Mark Brill 12.31.23B O A R D AND COMMITTEE CHECKLIST
APPOINTEE. MARK BRILL DATE OF APPOINTMENT. 8/10/23 ------
BOARD/COMMITTEE. POLICE/CITIZEN RELATION S Appointed y. STEVEN MEINER
FOR SCANNER
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Scan o
Scan o
Scan o
Scan a
FOR CLERK STAFF
o Letter of Appointment
o Letter of Reappointment
" PP}, 2',,efer ot Appointment«Reappointment e-mated to
gn2£p23 ]
o Board and Committee Application (Completed on_?J24423
o R~sum~/Curriculum Vitae ] ]
o Diversity Statistics Reporting (Completed on _p I 23 )
o Oath
renM EN 0: 1/1/23 TERM Luur 12/ 1 l30
Committee Liaison on
RECEIVED
AUG 10 2023
CITY OF MIAMI BEACH
OFF ICE OF THE CITY CLERK
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IMPORTANT INFORMATION FOR BOARD AND COM MITTE E MEMBERS BOOK
Y 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 2-111 -- 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)
t Highlights of the Miami-Dade County Ethics Code
Sunshine Law and Public Records -- Frequen tly Asked Questions
Memorandum - Solicitation by City Board and Committee Members
O Citywide Permit Application (Parking Department Form)
Booklet - Guide to Sunshine Amendment & Code of Ethics for Public Officers and Empl oyees
O Source of Income Statement
Scan O O 4Acknowledgmen t of Financial Disclosure Requirement
O Board and Committees Liaison Responsibilities ,.
O DIVERSITY STATISTICS REPORTING Keep
Received • 8/10/23 .Signed X
O RIGINAL for Annual Report.
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/
Scanned on.
Date
Processed on. 1VByEmployee:
city clerk's, Ofipe start initials
6/10/23 HA -r.( {ff]/@,a.or«-
City Clerk's Office Staff Initials
Date
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:ACLER\BOARO AND COMMIT TIES DATABASE\CHECKLIST MAS TERB&C Checklist 2015 MASTER.docx
1B
City of Miami Beach, 1/00 Convonlion Conler Drive, Miami Beach, Florida 33139 yw.iumibaachll_go
OFFICE OF THE CITY CIERK, Roal E. Granado, Ciy Clerk
Tel: 305.673.7411, Fax: 305.673.7254
Email: Ci#yClerk@miamiboochfl.gov
July 25, 2023
Mr. Mark Brill
1095 North Shore Drive
Miami Beach, Florida 33141
RE: Police/Citizens Relations Committee
Dear Mr. Mark Brill:
Congratulations! You have been appointed by Commissioner Steven Meiner to the above-referenced
Board or Committee, for a term ending: 12/31/2023.
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 as they concern your duties, responsibilities, and
requirements as a board or committee member.
Congratulations again and good luck.
Regar~
..«l
City Clerk
cc: Monica Beltran, Parking Director
Chief Rick Clements, City Liaison
ENCLOSURES:
Oath of Office/Oath of Civility/Acknowledgements
City Code/Ordinance section applicable to agency, board or committee
City Code Sections 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 of Miami Beach, I/O Conlion Cantor Diivo, Miami Bah, florida 33 139 ww.miamibacfl.got
OFFICE OF IHE CITY CIERI, Rafaol £. Granolo, Cuy Clerk
1al: 305.673.7a11, fa. 305.673.7254
Email: CIt/Cle«kt@mlomihaahf.gs
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Mr. Mark Brill
RE: Police/Citizens Relations Committee
I do solemnly swear or affirm to bear true faith, loyalty and allegiance to the Governmen t 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
ter m ending : 12/31/2023.
To my colleagues and to all of those l represent and serve, I pledge fairness, integrity and civility, in all
actions taken and all com mun ication s made by me as a pub lic 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.
Sworn to and subscribed before me this~ day of ,......_4<'' 2023
P le ase visit the City of Miami Be ach website at www.miamibeachft.gov und er City Cl erk /B oard and
Com mittees for additional information regarding the Financial Disclosure Requirements.
Mt
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florido 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfL_gov
Telephone: 305.673.7411
RECEIVED
AUG 10 2023
CITY OF MIAMI BEACH
OFFICE OF 7HE CITY CLERK
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
l am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (che ck (/) all that apply): r ,
L-] lam a resident of th e City of M iami Beach for six months or longer.
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Home Address: IO 15 1 ? ot p@& /B (q 33//
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E[4 H a ve an own er sh i p interest (for a minimum of six m o nths ) in a business establ ishe d in the
City of Miami Beach (for a minimum of six months).
Name of B usine ss: Hf6 , LS
sustess Address. 192,-96€ya_oAe_,_rd_foe 33/[
EE 1am 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: owe
B usi ne ss Address. woe
"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 businoss.
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 tr z •
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City of Miami Beach
1700 Convention Center Drive
Miami Bech, Florida 33139
www.miamibeachll.gov
OFFICE OF THE CITY CLERK
Email:. BC@miamibeachfl_go
Telephone: 305.673.7411
DIVERSITY STATISTICS REPORT
BRILL MARK A
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:
f.
