Andy Chabassol 12.31.25M IA MI BEA C H
DATE OF APPOINTMENT: _
FOR SCANNER
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BOARD AND COMMITTEE CHECKLIST
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BOARD/COMMITTEE: SSfANUALr
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o Letter of Appointment TERM END: [/l/ ZS TERM LIrr: _h l3l,]
o Letter or Reappointment "7 ,l
o Copy of Letter of Appointment/Reappointment e-mailed to Committee Liaison on 2fl0]
o Board and Committee Application (Completed on )
o R~sum/curriculum Vitae ·} )
o iversiiy Statistics Reporting (Compieied on ~l
o Oath Scan o
RECEIVED
MAR 112024
CI OF MIAMI BEA
OFFICE OF THE CITY CLERK
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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
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
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 agen cy, board or comm ittee fails to attend 33 per cent of the regularly sch eduled
meetings per calendar year, such member shall be automatically removed. To calculate the number of absences
under the 33 percent form ula, .4 or less rounds down to the next whole number and .5 or more rounds up to the
next wh ole number.
NOTE: Members of the Land Use Boards will be removed up on failure to attend three of the regularly sch eduled
me etings per calendar year, or upon abstaining irom voting due o a coniiict of interest on four different
ap p lica tion s within a ca le n da r year. A me m b er who is re m oved shall not be reappointed to m e m bersh ip on th e
bo ard for a t least o n e yea r fro m th e date of re m ova l.
Recaved on: [7"_kl,']02/ son eay %_iL'1u- I
pate Soard or Committee Me
Processed • l/14 » Ernployee: ... K/V)._·...;;;.... _
Date City Clerk's Office Staff Initials
We are committed to providing excellent public service and saety lo all who live, work, and play in our vibrant, tropical, historic community.
M IA M I BEACH
City of Miami Beach, I/OO Con vonlion Conlor Drivo, Mia mi Boach, Florida 33 139 yyyw_miamibgachll.gov
OFFICE OF THE CITY CLERK, Rafa»l E. Granado, City Clerk
Tel: 305.673.7411, Fax:. 305.673.7254
Email: CiyClerk@miamibeachll.gov
February 07, 2024
Mr. Andy Chabassol
408 W 25th Street, #6
Miami BEACH, FL 33140
RE: Sustainability Committee
Dear Mr. Andy Chabassol:
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.
Regards,
R&do
City Clerk
cc: Monica Beltran, Parking Director
Juanita Ballesteros, 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
City of Miami Beach, I/O Convention Conlon Divo, Miami Bach, Hloda 33139 ygyyy._riarib_cg_hll_gov
O FFICE OF IHE CI TY CIERK, Raf ael E. Granado, City Clerk
Iol: 305.673.7411, Fax. 305.673.7254
Email: CityClork@miamibeachfl.gov
Gath oi Ofiice
Oath of Civility
and
Acknowledgeme nts
TO: Mr. Andy Chabassol
RE: Sustainability 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, following the ing
oi the calendar year on wicn i nave served.
swom to and subscribed before me me _[I_aa ply 11,3ch4
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.
MIA MIBEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
RECEIVED'
MAR 11 2074
CI OF MIAMI BE?H'
OFFICE OF THE CITY CLERK
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):
ore Adress. '[o& g 1 Sr_, Maj be..d, F, 3
r 4so =5 47o e fe b6. n] le. teak, F, 3379 L ] !have an ownership interest (for a minimum oi six months in a business established in the'
City of Miami Beach (for a minimum of six months).
[]are f [ys]nesS,_
Py[fess JtdfeSS,
D 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).
[3ff% (of [[f][es5,
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.
lare that I have read the foregoing document and that the facts
Signature
[gt _C tote 4s=st
11/z/ 2sz ¥
Date ' '
Printed tame
M IA MI 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
Telephone: 305.673.7411
BOARD & COMMITTEE ACKNOWLEDGEMENT STATEMENTS
{Clod_o AAb;
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, inciuding those of a purely advisory nature, are required to comply with Miami-ade 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 resi ation from the City agency, board, or committee
Si'nature
8/2/z¥
Date 'r 7
' 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.
