David Adams 12.31.241B
DATE OF APPOINTMENT: 4_J21]23
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BOARD AND COMMITTEE CHECKLIST
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BOARD/COMMITTEE: DIo.bi_lhy Ad~ Appointed by: ( n. g@et 'Qoni nqu 2
FOR SCANNER FOR CLERK STAFF , I
scan o Letter of Appointment TERM END: [2/3l)2/ TERMLIMIT: 1213) O
Scan o o Letter of Reappointment
o Copy of J Letter of Appointment/Reappointment e-mailed to Committee Liaison on
4[24,23
o Board and Committee Application (Completed on
o R~sum~/Curriculum Vitae J
o Diversity Statistics Reporting (Completed on @]2323
o Oath Scan o
RECEIVED
SEP 27 2023
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
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
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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
0 DIVERSITY SlATjsi-,cs ~~t~ALfo,cAnnuaf t(eport,
__________ Signed by~
Board or Committee Member
Processed on: __ '1 __ /_~_--'--/_1-_b __ By Employee: \vvl _
Date
@l2al23 seres t
City Clerk's Office Staff Initials
Received on:
Date
City Clerk's Office Staff Initials
Scanned on:
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:\CLER\BOARD AND COMMITTIES DATABASE\CHECKLIST MASTER\B&C Checklist 2015 MASTER.docx
We are committed to providing excellent puiic service and salty lo all who live, work, and in our vibrani, topical, historic community.
M IA M I BEACH
City of Miami Beach, I/OO Convention Cantor Drive, Miami Boach, Florida 33 139 yyNwy_miamibcachll.gov
OFFICE OF THE CITY CLERK, Rafaol E. Granado, City Clerk
Tol: 305.673.7411, Fax. 305.673.7254
Email: CiNyClerk@miamibeachll.gov
September 22, 2023
Mr. David Adams
901 Pennsylvania Ave Suite 3-35
Miami Beach, FL 33139
RE: Disability Access Committee
Dear Mr. David Adams:
Congratulations! You have been appointed by Commissioner Laura Dominguez to the above-
referenced Board or Committee, for a term ending: 12/31/2024.
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.
:
R'Ztanado
City Clerk
cc: Monica Beltran, Parking Director
Valeria Mejia, 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
MAI
City of Miami Beach, 1ZOO Convention Conlon Drive, Miami Booch, Florida 33139 yyyy_miaIibeach[l_go
OFFICE OF THE CITY CLERK, Rafaol E. Granado, Ciiy Clork
Tel: 305.673.7411, Fax. 305.673.7254
Email: CityClerk@miamiboochfl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Mr. David Adams
RE: Disability Access Committee
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.
Mr. David Adams
Sworn to and subscribed before me this ~- 2023
eila Mena Caceres
Deputy Clerk
*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.
MI A\Ml
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
RECEIVED
SEP 27 2023
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305 .673 741
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): ti.. resident of the City of Miami Beach for six months or longer.
ore Ase..)2')2 \_/e d l(>\ ,»8 3512{
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).
Name of Business: -------------------------
Business Address: ------------------------- □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.
Under penalties of perjury, I declare that I have read the foregoing document and that the facts
"A-.
/\ o b ay !) d a.3
Printed Name •
1/A MI H
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)
p
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
~500 60 days in jail, or
Signature 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.
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Updated: June 2020
M IA N\I
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www_miamibegchf]. gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
DIVERSITY STATISTICS REPORT
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:
L3
Ll remale
D Other
El prefer not to ans wer.
Race/Ethnic Categories:
What is your race?
DI African American/Black
LJ Astan or Pacific Islander
LV-Ca ucasian/wh ite
DI Native American/American Indian
0 Other- Print Race: _
0 I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
T. Bs
OJ I prefer not to answer.
Do you consider yourself Physically Disabled?
ts.
ho
D I prefer not to answer this question.
Page 6 of 6
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Updated: June 2020