] remae
[J oner
El1prefer not to answer.
Race/Ethnic Categories:
What is your race?
[]Attican American/Black [J Asian or Pacne islander
LT Caucasian/White
[]Native American/American Indian
L] other -- Print Race: to
Ll1prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latinola?
/'/ Jve»
Io
[prefer not to answer.
Do you consider yourself Physically Disabled?
g,··.· ... ····.···• y );ft$.,/ LHivo
L ht refer not to answer this question.
Page 6 ot6
F CLERISALARE GBOARD AND COMMITTEE APPLICATIONS FINL DRAFTS3OARD AND COMAMMIT TEE APPLICATION REG FINAL.dx
Updated. June 2020
MIAMI E
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florido 33139
wrw.miamibea ch~l.gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachf.gov
Telephone: 305.673.7411
BOARD & COMMITTEE FINANCIAL ACKNOWLEDGEMENT STATEM ENT
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)
BRILL MARK A
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 Requirem ents.
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 Incom e Statement;" or
2. A "Statement of Financial Interests (Form 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
ot no more than 8509, 9days in ran, or bot
, / k ), 8nor 2 3
Sigpiature [.n
,./
' 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'RE GBOARD AND COMMIT TEE APPLICATION S FINAL DRAFTS\OARD ANO COMMITTEE APPLICATION REG FINAL. docx
Updated June 2020
SOURCE OF INCOME STATEMENT
Section 2-11.1(i) of the County Ethics Code requites 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 En ding I Last Name First Name Middle Name/initial
2022 BRI LL MARK A
Malling Address - Street Number, Street Name, r P,0. Box
1095 NORTH SHORE DRIVE
city, State, Zip
MIAMI BEACH, FLORIDA, 33141
ll your home addre ss is your mailing address, and your home address is exempt from public recor d s pursuant to Fla. Stat. $119.07, read
instructions on the tolowing page and check here.[]
Filing as an Em p loyee (ch e ck one)
[]County []Public Health Trust []Municipal:
(Municipality)
Department
Position or Title Employee ID Number
Work address l Work telephone Employment began on/endod on
Filing as a Board Member (chock one)
[J county [Z] Municipal: MIAMI BEACH, FLOR IDA
(Municipality)
Board where serving
MIAM BEA CH
Alternate address (if home address is exempt) I Work telephone
7863466950 I Term began on/ended on
8/10/23
List below overy 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, vlth the largest source first. Examples of sources of income include: compensation for servlces, Income from business, gains from
property dealings, interest, rents, dividends, pensions, IRA distributions, and soclal security payments. Also, Include any source ot income recelved by anothr
person (or 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 ot the Principal Business Actuvty_ yfS)
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30) \.006 wM- du)
I hereby swer (or affirm ) that the information above is a true and correct statement. • gj@4tr~ ot Person Disclosing/
&ls/23
@ sions
RECEIVE B
LC Hardcopy
Li Electron 0 2023
CI TY O F MI AMI BEACH
OFFICE OF THE C ITY CL ER K
OFFICE USE ONLY Accepted: ¥ } t Deficiency. Proce ssed Date/ittials: Scanned Date/lnilia#s:
1385P14 CCU 0 16
/\/\//\/\/\/ CWIDE (Cw) BOARD & COMMITTEES
cwy o+ Mier»i sos+, PRk c PARrNr PARKING APPLICATION
17 55 Moridian Avenue, Suite 200/Miami 8coch, FL 33139/Ph. (305) 673-7505 0r (305) 673-7000 et. 6200
A cilywide [CW) parking permit is honored at metered parking spaces and restricted residential zones
parking spaces. A CW parking permit IS NOT honored in prohibite d 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 action s, it is important that our records rellect the most current and
accurate information regarding your vehicle license plate. Inaccurate and/or outdated vehicle
inform ation 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. Io 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 ack no wl ed ge that should my access card be lost, sto len or
damage, I will be responsible to pay a $10.00 replacement fee.
Board M er Information
Dato of Application: 8/10/23
Applicant Name: MARK BRILL
B800rd/Committee Nome: pOLICE/CITIZEN RELATIONS
A ddress: 4095 NORTH SHORE DR I VE, MIAMI BEACH, FLORIDA, 33 141
E-M ail A ddr ess mar kbrill4@yahoo.com
Work Phone: 7863466950 Home Phone
Cell Phone' 7863466950 Preferred Contact Method: cell
Vehicle Information
Too: ?
State: FLORIDA
Make: TOYOTA
Color: 'WHITE
Year:
Model:
2018
TUNDRA
A pplicant Sianature: 5
Pl ease provide signed form to th e Parking D epor tmen t located at 1755 M eridian A venue, 2° floor. Working
hours are 8:30 to 5:00 p.m. or email to: ParlingReception@mniamibeachfl.gov
e-mail subject: BOARD & COMMITTEE PARKING APPLICATION -- APPLICANT NAME
Parking" tment Section
PERMIT SYSTEM GKR~GE CCSS
Expiration Date : ID Cord Serial #:
Issued By Print N am e: Print Namo:
Signature: Signature: i
Dale lssuod. Dote Completed: