David Doebler 12.31.24M IA M I BEACH
BOARD AND COMMITTEE CHECKLIST
APPOINTEE: David Doebler DATE OF APPOINTMENT. 2/8/2023
BOARD/COMMITTEE. Marine & Waterfront Protect/O Appointed by. Alex Fernandez
FOR SCANNER
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RECEIVED
MAR 16 2023
FOR CLERK STAFF
o Letter of Appointment
o Letter of Reappointment
o C o ry of Letter of Appointment/Reappointment e-mailed
2,1 2s I
Board and Committee Application (Complet ed on 2 l]l
o R esum e /c urricul um V ita e } ]
o D iversi ty St atist ics R ep or ti ng (C om p l et ed on 3 lg 23 )
o Oath
rRw No. 12l31h{ TERM LuMrr. 1]31/A
to Committee Liaison on
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
IM PORTANT 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 - Con flict 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 - Frequen tly Asked Questions
✓Mem oran dum - Solicitation by City Board and Committee Members
Scan o
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
Scanned on:
o Board and Committees Liaison Responsibilities
O DIVERSITY STATISTICS REPORTI NG Keep copy ir nit» and ORIGINAL for Annual Report.
v11J23 .siones y '
Date
Processed on: _3_____,J~l_u __ ,_)b By Employee: ------l-KJY)___::;____;_ _
Da;e City Clerk's Office Staff Initials 3l16/9 s» Employee: KJV)--=-___.'-----------
D ate City Clerk's Office Staff Initials
R ece ived on:
CONCLUDED & RESIGNATION LETTERS
T e rm E xpired Lett e r D ate P rocesse d In itia ls S can o
R esig na tio n Le tt e r D ate Pr o cessed In itia ls S can o
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R e m ova l Lett e r d ue to abse nce s D ate p roce sse d In itia ls S can o
F:ICLERIBOARD AND COMMITTIES DATABASE\CHECKLIST MASTERIB&C Checklist 2015 MASTER.docx
WVe are com mitted to providing excellent public service and safety to all wh o live, work, and play in our vibrant, tropical, historic community.
City of Miami Beach, N/0O Convention Canter Drive, Miami Bach, Florida 33 139 yxy_miamibaachl]gov
OFFICE OF THE CITY CLERK, Rafol E. Granado, Ciy Clerk
Tl 305.673.7411, Fax:. 305.673.7254
Emai l: City.Cl erk@m iam ibooch fl.gov
February 09, 2023
Mr. David Doebler
800 West Ave, #212
Miami Beach, Florida 33139
SUBJECT: Marine and Waterfront Protection Authority
Congratulations! You have been reappointed by Commissioner Alex Fernandez to the above
referenced, board or committee named above, for a term ending: 12 /31 /20 24 .
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.
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 - 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
M IAM I BEACH
City of M iam i Beach, I/O Convention Canter Drivo, Miami Boach, Florida 33 139 yyyy._miaIibaachll.go
OF F ICE OF THE CI TY CL ERK, Rafaol E. Gran ado, City Clerk
Tol: 305.673.7411, Fox. 305.673.7254
Email: CilyClerk@miamibeachfl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Mr. David Doebler
RE: Marine and Waterfront Protection Authority
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 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. ~
. avid Doebler
Sworn to and subscribed before me this -
Keil
' 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.
MIAMI BEACH
City of Miami Beach
1 700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CL ERK
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
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4), as (check
(/) all that apply):
IZl I am a resident of the City of Miami Beach for six months or longer.
Home Addres800 West Ave, #212, Miami Beach, FL 33139
□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 _
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.
">-us@rjury, I declare that I have read the foregoing document and that the facts stated in it
3l1u/3
Date
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of□physical presence or□online notarization,
owl@haa « Mo.rh zo2s Doi ] 00elo Lr
________ (City of Miami Beach Board/Committee Member).
1 bnt lore Produced ID
Personally
Form of Identification
,::-,__
Signature of Nota
Name of Notary, Typed, Printed, or Stamped
MIAMI BEACH
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: 305.673.7411
DIVERSITY STATISTICS REPORT
Doebler David d
Last Name First Name Middle Initial
The fo llow ing inform ation is voluntary and has no bearing on your consideration for appointment It is being
asked to comply with City diversity reporting requirements.
Gender:
[Z0 Male
0 Female
D Other
0 I prefer not to answer.
Race/Ethnic Categories:
What is your race?
Ll Amica American/Black
LlAstan or Pacific Islander
El Caucasian/white
D Native American/American Indian
0 O ther - Pr int Race: ------------- □I prefer not to answ er.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
ves
0 N o
D I prefer not to answ er.
Do you consider yourself Physically Disabled?
aves
zlo
D I prefer not to answ er this question.
Page 6 of 6
F:\CLER\$ALL\REGIBOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
MIAMI BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfl.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)
Doebler David J
Last Name First Name Middle Initial
I understand that no later than July.1,of each Vear 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.
e of these forms, pursuant to the Miami-Dade County Code, may subject the person to a fine
$5l 0ay: jail, or both.
Signa ure 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:ICLER\$ALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
MIAMl·DAD E-
&EI 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 Doebler David " Mailing Address - Street Number, Street Name, or P.O. Box
8 0 0 W e st Ave, #2 12
City, State, Zip
Miami Beach, FL 33139
If 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 an d che ck here.Ll
Filing as an Employee (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
Filing as a Board Member (check one)
[] county [] Municipal: City of Miami Beach
(Municipality)
Board where serving
Marine & Waterfront Protection Authority
Alternate address (if home address is exempt) I Work telephone I Term began on/ended on
(954) 415-7434
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
Miami-Dade Coastal Cleanup 800 West Ave, #212, Miami Non-profit
Beach FL 33139
(or affirm) that the information above is a true and correct statement.
3/4-23
Date signed
RECEIVED BY ELECTIONS DEPARTMENT:
D Hardcopy
ti ecni EIVED
MAR 16 2023
CITY OF MIAMI BEACH
OFFICE USE ONLY Accepted: Y / N Deficiency. Processed Date/Initials: Scanned Date/initials:
138_SP-14 COE 2016
±9\9A .1 - ?"±.l I
1755 Meridian Avenue, Suite 200/Miami Beach, FL 33139 /Ph: (305) 673-7505 or (305) 673-7000 ext. 6200 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 (G7) access.
IMPORTANT NOTE: Your vehicle license plate serves as your "parking permit". · 1n 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:
Applicant Name: David Doebler
Board/C om m ittee Name: Marine & Waterfront Protection Authority
Address: 800 West Ave, Apt 212, Miami Beach, FL 33139
E-M ail Address: dave.doebler@gmail.com
W ork Phone: Home Phone
C ell Phone: 954-415-7 434 Prefe rred Contact M ethod:
Vehicle Information
Ta g: RNX313 Color: Blue
State: FL Year : 2018
M ake: Kia M odel: Niro
A lcat sa«aore.« ?-/£-2
Please pro vi de signed fa m to th Parking Department located at 17 5. M eridian Aven ue, 2" floor. Working
hours are 8:30 to 5:00 p.m . or email to: ParkingReception@miamibeachfl.gov
e-mail subject: BOARD & COMMITIEE PARKING APPLICATION - APPLICANT NAME
P, ki D S ' ar ana epartment ection
PERMIT SYSTEM GARAGE ACCESS
Expiration Date: ID Card Serial #:
Issued By Print Name: Print Name:
Signature: 6 Signature: e6
Date Issued: Date Completed:
' pig man rar torms cw oaris «commntees par#mgtorm.doc