Mike Gibaldi 12.31.25MI A I BE A CH
BOARD AND COMMITTEE CHECKLIST
M ike G ib a ld i
APPOINTEE:______________ DATE OF APPOINTMENT: _
M W PA Tanya Bhatt
BOARD/COMMITTEE: Appointed by: _
12-7-23
FOR SCANNER
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FOR CLERK STAFF
o Le tt er of A p pointm ent
o Le tter of R eap po intm ent
o C opy of Letter of A ppointm ent/R eap poi ntm en t e-m ailed to C om m ittee Li aison on
TE RM EeN o: 12/21/) reauor. r?'l1
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R EC E IVED
EC 19 2023
C IT Y O F M IA M I B E A C H
OFFICE OF THE CITY CLERK
- o B o a rd a nd C o m m itte e A pplication (C om pleted on _,
o R ~sum 6/C u rricul um Vi tae ] ])y
o Diversity St a tistics R epor ti ng (C omp let e d on [,1'0)3_y
o O ath 7
IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
✓C ity C o d e O rdinan ce S ection applicable to the agency, board or com m ittee
City C o d e Se ction s 2-21, 2-22, 2-23, 2-24, 2-25, 2-26, 2-458 an d 2-459
✓C o u nty C ode S e ction 2-11.1 -- C on flict of Interest and C ode of Ethics O rdinance (as
am end ed th ro u g h Decem ber 2010)
✓A m endm ents to the C ode of Ethics O rdinance (S eptem ber 2009 thro ugh July 2012)
✓H ig hlights of the M iam i-D ade C ounty Ethics C ode
✓S unsh in e Law an d Public R ecord s - Fre quen tl y Asked Q uestions
✓M em or an d u m - S ol ici tation by C ity Board and C om m ittee M em bers
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R e ce ive d o n :
o C ityw ide Perm it A p p lica tion (P arking Depart m ent Form )
o B o ok l e t - G uid e to S unshine A m endm ent & C ode of Ethics fo r Public O fficers and Em ployees
o S o urce of In com e S tate m ent
o A cknow le d g m ent of Fin ancial D isclosure R equirem ent
O B o ar d an d C om m i tt ee s Li ai son R espon si bi liti es
o DIVERSITY STATISTICS REPO
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D ate C om m ittee M em ber
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fr a te C ity C lerk's O ffi ce Staff Initials
__ l_v_vi_· _fll> By Em p loyee: ~-------------
D ate C ity C lerk's O ff ice Staff Initials
CONCLUDED & RESIGNATION LETTERS
T e rm E xp ire d Le tte r D ate Pro cessed Initials Scan o
R e sig n a tio n Le tt e r D ate Pro cessed Initials Scan o
R e m o val Le tt e r d u e to ab sences D ate pro cessed Initials Scan o
F:\CLER\BOARD AND COMMITTIES DATABASE\CHECKLIST MASTERIB&C Checklist 2015 MASTER.docx
We are committed to providing excellent public service and safety to all who live, wok, and play in our vibrant, tropical, historic community.
'''
M IAMI BEACH
City of Miami Beach, I/OO Convention Conler Drive, Miami Boach, Florida 33 139 yyy wy.miaIibgachll.go
OFFICE OF THE CITY CIERK, Rfool E. Granado, Cly Clerk
Tel: 305.673.741, Fax. 305.673.7254
Email: Cit/Clerk@miamibeachfl.gov
December 11, 2023
1"
Mr. Mike Gibaldi
4780 Pine Tree Dr., Apt 1
MIAMI BEACH, FL 33140
RE: Marine and Waterfront Protection Authority
Dear Mr. Mike Gibaldi:
Congratulations! You have been appointed by Commissioner Tanya Bhatt to the above-referenced
Board or Committee, for a term ending: 12/31/2025.
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. 7 411.
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.
''Re~ .I...
City Clerk
cc: Monica Beltran, Parking Director
Tasha Byars, 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 - Am en dment 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 - (Par king Department Form)
Booklet - Guide to the Sunshine Amendment and Code of Ethics for Public Officers and Employees
M IA M I BEACH
City of Miami Beach, I/OO Convention Conto D«ivo, Miami Beach, Hlorida 33139 4yaw_miaIIbachll.go
OFFICE OF THE CIIY CLERK, Raf0l E. Granado, Ciy Clerk
Tl. 305.673.7411, Fax. 305.673.7254
Email. Ci/Clork @miamibeochfl. gov
O ath of O ff ice
O ath of C ivility
and
A ckno w ledgem ents
TO: Mr. Mike Gibaldi
RE: Marine and Waterfront Protection Authority
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: 12/31/2025.
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) Jylly 1st, foll6wylng the closing
of the calendar year on which I have served. '
Sworn to and subscribed before me this /$ ~ay of lJtc_, 2023
• D ep uty C lerk
*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.
M IAM I B E A C H
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florid 33139
RECEIVED
DEC 19 2023
CITY OF MIAM I BEA CH
OFFICE Ar IT CLERK
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
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 (ch eck (/) all that apply):
I el' I I am a resident of the City of Miami Beach for six months or longer.
