Gerald Schwartz 12.31.24B O A RD A N D C O M M IT T E E C H E C K L IS T
APPonrt.(j3t /5,\AT2 DATE OF APPoIrMenr. l [3
BOARD/COMMITTEE: f/_ Appointea ye/'/tgyzy22,__
FOR SCANNER
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RECEIVED
M4AR8 13 2023
FOR CLERK STAFF
o Letter of Appointment
o Letter of Reappointment "-{j{/")E%$° " Avommenveaomm«sent empted
o Board and Committee Application (completed on_[0l h]
o R~sum~/Curriculum Vitae ,J
o Diversity statistics Reporting (completed on3][3] Ly3)
o Oath
rerRw en. (/2l h] TERM uMur: nez_JV/0
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)
V Highlights of the Miami-Dade County Ethics Code
✓Sunshine Law and Public Records - Frequently Asked Questions
V Memorandum - Solicitation by City Board and Committee Members
or1y 0,949!9,P?f,),,k cone erit Ao»tcavon ear«oo penantmentro»
OFFICE 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 _/
_ ovensrrv sansncs RPoRTNg Ke· 99," e39890%9198999"9°
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Processed on: 3 / r:i> l J0>-5 By Employ e: ----1----7''-r--h'--:----------,-"."'.'"""'."------
Date ferk's Office Staff Initials 3hh ors f}
City Clerk's Office Staff Initials
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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:\CLER\BOARD AND COMMIT TIES DATABASE\CHECKLIST MASTER\IB&C Checklist 2015 MASTER.docx
WVe are ccommitted to providing excellent public service and safety to all who live, work, and play in out vibrant, tropical, historic community.
City of Miami Beach, I/OO Corvonlion Conler Drive, Miami Beach, Florida 33 139 yywy_miaIIihaachllgoy
OFFICE OF THE CITY CIERK, Rafoal E. Granado, Cy Clerk
Tl 305.673.7411, Fa¢ 305.673.7254
Emai l: Ci#yCl erk@miamibeoch fl.gov
February 21, 2023
Mr. Gerald Schwartz
5680 Pine Tree Dr.
Miami Beach, Florida 33140
SUBJECT: Disability Access Committee
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 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.
Congratulations and good luck. Rego/)
Rafael Granado
City Clerk
cc: Monica Beltran, Parking Director
Valeria Mejia, 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
City of Miami Beach, I/OJ Convention Conlr Dio, Miami Each, Florido 33139 y._miamibcachllgcy
OFFICE OF THE CITY CIERK, Raf0al E. Granado, Cly Clerk
Tol: 305.673.741, Fax¢ 305.673.7254
Em ai l: C i/Cl erk@ mia mi b ceach fl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Mr. Gerald Schwartz
RE: Disability Access 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 l have been appointed for a
term ending: 12/31/2024.
To my colleagues and to all of those l 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. L, _f-
• a %,
¢ pp C- . Gerald $fartzy
7/J;
i
-) ,4.:
S w orn lo an d su bscribed be fo re m e this ~~~023
eta Mun cacercs
Deputy Clerk
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.
City o f Mi am i Beach
1700 Convention Center Drive
Miami Beach, Florido 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
RECEIVED
MA4R 13 20
CITY OF MIAM I BEACH
OFFICE OF THE CITY CLERK
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
STATE OF FLORIDA
COUNTY OF MIAMI-DADE
l am in com pliance with the affiliation requireme nt of Miami Beach City Code Sections 2-22 (4), as (ch eck
(/) all that apply):
/ ti lam a resident of the City of Miami Beach for six mon ths or longer.
] I have an own ership interest (for a minimu m of six months) in a business established in the City of
Miami Beach (for a minimum of six months).
Name of Business
[I }r s,S (]Hf?S.
DI lam 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). - [are f [3ysin1es5S__
business ddreS_.
"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. . •'"' . f,
Under penalties of .P~.~j~~J~<t.eti~fite fia_·t ;. h:;e 1d-th1f'fotegoi~g doc.ument and th. at the facts stated in it
a/re,ttue,. ·>p::: ,;;: .... · . / tp,·',,,,0· .. ~':;,,:;, ,~?/4 /;;· L'.) .. ,.•r ,.-•, ?1tr·pf >» et. 23 AL; 'i Jg _] £et t <>
$i@nature Da6 /
/fee
Pfinted Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means o~ysical presence or online notarization ,
a.9_a en ,2 Geat k2an 2
Produced ID
(City of Miami Beach Board/Committee Member).
f Dvees le,e
Form of Iden tification
gig,, CHARLES J,pAG9TIN
j" wcouussis'SH\ s3hos
j,l,&j xPents: Decanter 14, 2025
f ] ;;@z~' ponded Thu Notary Public Underwriters Name "iii.is
Sign at
L)
MI AI BEACH
C ity of M iami Bea ch
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfl.gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
DIVERSITY SJAJISJICS REPORT
po
>-cn(#..
