Adrian Gonzalez 12.31.24MIA MI B C
BO A R D A N D CO M M ITTEE C H EC K LIST
APPOINTEE:BpQ_ c .2\2 2_ DATE OF APPOINTMENT: liq_lZZ
\J0• L,' · BOARD/COMMITTEE: _/2l) Appointed by. Al ,[hpLsSf)
res eo. I/31/0 4 rer u n+. n/l b FOR SCANNER
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FOR CLERK STAFF
o Letter of Appointment
o Letter of Reappointment
o CopY, qt L,etter of Appointment/Reappointment e4. ailed to Committee
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o Board and Committee Application (Completed on )
Resume/cortcutum vtae ))]
o Diversity Statistics Reporting (Completed on _&_]Bl)
o Oath
Liaison on
IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
✓City Code Ordinance Section applicable to the agency, board or committee
RECEIVED ✓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
MAY 17 2023 amended through December 2010)
✓Amendments to the Code of Ethics Ordinance (September 2009 through July 2012)
✓Highlights of the Miami-Dade County Ethics Code
CITY O F MIAM I BEACH ✓Sunshine Law and Public Records - Frequently Asked Questions
OFFICE OF THE CITY CLERK ✓Memorandum - Solicitation by City Board and Committee Members
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Received 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 DIVlERSITY STATISTICS REPORTING Keep COPY in file and ORIGINAL for Annual Report.
3/7/2 srs»X_-
ate 4a, cs.tee were
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Processed on lb9/3 s»more f2 Cl \;t/e ',;-:) ~s Office Sla fflnilials
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City Clerk's Office Staff Initials 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:ICLER\BOARD AND COMMITTIES DATABASE\CHECKLIST MASTERIB&C Checklist 2015 MASTER.docx
C ity o f M ia m i B e a c h , 1/00 Convention Cantor Drivo, Miami Boch, Florida 33 139 gs_Iiamihgachll.gov
OFFICE OF THE CITY CLERK, Ralaol E. Granado, City Clerk
Tel: 305.673.741, Fax 305.673.7254
Email: Cit/Clerk@miamibeachfl.gov
May 01, 2023
Mr. Adrian Gonzalez
5000 Lakeview Drive
MIAMI BEACH, FL 33140
RE: Visitor and Convention Authority
Dear Mr. Adrian Gonzalez:
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.
Regj;J
Rafael Granado
City Clerk
cc: Monica Beltran, Parking Director
Marcos Grosette Roque, 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
MI A\MA I AC
City of Miami Be ach, 1/O0 C on vention Cantor Drive, Miam i Beach , Florida 33 13 9 ywyg_miamibgachll.gov
OFFICE OF THE CITY CLERK, Rafael E. Granado, Cy Clerk
Tel: 305.673.7411, fax. 305.6 73.7254
Emal: Cit/Clerk@miamtbanachll.gov
Oath of Office
Oath of Civility
and
Acknowledgements
T O : M r. A drian G o nzalez
R E : V isitor an d C o nve ntion A uthority
I do so le m n ly sw e a r or affi rm to be a r true faith, loyalty and allegiance to the G overn m ent of the United
States, the State of F lo rid a , and the C ity of M iam i Beach, and to perfo rm all the duties of a m em ber of the
ab o ve -m e ntio ned bo a rd or co m m itt e e of the C ity of M iam i Beach to w hich I have been appointed fo r a
term ending: 12/31/2024.
T o m y co lle ag u e s and to all of tho se I represent and serve, I pledge fairn ess, integrity and civility, in all
actio ns taken and all co m m u nicatio ns m ade by m e as a public servant.
I ha ve be e n issued a copy of se ction 2-11.1 of the M iam i-D ade C ounty C ode (C onflict of Interest and
C o de of Ethics O rdina nce ), as w ell as Florida C om m ission on Ethics G uide to the Sunshine A m endm ent
and C o de of Ethics for Pu blic O ffi ce rs and understand that as a m em ber of a C ity of M iam i Beach Board
and/o r C o m m itt ee, I m ust co m p ly w ith the financial disclosure* requirem ents of M iam i-D ade C ounty or the
State of Flo rid a (de pe nding on the boa rd or com m ittee on w hich I serve) on July 1st, fo llow ing the closing
of the cale nda r year on w hich I have served.
2 ::n Gonzalez
Sw orn to and sub s cribed before m e thi s ' p2023
*P le a se visit the C ity of M iam i Bea ch w ebsite at w w w .m iam ibeachfl.gov unde r C ity C lerk/B oard and
C o m m itt ee s for additio nal info rm atio n regarding the Financial D isclosure R equirem ents.
MI A\MI B
City of Miami Beach
1 700 Convention Center Drive
Miami Beach, Florida 33139
OF F ICE OF THE CI T Y CLERK
Email:. BC@miamibeachfl.gov
Telephone: 305.673.7411
REC EIVE D
MA¥ 17 2023
CITY O F M IAMI BEACH
OFFICE OF THE CITY CLERK
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
ST ATE O F FLO R IDA
CO U NTY O F MIAM I-DADE
I am in com pliance w ith the affiliation requirem ent of Miam i Beach City Code Section s 2-22 (4), as (check
(0 9ll th at apply):
✓I am a resident of the City of Miam i Beach fo r six months or longer.
or e Aaares. go o keor@Ly D u
□I have an ow nership interest (fo r a minim um of six months) in a business established in the City of
M iam i Beach (fo r a minim um of six months).
[Qr9 ()f [/4[[eS,S
Business Address -------------------------
□I am a full-tim e em ployee of a business (fo r a minim um of six months) and I am based in an office or
other location of the business that is physically located in Miami Beach (fo r a minimum of six months).