4780 Pine Tree Dr., Apt 1, Miami Beach, FL 33140 [ [9me (](]f@sS,
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 pen alties
stat~re
Signature
Mike Gibaldi
f perjury, I declare that I have read the foregoing docum ent and that the facts
e
/2-/8- 23
Date
Printed Name
MI A\MI BEA CH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florido 33139
www.miamibeachfl,gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
DIVERSITY STATISTICS REPORT
Gibaldi Mike J
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:
El Male
IJ Femal e
.l omer
D I prefer not to answer.
Race/Ethnic Categories:
What is your race?
D African American/Black
D Asian or Pacific Islander
Ezl Caucasian/white
D Native American/American Indian
El other -- Print Race: ------------ □I prefer not to answer.
D o you consider yourself to be Spanish, Hispanic, or Latino/a?
Jv» no
0 I prefer not to answer.
D o you consid er yourself Physically Disabled?
.Iva
zlo
D I prefer not to answer this question.
Page 6 of 6
F:\CLER\SALL RE G\BOARD AND COMMIT TEE APPLICATIONS FINAL. DRAF TS\BOARD AND COMM ITTEE APPLICATION REG FINAL..dox
Updated: June 2020
MIAMI BEACH
City of Miami Beach
l 700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeach[l,gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
Gibaldi
BOARD & COMMITTEE ACKNOWLEDGEMENT STATEMENTS
Mike J
Last Name First Name Middle Initial
Acknowledgment 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)
l 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)';" 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.
Acknowledgment to Comply with Miami Beach Code of Ordinances Division 1 Sec. 2-22 (23)
I understand that commencing with terms beginning on or after January 1, 2024, and as a condition of applying
for appointment to a City agency, board, or committee, I voluntarily agree that in the event I file with the City
Clerk a Statemeh t of Candidate formally announcing candidacy for City elective office, such filing with the City
Clerk shall be d~emed tender of resignation from the City agency, board, or committee
Pe-us-23
-'----.4o<'-----.4""--------------
D ate
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 (Fo rm 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 6 of 6
F:\CLER\$ALLIBOARD AND COMMITTEES DATABASE\Board and Commlt1ee Appllcation\BOARD AND COMMITTEE APPLICATION OCT 2023.docx
Updated: January 9, 2023
MIAMl·DADE. &III SOURCE OF INCOME STATEMENT
Section 2-11.1(i) 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 I Last Name J . First Name Middle Name/Initial
2023 @ibal Michael J
Mailing Address - Street Number, Street Name, or P.O. Box
4780 Pine Tree Drive, Apt 1
City, State, Zip
Miami Beach, FL 33140
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)
D County D Public Health Trust [] Municipal:
(Municipality)
Department
Position or Title Employee ID Number
Work address I Work telephone Employment began on/ended on
Filing as a Board Member (check one)
D County E] Municipal: City of Miami Beach
(Municipality)
Board where serving
Marine Waterfront Protection Authority
Alternate address (if home address is exempt) I Work telephone I Term began on/ended on
305-389-4615
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
Brickell Energy 1951 NW 7 Ave, #600 Electric Vehicle charging stations
Miami, FL 33136
I hereb · · ave is a true and correct statement.
/2-17-23
Date signed
wove #497%9 97at.
L] Hardcopy
ems %9 723
CITY OF MIAMI BEACH
OFFICE OF THE CI TY CLERK
OFFICE USE ONLY Accepted: Y / N Deficiency. Processed Date/initials: Scanned Date/initials:
138_SP-14 COE 2016
l±4 ±4 .L u "#222 al
1755 Meridian Avenue, Suite 200/Mi a mi Beoch, FL 33139/Ph: (305) 673-7 505 or (305) 673-7000 ex4. 6200 PARKING
A citywide (CW) parking permit is honored at metered parking spaces and restricted residential zones
parking spaces. A CW parking permit IS N O T honored in prohibited areas. An Access Card will be
provided to you for City Hall Garage (G7) access.
IM P O R TA N T N O TE: 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 C A N N O T 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.
A C K N O W LED G E M E N T: I ack n o w le dg e th a t sh o uld m y acce ss ca rd be lo st, stolen or
d a m a g e, I w ill be re sp o n sib le to pa y a $10 .0 0 re pla cem e nt fee .
Board Mem ber Info rm ation
Date of Application: /z -18 -23
Applicant Name: Mike Gibaldi
Board/Committee Name: MW PA
Address: 4780 Pine Tree Drive, Apt 1, Mi am i beach, FL 33140
E-Mail Address: h20mikeg@gmail.com
Work Phone: Home Phone
Cell Phone: 305-389-4615 Preferred Contact Method:
Vehicle Info rmation
Tag: R0ASC Color: Grey
State: FL
Make:
Year: 2023
Hyundai Model: loniq 5
Applicant SR+nature: e5
Please provide signed' form to th Parking Department located at 1755 Meridian Avenue, 2d floor. Working
hours ore 8:30 to 5.0 0 p.m. or email to: ParkingReception@miamibeachfl.gov
e-m ail subject: BOARD & COMMITT EE PARK ING APPLICATION - APPLICANT NAME
P ·kt D S ar Ina epartment ection
PERMIT SYSTEM GARAGE ACCESS
Expiration Date: ID Card Serial #:
Issued By Print Name: Print Name:
Signature: e5 Signa ture : f
Date Issued: Date Completed:
• pig man rat' tormis w oar ls commlees pa' mgtrm,doc orm up(ave