Last Name First Name Middle Initial
The following information is voluntary and has no bearing on your consideration for appointment. It is being
asked to comply with City diversity reporting requirements.
Gender:
EE a»
El remale
Lloner
0 I prefer not to answer.
Race/Ethnic Categories:
What is your race?
El African American/Black
Ek Asian or Pacific Islander □Caucasian/White
[Si Native American/American Indian
[l Other -- Print Race.- Elt prefer not to ans w er.
Do you consider yourself to be Spanish, Hispanic, or, Latino/a?
Jes go
D I prefer not to answer.
Do you consider yourself Physically Disabled?
8:
D I prefer not to answer this question.
•
Page 6 of 6
F:ACLERI$ALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florido 33139
www.miamibeachll.gov
OFFICE OF THE CITY CLERK
Emai l: BC@miamibeachfl.go
Telephone: 305.673.7411
BOARD & COMMIT TEE FINANCIAL ACKNOWLEDGEMENT STATEMENT
Acknowledgement of fines/suspension fo r Board/Committee Members for failure to comply with Miami-
Dade County Financial Disclosure Code Provision Code Section 2-11.1(i) (2)
La st N a m e First Name Middle Initial
l 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"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 mpore tha ,,::n. $.·/'l-.iO,. r.;:,6.·0···"8a. 'Y~.·--.1~J~7il,_o '.'.both, .- . _ , . . ... · ... · .,
9, 2$ /09% 7/2/3222 . /ly'1l• .1l-Cd
/·gnatur r , -· , ,,. "j ' CJ;:lfe /
' 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. How ever, compliance wi th the County disclosure requirement does not satisfy the State
requirement.
Page 5 of 6
FACLER\SALLARE G\B O ARD AND COMMIT TEE AP PLI C ATI O NS FINAL DRAFTS\BOARDO AND COMMITTEE APPLICATION REG FINAL.docx
Updated: Jun e 2020
MIAMI-DADE. EE 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
a028 z0 2.3 Rs4.r; ;r Middle Name/initial
k
Mailing Address - Street Numb er, Street Name, or P.0. Box
5680 73. Jee
City, State, Zip
1):n», eel la 32/ 'D
lf your home address is your mailing address, and your home address is exempt from public records pursuant to Fla. Stat. $119.07, read
instructions on the following page and check here.[l
Filing as an Employee (check one)
[] county D Public Health Trust [] Municipal:
(Municipality)
Department
Position or Title Employee ID Number
W ork address Work telephone Employment began on/ended on
Filing as a Board Member (check one)
[] county J woninat: 1a-mtj Becct
(Municipality)
It sis exempt) Term b
co
List below every source of income you received, along with the address and the principal activity of each source. Include your publlc 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 paym ents. Also, incl ude 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
3veal Sec.h, is • I J ,
I
I hereby swear (or affirm) that . bove is a true and correct statement.
Dis
~F
RECEIVED BY ELECTIONS DEPARTMENT:
Jar@coy RECEIVED
[] Electronic Copy
MAR 13 2023
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/initials: Scanned Date/initials:
138_SP-14 COE 2016
///A \/\/\i BEACH- CIwDE (CW) BOARD & COMMITTEES
ciy ot Miami tea±, PARKING DEPARrMENr PARKING PP[CATON
1755 Meridian Avenue, Suite 200/Miami Beach, FL 33139/Ph: (305) 673-7505 r (305) 673-7000 ex. 6200
'I!:1 '
PARKING
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 (GZ) 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 replacem ent fee.
Board Member Information
Date of Application:
Applicant Name;
Board/Committee Name:,)__ 2) '
4Al·
E-Moil Address: ts=J{ ls<cg
Work Phone:
cal Pore3235752 Preferred Contact Method:f<<_g/ a,Ce/
Vehicle Information
Tag: Color: P Jove
State: 7/ Year: 2>/s
Make: 1Y Model: Co,Joe /,'rem9
Applicant Sianature: es
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 ·kd D rt S ar' mna epa ment ection
PERMIT SYSTEM GARAGE ACCESS
Expiration Dote: ID Card Serial #:
Issued By Print Name: Pint Nome:
Signature: Sign ature:
Date Issued: Date Completed:
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