Michel Tessier 12.31.26MIAMI BEACH
BOARD AND COMMITTEE CHECKLIST
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RECEIVED
NOV 12 2024
CITY OF MIAMI BEACH
F#ICE OF THE CITY CLERK
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FOR CLERK STAFF 3oLetterotAppointmentTERMENr[2.$].TERMuMI \2.3).24
o Letter of Reappointment loCopyofLetterofAppointment/Reappointment e-mailed to Committee Liaison on ][.'.Z>\
o Board and Committee Application (Completed on )
o Resume/Curriculum Vitae \[[,o Diversity Statistics Reporting (Completed on _LL[to [<'_{_yoOath
IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
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
t County Code Section 2-11,1 --Conflict of Interest and Code of Ethics Ordinance (as
amended through December 2010)Y Amendments to the Code of Ethics Ordinance (September 2009 through July 2012)
t Highlights of the Miami-Dade County Ethics CodetSunshineLawandPublicRecords-Frequently Asked Questions
t 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 ot Income Statement
O Acknowledgment Statement
O Board and Committees Liaison Responsibilities
O Diversity Statistics Reporting
l acknowledge that pursuant to Sec.2-22(9)ot the Miami Beach Code ot Ordinances,I will be removed
from my board/committee upon failure to attend 33%of the regularly scheduled meetings.
Sec.2-22(9)lt any member ofan agency,board or committee fails to attn 33 percent of the regularly scheduled
meetings per aiendar 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 mnd.5 or more rounds up to the
next whole number.
NOTE;Members of the Land Use Boards will be removed upon failure to att d three of the regularly scheduled
meetings per calendar year,or upon abstaining from voting due to a flict 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 ot removal
ILle,t.p
Date
Processes or_\L.9._2\
Date
Signed by Jlrl-
Boal or Committee Member
By Employee:---~--_:_L__~_
City Clerk's Office Staff Initials
Received on:
MIAMI BEACH
City of Miami Beach,1/0O Convention Coner Drivo,Miami Boach,Florida 33 139 yywy.miamnibachll.gov
OFFICE OF IHE CITYCLERK,Rafael E.Granado,Cy Clerk
Tel:305.673.7411,Fax.305.673.7254
Email:Ci#yClerk@miamlbeachfl.gov
November 07,2024
Mr.Michel Tessier
1665 Bay Road Unit 325
Miami Beach,Florida 33139
SUBJECT;Disability Access Committee
Congratulations!You have been reappointed by Commissioner David Suarez to the above referenced,
board or committee,for a term ending:12/31/2026.
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 appointmenUelection 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.
Congratulations and good luck.
Regards,
R~ado
City Clerk
cc:Jose Gonzalez,Parking Director
Valeria Mejia,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
City of Miami Beach,/0O Conwowon CG no Dwvo,Mom»Booch,Honda 33139 www.tuigpttacblL.aay
OHKCE OE IHCITY CLERK.,Rafool E Granado,CyClod
Tel 305.6/3.74l1,fax€305 673 7254Eal.CityClel@nlam/boa.hfl go
Oath ot Ottlce
Oath of Civility
and
Acknowledgements
TO:Mr.Michel Tessier
RE:Disability Access Committee
I do solemnly swear or affirm to bear true faith,loyalty and allegiance to the Government of the United
States,the State ot Florida,and the City of Miami Beach,and to perform all the dutles ot 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.12/31/2026.
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 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 closing
of the calendar year on which I have served
Sworn to and subscribed before me this
Please vsit the City ot Miami Beach website at www.miamlbeachf.gov under City Clerk/Board and
Committees for additional information regarding the Financial Disclosure Requirements.
AMI BEACH RECEIVED
City of Miami Beach
1700 Convention Center Drive
Miami Beach,Florida 33139
tu/NOV 12 2024
6,,grnowt cVF77I/9/BY.$pkoFFoEoriiicifvCi
OFFICE OF THE CITY CLERK
Email.BC@miamibeach'l.gov
Telephone:305.673.7411
AFFIDAVITOE AFFILIATION WITH THECITY OE MIAMIBEACH
l am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (check (/)all that apply):
[]1am a resident of the City of Miami Beach for six months or longer.
o.»led;fgp Rao.qt,225
[[1have 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:------------------------
Py]mes ]dress,
[_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).
[}arm9 tf Hynes,S,
[gs/mess dfe8,
"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
stat:d._in Im:!...ei--l'ft#=l 1p2cg
Signature •Date 7
Hi net8leePrintedName
MI MIBEACH
City of Miami Beach
17O0 Convention Center Drive
Miami Beach,Florido 33139ww.miamibeachfl.goy
OFFICE OF THE CITY CLERK
Email:BC@mimibeachf]_gOy
Telephone:305.673.7411
DIVERSITY STATISTICS REPORI
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:
E@Jae
[l remale
oherEliprefer not to answer.
Race/Ethnic Categories:
What is your race?
[African American/Black
[Asian or Pacific Islander
[g Caucasian/whiteLlNativeAmerican/American Indian
[}other --Print Race.»Eli prefer not to answer.
Do you consider yourself to be Spanish,Hispanic,or Latino/a?
vesEnoElprefer not to answer.
