Dean Campbell 12.31.24# #
B O A R D A N D C O M M IT T E E C H E C K L IS T
APPOINTEE. Dean Campbell D A TE OF AP P OI N TM EN r: 2(2,2/23
BOARD/COMMITTEE. "P"Pf Appointed y. CMB Commission
FOR SCANNER
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Scan
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FOR CLERK STAFF
o Letter of Ap pointmen t
Letter of Reappoi ntm ent {%] /'28 ° Aonoenuearomomen e-mates to
Board and Committee Application (Completed , [][
o R~sum~/Curriculum Vitae 16 / ">..
o Diversity Statistics Repor ting (Completed on 3 'b
o Oath
rER eNo. vl31]2( rerow Lurer. rl31h2¢
Committee Liaison on
R EC E IV ED
MAR 3 2023
C IT Y O F M IA M I B E A C H
OFFICE OF THE CITY CLERK
IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
City Code Ordinance Section applicab le to the agen cy, board or committee
City Code Section s 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
amen ded through December 2010)
Amendmen ts to th e Code of Ethics Ordnan ce (September 2009 through July 2012)
Highlights of the Miami-Dade County Ethics Code
Sunshine Law and Pub lic Records -- Frequently Asked Question s
¥ Mem orand um - Solicitation by City Board and Committee Members
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Scan O
o Citywide Permit Application (Parking Department Form)
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
Received on :
O Board and Committees Liaison Responsibilities
o DIVERSITY STATISTICS REPO
M arch 3, 2023 son«ea»y
Date
Processed on: March 3, 2023
Date
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ile and ORIGINAL for Annual Report.
a.«on"
City Cl~e Staff Initials
_M_a_r_c_h_3_,_2_0_2_3 By Employee: ----.,lf--~~---------------
Date ciy clerks of~e Staff initials
By Employee: _
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
FACLER\BOARD AND COMMIT TIES DATABASE\CHECKLIST MASTER\B&C Checklist 2015 MASTER.dOcx
City o f M ia m i B e a ch , I/OO Convention Canter Drive, Miami Bach, Florida 33139 yyy._miamihaachllgo
OFFICE OF THE CITY CLERK, Ra~al E. Granado, Cly Clerk
Tel 305.673.7411, Fax 305.673.7254
Email: Ci#Clerk@miamiboochfl.gov
February 23, 2023
Mr. Dean Campbell
900 Bay Drive, 619
Miami Beach, FL 33141
SUBJECT: Transportation, Parking and Bicycle-Pedestrian Facilities Committee
Dear Mr. Dean Campbell:
Congratulations! You have been reappointed by the City Commission to the above referenced board or
committee, 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. Congratulations and good luck. R ev
Rafael Granado
City Clerk
cc: Monica Beltran, Parking Director
Monica Beltran, 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
OHHCE OE IHE CI IY CIHK, Rafael L. Granado, City Clerk
Iol 305,73 7AH,fa. 305.673 7254
fmail. City.Clerk@miamtbeochfi gos
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Mr. Dean Campbell
RE: Transportation. Parking and Bicycle-Pedestrian Facilities 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: 12/31/2024.
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 Intere st and
Code of Ethics Ordinan ce), 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 Com mittee, I must comply with the finan cial disclosure requirem ents 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 subscribe d before'm e mus 31_ aa or N/'uo 23
Keilil.t.s-
Deputy Clerk
'Please visit the City of Miami Beach website at www.miami beachfl.gov und er City Clerk/Board and
Committees for additional information regarding the Financial Disclosure Requirements.
BE
City of Miami Beach
700 Convention Center Drive
Miami Beach, Florid 33139
OFFICE OF THE CITY CLERK
Email. BC@miambeachfl.gov
Telephone: 305.673.7411
RECEIVED
MAR 3 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):
tzl I am a resident of the City of Miami Beach for six months or longer,
Home Address 900 Bay Drive 619, Miami Beach, FL 33141
□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).
[]a/q (] P11,1[eS}
Business Address _
o 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 _
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.
e that I have read the foregoing document and that the facts stated in it
March 3, 2023
Signature
Dean C
Date
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of u physical presence or u online notarization,
a..3 a out·t ZSs Den. &
_________ (City of Miami Beach Board/Committee Member).
[v Produced ID ✓. Form of Identification
Personally Known
l. po /-
ir.. LISSETE MORALES
, Notary Public - State of Florida
• ii Commission t GG 961479 of% iy comm. Expires Mar 1, 2024
Bonded through National Nota
(NOTARY SEAL)
Signature of Notary Public
Liss5ere Mores
Name of Notary, Typed, Printed, or Stamped
City of Miami Beach
170 Convention Center Drive
Miami Beach, Florido 33139
ww.miamibeachfl_goy
OFFICE OF THE CITY CLERK
Email: BC@miamibeachf go
Telephone: 305.673.7411
DIVERSI TY STATISTICS REPOR I
Campbell Dean E
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:
[ZJ ate
D Female
D Other
D I prefer not to answer.
Race/Ethnic Categories:
What is your race?
D African Am erican/Black
D Asian or Pacific Islander
[} Caucasian/wh ite
LI Native American/American Indian D Other -- Print Race: _
0 I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
J ves
Jo
0 I prefer not to answer.
Do you consider yourself Physically Disabled?
le,
z0o
D I prefer not to answer this question.
