Isaiah Mosley 12.31.23MIAM IBE
BOARD AND COMMITTEE CHECKLIST
APPOINTEE: Isaiah Mosley
BOARD/COMMITTEE: Sustainability Committee
FOR SCANNER
Scan o
Scan o
Scan o
Scan o
Scan o
DATE OF APPOINTMENT. Feb 24, 2023
Appointed by: Steven Meiner
FOR CLERK STAFF
o Letter of Appointment
o Letter of Reappointment " %%£4/5 " NA»onvoonwvrResonoent e-rates to
o Board and Committee Application (Completed on2/[3
o R~sum6/curriculum Vitae J/]
o Diversity Statistics Reporting (Completed on24 '
o Oath
TERM END: 12[3[)23 rRM unr. 2/31l30
Committee Liaison on
RECEIVED
FEB 24 2023
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
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
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
✓Memorandum - Solicitation by City Board and Committee Members
o 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 Responsibilities
O DIVERSITY STATISTICS REPORTING Kop ~ 'Y in file and ORIGINAL for Annual Report.
Received oj. Feb 24, 2023 Signed by _I
Date
Processed on: Feb 24, 2023
Date
Scanned on:
ittee Member
By Employee: __._tM_..:.....,a _
City Cler~'s Offic Staff Initials
Fe?1CO? yEmpoyeer I
ate Ciy cieke ome siai 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
I
Ml Ml E
City of Miami Beach, I/OO Convention Canter Drive, Miami Bach, Florida 33139 yy_miam ihga chllgo
OF FIC E OF THE CITY CLERK, Raloal E. Gran ado, Cl y Clerk
Tel: 305.673.741, Fax: 305.673.7254
Email: Ci#yCl erk@m iamibooch fl.gov
February 22, 2023
Mr. Isaiah Mosley
1038 11 Street #18
Miami Beach, Florida 33139
RE: Sustainability Committee
Dear Mr. Isaiah Mosley:
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 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.
Al
Raf~ Granado
City Clerk
cc: Monica Beltran, Parking Director
Juanita Ballesteros, 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
Ml Ml E
C ity of M iam i B each , ZOO Convonlion Cantor Drive, Miami Boach, Florida 33139 yw.miamtbga chll.gov
OFFICE OF THE CITY CLERK, Rafool E. Granado, CIiy Cdork
Tel. 305.673.7411, Fax. 305.673.7254
Emal: CiNyClark. @miamtboachll.gov
O ath of O ff ice
O ath of C ivility
and
A ckn o w led gem ents
T O : M r. Isa ia h M o sle y
R E : S u staina b ility C o m m itt ee
I do so le m n ly sw e a r or aff irm to be ar true faith, loyalty and allegiance to the G overn m ent of the Unite d
State s, the S tate of Florida, an d the C ity of M iam i Beach, and to perform all the duties of a m em ber of the
abo v e -m e ntio n e d bo ard or co m m itt e e of the C ity of M iam i B each to w hich I have been appointed fo r a
term ending : 12 /3 1/2 0 23.
T o m y co lle a g u e s an d to all of tho se I re p resent and serv e, I pledge fairn ess, integrity and civility, in all
actio n s taken an d all co m m unications m ad e by m e as a public serv ant.
I ha v e be e n iss u e d a co py of sectio n 2-11.1 of the M iam i-D a de C ounty C ode (C onfli ct of Interest an d
C o de of Eth ics O rdinan ce), as w ell as Flo rida C om m ission on Ethics G uide to the S unshine A m end m e nt
an d C o d e of E thics fo r Pu blic O ffi ce rs an d understand that as a m em ber of a C ity of M iam i Beach B o a rd
and/o r C o m m itt e e , I m u st com ply w ith the finan ci al discl osure " require m ents of M iam i-D ade C ounty or the
State of Flo rid a (d ep en d ing on th e bo ard or comm i ttee on wh ich l serv e) on July 1st, follo wi n g th e clo sin g
of the ca le nd a r ye ar on w hich I ha ve serv ed. on wee woo
rood
r. Isaiah M osley
Sworn to and subscribed before me this 2-;;;r__ 2023
K eila M en a C aceres
Dep uty C lerk
*P le a se vis it th e C ity of M iam i B each w ebsite at w w w.mi a m ibe a ch fl .g o v under C ity C le rk/B oa rd an d
C o m m itt ee s fo r ad ditio nal in fo rm ation reg a rding the Financi al D iscl osure R equirem ents.
MIAMIB
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@mlamibeach[l.gov
Telephone: 305.673.7411
RECEIVED
FEB 24 2023
CITY O F 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):
I am a resident of the City of Miami Beach for six months or longer.
Home Audre835 Lenox Avenue, #316, Miami Beach, Florida 33139
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 Business Kate Mosley Design LLC
Business Address 835 Lenox Avenue, #316, Miami Beach, Florida 33139
a 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).
[[am t[ Py][]@Sr
[[JS[[%SS (]fSS.
