Michael Gongora Form 9 QTR 4 MIAMI BEACH
OFFICE OF THE CITY CLERK
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, FL 33139
www.miamibeachfl.gov
Telephone: 305.673-741 1
March 28, 2019
Florida Commission on Ethics
P.O. Drawer 15709
Tallahassee, FL 32317-5709
Pursuant to Sec. 112.3148, Florida Statutes, please find a Quarterly Gift Disclosure State Form
(9), for the quarter ending December 2018, for the following City of Miami Beach Personnel:
• Michael Gongora —City of Miami Beach (Commissioner)
Should you have any questions or require any additional information, please contact me at
305.673.7411.
Respectfully,
Rafael E. Granado,
City Clerk
Attachment
REG:cd
Sent Certified Return Receipt
9214 8901 9403 8380 8890 68
City of Miami Beach USPS CERTIFIED MAIL
City Clerk
1700 Convention Center Dr
Miami Beach Fl 33139
9214 8901 9403 8380 8890 68
FLORIDA COMMISSION ON ETHICS
PO Box 15709
TALLAHASSEE FL 32317-5709
Fold Here
Return Reference#:State Form 9 Gongora
Username:Charles Dagostin
Code Violation#:
Court Case#:
Property Address::
Permit ID#:
Custom 5:
Postage:$5.6000
Form 9 QUARTERLY GIFT DISCLOSURE
(GIFTS OVER $100)
LAST NAME--FIRST NAME--MIDDLE NAME: NAME OF AGENCY:
Gongora, Michael City of Miami Beach
MAILING ADDRESS: OFFICE OR POSITION HELD:
1700 Convention Center Drive Commissioner- Group III
CITY: ZIP: COUNTY: FOR QUARTER ENDING(CHECK ONE): YEAR
Miami Beach 33139 Miami-Dade ❑MARCH ❑JUNE ❑SEPTEMBER Pi DECEMBER 2018
PART A—STATEMENT OF GIFTS
Please list below each gift,the value of which you believe to exceed$100,accepted by you during the calendar quarter for which this statement is
being filed.You are required to describe the gift and state the monetary value of the gift,the name and address of the person making the gift,and the
date(s)the gift was received.If any of these facts,other than the gift description,are unknown or not applicable,you should so state on the form.As
explained more fully in the instructions on the reverse side of the form,you are not required to disclose gifts from relatives or certain other gifts.You
are not required to file this statement for any calendar quarter during which you did not receive a reportable gift.
DATE DESCRIPTION MONETARY NAME OF PERSON ADDRESS OF PERSON
RECEIVED OF GIFT VALUE MAKING THE GIFT MAKING THE GIFT
Sofitel Bogota Victoria Regia Hotel Accomodations for Keynote ($180 per night)Total: Colombia LGBT Chamber of Commerce Calle 57#10-24 Suite 4040
10/17(�/108 Speaker for Fav of Opportunities and Diverse Businesses. $900
wti7RADE20IS Bogota DC Colombia 110231
11/17/18
Sports Illustrated Celebrity Beach Soccer Charity ($100 per ticket)Total:
Event 5200 Great American Capital 11100 Santa Monica Blvd,
Partners Los Angeles,CA 90025
11/26/18 VIP Art Basel Card ($150 ea$150 Total. Art Basel 236 West 30th Street,6th Floor
New York,NY 10001
11/26/18 VIP Design Miami Card ($95 each card)Total:$95 Design Miami 3841 NE 2nd Avenue,Suite 400
Miami,FL 33137
liti CHECK HERE IF CONTINUED ON SEPARATE SHEET
PART B—RECEIPT PROVIDED BY PERSON MAKING THE GIFT
If any receipt for a gift listed above was provided to you by the person making the gift,you are required to attach a copy of that receipt to this
form.You may attach an explanation of any differences between the information disclosed on this form and the information on the receipt.
❑ CHECK HERE IF A RECEIPT IS ATTACHED TO THIS FORM
PART C—OATH
I,the person whose name appears at the beginning of this form,do STATE OF FLqp,DA
COUNTY OF I p N — PA E. 4.�
depose on oath or affirmation and say that the information disclosed Sworn to(or affirmed)and subscribed before me this 8 LL --u s
day of at L._ ,20 11 `'S8n-g
z „
herein and on any attachments made by me constitutes a true accurate, 0, ,,
by NICr1AeL Gan1,`c W s,a
Z.
and total listing of all gifts required to be reported by Section 112.3148, LL a E r
Fl rida tatut (Signature f Notary ublic-State of Florida) a i l 8 I
2.,....
l
C, (Print,Type,or Stamp mmissioned Name of Notary Public) ;
SI NATURE OF REPORTING OFFICIAL Personally Known OR Produced Identification .r --A,it
Type of Identification Produced -'° ay '
PART D—FILING INSTRUCTIONS
This form,when duly signed and notarized,must be filed with the Commission on Ethics,P.O.Drawer 15709,Tallahassee,Florida 32317-5709;physi-
cal address:325 John Knox Road,Building E,Suite 200,Tallahassee,Florida 32303.The form must be filed no later than the last day of the calendar
quarter that follows the calendar quarter for which this form is filed(For example,if a gift is received in March,it should be disclosed by June 30.)
CE FORM 9-EFF.1/2007(Refer to Rule 34-7.010(1)(g),F.A.C.)(Rev.6/2016) (See reverse side for instructions)r'
Date Description of Gift Monetary Name of Address
Received Value Person
Giving Gift
11/26/2018 Scope Platinum VIP Card ($200 each Scope 452 Baltic
card)-Total: Street, NY
$200 11217
•
11/26/2018 Bass Museum Bag With Various Art $200 Bass 2100 Collins
Show Tickets Museum Ave Miami
Beach, 33139
•
11/28/2018 Gala Dinner of the Diplomatic Flight$620 Malta 14/11,Vincenti
Correspondent of Malta in Paris- and Hotel Council for Building, Strait
Flight and Hotel Accommodations $660 Total: the Street,Valletta,
$1280 Voluntary II-Belta Valletta
Sector VLT1432 Malta
12/15/2018 Bass Museum Ball $1,500 per Bass 2100 Collins
tickert-Total: Museum Ave Miami
$1,500 Beach, 33139