William Warren Jr. 12.31.25M IAMI BEACH
BOARD AND COMMITTEE CHECKLIST
arro r te hit m us·+7
BOARD/COMMITTEE: Bl__A{k@f r_f
DATE OF APPOINTMENT: L2]Lb)[2 3
Appointed by:. 09 t9Ing Qr'y2
F O R S C A N N E R
S c a n o
S c a n o
S ca n o
S ca n o
S c an o
RECEIVED
EC 19 2023
F O R C L E R K S T A FF
o Letter of A ppointm ent
o Letter of Reappointm ent
o Copy, 9f ,Let ter of Ap pointm en t/R eappoi ntm ent e-m aile d
@4 t _23
o Board and Committee Application (Completed on'
o R~sum~/Curriculum Vitae _J
o Diversity Statistics Reporting (Completed on \1 [1[23_9
o Oath
TERM END:_(2-/31/25 TERM LIMIT:.D]31]?9
to Committee Liaison on
CITY Or MM!AMI BEACH
OFT HE CI TY CLERK
S ca n o
S c a n o
IM P O R T A N T 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
✓C ounty C ode S ection 2-11.1 - Conflict of Interest and Code of Ethics Ordinance (as
am ended through D ecem ber 2010)
✓A m endm ents to the C ode of Ethics O rdinance (S eptem ber 2009 through July 2012)
✓Highlights of the M iam i-Dade C ounty Ethics Code
✓S unshine Law and P ublic R ecord s -- Frequen tly A sked Q uestions
✓M em ora ndum - S olici tation by C ity Board and C om m ittee M em bers
o C ityw ide Perm it A pplication (P arking Departm ent Form )
o Book let - G uid e to S unshine A m endm ent & C ode of E thics fo r P ublic O fficers and Em ployees
o S ource of Incom e S tatem ent
o A cknow ledgm ent of Financial Di sclosure R equirem ent
S canned on:
o Board and C om m ittees Li aison R esponsibilities
O DI VE R SI T Y S T A TI S TI C S RE P O R TI J K e ep , .Q
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Dae @lpiuris once st aff initials
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D ate C ity Clerk's O ffice S taff Initials
ile a n d O R IG IN A L fo r A n n u a l R e p o rt .
R eceiv ed on:.
CONCLUDED & RESIGNATION LETTERS
Term Expired Letter Date Processed Initials Scan o
Resignation Letter D ate P ro cessed Initials Scan o
Rem oval Letter due to absences Date pro cessed Initials S c a n o
F:\CLER\BOARD AND COMMITTIES DATABASE\CHECKLIST MASTER\B&C Checklist 2015 MASTER.docx
We are committed to providing excellent public service and salety to all who live, work, and play in our vibrant, tropical, historic community.
I MIAMI BEACH
City of Miami Beach, 1/0O Convention Cantor Drivo, Miam i Boach, Horida 33 139 yyyy._miaIiboachll_go
OFFICE OF THE CITY CLERK, Rafool E. Gran ado, City Clerk
Tel: 305.673.7411, Fax: 305.673.7254
Email: CiyCl erk@mi amibeach fl.gov
December 13, 2023
Mr. William Warren Jr.
810 11th Street #202
Miami Beach, Florida 33139
RE: Black Affairs Advisory Com mitte e
Dear Mr. William Warren Jr.:
Congratulations! You have been appointed by Commissioner Laura Dominguez 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 Of fice 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,
JJanado
City Clerk
cc: Monica Beltran, Parking Director
Lissette Arrogante, City Liaison
ENCLOSURES:
Oath of Office/Oath of Civility/Acknowledgements
City Code/Ordinance section applicable to agency, board or committee
City Code Section s 2-22, 2-23, 2-24, 2-25, 2-26, 2-458 an d 2-459
Ordinance No. 2006-3543 - Am endment to City Code Section 2-22
Miami-Dade County Code Section 2-11.1 - Conflict of Interest and Code of Ethics
City Wide Permit Ap plication - (Par king Department Form)
Booklet - Guide to the Sunshine Amendment and Code of Ethics for Public Officers and Employees
City of Miami Beach, 1ZOO Convention Conler Drive, Miami Bouch, Florida 33 139 yyywy_miarniboachf_go
OF FICE OF THE CI TY CL ERK , Rofaal E. Gran ad o, City Clerk
Tel: 305.673.7411, fax. 305.673.7254
Em ai l: C i#yCl erk@miam i beach fl.g ov
O ath of Office
Oath of Civility
and
Acknow ledgements
TO: Mr. William Warren Jr.
RE: Black Affairs Advisory 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: 12/31/2025.
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) on July 1st, fo lowing the closing
of the calendar year on which I have served.
swor to and subs cribe d before me this_]1_ day or _LL, 2023 EL_
K eila Mena C acere s
Deputy 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.
