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Daniel Robles 12.31.24MIAMIBE BOARD AND COMMITTEE CHECKLIST APPOINTEE. Daniel Robles DATE OF APPOINTMENT: _3])/1 BOARDICOMMIT TEE. Marine & Waterfront Protection· Appointed y: _DV uyr_(9lb1 FOR SCANNER Scan o Scan o Scan o Scan o Scan o FOR CLERK STAFF o Letter of Appointment o Letter of Reappointment o Cor~ r Letter of Appointment/Reappointment e-mailed p. }?/ o Board and Committee Application (Completed on I]l 2 o R~sum~/Curriculum Vitae ] '3 o Diversity Statistics Reporting (Completed on 1,1 1- ) o Oath TERM No. /31/{ TERM LuMnr. 13 1)4 to Committee Liaison on RECEIVED FEB 97 2023 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 ✓ ✓ CITY OF MI AM I BEACH OFFICE OF THE CITY CLERK o Citywide Permit Application (Parking Department Form) Scan o Scan o Received on: o Booklet - Guide to Sunshine Amendment & Code of Ethics for Public Officers and Employees o Source of Income Statement o Acknowledgment of Financial Disclosure Requirement o Board and Committees Liaison Responsibilities o DIVERSITY STATISTICS REPORTING Keep COPY in file and ORIGINAL for Annual Report. 2/27/2023 soneaoyX )I A. e» Date Board or Committee Member Processed on: _2_12_7_1_2_0_2_3 By Employee: pv'I _ Date Scanned on: City Clerk's Office Staff Initials 22702023 s» Employee: µv} _ 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:\CLERIBOARD AND COMMITTIES DATABASE\CHECKLIST MASTER\B&C Checklist 2015 MASTER.docx We are committed to providing excellent public service and safety to oll who live, work, and play in our vibrant, topical, historic community. City o f M ia mi B e a c h , 1/OO Convonlion Canter Drive, Miami Bsach, Florida 33139 4ywy._miariboachll go OFFICE OF THE CITY CLERK, Rafoal E. Granado, Cy Clerk Tel 305.673.7411, fax 305.673.7254 Email: Ci#yClerk@miamiboochfl.gov February 21, 2023 Mr. Daniel Robles 5838 Collins Ave Miami Beach, FL 33140 SUBJECT: Marine and Waterfront Protection Authority Congratulations! You have been reappointed by Mayor Dan Gelberto the above referenced, board or committee named above, 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 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: Decembe r 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. Congratulations and good luck. % R al G ranado City Clerk cc: Monica Beltran, Parking Director Tasha Byars, 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 - Am end ment 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 - (P arking Department Form) Booklet - Guide to the Sunshine Amendment and Code of Ethics for Public Officers and Employees City of Miami Beach, N/OO Convention Coner Drive, Miami Bouch, Eorda 33 139 yyyy_miarihaachf]_go OFFICE OF THE CITY CLERK, Rafael E. Granado, City Clerk Tel: 305.6737411, Fax. 305.673.7254 Email: Ci#yClerk@miamibeochfl.gov Oath of Office Oath of Civility and Acknowledgements TO : M r. D aniel R obles R E : M arine and W aterfront Pro tection A uthority I do solem nly sw ear or affirm to bear true faith, loyalty and allegiance to the Government of the United States, the State of Florida, and the C ity of M iam i Beach, and to perform all the duties of a m ember of the above-m entioned board or com m ittee of the C ity of M iam i B each to w hich I have been appointed fo r a term ending: 12/31/2024. To m y colleagues and to all of those I represent and serve, I pledge fairn ess, integrity and ci vility, in all actions taken and all com m unications m ade by m e as a public serv ant. I have been issued a copy of section 2-11.1 of the M iam i-D ade C ounty C ode (C onflict of Interest and C ode of Ethics O rdinance), as w ell as Florida C om m ission on Ethics G uide to the S unshine A m endm ent and C ode of Ethics fo r P ublic O fficers and understand that as a m em ber of a C ity of M iam i Beach B oard and/or C om m ittee, I m ust com ply w ith the financi al discl osure* requirem ents of M iam i-Dade C ounty or the State of Florida (depending on the board or com m ittee on w hich I serve) on July 1st, fo llow ing the closing of the calendar year on w hich I have serv ed. M r. Daniel R obles S w orn to and subscribed befo re m e this 27 dd2 :__23 keiiain cceres Deputy Clerk *P lease visit the C ity of M iam i B each w ebsite at w w w .m iam ibeachfl.gov under C ity C lerk/B oard and Com m ittees fo r additional info rm ation regarding the Financial Disclosure R equirem ents. M\I A MI B City of Miami Beach 1 700 Convention Center Drive Miami Beach, Florida 33139 OFFICE OF THE CITY CLERK Email: BC@miamibeachfl.gov Telephone: 305 .673 .7 411 RECEIVED MAR 3 2023 CITY OF MIAMI BEACH OFFICE OF "AF 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): IZI I am a resident of the City of Miami Beach for six months or longer. Home Addres838 