Page 6 of 6
FACLERSALLIRE G'BOARD AND COMMIT TEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.doCx
Updated: June 2020
C ity o f M ia mi B e a c h
1700 Convention Center Drive
Miami Beach, florida 33139
ww.miamibeochfl. gov
OFFICE OF THE CITY CL ERK
Email: B@miamibeachf_gov
Telephone:. 305.673.741 1
BOARD & COMMIT IEE FINANCIAL ACKN OWLED GEMENT 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)
Campbell Dean E
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.
Qne 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"Statemen t 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 fo more)than $500, 60 days in jail, or both. /Pl worn s. 2023
=---,---------------- Sig 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
F CLER\SAL.LARE G'OARD AND COMMITTEE APPLICATIONS FINAL DR AF TS\BOARD AND COMMIT TEE APPLICATION REG FINAL dOcx
Updated: June 2020
M IA M l·DA D E♦Em SOURCE OF INCOME STATEMENT
Secon 2-111@) 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 y0at.
Disclosure for Tax Year Ending /Last Name
2022 ! Campbell
First Name
Dean
Middle Name/Initial
E
Mailing Address - Street Number, Street Name, or P,0. Box
900 Bay Drive 619
City, State, Zip
Miami Beach, FL 33141
f your home address is your mailing address, and your home address is exempt from public records pursuan t to Fla. Stat. $119.07, read
instru ctions on the following page and check here.[]
Filing as an Employee (check one) ······-·--·-~---·~--~-------
[] county [] Public Health Trust [] M un i cipal :
(M unicip ality)
Department
Position or Title Employee ID Number
Work address Work telephone Employment began on/ended on
!
as a Board Member (check one)
[] county [] Municipal: City of Miami Beach
(M unicip ality)
Board where serving
Transportation, Parking and Bicycle-Pedestrian Facilities
.
Alternate address (if home address is exempt) Work telephone /Term began on/ended on
(202) 674-2150 ] 3/3/2023 - 12/31/2024
~-- ----------------------~- ------~
List below every source of income you received, along wi th the address and the principai activity ot each sourc e. Include your public salary. Place the sources of
income in descending order, with the largest source first. Examples at 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 tor your benefit. However, the income of your spouse or any business partner need not be disclosed, If continued on a separate sheet, check here.[]
·············-···~---····· ....... toe : Name of Source of Income Address Description of the Principal Business Activity
lnvicta Watch Co. of America 3069 Taft Street Watch distribution
Hollywood, FL 33021
••-••-•••o=h'-.>hh,,, a«ta .... ••••••••••••••v••v•-•·-•••-h ...... it
I
- ......... _.- ·-------·
Bookkeeper 900 Bay Drive 619 Bookkeeping
(Independent Contractor) Miami Beach, FL 33021
' -------~---···
, ··•····· .. , .................. _. ___ ····•·--••········· r
Signa
h
r affirm ) th at the infor m ation/ab ove is a true an d correct statem en t. · /
Date signed
RECEIVED BY ELECTIONS DEPARTMENT:
wore »R E C EIVE D
Electronic Copy
MAR 3 2023
CITY OF MIAM I BEACH
OF} En-
O FFIC E USE O N LY Accepte d: Y i N De!iceny . --
13 _S .14 C9 2 0 16
Processed {ate;initials Scanned Dute;tliais...---
\/\[/AN/BE , }/CITYWIDE (CW) 6OARD & COMMITTEES
cay ct tori ea±, PARKING DAmRrMNr PARKING APP[ICATON
17 55 M eridi a n A venue, Sui te 200/Miami Beach, FL 33139/Ph: (30 5} 673.7505 0r (305) 673.7000 ex . 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 "pa rking 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 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 th e gate opens.
ACKNOWLEDGEMENT: I acknowledge that should my access card be iost, stolen or
da m a g e, I wi ll be respo nsible to pay a $10 .00 rep lacem en t fee.
Board Member Information ,=,.. ..... ~~~~
Dote of Application: March 3, 2023
Applicant Nome: D ean Cam pbell
Board /Com mittee Name : TPBPF
Address: 900 Bay D rive, 619; Miami Beach, FL 33021
E-Mail Address dcamp bel l@ deanecam pbel l.com
W ork Phone: 954-921-2444 Hom e Phon e 202-674-2150
Cell Phone: 202-674-2150 Pre ferred Contact Method: Cell
Vehicle Information
Tog: IJPB94 Color: Grey
Sla te. FL Year: 2020
M ake: Volvo M odel: XC40
Ap pl icant Sianatur e : es
Please pro vide signed form to th e Parking Department located at 7 55 Meridia n Avenue, 2 fl oor. W orking
ho urs are 8:30 to 5:00 p.m. or em ail to: ParkingReception@mi@mnibeachfl.gov
e-mail subject: BOARD & COMMITTEE PARKING APPLICATION - APPLICANT NAME
P, k' D ar in g 'epart m ent Section
PERMI T SYSTEM G AR A G E A C CES S
Expiration Date: ID Cord Serial #:
Issued By Print Name: Print Name:
Signature: 6 Signature:
Date lssued: Date Completed:
g m c n s r .an;s • as. so m m unte e pong'om,fC