an d Employees
o Source of Income Statement
o Acknowledgment of Financial Disclosure Requirement,
o Board and Committees Liaison Responsibilities !: O D IV E R S IT Y S T A T IS T IC S R E P O R T, K C 'ile and O R IG INA L for Annual R eport. ls_/lo' sores y }pp 44!l!=.. ...
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Date City Clerk's Office Staff Initials
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Date City Clerk's Office Staff Initials
Received on:
Scanned on:
CONCLUDED & RESIGNATION LETTERS
Term Expired Letter Date Processed Initials S can o
Resignation Letter Date Processed Initials Scan o
Removal Letter due to absences Date processed Initials Scan o
F :\C LER \BO A R D A N D C O M M ITT IE S DA TA B A S E\C H E CK LI S T M A STE R\B&C Checklist 2015 M A STER .docx
We are committed to providing excellent public service and safety to all who live, work, and play in our vibrant, tropical, historic community.
City of Miami Beach, I/OO Convention Conler Drive, Miami Florida 33 139 yew_miaIiheggrchl]go
OFFICE OF THE CITY CLERK, Ralal E. Granado, City Clerk
Tel 305.6 73.7411, Fax: 305.673.7 254
Email: City Clerk@miamiboochfl.gov
February 21, 2023
Mr. William Warren Jr.
810 11th Street #202
Miami Beach, Florida 33139
RE: Black Affairs Advisory Committee
Dear Mr. William Warren Jr.:
Congratulations! You have been appointed by Commissioner Steven Meiner to the above-referenced
Board or Committee, for a term ending: 12/31/2023.
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 Jan uary 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.
lf you are una ble to accept this appointm ent, or have an y questions, please call the Office of the City
Clerk at 305.673. 7 411.
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.
"7
Rafael Granado
City Clerk
cc: Monica Beltran, Parking Di rector
Lissette Arrogante, City Liaison
ENCLOSURES:
Oath of Office/Oath of Civility/Acknowledgements
City Code/Ordinance section applicable to agency, board or committee
City Code Section s 2-22, 2-23, 2-24, 2-25, 2-26, 2-458 an d 2-459
Ordinance No. 2006-3543 - Am en dmen t 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 - (Par king Department Form)
Booklet - Guide to the Sunshine Amendment and Code of Ethics for Public Officers and Employees
MI A MI BEA CH
City of Miami Beach, I700 Convonlion Center Drive, Miami Beach, Florida 33139 yyy.miamibeach]go
OFFICE OF THE CITY CIERK, Ralool E. Granado, Ciiy Clerk
Tel: 305.673.7411, Fax. 305.673.7254
Email: CilyClerk.@mlamilbeachfl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Mr. William Warren Jr.
RE: Black Affairs Advisory 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: 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 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.
Sworn to and subscribed before me tip 2t(day of'2_, 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.
M IA M 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
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
RECEIVED
FEB 24 2023
CITY OF MIAM I BEACH
OFFICE O THE CITY CLERK
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):
✓I am a resident of the City of Miami Beach for six mo ths or longer.
ors A«oe.. ?e th/ 4 , 33
VI have an ownership interest (for a minimum of six months) in a business established in the City of
Miami Beach (for a minimum of si 1on ths).
□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).
[Jar]9 ( [1&1feSS-
Business Address _
"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.
f6efi(ir, I declare that l have read the foregoing document and that the facts stated in it z ± u
Printed Name 1
NOTARY
Sworn to ( or affirmed) and subscribed before me, by means of o physical presence or o online notarization,
he 2{ aa r Far2, 2023 by vi]hon Jr
---=------- (City of Miami Beach Board/Committee Member).
roaoceat boy(SCon
Name of Notary, Typed, Printed, or Stamp ed
MIAMI BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfl.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(@) (2) a.a 1, Al. ta if~ks Middle Initial
I understand that no later than Jul.1@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 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 Incom e Statem ent;" or
2. A "Statement of Financial Interests (Form 1)1;" or
3. A Copy of your latest Federal Income Tax Return.
F . . f 1ese forms, pursuant to the Miami-Dade County Code, may subject the person to a fine
, 60 days in jail, or both.
Date '
1 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 of6
F:CLERISALLREGBOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
MIAM I BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfl.gov
OFFICE OF THE CITY CLERK
Emai l: BC@miamibeachfl.gov
Telephone: 305.673.7411
DIVERSITY STATISTICS REPORT
Last Nam e 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:
Lice
[l remale
Ll other
D I prefer not to answer.
Race/Ethnic Categories:
WV'h at,is your race?
L#A frican Am er ican /B l a ck
[l Asian or Pacific Islander
El Caucasian/wh ite
D Native American/American Indian 0 Other- Print Race: _
0 I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
Bk
0 I prefer not to answer.
Do you consider yourself Physically Disabled?
E,ya.
Lio
D I prefer not to answer this question.
Page 6of 6
F:CLERISALLIREGBOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
MIAMl·DADE- EEl · 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.
Disclosure for Tax Year Ending
2022
Midd~me/lnitial
Mailing umb
Cit
If your home address is your m ailing addre ss, and your home address is exempt from public records pursuant to Fla. Stat. $119.07, read
instructions on the following page and check here. D
Filing as an Employee (check one)
D County □Public Health Trust [] Municipal:
(Municipality)
Department
Position or Title Employee ID Number
Work address I Work telephone Employment began on/ended on
Filing as a Board Member (check on e)
D County
ess is exempt) Term began on/ended on
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
O ne r 4
f f >
information above is a true and correct statement.
g
2. +
RECEIVED BY ELECTIONS DEPARTMENT;
D Hardcopy R E C E IV E D
[] Electron ic Copy
FEB 24 2023
C ITY O F M IA M I BEA C H
RK
OFFICE USE ONLY Accepted: Y / N Deficiency. Processed Date/Initials: Scanned Date/Initials:
138_SP -14 C OE 2016
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17 55 M eridia n A venue, Suite 20 0/M iam i Beach, FL 33139 /P h: (305) 673-7505 or (3 05) 673-7000 exl. 6200 PA RK IN G
A citywide (CW) parking permit is honored at metered parking spaces and restricted residential zones
parking spaces. A CW parking permit IS N OT honored in prohibited areas. An Access Card will be
provided to you for City Hall Garage (G7) access.
IM PO RTA N T N O TE: 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 CA N N O T 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.
A C KN O W LEDG EM EN T: 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 In ation
D a te of Applicafior Z1o22
Applicant Name:
Board/Committee
Address: ?2 /£ _
DY //'- 9,
E-Moil Addres8 r e Gre e >.C
W ork Ph on e#-6go Home Phone -
Vehicle Information
Ta g:
State:
Make:
2?
Cell Ph on e s. f95 2 Preferred Contact Method:
color.
Year:
Model:
Ap pl icant Si@nature: es
Please provide signed form to e Parkin Depar tm ent located at 1755 Meridian Avenue, 2d floor. Working
hours are 8:30 to 5:00 p.m. or email to: ParkingReception@miamibeachfl.gov
e-mail subject: BOARD & COMMITTEE PARKING APPLICATION -- APPLICANT NAME
P ·ti D S ar' Ina epartment ecion
PERMIT SYSTEM G A RA G E A C C ESS
Expira tion Date: ., ID Card Serial #:
Issued By Print Name: Print Name:
Signature: e6 Signature: e
Date Issued: Date Completed:
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