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F:ICLER\$ALL\BOARD AND COMMITTEES DATABASE\Board and Committee Application\BOARD AND COMMITTEE APPLICATION 0CT 2023.d00x
Updated: Jan uary 9, 202 3
MIAMI BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfl,gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachf.a0y
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 com ply with City diversity rep or ting requirem en ts.
Gender:
[J Mae
[l Female
( omer
D I prefer not to answer.
Race/Ethnic Categories:
What is your race?
D African American/Black
0 Asian or Pacific Islander
L2] Caucasian/white
El Native American/American Indian
0 Other - Print Race: ------------ EH prefer not to an s w er.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
pg L i Yes
J No
CJ I prefer not to answer.
Do you consider yourself Physically Disabled?
Ev»
ji o
t, prefer not to answer this question.
Page 6of6
F:\CLER\$ALL\REG\BOARD AND COMMITTE E APPLICATIONS FINAL DRAF TS\BOARD AND COMMITTEE APPLICATION REG FINAL .docx
U pd ate d : June 20 20
MIAMI BEACH
City of Miami Beach, PARKING DEPARTMENT
BOARD & COMMITTEES
PARKING APPLICATION
M/0 Meniarar verue, ui le ) Marr beach, FL 3313/rt1: (30) 6/3-/0 or (30) 6/3-/00 exl. 6)
a
PARKING
As a Board/Com mittee member you are entitled to a Citywide Parking Permit, which includes City Hall
garage (G7) parking access {Access Card), or a complimentary Citi Bike/Deco Bike Memb ership, or a
discounted MDC Monthly Transit Pass throughout your term.
Board Member Information
Date of ppiication: 19 2
Applicant Name: CH4+A
Board/Committee Name: us7PM)A)Z1
Address:
E-Mail Address: CG#it
W ork Ph on e : Home Phone:
C e ll Phone : 92- 5 Preferred C o ntact M ethod:
Please Choose One 1 0 tlon:
Citywide Parking Permit/G7 Access Card Cili Bike/Deco Bike Membership MDC Monthly Transit Pass
Vehicle Information (For Citywide Parking Permit/Access Card Only)
Tag : C C P7o C o lor: BACY
Sla te: f Year: 01
M a ke: ex«> M ode l: ex 950 4
A ci tyw ide (C W ) par king perm it is ho nored at metered parking spaces and restricted residential zones
parking spac es. A C W parking perm it IS NOT ho nored in prohibited areas. An Access Card will be
provide d to yo u for City Ha ll G ar ag e (G 7) access.
IMPORTANT NOTE: Your vehicl e lice nse plate serv es as your "parking permi t". To avoid any
unne cessary enfo rcem e nt act io ns, it is im port a nt tha t our records reflect the m ost current and
ac curate inform atio n regarding your vehicl e license plate. Inacc urate and /or outdated vehicl e
iniormaiion may iead to the issuance oi parking citation[s) and/or ih e towing of your ve hicle .
Please note tha t this new access card CANNOT be ho le-p unc hed or perf orated in any m a nner. To use
, the new card pl e ase ho ld the card at clo se pro ximi ty to the read er until the gate ope ns. You m ay
ne ed to try the other side of the card. Please ensure you ho ld the entire surf ac e of the card aga inst
the read er until the ga te ope ns.
A C K NO WL E D G E ME NT : ! acknowledge that sho ul d my access card be lost, stolen or damage, I will be
responsible to pay a $10.00 replacement fee.
Ple a se pr o vide signed for m to the Parkin g Dep a ent located at 1755 M eridi a n Aven ue, 2d floor .
W orking ho urs ar e 8:30 to 5:00 p.m . or em ail to: ParkingReception@miamibeachfl.gov
e-mail sub ect: BOARD & COMMITTEE PARKING APPLICATION - APPLICANT NAME
f\piny \$man\rar\toms\cw boards&committees orkin@form.doc form uy dated 118/2024