Martin Zaiac 12.31.28MIA\MAIBE
BOARD AND COMMITTEE CHECKLIST
aerowree..4i,_
oArD/co»Mrrrtee:le!Hallie34Go«j @as&/FOR SCANNER FOR CLERK STAFF'\
scans oLetter ot Appointment TERM END:\2\1\20 TERMLIMIT:_,Scan o o Letter of Reappointment
o Copy of Letter of AppointmenUReappointment e-m~!ed to C':1m.ittee.Liaison on 7l'8':Scan o o Board and Committee Application (Completed on _]-3.Zk )
Scan o o Resume/Curriculum Vitae-••...
t City Code Ordinance Section applicable to the agency,board or committee
Y City Code Sections 2-21,2-22,2-23,2-24,2-25,2-26,2-458 and 2-459
RECEIVED ✓County Code Section 2-11.1 -Conflict of Interest and Code of Ethics Ordinance (samendedthroughDecember2010)
t 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
DATE OF APPOINTMENT:A'
✓
✓
✓CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK,,,p 4,A•-Citywide 'ermit Application (Parking Department Form
$£P 18 2024
Scan o
Scan O
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
from my board/committee upon failure to attend 33%of the regularlyscheduled meetings.
Sec.2-22(9)lfany member of an agency,board or committeefails to attend33 percent of tho regularly schedulez%5ziz.7±it±c
$3ez:cs;es±e3%%%25
applications within a calendaryear.A member whoisremovedshallnot be,pointed to membershipon thboardforatleastoneyearfromthedateofremoval.
Received on:.l.'{sons«»y%t4
Date
Process«@on.Q.(9.2\
Date
Hy [rp[9/@¢,kf-
Ve ore committed to providing excellent public service and safely to all who live,wok,and play in our vbrant,tropical,bistoic community.
MIAMI BEACH
City of Miami Beach,I/O Convonfion Conler Drive,Miami Boach,Florida 33139 yNywy_miamibcachllgo
OFFICE OF THE CITY CLERK,Rafael E.Granado,CityClerkTel:305.673.7411,Fax 305.673.7254
Email:CiNyClerk@miamibeachll.gov
September 12,2024
Mr.Martin Zaiac
4308 Alton Road,Suite 750
Miami Beach,FL 33140
SUBJECT:Health Facilities Authority Board
Dear Mr.Martin Zaiac:
Congratulations!You have been reappointed by the City Commission to the above referenced board or
committee,for a term ending:12/31/2028.
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.
cc:Jose Gonzalez,Parking Director
Jason Greene,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
MIAMI
City of Miami Beach,I/OO Convention Canter Drive,Miami Each,Florida 33 139 yy_migribachf]_ggy
OFFICE OFTHE CIIYCLERK,Raloal E.Granado,CiNy ClokTel:305.673.7411,Fox:305.673.7254
Email:Ci/Clerk@miamiboachfl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO:Mr.Martin Zaiac
RE:Health Facilities Authority Board
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:12/31/2028.
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 mendr mnt
and Code of Ethics for Public Officers and understand that as a member of a City of Miami Beac),ioard
and/or Committee,I must comply with the financial disclosure"requirements of Miami-Dade Co fy or the
State of Florida (depending on the board or committee on which I serve)on July 1st,followiy e clos'
of the calendar year on which I have served.
Sworn to and subscribed before me this.....,.._,_-_day of,.¥_.2024
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.
MIAMIBE
City of Miami Beach
1700 Convention Center Drive
Miami Beach,Florido 33139
RECEIVED
$EP 18 2024
CITY OF MIAMI BEACH
OFFICE Or 'HE CITY CLERK
OFFICE OF THE CITY CLERK
Email:BC@miamibeachfl.gov
Telephone:305.673.7411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
l am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (check (/)all that apply):
D I am a resident of the City of Miami Beach for six months or longer.
l{fP J]][Sb,»
D 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).
[[qt9 9f P[1,]mSS,
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
mi.nimum of six months},t j,••.ff,..J
Name of Business:lJ/l'C :i;,/IA~•,J (/4 ,/~
-sos..for M../1 jar#e
"Ownership Interest"means the ownership of ton percent (10%)or more (including the
ownership of 10%or more of the outstanding capital stock)in a business.
"Business"means any so 'proprietorship,sponsorship,corporation,limited liability company,
or other entity or bi :in asso jation.
Signature
are that I have read the foregoing document and that the facts¢¢1Date
1IA/\1BE
City of Miami Beach
1700 Convention Center Drive
Miami Beach,Florida 33139
www.miamibeachll.gov
OFFICE OF THE CITY CLERK
Email:BC@miamibeachfl,gov
Telephone:305.673.7411
Last Name
DIVERSITY STATISTICS REPORTcFirstName Middle Initial
The following information is voluntary and has no bearing on your consideration for appointment.It is bein
asked to comply with City diversity reporting requirements.
Gender:•L]emateLlotherLlprefer not to answer.
Race/Ethnic Categories:
What is your race?
[African American/BlackLAsianorPacificIslanderLiCaucasian/WhiteLlNativeAmerican/American Indian
[]y Other Print Race.'!□I prefer not to answer.
Do you consider yourself to be Spanish,Hispanic,or Latinola?
ts.JoElprefer not to answer.
Do you consider yourself Physically Disabled?
fl:
W I prefer not to answer this question.
