Maceo Hall 6.30.24BOARD AND COMMITTEE CHECKLIST
APPowrEE: _Jo kl]
BOARD/COM MITTEE: _hull Lonn';6ion1
FOR SC ANNER
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DATE OF APPOI NTMENT: fl!o4
Appointed by 'sa tf Bhat
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Scan
FOR CLERK STAFF [,E. }£
Letter of Appointment TERMEN ,IO _ ERM LIM
• Letter of Reappointment
Copy of Letter of Appointment/Reappointment e-mailed to qmmttee Liaison on
Board and Committee Application (Completcd on L]2Q]]_ )
Resume/Curculum Vitae ,]
Diversity Statistics Reporting (Completed on 3/12[Q]
• Oath
RECEIVED
4AR 12 2024
cmyoE 9492}
OFF!CE " "
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IMPORTANT INFORMATION FOR BOARD AND COMMITT EE 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
t County Code Section 2-111 - 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 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)/1 Signed by X 0@
Date Board or Committee Member
al1/24 By Employee t
Processed on City Clerk's Office Staff Initials Date
A/ AA[BE ACH IA / /, _/, '
City of Miami Beach, WOO Convonlion Coner Drive, Miami Bach, Florida 33139 yy ._miImib_Ahl]_g
OFFICE OF THE CITY CLERK, Rafael E. Granado, Cy Clerk
Tel 305.6737411, Fax. 305.673.7254
Email: Cit/Cl erk@mi amibooch ll.gov
February 01, 2024
Mr. Maceo Hall
57 48pinetreedrive
Miami Beach, Florida 33140
RE: Youth Commission
Dear Mr. Maceo Hall:
Congratulations! You have been appointed by Commissioner Tanya Bhatt to the above-referenced
Board or Committee, for a term ending: 06/30/2024.
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. 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.
" -4.
City Clerk
cc: Monica Beltran, Parking Director
Dr. Leslie Rosenfeld, 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
MI AIBEACH .. socs
City of Miami Beach, I7OO Con vention Center Drive, Miami Beach, Forid 3313
OFFICE OF THE CITY CLERK, Rafael E. Gran ado, Ciy Chrk
Tel: 305.673.7411, Fax: 305.673.7254
Email: Ci/Clerk@miamibeachfl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Mr. Maceo Hall
RE: Youth Commission
l 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: 06/30/2024.
•. .
To my colleagues and to all of those l 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 Amendmen t
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 closing
of the calendar year on which I have served.'
--~~Gl'lall
Sworn to and subscribed before me this _l day r [1_33o, . ,y!L_
Ke~la Mena Caceres
Deputy Clerk
,
he City of Miami Beach website at www.miamibeachf.
dona tomato reoar@rs ire franc6i oisci6'.h,,],7,,"" Ger@soars ana
C i ty of Miami Beach
1700 Convention Center Drive
Miami Beach Florido 33139
RECEIVED
MA R 12 2024
CI TY O F MIAM I B E A CH
r tr - ··E F TH E CITY CLERK
OFFICE OF THE CITY CLERK
Email BC@mamibeachf_gov
Telephone 305 673 7411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF AIAML_BEACH
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4).
as (check (/) all that apply).
[lf I am a resident of the City of Miami Beach for six months or longer.
Home Aaress _574g Ro [roe Dive,
0 \ 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 --------------------------
\ [1am 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.
Under penalties of perjury, I declare that I have read the foregoing document and that the facts
stated in---------
Signature
/'t oe haul
Date
printed Nam e
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florido 33139
www.miamibeachfl.gov
OFFICE OF THE CITY CLERK
Email BC@mamubeachf_gov
Telephone: 305 673 7411
DIVE RSI TY STATISTICS REP ORI
lo.l
Last Name
First Name
z
Middle Initial
The following information is lt tz 1d.._ ,, voluntary an has no bearing on your consideration for appointment It is being
asked to comply with City diversity reporting requirements
Gender:
fa.
[l Female
Ll oner □I prefer not to answer
Race/Ethnic Categories:
What is your race?
[ African American/Black
D Asian or Pacific Islander
[ Caucasian/white
L]Native Amencan/American Indian D Other - Print Race: _
El prefer not to answer
Do you consider yourself to be Spanish, Hispanic, or Latino/a? ~s.
Jo
Llt prefer not to answer
Do you consider yourself Physically Disabled?
es
g1
D I prefer not to answer thts question.
