John Ospitia 12.31.26+
MIA\M/BEACH
BOA R D A ND COMMITTEE CHECKLIST
aPPorEe.Joho Cspit e
BOARD/COMMITTEE:}[he(A _P o @ .
DATE OF APPOINTMENT..4.2{
Appointed y.M?yo/Ok/_vie2
FOR SCANNER
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RECEIVED
NOV 20 2024
CITY O F MIAMI BEACH
FFIQE O F TE CITY CLERK
FOR CLERK STAFF
o Letter of Appointment TERM END:(2.t .lg TERMLuMrT:(2.8[.l
o Letter of Reappointment f
o Copy of Letter of Appointment/Reappointment e-mailed to Cgmqittee Liaison on o222{
o Board and Committee Application (Completed on ••_)
o Resume/Curriculum Vitae
o Diversity Statistics Reporting (Completed on _[_-2o[_y
o Oath
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
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Scan o
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 ro unds 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 fro m 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 fro m the date of removal.
Received on:\d2o.2t sores»
Date oa~ommittee Member
Processed o:\l.Z'yEmployee V.lo
Date City Clerk's Office Staff Initials
WVe are com m itted to providing excellent public service and salety lo all who live,work,and play in our vibrant,tropical,historic community.
MIAMI BEACH
C ity of M ia m i Be a ch ,1/0O Convention Contor Drive,Miami Beach,Florida 33 139 yNyyyy_miamiboachf]go
OFFICE OF THE CITY CIERK,Rafael E.Granado,City Clerk
Tl:305.673.7411,Fa€305.673.7254
Email:CiNyClerk @m iamibeach ll.gov
December 17,2024
Mr.John Ospitia
6940 Bay Drive Apt #8
Miami Beach,FL 33139
SUBJECT:Sister Cities Program
Congratulations!You have been reappointed by Mayor Steven Meiner 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 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 305.673.7411.Please read the enclosed materials carefully.
Congratulations and good luck.
Regards,7at
Rafael Granado
City Clerk
cc:Jose Gonzalez,Parking Director
Heather Shaw,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 W ide Permit Applica tion -(Parking Department Form)
Booklet -Guide to the Sunshine Amendment and Code of Ethics for Public Officers and Employees
MIAMIBEACH
City of M iam i Beach,17OO Convention Center Dr iv e,Mia m i Beach,Florid a 33 139 yyyy _m iam ibea chfl_gov
OFFICE OF THE CITY CLERK,Rafae l E.Granado,City Clerk
Tel:305.673.7411,Fax€305.673.7254
Ema il:C i/Cl erk @m iam ibeac hfl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO:Mr.John Ospitia
RE:Sister Cities Program
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:12/31/2026.
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 Jul 1st,following the closing
of the calendar year on which I have served.
Sworn to and subscribed before me this 20 day of Dec ,2024z-Alice Lavado
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.
MIAMI BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach,Florida 33139
OFFICE OF THE CITY CLERK
Email:BC@miamibeachfl.gov
Telephone:305 .673 .7 411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
RECEIVED
NOV 20 2024
CITY OF MIAMI BEACH
OFFICE OF THE CIT CLERK
I am in com pliance with the affi liation require ment of Miami Beach City Code Sections 2-22 (4),
as (check (✓)a II that apply):
[%/1am a resident of the City of Miami Beach for six months or longer.
Home A@ares ._1 a 0 a Dy led_33141
J;2]_1 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).
e re or susness._la(ma/onSr4-eGov
sos»s o s_G14oT,DeAeed33781□I am a full-tim e em ployee of a business (for a minimum of six months)and I am based in an
offi ce or other location of the business that is physically located in Miami Beach (for a
minimum of six months).
Nam e 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 oth r ntity or business association.
ltie of perjury ,I declare that I have read the foregoing document and that the facts
N0u.20-202/
Date05040G-
Printed Nam e
MIAMI BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach,Florida 33139
www_miamibeach[l_gov
OFFICE OF THE CITY CLERK
Email:BC@miamibeachfl.gov
Telephone:305.673.7411
DIVERSITY STATI STICS REPORI
SA
Last Name First Name
1
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:
I0Mate
[l Female0OtherElprefer not to answer.
Race/Ethnic Categories:
What is your race?D African American/BlackAsanoorPacificIslanderECaucasianwhiteDNativeAmerican/American IndianLother-Print Race:-------------□I prefer not to answer.
Do you consider yourself to be Spanish,Hispanic,or Latino/a?
Ev esJoDIprefer not to answer.
Do you consider yourself Physically Disabled?
a v es
~~;refer not to answer this question.
