Tim Carr 12.31.24Ri COMMITTEE CHECKLIST
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BOARD/COMMIT TEE:
FOR SCANNER
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RECEIVED
MR 16 2023
Are or AProrwEeNr. 122]/Z?
Appointed by; L clue~ J)~ r,:,t a
ssh/a4 co. 1all2 FOR CLERK STAFF
o Letter of Appointment
o Letter of Reappointment " 812 [$'$ ootoenvmesoronorent a-mate
o Board and Committee Appication (corieted on 3_lo[2
o Resume/curriculum Vitae E'
o Diversity statistics Reporting (completed on __ [,
o Oath
to Committee Liaison on
IMPORTANT INFORMATION FOR BOARD AND COMMIT TEE MIEMIBERS BOOK
t 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 S e ction 2 -11.1--- Con flict of Interest and Code of Ethics Ordinance (as
amended through December 2010)
Amendments to the Code of Ethics Ordinan ce (September 2009 through July 2012)
V Highlights of the Miami-Dade County Ethics Code
t Sunshine Law and Public Records -- Frequently skcd Questions
t Memorandum - Solicitation by City Board and Committee Members
CI TY O F M IAM I BE A CH
IC E O F THE CI TY CLERK OFFI - O Citywide Permit Application (Parking Department Form)
S can O
Scan O
Received on:
Processed on:
Scann e d 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
:. 2A
ate oar4 or co") emer
3llgl1, s»mores. ,,,,,[<._h,,,,
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' Dy Employee: 1-Ht
Date City Clerk's Office Staff Initials
ERS
Term Expired Letter Date Processed Initials Scan O
Resignation Letter Date Processed Initials Scan O
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o are committed to excellent service and to all who five, work, and play in our vibrant, tropical, histric comrumity
City of Miami Beach, I/OO Convonlion Conler Drive, Miami Beach, Florida 33 139 yywy._ILiaIihaachllqoy
OFFICE OF THE CITY CLERK, Raf0al E. Granado, Ciy Clerk
Tel: 305.673.7411, Fax: 305.673.7254
Email: C i#yCl erk@miamiboochfl.gov
December 29, 2022
Mr. Tim Carr
540 West Ave #2214
Miami Beach, FL 33139
SUBJECT: Marine and Waterfront Protection Authority
Congratulations! You have been reappointed by Commissioner Laura Dominguez to 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: Decem ber 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.
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 en dment 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 Wiami each, !/0) Convention Cnlor Drivo, Miami Bah, Hloida 33139 yyy.miamihoachll.gov
OFFICE OF THE CITY CIERK, Rolaol E. Granado, Cy Clerk
ol: 305.673.74I, fax. 305.673.7254
Email: CiyClerk@mlamlbeachl.gov
Oath of Office
Oath of Civility
and
Acknowl edgements
TO: Mr. Tim Carr
RE : Marine and Waterfront Protection Authority
l 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 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 sen,ed. . __..--, -~
-2 {
Mr. Tim Carr
swor to and subscribed before me this _lo h day ot le 2023
l
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 of Miami Beach
1/00 Convention Center Drive
Miam i Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
RECEIVED
MAR 16 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
l am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4), as (check
(/) all that apply):
o I am a resident of th. e·. City of Miami Beach. f:. r six mon.ths ~~.r longer. . . . . . . . O
or- A«aces 3 <2 0 2 7 k02427//4h72/ 322%j 7
I have an ownership interest (for a minimum of six months) in a business established in the City of
Miami Beach (for a m7inimum six months).
[9ff (f [1A-,]f}.pr
Business Address -.,----------------------
a lam a full-time employee of a business (for a minimum of six months) and am based in an office or
other location of the business that is physically located in Miami Beach (for a minimum of six months).
[qff1 tof 1S,]fS3..
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"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
are true.
clare that I have read the foregoing document and that the facts stated in it
7.
Signature
5 CC
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of physical presence or a online notarization,
ne [a day ow Harah oz22n limo Cart
(City of Miami Beach Board/Committee Member).
Produced ID
Form of Identification
Notary Publlc State of Florida
Janiffer Rodriguez
My Commlsslon HH 327629
Expires 10/31/2026
(NOTARY SEAL)
City of Miami leach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfl.gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.,gOy
Telephone: 305.673.7411
DIVERSI TY STATISTI CS REPORT
Last Name First Nam e Middle Initial
Th e followi ng inform ation is volunt ar y an d has no bearing on your con sideration for appointment. It is being
asked to comply with City diversity reporting requirements.