Collins Ave Apt. 6E Miami Beach FL 33140 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 BlackOak Capital Group Business Address 5838 Collins Ave Apt. 6E Miami Beach FL 33140 □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 ------------------------ HS[fess J\(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. Under penalties of perjury, I declare that I are true. y 'ck. A. 2o{an/ ave rad the foregoing document and that the facts stated in it 2/27/2023 Signature Daniel Robles Date Printed Name NOTARY Sworn to (or affirmed) and subscribed before me, by means of□physical presence or□online notarization, l cay oro ,zo»3 o Oh[ /4bl& _________ (City of Miami Beach Board/Committee Member) . oy£ Ct Produced ID Signature of Notary Public Name of Notary, Typed, Printed, or Stamped MI/A l City of Miami Beach 1700 Convention Center Drive Mi ami Beach , Florida 33139 ww w _mi am ibeach]. gov OFFICE OF THE CITY CLERK Em ai l: BC @m i ami be achfl.gov Telephone: 305.673.7 411 DIVERSITY STATISTICS REPORT Robles Daniel Last Name First Name Middle Initial The following information is voluntary and has no bearing on your considera tion for appointment. It is being asked to comply with City diversity re porting requirements. Gender: [Mate Ll emate D Other OJ I pre fer not to answer. Race/Ethnic Categories: What is your race? DI African American/Black LJ Asia or Pacific Islander El Caucasian/wh ite 0 Native American/American Indian 0 Other- Print Race: _ DI I prefer not to answer. Do you consider yourself to be Spanish, Hispanic, or Latino/a? [0 ves (J o 0 I prefer not to answer. Do you consider yourself Physically Disabled? (Tes zl Ro D I prefer not to answer this question. Page 6 of 6 F:\C L E R \$A LL\R E G \B O A R D A N D C O M M ITT E E A P P LI C A T IO N S FIN A L D R A FT S \B O A R D A N D C O M M ITT E E A P P LI C A T IO N R E G FIN A L.do cx Updated: June 2020 MIB H City of Miami Beach 1 700 Convention Center Drive Miami Beach, Florida 33139 www.miamibeachfl.gov OFFICE OF THE CITY CLERK Email: BC@miamibeachfl.gov Telephone: 305.673.7 411 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) Robles Daniel 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 )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 jail, or both. I )LL. A. 2,o t/ M- Signature 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:ICLER\$ALL\REG\BOARD AND COMMITT EE APPLICATIONS FINAL DRAFT S\BOARD AND COMMITT EE APPLICATION REG FINAL.docx Updated: June 2020 MIAMl·DADE- EII 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 I Last Name First Name Middle Name/Initial 2022 Robles Daniel A Mailing Address - Street Number, Street Name, or P.O. Box 58 38 C ollins A ve A p t. 6E City, State, Zip M iam i B e ach, F L If your hom e addre ss is your m ailing address, and your hom e address is exem pt fro m public re cords pursuant to Fla. Stat. $119.07, read instructions on the follow ing page and chec k here. D Fili ng as an Em ployee (check one) [] county □Public Health Trust [] Municipal: (Municipality) Department Position or Title Employee ID Number Work address I Work telephone Employment began on/ended on Fili ng as a Board M em ber (check one) [] county ] Municipal: DA1 A D 3e (Municipality) Board where serving Alternate address (if home address 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 B lackO ak C apital G roup 5838 Collins A ve A pt. 6E M iam i R eal Estate Beach FL 3314 0 I hereby sw ear (or affi rm ) that the inform ation above is a true and correct statem ent. ), e.Ao t, 0\- Signature of Person Disclosing _2/27/2023 Date signed RECEIVED BY ELECTIONS DEPARTMENT: J Hard co y p.IVE J El ectron @e ci«#h! :D FEB 97 2023 CIT Or MIA MI BEACH OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/Initials: Scanned Date/Initials: _ 138_SP-14 COE 2016 /\/\//\/\/\/ CI7 WI DE (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 D ate of A pplication: 212712023 A pplicant N am e: Daniel R obles Board/C om m ittee N am e: M arine & W aterf ro nt P ro tection A uthority A ddress: 5838 Collins A ve A pt. 6E M iam i Beach FL 3314 0 E-M ail A ddress: ro blesadaniel@ gm ail.com W ork Phone: H om e Phone C ell Phone: 954-610-0185 Preferred C ontact M ethod: Vehicle Information Ta g: 889G Q C olor: W hite State: Florida Year: 2023 M ake: B M W M odel: 430i o., I App licant Si anat ur e: e /a.t. p.. &ot.> .@ t Please pro vide signed form to th e Parking Departm en t located at 1755 M eridi a n A ven ue, 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 ·ki D ar mna enarmen ec Ion PERMIT SYSTEM GARAGE ACCESS Expiration Date: ID Card Serial #: Issued By Print Name: Print Name: Signature: 6 Signature: e Date Issued: Date Completed: t t S ·ti : pmg man «rat' torms cw oats commntees paruigtonm.doc Orm upaofe . ' 4.9.2