Shawna Meyer 12.31.24MIAMIBE
BOARD AND COMMITTEE CHECKLIST
APPOINTEE: Shawna Meyer
BOARD/COMMITTEE: Design Review Board
DATE OF APPOINTMENT. 6/28/2023
Appointed by: City Commission
FOR SCANNER
Scan o
Scan o
FOR CLERK STAFF
o Letter of Appointment
o Letter of Reappointment
o Copy of Letter of Appointment/Reappointment e-mailed
6/30/23
TERM END: 12/31/24 TERM LIMrr. 12/31/28
to Committee Liaison on
Scan o
Scan o
Scan o
o Board and Committee Application (Completed on %'%°
o R~sum~/Curriculum Vitae
o Diversity Statistics Reporting (Completed o, Z/25/23
o Oath
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
amended through December 2010)
JUL 25 2023 ✓Amendments to the Code of Ethics Ordinance (September 2009 through July 2012)
✓Highlights of the Miami-Dade County Ethics Code
CITY OF MIAMI BEACH ✓Sunshine Law and Public Records - Frequently Asked Questions
OFFICE OF THE CITY CLERK ✓Memorandum - Solicitation by City Board and Committee Members
Scan o
Scan o
Received on:
Scanned 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 DIVERSITY STATISTICS REPORTING Keep COPY in file and ORIGINAL for Annual Report.
3/25/23 sos»X A, LA
t#%p, % Processed on: t ' ByEmployee: [</
Date ci @rel once saf initials
1/2«/23 oo» '-1
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 sale#y to ol who live, work, and play in our vibrant, tropical, historic community.
M IA M I BEACH
City of Miami Beach, I/OO Convention Center Drivo, Miami Boch, Florida 33 139 ywyyw_miamiboachll.gov
OFFICE OF IHE CITY CLERK, Rof0ol E. Gran ado, City Clerk
Tel: 305.673.7411, Fox. 305.673.7254
Email: Ci/Cl erk@miamibeac hfl.gov
June 29, 2023
Ms. Shawna Meyer
3642 William Avenue
Miami, Florida 33133
RE: Design Review Board
Dear Ms. Shawna Meyer:
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,
-- City Clerk
cc: Monica Beltran, Parking Director
Michael Belush, 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
C ity of Miami Beach, LOO Convention Conler Drive, Miami Booch, Florida 33 139 yywy_miaIIiboachfl_go
OFFICE OF THE CITY CLERK, Rofal E. Granado, City Clerk
Tel: 305.673.7411, Fox. 305.6 73.72 5 4
Email: Cit/Clerk@miamibeachfl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
T O : M s. S haw na M eyer
R E : D e sign R eview B oard
I do so le m n ly sw ea r o r a ffi rm to b e a r true faith, lo yalty a nd alle gia nce to the G o vern m e nt of the U n ited
S tates, the S tate of F lorid a , and the C ity of M ia mi Beach, and to perform all the duties of a member of the
a b ove-m e ntio n e d b o a rd o r co m m itt ee of the C ity o f M ia m i B e a ch to w h ich I ha ve b een appointed for a
term e nding: 12/31/2024.
T o m y colle a gu e s and to a ll o f tho se I represe nt a n d se rve , I ple dge fairn e ss, integrity a nd civ ility, in all
actio ns taken a nd a ll com m unicatio ns m a de by m e as a p ublic se rv an t.
I h a ve be e n issu e d a co p y of se cti o 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 n flict o f In tere st and
C o de of E thics O rdina nce), as w ell a s F lo 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 of E thics fo r P u b lic O ffi cers and un de rstand that as a member of a City of Miami Beach Board
a nd/or C o m m itt ee , I m u st com ply w ith the fina ncial disclosure* requirements of Miami-Dade County or the
S tate of Florida (depending on the board or committee on which I serve) on July 1st, following the closing
of the cale nda r ye ar o n w h ich I have se rv e d.
S w orn to and sub scrib ed b efore me this
*P le a se visit th e C ity o f M ia m i B e a ch w eb site a t w w w .m ia m ib e a chfl.gov under City Clerk/Board and
C o m m ittees fo r add itio nal info rm atio n rega rding the F ina nci a l D iscl osure R equirem e n ts.
