Jose Smith 12.31.25 MIAMI BEACH
BOARD AND COMMITTEE CHECKLIST
APPOINTEE: jost .,J M 1-S'1 DATE OF APPOINTMENT: I 11 hiq
BOARD/COMMITTEE: CRA Appointed by: VL I vk (,OYYI Si i1�
FOR SCANNER FOR CLERK STAFF IV/ 31 I�S^- u » i I Z�
Scan o o Letter of Appointment TERM END: TERM LIMIT: ,"`
Scan a o Letter of Reappointment Itx1 „p
o Copy of Letter of Appointment/Reappointment e-mailed to Committee Liaison on "UI'U I !g
Scan a a Board and Committee Application (Completed on — )
Scan a o Resume/Curriculum Vitae o Diversity Statistics Reporting (Completed on 2 I 1 l f
�`i )
Scan a 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
FEB 16 LD24 amended through December 2010)
✓ Amendments to the Code of Ethics Ordinance (September 2009 through July 2012)
✓ Highlights of the Miami-Dade County Ethics Code
CITY OF
OFFICE OF THE CII BEACH TY CLERK ✓ Sunshine Law and Public Records—Frequently Asked Questions
✓ Memorandum-Solicitation by City Board and Committee Members
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.
NOTE: Members of the Land Use Boards will be removed upon failure to attend three of the regularly scheduled
meetings per calendar year; or upon abstaining from voting due to a conflict of interest on four different
applications within a calendar year. A member who is removed shall not be reappointed to membership on the
board for at least one year from the date of removal.
Received on: 2 15174 Signe b
ate Boa �/1/o�mmittee Member
Processed on: Alt 11A- By Employee: `
Date City Clerk's Office Staff Initials
We are committed to providing excellent public service and safely to all who live, work,and ploy in our vibrant, tropical, historic community.
MIAMI BEACH
City of Miami Beach, 700 Convention Center Drive, Miami Beach, Florida 33 139 www.miamiboachfl.gov
OFFICE OF THE CITY CLERK,Rafael E.Granada,City Clerk
Tel:305.673.7411,Fax:305.6731254
Erna:CityClerk@miornibeochfl.gov
February 07, 2024
Mr. Jose Smith
887 North Shore Drive
Miami Beach, Fl 33141
RE: North Beach CRA Advisory Committee
Dear Mr. Jose Smith:
Congratulations!You have been appointed by the City Commission to the agency, board or committee
named above for a term ending: 12/31/2025.
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
Rickelle Williams, City Liaison
ENCLOSURES:
Oath of Office/Oath of Civility/Acknowledgements
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
City Wide Permit Application - (Parking Department Form)
Booklet-Guide to the Sunshine Amendment and Code of Ethics for Public Officers and Employees
MIAMI BEA H
City of Miami Beach, 1/00 ConvonUon Center[hive, Miami Boach, I lorida 33139 www.muomiFx'achfl.gov
OFFICE Of THE CITY CLERK,Rafael E.Granada,City Clock
Tel:305.673.741 1,Fax:305 673.7254
Email:CifyClerkCdniomibeachfi gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Mr. Jose Smith
RE: North Beach CRA 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.
•
e Smith
Sworn to and subscribed before me this I day of Ek) , 2024
Keila ena 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.
M
A/\A
��... H. RECEIVED
City of Miami Beach FEB 15
2024
1700 Convention Center Drive
Miami Beach, Florida 33139 CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK OFFICE OF THE CITY CLERK
Email: BCAmiamibeachfl goy
Telephone:305.673.7411
NORTH BEACH CRA ADVISORY COMMITTEE AFFIDAVIT OF COMPLIANCE
I am in compliance with the North Beach CRA Advisory Committee's Membership Composition
requirements pursuant to Section 2-190.151 of the Miami Beach City Code as a:
❑ Resident Member.
a. Currently residing, for a minimum of five (5) years, within the North Beach area, generally
considered as that portion of Miami Beach located north of 63`d Street.
Home Address:
b. Currently residing, for a minimum of five (5) years within the geographic boundaries of the
North Beach CRA or a 300-foot radius thereof.
Home Address:
❑ Business Member with ownership interest for a minimum of five (5) years in a business
established within the geographic boundaries of the North Beach CRA.
Name of Business:
Business Address:
❑ Real Estate Industry Member residing generally within the City of Miami Beach.
Home Address:
/License Number:
C� Attorney Member with experience in land use, real estate, or other related practice area,
residing generally within the City of Miami Beach or maintaining a full-time law practice and
physical office located in North Beach. r
Home Address: (6:3 I N L� $ �- Pirif
Law Practice Address: 5C' '
License Number: 11 ��e
El The five (5) year minimum residency requirement for the Resident Member Category has
been waived by a 5/7ths vote of the City Commission.
