Curtis W. Slipman, MD 12.31.24 MIAMI BEACH
BOARD AND COMMITTEE CHECKLIST
Curtis W. Slipman, MD �Q
APPOINTEE: DATE OF APPOINTMENT: 113 1
BOARD/COMMITTEE: 64Ve-t.k. Vt.& Appointed by: C L Cyni'f&S EGt/1
FOR SCANNER FOR CLERK STAFF
Scan o Letter of Appointment TERM END: I VI 3( 17'4 TERM LIMIT: I li( 3/ 13 1
Scan o Letter of Reappointment 'LI �2l
o Copy of Letter of Appointment/Reappointment e-mailed to Committee Liaison on
Scan o Board and Committee Application (Completed on �— )
Scan o Resume/Curriculum Vitae '
o Diversity Statistics Reporting (Completed on > 24 )
Scan o o Oath
IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
✓ City Code Ordinance Section applicable to the agency, board or committee
RECEIVED ✓ 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)
FEB 0 5 2024 ✓ 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
CITY OF MIAMI BEACH v Memorandum-Solicitation by City Board and Committee Members
OFFICE OF THE CITY CL ER,.
o Citywide Permit Application (Parking Department Form)
O Booklet-Guide to Sunshine Amendment&Code of Ethics for Public Officers and Employees
Scan 0 0 Source of Income Statement
Scan 0 0 Acknowledgment Statement
O Board and Committees Liaison Responsibilities
O Diversity Statistics Reporting
✓ 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: 7/t I 124 Signed by X Curtis Slipman
Date Board or Committee ember
Processed on: 21 (Q I it)' By Employee: ' ,
Date City Clerk's Office Staff Initials
Scanned on: 1/! W l i(j By Employee: KAA
Date City Clerk's Office Staff Initials
MIAMI BEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33 139 www.miamibeachfl.gov
OFFICE Of THE CITY CLERK,Rafael E.Granada,CiLy Clerk
Tel:305.673.7411,Fax:305.673.7254
Email:CityClerk@miamibeachfl.gov
January 29, 2024
Mr. Curtis Slipman
1455 Ocean Drive, Ste 710
Miami Beach, FL 33139
RE: Budget Advisory Committee
Dear Mr. Curtis Slipman:
Congratulations!You have been appointed by Commissioner Joseph Magazine 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.
Regards,
Rafael Granado
City Clerk
cc: Monica Beltran, Parking Director
Tameka Otto Stewart, 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
MIAMI BEACH
City of Miami Beath, 1700 Comedian Center Drive,Miami Beath,Florida 33139 www.mlamdxiachfl.gov
OFFICE OF ME CITY CLERK,Wool E.Granado,C1y Clerk
Tel:305-673.7411,Fax:305.673.7254
beat:CI1yCJerk@miomibeadagvv
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Mr.Curtis Slipman
RE: Budget 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: 12/31/2024.
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 Count e
State of Florida(depending on the board or committee on which I serve)on July is ollowi e closing
of the calendar year on which I have served.
M C rtis Slipman
Sworn to and subscribed before me this 6 day of r'fib,2024
Keila 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.
RECEIVED
MIAMI BEACH FEB 0 2024
CITY OF MIAMI E3EACH
City of Miami Beach OFFICE OF THE dry Cl F
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email:BCAmiamibeachfl.gov
Telephone: 305.673.741 1
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):
✓ I am a resident of the City of Miami Beach for six months or longer.
Home Address: 1455 OCEAN DRIVE,#710, Miami Beach, Fl 33139
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 e ity or business association.
ser .-n: -. of perjury, I declare that I have read the foregoing document and that the facts
stated in ' . - rue.
1
2.05.2024
Sig;cure Date
C jr s Sli• an
'tinted Name
MAMI BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeochfl.gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
DIVERSITY STATISTICS REPORT
Slipman Curtis w
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:
Male
❑ Female
El Other
❑ I prefer not to answer.
Race/Ethnic Categories:
What is your race?
( African American/Black
(i Asian or Pacific Islander
a Caucasian/White
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?
Ell Yes
a No
a I prefer not to answer.
Do you consider yourself Physically Disabled?
Yes
Q No
I prefer not to answer this question.
Paae 6 of 6
MIAMI BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www,miamibeachfl,gav
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
BOARD & COMMITTEE ACKNOWLEDGEMENT STATEMENTS
Slipman Curtis W
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)
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 ' .mply with Miami Beach Code of Ordinances Division 1 Sec. 2-22 (23)
I underst-.. that comme,ci g with terms beginning on or after January 1, 2024, and as a condition of applying
for app• ntme to a C' y agency, board, or committee, I voluntarily agree that in the event I file with the City
Clerk : Statem- t o and date formally announcing candidacy for City elective office, such filing with the City
Cler shall be de_' ed a t:nder of resignation from the City agency, board, or committee
2.05.2024
Signature AEI 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.
•�.yyyW- -- -- --- -- ---- ----- - -- --- - --- -
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 Slipman Curtis
Mailing Address-Street Number,Street Name,or P.O.Box
1455 Ocean Drive, #710
City,State,Zip
Miami Beach, FL 33139
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.❑
Fling as an Employee(check one)
❑ County ❑Public Health Trust ❑ Municipal:
(Municipality)
Department
Position or Title Employee ID Number
Work address Work telephone Employment began on/ended on
Fling as a Board Member(check one)
❑County ❑ Municipal:
(Municipality)
Board where serving
Alternate address(if home address is exempt) Work telephone 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 anotar
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.11
Name of Source of Income Address Description of the Principal Business Activity
Curtis W. Slipman MDPA 1455 Ocean Drive, Miami Beach Medical Consulting
Annuity 1455 Ocean Drive, Miami Beach Financial
Dividents, interest, stock capital 1455 Ocean Drive, Miami Beach Investing
gains
I hereby ear(or affirm e information above is a true and correct statement. RECEIVED BYE TW14S,11FPARTMENT:
❑Hardcopy L'l I Vr L)
❑Electronir�py O
gn re Person Disclosing I-�ti 0 2024
CITY OF�/li4MI BEACH
2-05.2024 OF,`'-r
Date signed -/TY CLERK
IVII/..1\IV\I V`/AVri �.II I VVIVL IL.VVi U JF'tI.I✓ VC ILLJ -
City of Miami Beach,PARKING DEPARTMENT PARKING APPLICATION EMS
1755 Meridian Avenue,Suite 200/Miami Beach,FL 33139/Ph: (305)673.7505 or(305)673-7000 ext.6200
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 replacement fee.
Board Member Information
Date of Application:February 5, 2024
Applicant Name:Curtis W. Slipman
Board/Committee Name: Budget Advisory
Address:1455 Ocean Drive
E-Mail Address:cslipman@mac.com
Work Phone:305-842-1484 Home Phone
Cell Phone:as above Preferred Contact Method:
Vehicle Information
Tag: BS95IQ Color: Blue
State: FL Year: 2022
Make: Porsche Model: Cayenne
Applicant Signature: •K
Please provide signed form to the Parking Department located at 1755 Meridian Avenue, 2nd floor. Working
hours are 8:30 to 5:00 p.m. or email to: ParkingReception@tniamibeachfl.gov
e-mail subject: BOARD & COMMITTEE PARKING APPLICATION — APPLICANT NAME
Parking Department Section
PERMIT SYSTEM GARAGE ACCESS
Expiration Date: ID Card Serial #:
Issued By Print Name: Print Name:
Signature: AS Signature: AC
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