[]q/ (f [[][eS,
[[I,[[, J\(]F%S,3
"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 nder penalties of perjuy ,I declare that I have read the foregoing document and that the facts stated in it
are tr ue. cpl03
--~-----------
Signature Date
0 0w) ox 020 2
Printed Nam e
NOTARY
Sw orn to (or affirm ed) and subscribed befo re me, by mean s of ph ysical presence or□online notarization,
et+cos Mr} ao13» Plcn eon6l2 m a,,
eiA ii"co,
(City of Miami Beach Board/c omm ittee Member ). s h;;;$:. ",
s ' U8,·,, % - Mg±. (£..)
Pers on al ! EXPI RES 1-3-2027} £
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&;Qntp«a.%%{$%/ 3; Ur'F.2@r$ "}S;3··.···:4l%, ":NV NuMgE%;;i" '+
Nam e of N otary , Typed, Printed, or Stam ped
IA\Ml
City of Miami Beach
I700 C on v en tion Center Drive
Miami Beach, Flor id a 33139
www.miamibeachll.gov
OFFICE OF THE CITY CL ERK
Email:. BC@miamibeachfl. gov
Telephone: 305.673.7411
DIVERSITY STATISTICS REPORT
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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:
ta
D Female
D Other
D I prefer not to answer.
Race/Ethnic Categories:
What is your race?
D African American/Black
J Asta or Pacific Islander
D Caucasian/White
D Native American/American Indian
Lrom her -Print Race: Lis 2o9\c
D I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
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D I prefer not to answer.
Do you consider yourself Physically Disabled?
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D I prefer not to answer this question.
Page 6 of6
F \CLER\$ALL\REGIBOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINALdocx
Updated: June 2020
M IAM I EAC
City of Miami Beach
1700 Convention Center Drive
Mi ami Beach, Florida 33139
www.miamibeachfl,gov
OFFICE OF THE CITY CLERK
Em ail: BG@miamibeachfl.gov
Telephone: 305.673.7411
BOARD & COMIMII TEE FINANCIAL ACKNOWL EDGEMENT STATEMENT
Acknowledgement of fines/suspension for Board/Committee Members fo r failure to comply with Miami-
Dade County Financial Disclosure Code Provision Code Section 2-11.1(i) (2)
__dt_
Middle Initial Last Name First Name
I understand that no later than July 1, of each year all member s of Boards and Com mittees 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 th n $500, 60 days in jail, or both.
Signatu Date
' Mem bers 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. Plan ning 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:\CLER\$ALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
MIAMl·DAD EI
EI SOURCE OF INCOME STATEMENT
Section 2-11.1() 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
2022 ooN]
First Name Middle Name/Initial
>
Mailing Address -- Street Number, Street Name, or P.O. Box
o> -ko y
City, State, Zip
\W
\
33/0
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 and check here. D
Filing as an Employee (check one)
[] county □Public Health Trust [] Municipal:
(Municipality)
Department
Position or Title Employee ID Number
Work address Work telephone Employment began on/ended on
Filing as a Board Member (check one)
[] county [I ~unicipal: 01l, 0 / 'wQ £en&h
(Municipality)
Board where serving od (o»tho Abo 'k VA kr
Alternate address (if home address is exempt) Work telephond' Term began on/ended on
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
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%!Iuudt the information above is a true and correct statement.
Signature of Person Disclosing
sh/zs
Date signed
RECEIVED BY ELECTIONS DEPARTMENT:
LU or at e RECEIVED
a we»a ,%?7%/ +1 2
CITY OF MIAMI BEACH
OFFICE Or TH E CITY CL ER K
REMEMBER TO PRINT, SIGN, AND SUBMIT TO THE OFFICE OF THE CITY CLERK VIA EMAIL OR HARDCOPY.
[/\/\/\/ CI wI DE (C w ) B O AR D & C O M MI TTE ES
City o f Miami Beach, PARKING DEPARTMENT PARKING APPLICATION
1755 Meridian Avenue, Suite 200/Miami Beach, FL 33139/Ph: (305) 673-7505 or (305) 673-7000 ext. 6200
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 fo r City Hall Garage (G7) access.
IMPORTANT NOTE: Your vehicle license plate serves as your "parking perm it". 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. lnaccurate 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 car d. Please ensure you hold the entire surface of the card against the reader
until the gate opens.
ACKNOWLEDGEMENT: I acknowledge that should m y access card be lost, stolen or
damage, I will be responsible to pay a $10.00 replacement fee.
Board M ember information
Date of Application: >lo l3
Applicant Name: b, ,) oo20e 2
-
Board/Committee Name: @
Address: 0 o oke v«lg «o Dabe p 5 23//0
E-Mail Address: Aih 9o .Coo
wok Phone35. 534.77 Home Phone
Cell Phone: 3s5. o 4 Preferred Contact Method: (a0)(
Vehicle Information
Ta g: 3o By Color: 8 /0c k
State: 1 Year: a0[
Make: \h li< Model: Coss-Sol
1>
Applicant Sianature: e5 Gr - er
Please provide signed form to th e Parking Depar tm ent located at 17 55 Meridian Avenue, 2 floor. Working
hours are 8:30 to 5.00 p.m. or em ail to: Parking~Reception@miamibeachfl.gov
e-mail subject: BOARD & COMMITTEE PARK ING APPLICATION -- APPLICANT NAME
p, ·k¢ D rt ar mna epa men ec'o n
PERMIT SYSTEM GARAGE ACCESS
Expiration Date: ID C ard Serial #:
Issued By Print Name: Print Name:
Signature: es Signature: e
Date Issued: Date Completed:
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