I have an interest in neighborhood leadership issues, including, without limitation,
neighborhood business groups, homeowner or condominium association associations and
cooperatives, civic groups, and/or other similar qualifications.
"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 document and that the facts
stated in it are true.
ur Date
Printed Name
RFIP8tiPD
MLAM BEACH FVEgl15 2024
City of Miami Beach i i '"' '
1700 Convention Center Drive p ��
Miami Beach, Florida 33139
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 (I) all that apply):
1:�1 1 am a resident of the City of Miami Beach for six months or longer.
Home Address: ff.-1 N RE U
LJ 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: k Q 5C Sr\1-r ,J `T-1-0 E'I
Business Address: p-►�.. -�r_,I .z-••��
RI 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: d 05*g. 5IM ( T y, kr R NE
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 document and that the facts
in it are ue.
Z, )S'zy
6 , Date
J 05 P\ i H
Printed Name
M AM1 BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfl.gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfL ov
Telephone: 305.673.7411
DIVERSITY STATISTICS REPORT
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
Other
0 I prefer not to answer.
Race/Ethnic Categories:
What is your race?
ED African American/Black
Asian or Pacific Islander
�Caucasian/White
ED Native American/American Indian
0 Other—Print Race:
ID I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
1 Yes
O No
0 I prefer not to answer.
Do you consider yourself Physically Disabled?
LYes
No
0 I prefer not to answer this question.
Page 6of6
F\CLER\$ALL\REGVBOARD AND COMMI TTEF APPLICATIONS FINAL DRAFTS BOARD AND COMMITTEE APPLICATION REG FINAL docx
Updated:June 2020
M AMI BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfl.gov_
OFFICE OF THE CITY CLERK
Email: BC(a�miamibeachfl.gov
Telephone: 305.673.7411
BOARD & COMMITTEE ACKNOWLEDGEMENT STATEMENTS
ci5'rvm Jos 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 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 s II be deemed a t er of resignation from the City agency, board, or committee
I $5 )2 Li
Si Date
' Members of the Planning Board and Board of Adjustment will be notified directly by the State of Florida,
pursuant to F.S. §112.3145(1)(a), to file a Statement of Financial Interests (Form 1)with the Miami-Dade County
Supervisor of Elections by 12:00 noon, July 1. Planning Board and Board of Adjustment members who file their
Form 1 with the County Supervisor of Elections automatically satisfy the County's financial disclosure
requirement as a Miami Beach City Board/Committee member and need not file an additional form with the Office
of the City Clerk. However, compliance with the County disclosure requirement does not satisfy the State
requirement.
Page 6 of 6
F\CLER1$ALL1BOARD AND COMMITTEES DATABASERoard and Committee Application\BOARD AND COMMITTEE APPLICATION OCT 2023.docx
Updated.January 9,2023
ARD & COMMITTSi\A AMBEACH PARKING APPLICATION . n„: s .
PARKING
City of Miami Beach,PARKING DEPARTMENT
1755 Meridian Avenue,Suite 200 Miami Beach,FL 33139/Ph: (305) 673-7505 or(305) 673 7000 ext. 6200
A
mittee member you are entitled to a Citywide Parking Permit,
Bikeh includes Membership,City
yo al
garage a /Com Citi Bike/Deco
(G7) parking access (Access Card), or a complimentary
discounted MDC Monthly Transit Pass throughout your term.
Board Member Information ---
Date of Application: $ •
ry
Applicant Name: G Ef IA
,
Board/Committee Name: t-A C R1� �7_
Address: 55 V7 9 6 AC 0
E-Mail Address: J 054,5N1 j rw i L,Ca ri ______----
Work Phone: ---2.Sz-qzli Home Phone: .905-_ g6�-307
Cell Phone: g� -z9Z - 2 ) Preferred Contact Method:
Ple se Choose One (1) Option:
Citywide Parking Permit/G7 Access Card 1 Citi Bike/Deco Bike Membership 1 MDC Monthly Transit Pass
1 I
Vehicle Information (For Citywide Parking Permit/Access Card Only)
Tag: 1 . 1
�M1/n o z Color: WI-1 !re
State: Fl--.A Year: 2.02,i1
Make: H^ p Model:
J 5 —
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". 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. placeme ee.
Applicant Signat re:
Please provide . Parking Department located at 1755 Meridian Avenue, 2nd floor.
Working hours are . 0 to 5:00 p.m. or email to: ParkinaReception@miamibeachfl.gov
e-mail subject: BOARD & COMMITTEE PARKING APPLICATION - APPLICANT NAME
t\pirxg\$manVar\forms\cw boards&committees porxingform doc form updated f/18/2024