Hilda M. Fernandez June 2012 i
Form 9 QUARTERLY'GIFT DISCLOSURE
(GIFTS OVER $100)
LAST NAME--FIRST NAME-MIDDLE NAME: NAME OF AGENCY:
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MAILING ADDRESS: OFFICE OR POSITION HELD:
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CITY: ZIP: COUNTY:A11A y P Pfibi FOR QUARTE�ENDING(CHECK ONE): YEAR
❑MARCH UJUNE ❑SEPTEMBER ❑DECEMBER 20_Lf-
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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
mod. * 3evwjes a-'-- Pc). &x 72-W40
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❑ CHECK HERE IF CONTINUED ON SEPARATE SHEET �-
PART R—RECEIPT PROVIDED BY PERSON MAKING THE GIFT = w 71
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(&thailzceiptfi this
form.You may attach an explanation of any differences between the information disclosed on this form and the informat�on the receipt.
❑ CHECK HERE IF A RECEIPT IS ATTACHED TO THIS FORMS C.J
PART C—OATH
I,the person whose name appears at the beginning of this form,do STATE OF FLORIDA
COUNTY OF M;I A-M I-
depose on oath or affirmation and say that the information disclosed Sworn to Sor affirmed)and suAscribed before me this
12 day of \j LL n-e . 20
herein and on any attachments made by me constitutes a true accurate,
by
and total listing of all gifts required to be reported by Section 112.3148, i
tt
Florida Statutes. @*turgpt t§Wp of orida)
EXPIRES:September 26,2014
QV51 •;�~� Bonded Thru Notary Public Underwriters
(Print,Tyo NWAW 15WERFIR90y Public)
SIGNA RE OF REPORTING OFFICIAL Personally Known OR Produced Identification
Type of Identification Produced
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:3600 Maclay Blvd.South,Suite 201,Tallahassee,Florida 32312.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 (See reverse side for instructions)
Refreshments
USA
GORKI DE LOS SANTOS P.O.BOX 723040
PUBLIC AFFAIRS&COMMUNICATIONS MANAGER ATLANTA,GA 31139-0040
954-985-5024
G D E L O S S ANTO S @COCA-CO LA.COM
June 5, 2012
Assistant City Manager Hilda Fernandez
City of Miami Beach—City Hall
1700 Convention Center Drive
Miami Beach, FL 33139
Re: Gift Reporting
Dear Assistant City Manager Fernandez:
Thank you for joining us to commemorate the new partnership between Coca-Cola and the City
of Miami Beach on March 22. We are proud of our efforts in Miami Beach and we are grateful
.for your support.
It has come to our attention that the food and beverage at this event, $71.89 per person, is
considered a gift under Section 112.3148, Florida Statutes, and thus we are required to report it
to the Florida Commission on Ethics. We sincerely apologize for not providing you this
information in advance, but hope that you appreciate our need to strictly comply with the letter
of the law.
If you have any questions,please feel free to contact me at 954-985-5024.
Sincerely,
or i De Los Santos
CC:
Mayor Mattie Herrera Bower
City Manager Jorge Gonzalez
City Commissioner Jerry Libbin
City Commissioner Michael Gongora
Director of Housing & Community Development Anna Parekh
Development Coordinator Mariu Saralegui Emmons