Prakash Kumar 12.31.24MIAMI BEACH
BOARD AND COMMITTEE CHECKLIST
APPOI NTEE :, .._('fQys'\ (-0 DATE OF APPOI NTMENT:
BOARDCOMMITTEE: _(Qhuuhn (u k &c/ Appointed by: rrc
FOR SCANNER
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RECEIVED
IAN 12 2024
FOR CLERK STAFF
o Letter of Appointment
o Letter of Reappointment
o Copy of Letter of Appointment/Reappointment e-mailed to Committee Liaison on
o Board and Committee Application (Completed on )
o Resume/Curriculum Vitae [{)
o Diversity Statistics Reporting (Completed on [_ [L )y )
o Oath
TERM END: 1(3th} TERM LIMIT: _p[/4
/n/4
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 om or MAM0Eg!
OFFICE OF THE CITY GI-
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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 Statement
o Board and Committees Liaison Responsibilities
o Diversity Statistics Reporting
[J I acknowledge that pursuant to Sec. 2-22(9) of the Miami Beach Code of Ordinances, I will be removed
from my board/committee upon failure to attend 33% of the regularly scheduled meetings.
Sec. 2-22(9) If any member of an agency, board or committee fails to attend 33 percent of the regularly scheduled
meetings per calendar year, such member shall be automatically removed. To calculate the number of absences
under the 33 percent formula, .4 or less rounds down to the next whole number and .5 or more rounds up to the
next whole number.
Received on: Signed by X • Date Board or Committee Member
Processed on: u]I]24 By Employee: K1
Date City Clerk's Office Staff Initials
Scanned on: th[e]4 By Employee: /A
Date City Clerk's Office Staff Initials
We are committed to providing excellent public service and salely to all who live, work, and play in our vibrant, tropical, historic community.
MIAMI BEACH
City of Miami Beach, 1/OO Convention Canter Drive, Miami Boach, Florida 33 139 yywwy_IiaIibeachll.gov
OFFICE OF THE CITY CIERK, Rafaol E. Granado, City Clerk
Tl: 305.673.7411, Fox: 305.673.7254
Email: CiyCl erk@mi amibeach fl.gov
January 11, 2024
Mr. Prakash Kumar
533 Collins Avenue, Apt 1204
Miami Beach, Florida 33139
SUBJECT; Convention Center Advisory Board
Congratulations! You have been reappointed by Commissioner Tanya Bhatt to the above referenced,
board or committee named above, 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.
Congratulations and good luck.
Regard:161
Rafa2ranado
City Clerk
cc: Monica Beltran, Parking Director
Heather Shaw, City Liaison
ATTACHMENTS:
Letter of Appointment
Oath
City Code/Ordinance section applicable to agency, board or committee
City Code Section 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 Ordinance
City Wide Permit Application - (Parking Department Form)
Booklet - Guide to the Sunshine Amendment and Code of Ethics for Public Officers and Employees
M IA M I BEACH
City o f M ia m i B e a ch , I/00 Convention Conlor Drive, Miam i Boach, Florida 33 139 ywyww_miamibgachllgo
OFFICE OF THE CITY CLERK, Rafool E. Granado, City Clerk
Tol: 305.673.7411, Fax: 305.673.7254
Emal: Ci#yClerk@miamiboochfl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
T O : M r. Prakash K um ar
R E: C o nvention C e nter A dvisory Board
I do so le m n ly sw ear or affirm to bear true faith, loyalty and allegiance to the Govern m ent of the U nited
States, the State of Florida, and the C ity of M iam i Beach, and to perf orm all the duties of a m em ber of the
abo ve-m entioned board or com m ittee of the C ity of M iam i Beach to w hich I have been appointed fo r a
term ending: 12/31/2024.
T o m y collea gu e s and to all of those I represent and serve, I pledge fairn ess, integrity and civility, In all
actio ns taken and all com m unications m ade by m e as a public serv ant.