"O w nership Interest" m eans 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 pro prietorship, sponsorship, corporation, limited liability company, or other
entity or business association.
of perjury, I declare that I have read the foregoing document and that the facts stated in it
Feb 24, 2023
Date
Isaiah Mosley
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of o physical presence or online notarization,
-2a» Fat as23»La b /toy
________ (City of Miami Beach Board/Committee Member).
Produced ID
iii. JANICE BROWN %p4 Notary Police - sate ot Florida 3;Si commtson r H» 05962 ?=K$ uy comm. Expires Jan 34424
yd"[ Bys1 -nded through Nationat Ntlk] }sh'
Form of Identification
Y SEAL)
Name of Notary, Typed, Printed, or Stamped
M IA M IB E A H
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Flor ida 33139
w ww.miam ibeach fl.g ov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
DIVERSITY STATISTICS REPORI
Mosley Isaiah N
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:
[l Mate
0 Female
0 Other
D I prefer not to answer.
Race/Ethnic Categories:
What is your race?
D African American/Black
0 Asian or Pacific Islander
DO Caucasian/white
0 Native American/American Indian 0 Other- Print Race: _
0 I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/la?
Ll ves
(h o
D I prefer not to answer.
Do you consider yourself Physically Disabled?
,
lo
D I prefer not to answer this question.
Page 6 of 6
FACL E R\SALL\R EG\B O ARD AN D COMMITT EE APPLI C ATIO NS FINAL DRAF T S\BOAR D AND COM MI TTE E AP PLICATION RE G FINAL .docx
Updated. June 2020
M IA M IB E H
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.mi am i beach fl,gov
O FF IC E O f TH E CI TY C LERK
Em a il: BC @ m iam ibeachfi.gov
Telephon e: 305.673.7411
BOARD & COMMI TTE E FINANCIAL A CK NO WL ED GE MENT STATE MEN T
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)
Mosley Isaiah N
Last Name First Name 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)';" 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 tHmn $5 0 , 60 days in jail, or both.
Feb 24, 2023
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 of 6
F:\C LER\$ALL\REG\BO ARD AND CO M M ITT EE APPLI CATIO NS FINAL DRAFT SIBOARD AND CO M MITT EE APPLICATIO N REG FINAL.docx
Updated: June 2020 ·
M IA M l-llAD E- EEm 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 'Last Name First Name Middle Name/Initial
2022 Mosley Isaiah
Mailing Address - Street Number, Street Name, or P.0. Box
835 Lenox Avenue, #316
City, State, Zip
Miami Beach, Florida 33139
If your home address is your mailing address, and your home address is exempt fro m public records pursuant to Fla. Stat. $119.07, read
instructions on the following page and check here. D
Filing as an Em ployee (check one)
[] county □Public Health Trust [] M un ici pal :
(Municipality)
Department
Position or Title Employee ID Number
Work address I Work telephone Employment began on/ended on
Filing as a Board Member (check one)
D County E] Municipal: City of Miami Beach
(Municipality)
Board where serving
1700 Convention Ctr Dr, Miami Beach, FL 33139
Alternate address (If home address is exempt) I Work telephone I 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
AECOM 2 Alhambra Plaza, Coral Engineering Firm
Gables, FL 33134
"LU SW+at _(Qr affirm) that the information above is a true and correct statement.
t3 21 2023
Date signed
RECEIVE D BY ELE CTIO NS DEPAR TM ENT:
D Hardcopy RECEIVED
[] Electronic Copy
FEB 24 2023
C IT Y OF M IAM I BE A C H
OFFICE OF THE CITY
OFFICE USE ONLY Accepted: Y / N Deficiency...-._ Processed Date/initials:..Scanned Date/initials:.-
138_SP-14 COE 2016
M IA M I B E CITYWIDE {CW) BOARD & COMMITTEES
City of Miami Beach, PARKING DEPARTMENT PARKING APPLICATION
17 55 M eridian A ven ue, Suite 20 0/Mi ami Beoch , FL 33 139/Ph: (305) 673-7 505 or (30 5) 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 NO T 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 CANN OT 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.
ACK N OW LEDGEM EN T: I ackno w ledg e that should m y access card be lost, stolen or
d a m a g e, I w ill be resp o n sible to pay a $10 .0 0 rep l acem en t fee.
Board Member Information
D a te o f A p p lica tio n : F eb 24 2 0 23
'
A p p lica nt N a m e : Isa ia h M os le y
Bo a rd/C o m m ittee N a m e : S u s ta in ab ili ty C o m m itt e e
A d d ress: 8 3 5 L en ox A v e n u e , #316 , M ia m i B ea ch , Fl or ida 3313 9
E-M a il A d d ress: lsa ia h W in s @ gm a il.co m
W o rk Pho ne : 3 0 5 .5 14 .2 4 68 Hom e Phone
C e ll Pho ne : Preferred C o ntact M ethod: em ail
Vehicle Information
Ta g : 3 5 6 7N U C olo r: Y e llo w
State: F lo rid a Year : 20 0 9
M a ke : Y a m a ha M od el: T M AX
a= - Ap pl ica nt Si g na ture : e '
Pl ea se provi d e sig ned form To me Park~ng D ep artm ent locate d at 17 55 M eridia n A ven ue, 2" floor. W orking
ho urs are 8 :3 0 to 5 :0 0 p.m . or email to: Park<ingReception@mniamibeachfl.gov
e-mail subject: BOARD 8& COMMITTEE PARKING APPLICATION -- APPLICANT NAME
P ·ki D ar Ing e p a rt m e n t ection
PERMIT SYSTEM GARAGE ACCESS
Expiration Dote: ID Card Serial #:.
Issued By Print Name: Print Name:
Signature: 6 Signatur e: e
Date Issued: Date Completed:
s .
.'pg man uar torms cw corress pa+agl r doc