Joshua Lifshultz 12.31.24MIAMIBE
BOARD AND COMMITTEE CHECKLIST
AP POINTE E:.@o hy6- [hlh DATE OF APPOI NTM ENr;_3 /9/2s
BoARDcoMMrrree.Vo ny.& •Kahih_zAApoointea y. hq maw
FOR SCANNER
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RECEIVED
APR 10 2023
FOR CLERK STAFF
o Letter of Appointment
o Letter of Reappointment
o Copy of Letter of Appointment/Reappointment e-mailed to
3[]13 0/4/2
o Board and Committee Application (Completed on _
o R~sum~/Curriculum Vitae ;)
o Diversity Statistics Reporting (Completed on hQL2
o Oath
TERM END: 2l3Lb4 • TERM LuMrr. pl1)24
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 CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
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
o Board and Committees Liaison Responsibilities
o DIVERSITY STATISTICS REPORTING Keep COPY in file and 0
Recevea o. -}/)_Jg2} stones oy yv hk
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rocessaaa. ft /3
Date Cly9gg o ce stat initials
_Lf_)_l_~_,_v_~ By Employee: lV __ v '----------
Board or Commit
By Employee: k/V) _
Scanned on:
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:\CLER\BOARD AND COMMITTIES DATABASE\CHECKLIST MASTER\B&C Checklist 2015 MASTER.docx
We are committed to providing excellent public service and salty to all who live, work, and play in our vibrant, topical, historic community.
IBE
City of Miami Beach, 1/00 Convention Conlor Drivo, Miami Boach, Florida 33139 yyw_miamihaachll.gay
OFFICE OF THE CITY CLERK, Rafael E. Granado, City Clerk
Tel: 305.673.741I, Fax 305.673.7254
Email: City/Clerk.@miamibeoch fl.gov
March 28, 2023
Mr. Joshua Lifshultz
2498 Prairie Avenue
Miami Beach, Florida 33140
RE: Parks and Recreational Facilities Board
Dear Mr. Joshua Lifshultz:
Congratulations! You have been appointed by the City Commission to the agency, board or committee
named above 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 as they concern your duties, responsibilities, and
requirements as a board or committee member.
Congratulations again and good luck.
Regards
Rafa I
City Clerk
cc: Monica Beltran, Parking Director
Cynthia Casanova, 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 o f M ia m i B e a c h , 1/OO Convention Conler Drive, Miami Boach, Florida 33 139 yywy_miaIibggchf_go
OFFICE OF THE CITY CLERK, Rofoal E. Gran ado, Ciiy Clerk
Tel: 305.673.7411, Fox. 305.673.7254
Email: Ci/Clerk@miamibeach fl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Mr. Joshua Lifshultz
R E : P a rks and Recreational Facilities Board
I d o so le m n ly sw e ar or affirm to b e a r true faith, loyalty and allegiance to the Government of the United
S tates, the S tate o f F lo rid a , and the C ity of M ia m i B e ach, and to pe rf orm all the d utie s o f a m e m b e r o f the
ab o ve-m e ntio ne d b o a rd or co m m itt e e of the C ity o f M ia m i B e a ch to w hich I h a ve b e en a p p o inte d fo r a
term e nding: 12 /3 1/20 24 .
T o m y co lle a gu e s and to all of tho se I rep re se nt and serve , I ple dg e fairn e ss, inte grity and ci vility, in all
a ctio ns taken a nd a ll com m u nicatio ns m ade by m e a s a p ub lic serv ant.
I h a ve b e e n issu e d a co p y o f se ctio n 2-1 1 .1 o f the M ia m i-D a d e C o u nty C o d e (C o nflict o f In terest and
C o de o f E thics O rdina nce), as w ell as Flo rid a C o m m issio n on E thics G uide to the S un shine A m e nd m e nt
and C o de o f E thics fo r P ub lic O ffi cers and un de rsta nd that a s a m e m b e r o f a C ity of M ia m i B ea ch B o ard
and/or C o mm itt ee , I m u st com pl y wi th th e finan ci al di sclosure requi rem en t s o f M iam i -D ade C o unty or th e
S tate o f F lo rid a (de pe nd in g on the board or com m itt ee on w hich I se rve) on Ju ly 1s t, fo llow ing the cl o sing
o f the cale nda r yea r on w hich I have serve d.
S w orn to and subscrib ed befo re m e this [ob a a, rl a02a
*P le a se visit the C ity of M ia m i B e a c h w e b site a t w w w .m ia m ib e a c hfl.g o v u n d e r C ity C le rk/B o a rd an d
C o m m itt ee s fo r add itio nal info rm atio n rega rding the F in a ncia l D iscl o sure R equirem e n ts.