I ha ve be en issued a copy of section 2-11.1 of the M iam i-D ade C ounty C ode (C onflict of Interest and
C o de of Ethics O rdinance), as w ell as Florida C om m ission on Ethics G uide to the Sunshine Am endm ent
and C ode of Ethics fo r Public O ff icers and understand that as a m em ber of a C ity of M iam i Beach Board
and/or C o m m itt ee , I m ust com ply w ith the finan cial discl osure requirem en ts of M iam i-Dade C ounty or the
State of F lo rida (d e pending on the board or com m ittee on w hich I serve) on July 1st, fo llow ing the closing
of the cale nda r yea r on w hich I have serv ed.
Sw orn to and subscribed befo re m e this f "2
Keil
*P le a se visit the C ity of M iam i Beach w ebsite at w w w .m iam ibeachfl.gov under City Clerk/Board and
C o m m itt ees fo r ad ditional info rm ation regarding the Financial D iscl osure Requirem ents.
M IA M I BEACH
City of Miami Beach
1 700 Convention Center Drive
Miami Beach, Florida 33139
RECEIVED
JAN 12 2024
CITY nF :V-J~\\/11 BEACH
- rVCLERK OFFICE
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673 .7 411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
I am in com pliance with the affiliation requirem ent of Miam i Beach City Code Sections 2-22 (4),
as (check(✓) all that apply):
~m a resident of the City of Miam i Beach for six months or longer.
Hom e Addre ss,3 3 Collins aven ue ( 1204),M .Beach , FI- 33139
D I have an ow nership interest (fo r a minim um of six months) in a business established in the
City of Miam i Beach (for a minim um of six months).
[]ar e (f [[g[hes8S,
Business Address: ------------------------- □I am a full-tim e em ployee of a business (for a minim um of six months) and I am based in an
office or other location of the business that is physically located in Miam i Beach (for a
minim um of six months).
[ar e f [3JS//eSS,
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 docum ent and that the facts
A- U-". ovos
Signature Date
Prakash kum ar
Printed Nam e
M IA M I B EA CH
City of Miami Beach
17 0 0 C on venti on Cent er D rive
Miami Beach, Florida 33139
www.mi am i be ach fl.gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Tel epho ne: 305.673.7411
DIVERSITY STATISTICS REPORI
Prakash s
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:
1l Mae
D Female
Doner
D I prefer not to answer.
Race/Ethnic Categories:
What is your race?
L) African American/Black
2S,Asian or Pacific Islander
0 Caucasian/White
0 Native American/American Indian 0 Other- Print Race: _
D I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
ves
No
El prefer not to answer.
Do you consider yourself Physically Disabled?
ves zh t prefer not to answer this question.
Page 6 of 6
F:\C LER\$ALL\REG \BO ARD AND CO M M ITT EE APPLICATIO NS FINAL DRAFTS\BOARD AND COMMITT EE APPLICATION REG FINAL.docx
Updated: June 2020
M IA M I B EA CH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florido 33139
ww w.miamibeachfl.gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
Kumar
BOARD & COMMITTEE ACKNOWLEDGEMENT STATEMENTS
Prakash s
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)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 shall be deemed a tender of resignation from the City agency, board, or committee
sea0-
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 of 6
F:IC LE R \$A L LIB O A R D A N D C O M M ITT E E S D A T A B A S E \B oard and C om m ittee Applica tion\BO A R D AN D C O M M ITT E E AP PLI C A TIO N O C T 2023.docx
Updated: January 9, 2023
M IA M l·DAD E- EMEI
Clear From Print Form
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 'Last Name First Name Middle Name/Initial
2023
Mailing Address - Street Number, Street Name, or P.O. Box
City, State, Zip
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 □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)
1] county ES Municipal: W1uni e- (Municipality)
Board where serving
CCAC
Alternate address (if home address is exempt) I Work telephone I 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
SSI only
Me
I hereby swear (or affirm) that the information above is a true and correct statement.
Signature of Person Disclosing
Date Signed T
ECED sY ELECTIONS DEPARTMFNT
J aracoy RECEIVE
D Electronic Copy
ii 12 2024
CITY OF MIAMI BEACH
OFFICE OF TE CITY CLERK
REMEMBER TO PRINT, SIGN, AND SUBMIT TO THE OFFICE OF THE CITY CLERK VIA EMAIL OR HARDCOPY.