Page 6 of 6
F:CLER\SALLREG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated:June 2020
MAIAMIBEA H
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 ACKNOWLE NT STATEMENTS «d
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(1)(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.Ioneofthefollowingformsmustbe_filed with the City Clerk of Miami Beach,1700 Convention Center Driv,
Miami Beach,Florida,no later than 12:00 noon of July 1,of each year:
1.A "Source of Income Statement;"or
2.A Copy of your latest Federal Income Tax Return.
Members of the Planning.Board and th.e Board of Adjustm.ent must electronically file a "Statement of Financ_iilInterests(Form 1)""directly with the Florida Commission on Ethics.
Failure to file one of these.forms,pursu.ant to the Miami-Dade County Cod.e,may subject the person to a fl.nlofnomorethan$500,60 days in jail,or both.
Acknowledgment to Comply with Miami Beach Code of Ordinances 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 Statemen.t.of Candidate for..mally .ann·o·uncing candidacy for City elec.tive office.•such filing.with the Ci.1ClerkshallbedeemedatenderofresignationfromtheCityagency,board,or committee.
Acknowledgment to Comply with Miami Beach Code of Ordinances Sec.2-22 (24)
I understand that if l am engaged to provid Services,for compensation,to either (1)a candidate for City elected
office,or (2)a political committee or eleSneering communications organization expending funds for or against
candidates for City elected off ,s ng;1ement shall be deemed a tender of resignation from the City
agency,board,or committee.
Signature Date
1 Members of the Plannj'Board and Board of Adjustment will be notified directly by the State of Florida,
pursuant to F.S.$112.3;(5(1)(a),to electronically file a Statement of Financial Interests (Form 1)with the Florida
Commission on Ethics by 12:00 noon,July 1.Planning Board and Board of Adjustment members who file their
Form 1 with the Florida Commission on Ethics 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.
Page 6 of 6
F:\CLER\SALL\BOARD AND COMMITTEES DATABASE\Board and Committee Application\BOARD AND COMMITTEE APPLICATION JULY 2024.d0cx
Updated:July 2,2024
MIAMl·DADE.EIII 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 Istofeveryyear.
Disclosure for Tax Year Ending Last lame
2023 nc
a#7"7#%"%2.7
city,State,Zip
Middle Name/initial/ut
lf your home address is your mailing address,and your ome address is exempt from public records pursuant to Fla.Stat.$119.07,read
instructions on the following page and check here.[]
Filing as an Employee (check one)
[]County []Public Heath Trust [Municipal:
(Municipality)
Department
Position or Title Employee ID Number
Work address Work telephone Employment began on/ended on /
Filing as a Board Wember (check one)
[]county []Municipat:
(Municipality)
Board where serving
Alternate address (if home address is exempt)Wu telephoner3my 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 ofincomeindescendingorder,with the largest source first,Examples of sources of income include:compensation for services,income from business,gains frompropertydealings,interest,rents,dividends,pensions,IRA distributions,and social security payments.Also,include any source of income received by anothgrpersonforyourbenefit.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
%4r
9n Etc'1 3y4
RECEIVED BY ELECTIONS DEPARTMENT:tor«cE.CEIVED
I]Electronic Copy
$EP 1 8 2024
CITY OF MIAMI BEACH
OFFICE Or HF CITY CLERK
OFFICE USE ONLY Accepted:}N Deficiency.Processed Date/initials:Scanned Date/initials.
138_SP-14 COE 2016
/V\IA/V\I BECityofMiamiBeach,PARKING DEPARTMENT
1755 Meridian Avenue,Suite 200 Miami Beach,FL 33139/Ph:(305)673-7505 0r (305)673-7000 ext.6200
BOARD &COMMITTEES
PARKING APPLICATION
As a Board/Committee 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 Membership,or
discounted MDC Monthly Transit Pass throughout your term.
Board Member Information
Date of Application:
Applicant Name:
Work Phone:Home Phone:
cePnone:?er -fr-9if Preferred Contact Method:Te,2J Mr r«
itywide Parking Permit/G7 Access Card (]Citi Bike/Deco Bike Membership [(}MDC Monthly Transit Pas
ootool.td oooet
Vehicle Information 'For Citywide Parkin Permit/Access Card Onl
Tog:PJ-03 Color.
State:
Make:
Year:
Model:
A citywide (CW)parking permit is honored at metered parking spaces and restricted residential zone
pa,rking spa.ce.s..A CW.parking permit IS NOT honored in prohibited areas.An Access Card will blprovidedtoyouforCityHallGarage(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
informatio.n may le~d tot.he issuance o.f parking citation(s)and/or the lowing of .your ve.hicle.~I
Please note that this new access card CANNOT be hole-punched or perforated in any manner.To us
the new card please hold the card at close proximity to the reader until the gate opens.You ma
need to try the other side of the card.Please ensure you hold the entire surface of the card agains
the reader until the gate opens.
ACKNOWLEDGEMENT:I acknowledge th
responsible to pay a $10.00 replacem
A "mature:es
Please provide signed for
Working hours are 8:30 to 5:
e-mail sub1ect:BO
my access card be lost,stolen or damage,I will b
g Department located at 1755 Meridian Avenue,2d floor
or email to:ParkingReception@miamibegchfL.gov
&COMMITTEE PARKING APPLICATION -APPLICANT NAME
f:\ping\$ran\rat\forms\cwboards&committees parkingfom,doc torn updated 1{18/2024