Page 6 of 6
F:IC LE R \$A LLIR E G \B O A R D A N D C O M M ITT E E A P P LI C AT IO N S FIN A L D R A FT SIBO A R D A N D CO M M ITT E E A PP LI C A TIO N REG FIN A L.docx
U pda ted:June 2020
MIAMI BEACH
City of Miami Beach
1700 Convention Center Drive
Miam i Beach,Florida 33139
www .m iam ibeachfl.gov
OFFICE OF THE CITY CLERK
Email:BC@m iamibeach fl_gov
Telephone:305.673.7411
O p@ a
Last Name
BOARD &COMMITTEE ACKNOWLEDGEMENT STATEMENTS
54.
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 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)
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 resignation from the City agency,board,or committee.
Acknowledgment to Comply with Miami Beach Code of Ordinances Sec.2-22 (24)
I understand that if I am engaged to provide services,for compensation,to either (1)a candidate for City elected
office,r (2)a political committee or electioneering communications organization expending funds for or against
candid te for City elected office,such engagement shall be deemed a tender of resignation from the City
rd,or committee.
/0u 20-204
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 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 of6
F:ICLER\$ALL\BOARD AND COMMITTEES DATABASEBoard and Committee Application\BOARD AND COMMITTEE APPLICATION JULY 2024.docx
U pdated :July 2,2024
MIAMI-DADE-EI SOURCE OF INCOME STATEMENT
Section 2-11.1(i)of the County Ethics Code requires that certain em ployees and public offi cials file a financial disclosure Statem ent on a yearly basis by July 1st
of every year.
Disclosure for Tax Year Ending I Last Name ""T.Middle Name/Initial
2023 OP/+to
Mailing Address -Street Number,Street Name,or P.D.Box )d 26140?as,kiv 33147
City,State,Zip r ,[loud a((0 ,ea H 33/4
If your home address is your mailing address,and your home address is exempt from public records pursuant to Fla.Stat.$119.07,read
instructions on the following page and check here.D
Filing as an Employee (check one)
[]county []Public Health Trust D Municipal:
(M unicipality)
Department
Position or Title Employee ID Number
Work address I Work telephone Employment began on/ended on
Filing as a Board Member (check one)
[]county D Municipal:
(M unicipality )
Board where serving
Alternate address (if home address is exempt)I Work telephone I Term began on/ended on
List below every source of incom e you received,along with the address and the principal activity of each source.Include your public salary.Place the sources of
incom e in descending order,with the largest source first.Exam ples of sources of incom e include:com pensation fo r services,incom e fro m business,gains from
pro perty dealings,interest,rents,dividends,pensions,IRA distributions,and social security payments.Also,include any source of incom e received by another
person for your benefit.However,the incom e 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
Date signed
r (or affirm)that the information above is a true and correct statement.
Person Disclosing
02o24
RECEIVED BY ELECTIONS DEPARTMENT:
Jar«co?ECEIVED
[]Electronic Copy
NOV 20 2024
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
OFFIC E USE ONLY Accepted:Y /N Deficiency.Pro cessed Date/initials:Scanned Date/initials:
138SP-14 COE 2016
MIAMI BEACH
City of Miami Beach,PARKING DEPARTMENT
BOARD &COMMITTEES
PARKING APPLICATION
1755 Meridian Avenue,Suite 200 Miami Beach,FL 33139/Ph:(305)673-7505 or (305)673-7000 ext.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,or a
discounted MDC Monthly Transit Pass throughout your term.
Board M em ber Info rm ation
Date of Application:I0U-20 -2024
Applicant Name:Jh Qe#a
Board/Committee Name:Sl/cu#-,(0tao
Address:a4o a»dus I 44A.2>
E-Mail Address:b.+4 (d 5 0 0l o .o
Work Phone:305 50 0 620 Home Phone:
Cell Phone:35 roo 02 0 Preferred Contact Method:ell a/U
Please Choose O ne 1 0 tion:
C ityw id e Par king Pe rm it/G 7 A c c e ss C ar d C iti Bike /D e co Bike M em b e rship
Vehicle Info rmation (For Cityw ide Parking Permit/Access Card O nly)
Tag:Color:
State:Year:
Make:Model:
A citywide (CW)parking permit is honored at metered parking spaces and restricted residential zones
parking spaces.A CW parking permit IS NO T honored in prohibited areas.An Access Card will be
provided to you for City Hall Garage (G7)access.
IM PO RTANT NO TE: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 CANNO T 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.
AC KNO W LEDG EM ENT:I ack ow ledge that should my access card be lost,stolen or dam age,I will be
responsible to pay a $10.00 ·p)1cem ent fee.
A,licant Si [nature:es
Please provide signed fort Parking Department located at 1755 Meridian Avenue,2d floor.
Working hours are 8:30 to 5.00 p.m.or email to:ParkingReception@miam ibeachfl.gov
e-m ail subiect:BO ARD &CO M M ITT EE PARKING APPLICATIO N -APPLIC ANT NAM E
f:\ping\$man\rar\forms\cw boards&committees parkingform.doc form updated 1/18/2024