Gender: .
1itae
Lremate
L.loner
Ll 1pr e fer not to an sw er.
Race/Ethn ic Categories:
What is your race?
El African American/Black
Ll Asian or Pacific Islander
[ C aucasian /wh ite
El Native American/American Indian
[} Other - Print Race.
Lliprefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
L..Ives
No
Ll 1pr ef e r not to ans w er.
Do you consider yourself Physically Disabled?
Ches
Ao
Ll 1prefer not to an swer this question.
Page 6 of 6
f:\CLER\$ALLREG\OARD N D COMMIT TEE APPLICATIONS FINAL DRA FTS\OARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachll.gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
BOARD & COMMITTEE. FINANCIAL ACKNOWLEDGEMENT STATEMENT
A cknowl edgem ent of fines/suspension for Board/Committee Members for failure to com ply with Miami-
Dade County Financial Disclosure Code Provision Code Section 2-11.1(i) (2)
Middle Initial
I understand that no later than July1, 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 d (s in jail, or both.
Signature
' Members of the Planning Board and Board of Adjustment will be notified directly by the State of Florida,
pursuant to F.S. $112.3145(1)(a), to file a Statement of Financial Interests (Form 1) with the Miami-Dade County
Supervisor of Elections by 12:00 noon, July 1. Planning Board and Board of Adjustment members who file their
Form 1 with the County Supervisor of Elections automatically satisfy the County's financial disclosure
requirement as a Miami Beach City Board/Committee member and need not file an additional form with the Office
of the City Clerk. However, compliance with the County disclosure requirement does not satisfy the State
requirement.
Page 5 0f6
F:CLERI$ALLIREGBOARD AND C OM M IT TEE AP PLICATIONS FINAL DRAFTS\BOARD AND C OM MI T TEE A P PL I C A TION REG FINAL .doox
Updated: June 2020
SOURCE 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.
Dlsclosure tor Tax Year Ending [Last Name
2o22 A9
First Name
H11
~le Name/lnltlal
Malling Address - Street Number, Street Name, or P.0. Box
5, O z # v
Iry, State, Zip
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.[]
FIng as an . (check one) . 11
[] county [] Public Health Trust EI Municipal: _,
(Municipality)
Department
Pasltion or Title Employee ID Number
·-rWork telephone Work address Employment began on/ended on
I county _k Mancia :_di11 grit'
(Municipality)
Board where serving
/4
Alternate at tress tome at less ls exemp
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, wi th 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 anothgf
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.L_]
too no o,
Name of Source of income ddress Description of the Principal Business Activity
vO >src
7z f1n2 4 7) -
I hereby swear (or affirm) that the inf rmatlon above is a true and correct statement.
Signature of Person Disclosing
a@/3
RECEIVED BY ELEGIONS DEPARTMEN T:
] Hardon, "E o ti Vr zL )
) tectonic ?gR% 16 2023
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
EMEMBER TO SIGN, AND SUBMIT TO THE OFFICE OF THE CITY CLERK VIA EMAIL OR HARDCOP
M I CITYWIDE (CW) BOARD & COMMITTEES
cwwy sot Miami seat, PARKING DEPARTMENT PARKING APP[[CATON
1755 Meridian venue, Suite 200/Mimi Beach, FL 33139/Ph: (305) 673-7505 or (305) 673-7000 ex. 6200
A cilywide (CW) parking permit is honored at metered parking spaces and restricted residential zon es
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 impor tant that our records reflect the most current and
accurate information regarding your vehicle license plate. Inaccurate and/or outdated veh icle
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 en sure 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, will be responsible to pay a $10.00 replacement fee.
Board Member Infos
Date of Applicatio
Applicant Name:
Address:
E-Mail Address:
?
« og t¢ aa »fa iloo«oooho
Work Phone: Home Phone
Cell Phone: 0 a79 9,75 Preferred Contact Method:
Vehicle Informal'
Tag:
State:
Make:
Color:
ear:
Model:
Applicant Sf +nature: as
Please provide signed form to the Parking Department located at 1755 Meridian Avenue, 2d floor. Working
hours are 8:30 1o 5.00 p.m. or email to: Parking!Reception@miamibeachfl.gov
e-mail subiect: BOARD 8& COMMITTEE PARKING APPLICATION - APPLICANT NAME
rtment Section
GARAGE ACCESS
ID Card Serial ##:
Issued By Print Name: Pint Name:
Signature: Signature: 45
Date Issued: Dote Completed:
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