MIAMI BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
RECEIVED
EC 19 2023
CITY OF MIAMI BEACH
OFFICE O THE CITY 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 (check (/) all that apply):
~am a resident of the City of Miami Beach for six months or longer.
or- no» i/e " 31 A2l 2 6¢ hf6, a.,, £ 33
~ have an ownership interest (for a minimum of six months) in a business established in the
City of Miami Beach (for a mini of six months).
are or sos»es. bs. f,4 es
Business Address: /67 loll«ill □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.
u .
s
, I declare that I have read the foregoing document and that the facts
Date 7 7
Printed Name
M IA M I BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachll.gov
O FFIC E O F THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephon e: 305.673.7411
Last Name
y
DIVERSITY STATISTICS REPORT
t. //
I
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:
tr
[l Female
Ll oner
0 I prefer not to answer.
Race/Ethnic Categories:
What is your race?
L#African American/Black
D Asian or Pacific Islander
0 Caucasian/White
LI Native American/American Indian D Other- Print Race: _
DI I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
Loe»
L4N o
0 I prefer not to answer.
Do you consider yourself Physically Disabled?
L yes
No
D I prefer not to answer this question.
Page 6 of 6
F:ICLER\$ALL\REGIBOARD AND COMMITTEE APPLICATIONS FINAL DRAFTSIBOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
MIAM I BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfl,gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telep ho n e : 3 0 5. 673 .7 4 l l ? BOARD & COMMITTEE ACKNOW E
l @a,_ ttha
Last Name r = First Name
/I
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)
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 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 Statement of Candidate formally announcing candidacy for City elective office, such filing with the City
Clerk shal be deemed ender of resignation from the City agency, board, or committee
Si 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 6 of6
F:\CLER\$ALL\BOARD AND COMMITTEES DATABASE\Board and Committee Application\BOARD AND COMMITTEE APPLICATION 0CT 2023.d0cx
Updated: January 9, 2023
M IA M l·DAD E-
EI 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
2023
Mailing Address - Street Number, Street
8 'o //! $£
City, t e, Zip
q2/¢
If your home address is your mailing address, and your home address is exempt from public records pursuant to Fla. Stat. $119.07, read
instructions on the following page and check here. D
Filing as an Employee (check one)
[] county D Public Health Trust [] Municipal:
(Municipality)
Department
Position or Title Employee ID Number
Work address I Work telephone Employment began on/ended on
Filing as a Board Member (check one)
[] county rZJ 1~unteiat:
Board yh9re serying
6/{ air
Alternate address (if home address is exempt) Term began on/ended on
List below every source of income you received, along with the address and the principal activity of each source. Include your public salary. Place the sources of
income in descending order, with the largest source first. Examples of sources of income include: compensation for services, income from business, gains from
property dealings, interest, rents, dividends, pensions, IRA distributions, and social security payments. Also, include any source of income received by another
person for your benefit. However, the income of your spouse or any business partner need not be disclosed. If continued on a separate sheet, check here.□
Name of Source of Income Address Description of the Principal Business Activity
g
•
information above is a true and correct statement. RECEIVED BY ELECTIONS DEPARTMENT:
J artcoWECEIVED
[] Electronic Copy
DEC 19 2023
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
OFFICE USE ONLY Accepted: Y / N Deficiency. Processed Date/initials: Scanned Date/initials:-
138_SP-14 COE 2016
£%29.A.l 2$%£ La
1755 Meridian Avenue, Suite 200/Miami Beach, FL 33139 /Ph: (305) 673-7505 or (305) 673-7000 ext. 6200 PARKING
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 replacem ent fee.
Board Member lnfor ·
D a te of A pp lica tio n:
A pp lica nt N am e :
A ddr e ss 4, 7 , Zz
E-M ai l A ddr e ss: ,,) ,4 /. P d 'Yr€do (0d
Work Phone'4.5- 6oY 8o rs
cell Ph on e: ,5. -3 7Z Prefe rre d C on ta ct M eth o d : // ]
Ce Thon
Vehicle lnforma ·
Tag:
Sta te:
M a ke :
C o lo r:
Y ear :
M ode l:
Ap pl ican t Si«n atu re: e
Pl e ase provi d e sig ned' form to fhe 'arki ng D ep ar tm en t lo cate d at 17 5 5 M eri di a n A ven ue, 2d floor. W orking
ho urs ar e 8:3 0 to 5 :0 0 p.m. or em a il to : ParkingReception@miamibeachfl.gov
e-mail subject: BOARD 8& COMMITTEE PARKING APPLICATION - APPLICANT NAME
p ·k d D rt tS :ti ar mna ea men ec1Ion
PE R MI T S Y S TE M G A RA G E A C C E S S
Exp iratio n D a te: ID C a rd S eria l #:
Issue d By Prin t N a m e: Prin t N am e:
Sig n a ture: e Si g nat u re: e
D ate Issue d : D ate C o m p leted :