11 A M RECEIVED • .f
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
APR 10 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):
)/ I am a resident of the City of Miami Beach for six months or longer.
o-ace. Q'14ace Ave oe,f), 3319
□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).
[]qr)e (f [[neSS
PIS/[es, J(]fSS
□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 ------------------------
HIS[fess, [(]]reSS
"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 penaltie
are true.
lar.e that I have read the foregoing document and that the facts stated in it
)/]/2o23
Signature
Jsk4.
Date 7= 7
Printed Name
NOTARY
--,--------- (City of Miami Beach Board/Committee Member).
a ca o RL DOn ye @re
Sworn to (or affirmed) and subscribed before me, by means of□physical presence or online notarization, va or _Aoiil _oa @chy Lu(hlh
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'il}}NV NUMEE"" "iii+ww
Form of Identification
Personally Known
Signature of Notar
Name of Notary, Typed, Printed, or Stamped
MIAM IBE 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
DIVERSITY STATISTICS REPORT
Jo5\4a
Last Name First Name
(0 eiv
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:
td
[l Female
D Other
0 I prefer not to answer.
Race/Ethnic Categories:
What is your race?
Di African American/Black
ElAsian or Pacific Islander
[ Caucasian/white
D 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?
Ee»
d No
D I prefer not to answer.
Do you consider yourself Physically Disabled?
Les
bf t prefer not to answer this question.
Page 6 of 6
F:ICLER\$ALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
MI A MI BE H
City of Miami Beach
1 700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfl.gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachf.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)
Last Name First Name
\eire
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 5016, 60 days i ·ail, or both.
Signature Date 7 7
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.
Page 5 of 6
F:ICLER\$ALL\REG\BOARD AND COMMITT EE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITT EE APPLICATION REG FINAL.docx
Updated: June 2020
±gc,22 13
1755 Meridian Avenue, Suite 200/Miami Beach, FL 33139/Ph: (305) 673-7505 or (305) 673-7000 ex4. 6200 PA RKll IG
A citywide (CW ) parking permit is honored at metered parking spaces and restricted residential zones
parking spaces. A CW parking perm it 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 enfo rcement actions, it is important that our records reflect the most current and
accura te info rm ation regarding your vehicle license plate. Inaccura te and/or outdated vehicle
info rmation 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 dose 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
dam age, I w ill be re sponsible to pay a $10.0 0 re placem en t fe e.
Board Member Information
Date of Application: 1) ')023
Ap orolicant Name: J@ Ska L\
Board/Committee Name: p9 \
\YI\ loo
Address 4{ fa\re 33\0
E-Mail Address: '9 km el 0 • )r
Work Phone:
cell Ph on e3
Home Phone
Preferred Contact M ethod: e[\
Vehicle Inform · ·
toe: E
see: ]
M ake: ]
Color:
Year:
Model:
Gee
Soot
A pp lic a nt St +n atur e : e
Please provide signed f partm ent located at 1755 M eridian Avenue, 2" foor. Working
hours are 8:30 to 5:00 ri. or em ail to: 'arkingReception@miamibeachfl.gov
e-mail subiect: BOARD & COMMITTEE PARKING APPLICATION - APPLICANT NAME
P a rk in a D e p a rt m e n t Se ctio n
PERMIT SYSTEM G AR A GE A C CE SS
Expiration Date: ID Card Serial #:
Issued By Print Name: Print Name:
Signature: e Si gnat u re:
Date Issued: Dote Completed:
...#%:3 1
1755 Meridian Avenue, Suite 200/Miami Bech, FL 33139/Ph: (305) 673-7505 or (305) 673-7000 e4. 6200 PARKI IG
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 lnfor ·
Date of Application:
Applicant Name: 1
Address: ju)q
E-Mail Address:
Work Phone:
Cell Phone:
Vehicle Inf ·
Tag:
State: Fl
Home Phone
Preferred Contact Method = )]
Color:
Make:
Year:
Model:
6o
Applicant St«nature: ef
Please provide signed form 'the Parkin rtment located at 1755 Meridian Avenue, 2d floor. Working
hours are 8:30 to 5:00 p.m. or email to: Prkin Recer tion@miamibeachfl. 1ov
e-mail subject: BOARD & COM MITT EE PARKING APPL ICATION - APPLICANT NAM E
p, ·i D ar Ina epartment ection
PERMIT SYSTEM GARAGE ACCESS
Expiration Date: ID Card Serial #:
Issued By Print Name: Print Name:
Signature: e Signature: e
Date Issued: Date Completed:
s
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