MI A\l
City of Miami Beach
1 700 Convention Center Drive
Miami Beach, Florida 33139
RECEIVED
JUL 25 2023
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305 .673 .7 411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as ( check ( ✓) all that apply):
D I am a resident of the City of Miami Beach for six months or longer.
ore Adas. Not +oared e.10a 2 (c)
D 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).
[[are f [[yS[[eSS,
[3JS[[eSS (]reSS.
D 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).
[[9re (f [[[[eSS,
[IS[[es,S J(](]fr@SS,
"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, I declare that I have read the foregoing document and that the facts
stated in it are true. .---. en , ,. 'l)' / 1,o 'J..-}
Signat e Date /
Shawna Meyer
Printed Name
IA M IB 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
Meyer Shawna
Last Name First Name Mid~lial
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:
[l at e
id eate
D Other
0 I prefer not to answer.
Race/Ethnic Categories:
What is your race?
DI African American/Black
0 Asian or Pacific Islander Et caucastan white
D Native American/American Indian 0 Ot her- Print Race: _
0 I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
El ves to
0 I prefer not to answer.
Do you consider yourself Physically Disabled?
t I Yes
•• to answer this question.
Page 6 of 6
F:\C LER\$ALL\REG \BO ARD AND CO M M ITT EE APPLIC ATIO NS FINAL DRAFTS\BOARD AND CO MMITT EE APPLICATION REG FINAL.docx
Updated: June 2020
1IA MI B H
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeach[l.gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfLgov
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(1) (2)
Meyer Shawna
Last Name First Name 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 mo than $500, 60 days in jail, or both. (:, \ / V: 11..dl, j
Date /
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:\CLER\$ALL\REG\BOARD AND COMMITT EE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITT EE APPLICATION REG FINALdocx
Updated: June 2020
MIAMI-DADE- EII 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 Meyer
First Name
Shawna
Middle Name/Initial
Mailing Address - Street Number, Street Name, or P.O. Box w
City, State, Zip
If your hom e address is your m a iling addre ss, and your home address is exempt from public records pursuant to Fla. Stat. §119.07, read
instructions on the follow ing page and check here. D
Filing as an Employee (check one)
[] county □Public Health Trust [] Municipal:
(M unicipality)
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 E] Municipal: _Miami Peach
(M uni ci pality)
Board where serving
Design Review B oard
Alternate address (if home address is exempt) Term began on/ended on
110/ 626p202s
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
() )Vsn» M»M l
Cos - A
Lw ?_
SL-F- €Mooyeo 3t H wM- /wre A M-M t FL, ,1)
s.Teel Me'/ ud-
firm ) that the info rm ation above is a true and correct statement.
Signature of Person Disclosing
RECEIVED BY ELECTIONS DEPARTMENT:
[] Hardcopy RECEIVED □Electronic Copy
JUL 25 2023
CITY OF MIAMI BEACH
OFF!
OFF ICE USE ONLY A ccepted: Y / N D efi ciency: Pro cessed Date/i nitials: Scanned Date/Initials:
138_SP-14 COE 2016
/V\IA /V\I CITYWIDE {CW) BOARD & COMMITTEES
City of Miami Beach, PARKING DEPARTMENT PARKING APPLICATION
1755 Meridian Avenue, Suite 200/Miorni Beoch, 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 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 Information
Date of Application: 0 (s >
Applicant Name: Shawna Meyer
Board/Committee Name: Design Review Board
Address:
E-Mail Address:
Work Phone: Home Phone
Cell Phone: \ ' t Preferred Contact Method:
Vehicle Information
Ta: w05
State:
Make:
Do/A Year:
Model:
Applicant Sf+nature: e
Color:
t
Please provide signed form to the Parking Department loc fed at 1755 Meridian Avenue, 2d floor. Working
hours are 8:30 to 5:00 p.m. or email to: PgrkingReception@miamibeachfl.gov
e-mail subject: BOARD & COMMITTEE PARKING APPLICATION - APPLICANT NAME
p, ·ki D ar Ina epartmen ection
PERMIT SYSTEM GARAGE ACCESS
Expiration Date: ID Cord Serial #:
Issued By Print Name: Print Name:
Signature: Signature:
Date Issued: Date Completed:
tS
: .pmg ·man rar torms cw oaras commmtees paraglorm,doc