David Grieser 12.31.23 (2)Ml MIB
BO ARD AND COMM ITTEE CHECKLIST
APPorte. _LQd_@nRr DATE or APPonrwer. 2/2/23
soAcon»wmrre. b/lot Alu@o oallAoontea oy._a'(omssen
rERw no.pl31/23 FOR SCANNER
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RECEIVED
MAR 10 2023
FOR CLERK STAFF
o Letter of Appointment
o Letter of Reappointment 7 41'?$$° " A oono envr eanoon eon e-m ates
o Boar@ and Committee Application (completed o,_1/l0[
o R~sum~/Curriculum Vitae J,J)3
o Diversity Statistics Reporting (Completed on _. , k
o Oath
rERM Lurr. p2[31 /2 1
to Committee 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
✓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 C ITY O F MI AM I BE A CH
OFFICE OE TIE OITY CL ERK
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Received on:
Scanned on:
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
o Board and Committees Liaison Responsibilities
O DIVERSITY STATISTICS REPORTING Keep copy in file and ORIGINAL for Annual Report.
s/@ l3 sear s,X<= de
Date
Processed • al»/ Employee:----+=------------------
Date
_a_,_\ _Ci>_}_}_~ __ By Employee: ___,_ _
Date City Clerk's Office Staff 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:\C LER\BO ARD AND COM M ITT IES DATABASE\CHECKLI ST MASTER\B&C Checklist 2015 MASTER.docx
We re committed to providing excellent public service and safety to oll who live, work, and ploy in our vibrant, tropical, historic community.
MI AMI E
City of Miami Beach, LOO Convention Conler Drive, Miami Bach, Florida 33139 yw_miamibggchf]_go
OF FICE OF THE CI TY CIERK, Rafaal E. Gr an ado, Cy Clerk
Tel: 305.673.741I, Fax. 305.673.7254
Email: Cit/Clerk@miamiboochfl.gov
February 23, 2023
Mr. David Grieser
1754 Meridian Ave, Apt. 201
MIAMI BEACH, FL 33139
RE: Budget Advisory Committee
Dear Mr. David Grieser:
Congratulations! You have been appointed by the City Commission to the agency, board or committee
named above for a term ending: 12/31/2023.
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.
»
Rafael Granado
City Clerk
cc: Monica Beltran, Parking Director
Tameka Otto Stewart, 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
City of Miami Beach, 1/OO Convention Conler Diva, Miami Booch, Florida 33 139 ygywy_Iiarilggchfl_go
OFFICE OF THE CITY CLERK, Rafael E. Granado, Cly Clerk
Tel: 305.673.7411, Fax. 305.673.7254
Email: Ci/Clerk@miamibeochfl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Mr. David Grieser
RE: Budget 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 e nding: 12/31/2023.
T o m y colle ag u e s a nd to a ll of th o se I rep re se nt and serve, I pledge fairness, integrity and civility, in all
a ctio ns take n and a ll com m unicatio ns made by me as a public servant.
I ha ve b e e n issu e d a co p y of section 2-1 1 .1 of the M ia m i-D a d e C o un ty C o de (C o nflict of Interest and
C o de of E thics O rdin a nce), as w ell as F lo rid a C o m m issio n o n Ethics Guide to the Sunshine Amendment
a nd C o de o f E thics fo r P u b lic O ffi cers a nd und e rstand that a s a m e m b er o f a C ity of M ia m i B each B o ard
a nd/or C o m m itt ee , I m u st com p ly w ith the fina ncia l discl osure * requ irem e nts of M ia m i-D ade C o unty o r the
S ta te o f F lo rida (de pe nd ing on the b oa rd o r co m m itt ee o n w hich I serve) on July 1s t, fo llow ing the cl o sing
of the cale nd a r year on w h ich I have serve d. ~-
___,_......,,..._· -~-~~~-
M r. D avid G rie ser
S w orn to and sub s cr ibe d b efore m e this []
*P le a se visit the C ity o f M ia m i B e a ch w e b site a t w w w .m ia m ib e a chfl.g o v u n d e r C ity C le rk/B o a rd and
C om m ittee s fo r add itio na l info rm atio n regarding the F ina ncia l D iscl osure R e quirem e n ts.
I
MIAMIBE H
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
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
(0 a3l- that apply):
ip/' I am a resident of the City of Miami Beach for six months or longer.
Home a@ress ])( y•.- /lo _M t2.L,
7
□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 _
Business Address ------------------------
□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.
U"G'PS ties of perjury, I declare that I have read the foregoing document and that the facts stated in it ",°- -a I-2y
Signature Date
David Grieser
Printed Name
o m 6v
Sw°/: to (or affirmed) and subscribed before m_e, by me_:s 0~;1ca~ presence or online notarization,
lg «QA/w_SPA oee
X Produced 1D
(City of Miami Beach Board/Committee Member).
[vs re<e
Form of Identification
g3ij., CHARS i. DAGosrii
? b h,; MY coussIoN # H+ 16s7os %j;},J!dis ExPRes: December 14, 2025
"jj@?" Bonded Tru Notary Pubic Underwrit ers
(NOTARY SEAL)
Name of Notary, Typed, Printed, or Stamped
M IA M IB E H
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeach~l,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)
Grieser David
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. /a c -»3
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.
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F:\CLER\$ALL\REG\BOARD AND COMMITT EE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITT EE APPLICATION REG FINAL.docx
Updated: June 2020
N\IAMI
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeach[l.gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
DIVERSITY STATISTICS REPORT
Grieser David
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:
ten.
D Female
Lloher
D I prefer not to answer.
Race/Ethnic Categories:·
What is your race?
DI African American/Black LI Asian or Pacific Islander
EZI Caucasian/wh ite
DI 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?
p,es LI No
D I prefer not to answer.
Do you consider yourself Physically Disabled?
B# " (es
.... No t prefer not to answer this question.
Page 6 of 6
F:\C L ER \$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 F T 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
MIAMIBE
City of Miami Beach, PARKING DEPARTMENT
1755 Meridian Avenue, Suite 200/Miami Beach, FL 33139/Ph: (305) 673-7505 or (305) 673-7000 e4. 6200
CITYWIDE (CW) BOARD & COMMITTEES
PARKING APPLICATION
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: ] 23
Applicant Name: David Grieser
Board/Committee Name: Budget Advisory Committee
Address: 1754 We.)- 3 El o l
E-Mail Address: kl cleeO <oil, l 8/-
Work Phone: ) ) Home Phone 3e- S,3- $198
Cell Phone: }6- $3- -,$7 f~ Preferred Contact Method: cl
Vehicle Information
Tag: 22R \<.RC,- Color: Se
State: f- - Year: L 2o2
Make: Coy Model: 13, () \-{:: uV
Applicant Sianature: ef
Please provide signed form to the Parking Department 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, ·ki D ar Ina epartment ection
PERMIT SYSTEM GARAGE ACCESS
Expiration Date: ID Card Serial #:
Issued By Print Name: Print Name:
Signature: Signature:
Date Issued: Date Completed:
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