Page 6 of 6
F CLER SALL RE G BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS BOARD AND COMMITTEE APPLICATION REG FINAL docx
Updated June 2020
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 67 3 741 l
BOARD & COMMITTEE ACKNOWLEDGEMENT_STATEMENTS
asi Name
Mateo
First Name
2
Middle Initial
itte Members for failure to comply with Miami- Acknowledgment of fines/suspension for Board/Com mittee IeI , 2-411.1(i) (2)
Dade County Financial Disclosure Code Provision Code Section '· '
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.
Qne 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 Jul y 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 wi th 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
Signature
' 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 wi th the County disclosure requirement does not satisfy the State
requirement
Page 6 of 6
F CLER SALL BOARD AND COMMIT TEES DATABASE Board and Committee Application\BOARD AND COMMITTEE APPLICATION OCT 2023 &cx
Updated Jan ua ry 9. 20 2 3
....MM99 ±iii ii
Clear From Print Form
SOURCE OF INCOME STATEMENT
Sec tion 2-11\() of the County Ethic.s Code requites that certain empioyoes and public officials tile a financial disclosure Stat emen t on a yarly bas by July 1t
of every yeat
Di scl osure tor Tax Year Ending ]Last ian Ti
2023 ill
Malling Address - Street Number, Street Name, or P.0. Box
/$ fnenc 'iv
nsiw» ff#¢ Middle Nam«initial
City, State, Zip
tr 1, }, 1
---. lfp)ht i ' i[1fl{ [,
lf your home address Is your mailing address, and your home address is exempt from public records pursuant to Fla. Stat. 5119.07, read
instructions on the follo wi ng page and ch eck here.[]
Fling as an Employee (check 00%l
[ County [] Pub lic Health rust [ Municipal:
(Municipallty)
Department
Posi tion or Ti tle Employee ID Number
wk
Work address 'A 'Y t
Work telephone
1,IA
Employment began on/ended on
#
Filin g as a Boar d M em ber (ch eck one)
[] county [J Municipal: Nao «ch
(Municipality)
Board where serv in g
Al ter n ate address (it home address ls exempt) Work telephone
t gt (r6 ct-u
Term began on/ended on
any '2c u
List below every source of income you received, alon g with the address and the principa l 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 tor 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
/4
± 'A 4/ 1H
M/4 NV/A
I hereb y swear (or affirm ) th at th e information ab ove is a true an d correct stat em ent .
,..,.,.,.,,,,
RECEIVED BY ELECTI ONS DEP ARTM ENT:
J Har@copy HE3Ee
/ Electronic cop VVEt
M R ,» ,
.ut $
CIT Y Oi:;-,... "--•·· 'lr c s or$,t
G HE OFFICE JF THE CITY CL ER K VA MAR. OH HA~C OP Y
C IT Y W ID E (C W ) B O AR D & C O M MI TTE E S a City of Miami Bea ch, PARKI NG DEPARTMENT PARKING APPLICATION
1755 Mendion Avenue. Suite 200/ Miami Be0ch, FL 33139/Ph (305/ 673.7505 or (305) 6737000 ex 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: l acknowl edge that should my access card be lost, stolen or
damage, I will be respo nsible to pay a $10.00 replacement fee.
Board Member Information
Dote of Application: ,, > z,S 4
Applicant Name:. rte ial I
' Board/Committee Name: ,, /7m e ,an
Address: 172 - · ' rf tefr&
.
E-Mail Address: lecz hat@a, •fr7
Work Phone:/5)-cu- Ly Home Phone
'- 4 4
Cell Phone: /·,)..e, if Preferred Contact Method: Cent Who - -Cu2lul
Vehicle Information
Tag: Yvt5 Color: rev
State: I+ ·, Year:
I id0
Make: ," Model: 1< lud !5
Applicant Sianoture:
, Please provide signed form to the Parking Department located at 1755 Meridian Avenue, 2" Hoor. Working
hours are 8:30 to 5:00 p.m. or email to: PgrkingReception@m iamnibegchfl.gov
e-mail subject: BOARD & COMMITTEE PARKING APPLICATION - APPLICANT NAME
Parkina Department Section
EMT SYSTEM GARAGE ACCESS
Expiraton Date ID Card Serial #: ·,
ed by Pint Name. Print Name.
gctre a Signature. «i
Doe /«oed Dote Compleled:
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