Do you consider yourselt Physically Disabled?
ve»
9RoLloreter not to answer this question.
Page 6 ot6
F CLER$ALLREGBOARD ANDCOMMITTEE APPLICATIONS FINAL RAF TSBOARDANDCOMMITTEE APPLICATION REG FINAL.doxUpdatedJune2020
MIAMIBEACH
Clty of Miami Beach
I7OO Convention Center DriveMiamiBeach,Florida 33139
www.,miamibeachfL,gov
OFFICE OF THE CITY CLERK
Email:BC@miamnibeachf\.gov
Telephone:305.673.7411
BOARD &COMMITTEE ACKNOWLEDGEMENT STATEMENTS
1re [curd-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.
9ne of the following forms must be filgd 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 Copy of your latest Federal Income Tax Return.
Members of the Planning Board and the Board of Adjustment must electronically file a "Statement of Financial
Interests (Form 1)"directly with the Florida Commission on Ethics.
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 Sec.2-22 (23)
l 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 CityClerkshallbedeemedatenderofresignationfromtheCityagency,board,or committee.
Acknowledgment to Comply with Miami Beach Code of Ordinances Sec.2-22 (24)
I understand that if l am engaged to provide services,for compensation,to either (1)a candidate for City elected
office,or (2)a political committee or electioneering communications organization expending funds for or againstcandidatesforCityelectedoffice,such engagement shall be deemed a tender of resignation from the City
7-us
Signature .Date
'Members of the Planning Board and Board of Adjustment will be notified directly by the State of Florida,
pursuant to F.S.$112.3145(1)(a),to electronically file a Statement of Financial Interests (Form 1)with the FloridaCommissiononEthicsby12:00 noon,July 1.Planning Board and Board of Adjustment members who file their
Form 1 with the Florida Commission on Ethics automatically satisfy the County's financial disclosure requirementasaMiamiBeachCityBoard/Committee member and need not file an additional form with the Office of the City
Clerk.
Page 6 of 6F:'CLER$ALLBOARD AND COMMITTEES DATABASEBoard and CommitteeApplication\BOARD AND COMMITTEE APPLICATION JULY 2024.d0cxUpdated:July 2,2024
HlAMf..EIII SOURCE OF INCOME STATEMENT
Clear From Print Form
Section 2-11.1(0)ofthe County Ethics Code requires that certain employees and publlce offclals file a financial disclosure Statementon a yearty basis by July 1stofeveryyear.
Disclosure for Tax YearEnding Last Name,.Mlddle Name/inltlalesEt'Gr
lf your home address is your malling address,and your home address ls exempt trom public records pursuant to Fla.Stat.$119.07,read
instructions on the to'lowing page and check here.[]
Filing as an Employee (eheckone)
[]county []Public Health Trust []Municipal:
(Municipality)---Department-Posltlon or Title Employee ID Number
Work address [worktelephone Employment began on/ended on
Filing as a Board Member (check one)
DJ county q neat Et A 6-l1_(esjct-I @iiciailif
Board where serving\7Alternateaddress(ithome address ls exempt)Work telephone136%.9 Term began on/ended on
List below every source of income you received,along with the address and the principal actvtty ot each source.Include your public salary.Place the sources ofincomeindescendingorder,with the largestsource first.Examples of sources of income include:compensation tor servlces,income from business,gains frompropertydealings,Interest,rents,dividends,pensions,IRA distributions,and social security payments.Also,include any source ot Income received by anothgpersontoryourbenefit.However,the income ot your spouse orany business partner need not be disclosed.Itcontinued on a separate sheet,check here.L_]-Name ofSource ot Income Address Description otthe Principal Business Activty-0el«eoTruce Ill£fee HA4 cf?
Signature ot Person Dlsclosing
[L.Itiktaa
above is a true and correct statement.RECEIVED YELECTIONS DEPARTMENT:narc»y RECEIVED
[O Electronic Copy
NOV 12 2024
ITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
FT'P NT SIGN ANI UBMIT A OI HAR
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A/[AAA/ID[\,I Ar"LI
Clly of Mlam/Beach,PARKING DEPARTMENT
BOARD &COMMITTEES
PARKING APPLICATION
1755 Meridian Avenue._suite 200 Mlomi each_FL 33139/Pn:(30.5)673-7505 or [305)_6/3-7000et.6200
aPARKING
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,gr a
discounted MDC Monthly Transit Pass throughout your term.
Board Member [formallon
Date of Application:
Applicant Name:\nv
Board/Committee Name:
Address:
Work Phone:
Cell Phone:Preferred Contact Method:
Please Choose One
Citywide Parking Permit/G7 Access Card Cit Bike/Deco Bike Membership
Vehlcle Information 'For ermit,Access Ca
Tao:5
State:
Make:
color:.Gp.e)/.
Year.7,0225.
Modet:[C O(>
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 $10.00 replacement fee.
A licant Si mnature:as
Please provide signed form to the Parking Department located at 1755 Meridian Avenue,2+floor.
working hours are 8:30 to 5:00 p.m.or email to:PgrklngReception@miamlbeachfl.gov
e-mall subject:BOARD &COMMITTEE PARKING APPLICATION --APPLICANT NAME
tam uu ·te 118/2024