Loading...
Mohammed Islam Application PackageIslam Mohammed Last Name First Name Middle Initial 1004 Biarritz Drive #3 Miami Beach Home Address City Florida 33141 State Zip Code (786) 303-3407(305) 861-9911 HomeWork MohammedIslam1960@gmail.com Email Address (786) 303-3407 Cellular Miami Beach Business Address 1004 Biarritz Drive #3 City Florida State 33141 Zip Code Islam Realtor LLC Occupation:Business Name: Civil Engineer Please list your preferences in order of ranking [1] first choice [2] second choice, and [3] third choice. Please note that only three (3) choices will be observed by the City Clerk’s Office. (Regular Boards of City) Choice 1: Choice 2: Choice 3: Affordable Housing Advisory Committee Health Advisory Committee Sustainability Committee BOARD AND COMMITTEE APPLICATION FORM Note:If applying for the At-Large position of the Historic Preservation Board, please answer the below questions: Have you ever resided in one of the City's Historic Districts for at least one year?Yes No Address in City Historic District submitted. Professional License License Number Issuance Date Expire Date Notary public state of Florida GG234749 7/5/2022 7/4/2026 Note:If you are seeking appointment to a professional seat (e.g. attorney, architect, etc.), you must attach a copy of your currently effective corresponding professional license. Pursuant to City Code section 2-22(4) a, b and c: Members of Agencies, Boards, and Committees shall be affiliated with the city. This requirement shall be fulfilled in the following ways: YesResident of the City for a minimum of six (6) months: Demonstrate an ownership interest in a business established in the City for a minimum of six (6) months:Yes AFFILIATION WITH THE CITY OF MIAMI BEACH a. ● I am resident of:N/A Or b. "Ownership Interest" shall mean the ownership of ten percent (10%) or more (including the ownership of 10% or more of the outstanding capital stock) in a business. "Business" shall mean any sole proprietorship, sponsorship, corporation, limited liability company, or other entity or business association. c.Full-time employee of such 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):No Notwithstanding the requirements set forth herein, the qualified full-time employee of a business must be approved by a 4/7th vote of the Mayor and City Commission. NOTE: Members of Agencies, Boards, and Committees shall be required to demonstrate compliance with the City affiliation requirements of section 2-22 (4) a and b of the Miami Beach City Code by executing an affidavit, stipulating that they have met either (or both) of said affiliation requirements. The original affidavit shall be filled with the Office of the City Clerk prior to being sworn in as a member. Or No● Have you ever been convicted of a felony:If yes, please explain in detail: ● Do you currently have a violation(s) of City of Miami Beach codes:No If yes, please explain in detail: ● Do you currently owe the City of Miami Beach any money:Yes If yes, please explain in detail: ● Are you currently serving on any City Boards or Committees:Yes If yes, which board? Affordable housing board committee. Some fees, like building recertification fee and others ● Are you presently a registered lobbyist with the City of Miami Beach?No ● I am applying for an appointment because I have special abilities, knowledge and experience. Please list below: I am a Civil Engineer & have huge experience about Sea Wall, Flood & Drainage Systems NOTE: IF APPOINTED, YOU WILL BE REQUIRED TO FOLLOW CERTAIN LAWS THAT APPLY TO CITY BOARD/COMMITTEE MEMBERS. THESE LAWS INCLUDE, BUT ARE NOT LIMITED TO: o Prohibition from directly or indirectly lobbying city personnel (Miami Beach City Code section 2-459). o Prohibition from contracting with the city (Miami-Dade County Code section 2-11.1). o Prohibition from lobbying before board/committee you have served on for period of one year after leaving office (Miami Beach Code section 2-26) o Requirement to disclose certain financial interests and gifts (Miami-Dade County Code section 2-11.1). o Sunshine Law - Florida's Government-in-the-Sunshine Law was enacted in 1967. Today, the Sunshine Law regarding open government can be found in Chapter 286 of the Florida Statutes. These statutes establish a basic right of access to most meetings of Boards, Commissions, and other governing bodies of state and local governmental agencies or authorities. o Voting conflict - Form 8B is for use by any person serving at the county, city, or other local level of government on an appointed or elected Board, Council, Commission, Authority, or Committee. It applies equality to members of advisory and non-advisory bodies who are presented with a voting conflict of interest under Section 112.3143. Florida Statutes. ● In what organization(s) in the City of Miami Beach do you currently hold membership in? Name Position Miami Beach Democratic Club Member ● List the address of all properties owned or in which you have an interest within the City of Miami Beach: Property 1004 Biarritz Drive #3, MB, FL 33141 774-776 81st.street Miami Beach Fl.33141 If so, which department and title?No● Are you now employed by the City of Miami Beach: ● Pursuant to City Code Section 2-25 (b): Do you have a parent, spouse, child, brother, or sister who is employed by the City of Miami Beach?No If "Yes", identify person(s) and department(s): No relative's information submitted. BOARD & COMMITTEE FINANCIAL ACKNOWLEDGEMENT STATEMENT Acknowledgement of fines/suspension for Board/Committee Members for failure to comply with Miami-Dade County Financial Disclosure Code Section 2-11.1(i)(2) 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 filled 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 $500, 60 days in jail, or both. _____________________________ 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. DIVERSITY STATISTICS REPORT 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. Asian or Pacific IslanderRace/Ethnic Categories What is your race? No details providedOther Description: Gender:Male Are you Spanish/Hispanic/ Latino? Mark the "No" box if not Spanish / Hispanic / Latino.No Physically Challenged:No UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING APPLICATION AND THAT THE FACTS STATED IN IT ARE TRUE. ADDITIONALLY, I AGREE AND ACKNOWLEDGE THAT ANY FALSE STATEMENTS OR FALSE INFORMATION SUBMITTED AS PART OF THIS APPLICATION SHALL BE A BASIS FOR MY REMOVAL FROM A CITY BOARD OR COMMITTEE. I HAVE RECEIVED, READ, AND WILL ABIDE BY CHAPTER 2, ARTICLE VII, OF THE MIAMI BEACH CITY CODE, ENTITLED “STANDARDS OF CONDUCT FOR CITY OFFICERS, EMPLOYEES AND AGENCY MEMBERS” AND ALL OTHER APPLICABLE CITY, COUNTY, AND/OR STATE LAWS AND STATUTES ACCORDINGLY. I Mohammed Islam agreed to the following terms on 11/26/2023 10:07:53 PM Received in the City Clerk's Office by: Name of Deputy Clerk Control No. Date Board and Committee Application Checklist: Please ensure you have provided all information before applying or reapplying to any Board and Committee. YES YES YES YES I have answered all questions fully. I have uploaded a current resume, photograph, and a copy of any applicable professional license. I have completed and attached the Board & Committee Financial Acknowledgment Statement. I have completed and attached the Diversity Statistics Report. If you have any questions, please contact the Office of the City Clerk via email: BC@miamibeachfl.gov or telephone: 305.673.7411 Note: Florida Statutes 119.071: The role of the Office of the City Clerk is to receive and maintain forms filed as public records. If your home address, telephone numbers, and/or photograph are exempt from disclosure and you do not wish your home address, telephone numbers, and/or photograph to be made public, please: 1) Use your office or other address for your mailing address; 2) Use your office or other telephone number for your contact number; and 3) Do not attach a photograph.