Irene Valines 12/31/2012 City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeach[l.gov
OFFICE OF THE CITY CLERK, Rafael Granada, City Clerk
Tel: (305) 673-7411, Fax: (305) 673-7254
06-18-2012
Irene Valines
5333 Collins Ave. Apt. #1009
Miami Beach, Florida 33140
=SUBJECT ] Safety Committee
Congratulations! You have been appointed by Commissioner Ed Tobin
to the agency, board or committee named above for a term ending: 12/31/2012.
Pursuant to Ordinance No. 2006-3543, commencing with terms beginning on or after
January 1, 2007, the term of board members who are directly appointed by a member of
the City Commission shall automatically expire on December 31 of the year the appointing
elected official leaves office.
If you are unable to accept this appointment or have any questions, please call the
City Clerk's Office at 305-673-7411. Please read the enclosed materials carefully.
Congratulations again and good luck.
Sincerely,
R ael E. Granado
City Clerk
cc: Saul Frances, Parking Director
Clifton Leonard
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 Employee
We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community.
MIAMI BEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139 WWW.miamibeachfl.gov
OFFICE OF THE CITY CLERK, Rafael E. Granada, City Clerk
Tel: ►305►673-7411, Faz:.i305i 673-7254 Email: CiyClerk @miamibeachfl.gov
TO: Irene Valine's
RE: Safety Committee
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: 12/31/2012.
I have been issued a copy of Section 2-11.1 of the Miami-Dade County Code (Conflict of Code of
Ethics Ordinance), as well as the Florida Commission on Ethics Guide to the Sunshine
Amendment and Code of Ethics for Public Officers and Employees, 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 1, following the-closing of the calendar year on which I have
served.
V
Irene Valines
Sworn to and subscribed, before me this��day of 12012.
Silvia Prieto
Deputy Clerk
*Please visit the City of Miami Beach website at www.miamibeachfl:eov under City Clerk/Board and
Committees for additional information.regarding the Financial Disclosure Requirement.
*Have you ever been convicted of a felony: Yes 0 or No If yes, please explain in detail:
• Do you currently have a violation(s) of City of Miami Beach codes: Yes ❑ or No cvflyes, please explain in detail:
• Do you currently owe the City of Miami Beach any money: Yes ❑ or No X/If yes, explain in detail
• Are you currently serving on any City Boards or Committees: Yes❑or No to If yes; which board?
• What organizations in the City of Kamp* Beach do you currently hold membership 1 ?
Name:
01 1 ' [ MC.t \ O itlp-:
Name: er i e.
.. List all properties owned or have an interest in, which are located within the City of Mia i Beach:
011
• I am now employed by the City of Miami Beach: Yes ❑or NV. Which department?
• Pursuant to City Code Section 2-25(b): Do you have a parent❑, spouse❑, child❑, brother❑, or sister❑who is employed by the
City of Miami Beach?Check all that apply. Identify the department(s): Ey )A
The following Information is voluntary and is neither part of your application nor has any bearing on your consideration for appointment. It Is
being asked to comply with federal equal opportunity reporting requirements.
Gender: ❑ Male 9 emale
7 h1is Origin: Check one only(1)
te (Not of Hispanic Origin):All persons having origins in any of the original peoples of Europe,North Africa or the Middle East.
❑ African-American/Black (Not of Hispanic Origin):All persons having origins in any of the Black racial groups of Africa.
❑Hispanic: All persons of Mexican,Puerto Rican,Cuban,Central or South American,or other Spanish culture or origin,regardless of race.
❑Asian or Pacific Islander:All persons having origins in any of the original peoples of the Far East,Southeast Asia,the Indian Subcontinent,on
the Pacific Islands. This area includes,for example,China,India,Japan,Korea,the Philippine Islands and Somoa.
❑American Indian or Alaskan Native: All persons having origins in any of the original peoples of North America,and who maintain
Cultural identification through tribal affiliation or community recognition.
Physically Challenged: Yes❑or No❑.
Employment Status: Employed 0 Retired❑ Homemaker Other❑
NOTE: If appointed,you will be required to follow certain laws which apply to city board/committee members.
These laws include, but are not limited to,the following:
• Prohibition from directly or indirectly lobbying city personnel(Miami Beach City Code section 2-459).
• Prohibition from contracting with the city(Miami-Dade County Code section 2-11.1).
• Prohibition from lobbying before board/committee you have served on for period of one year after leaving office (Miami
Beach City Code section 2-26).
• Requirement to disclose certain financial interests and gifts(Miami-Dade County Code section 2-11.1).
(re: CMB Community Development Advisory Committee): prohibition, during tenure and for one year after leaving office,
from having any interest in or receiving any benefit from Community Development Block Grant funds for either yourself,
or those with whom you have business or immediate family ties(CFR 570.611).
Upon request, copies of these laws may be obtained from the City Clerk.
"l,hereby attest to the accuracy and truthfulness of the application and have received, read and will abide by Chapter 2,
re-
'tie VII— f e City Code"Standards of Conduct for City Officers, Empll-o—yeeesjnd Agency Me be s."
Alfplicant's Signature Date Name of Applicant(PLEASE PRINT)
Received in the City Clerk's Office by: Date:_/ 12010 Control No. Date:_/_/2010
Name of Deputy Clerk
�I
MIAMI
MMO SOUR OF INCOME .STATEMENT
Please.Print.or7ype First Name middle Name Initial Last Name Disclosure
For'Tax Year
VC I e 5 Ending:
Name:
mailing address; 3� �-tJ��1 A 1kQ-
Cit7r/State/.Zip:
1►011i FL IttO
Social.Security Number: - i
Filing as a: ® County Employee:
® municipal Employee of: +,, c
Position held or sought: i ' I I Qi'n i B ea�A l \e- Cayir 1 f��
Board where serving: Comm f �.� .3e ar Employment
�8ega n.aR:
Department-where employed:
Work Address: I�
Ifyour home address is exempt from public records pursuant to WOrl�Tele hvrle: N
Fiarids Statutes 1119.137 pisase check here(reed instruatioms); P
Horne Address:
Street Address
City .State. Zip Code
Please list bellow in descending.order with the largest source first; the name, address and
principal business act'rvlty of every source of your'income including public salary you
received or any person received for your.benefit.or use during the disclosure period. ?he
income of your spouse or-any.business partner need not be.disclosed. If continued.an a
separate sheet,.check here:
Descri ion of-the Principal
Name of Source of Income Address B 5iness.Activ
T hersby swear (:or affirn-o)that the aforesaid information ism true•and morrect statement.
--�1- —
.signature of person.disciosr;ng Date signed
J
MIAMI BEACH
City of Miami Beach,
1 700 Convention Center Drive,
Miami Beach,Florida 33139,
www.miamibeochfl.aov
CITY CLERK Office CityClerk @miomibeochfl.gov
Tel:305.673.7411 , Fax:305.673.7254
Acknowledgement of fines/suspension for Board Members for failure to comply with Miami-
Dade County Financial Disclosure Code Provision Code Section 2-11 .1(i) (2)
Board Member name: ��1/\eJ1�11� c� 6 ri e_s
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
Disclosure Requirements. This means that the members of City Advisory Boards, whose sole or primary
responsibility is to recommend legislation or give advice to the City Commission, must file, even though you
may have been recently appointed.
You must file one of the following with the City Cierk of Miami Beach, 1700 Convention Center Drive,
Miami Beach, Florida, by July 1 each year.
1. A "Source of Income Statement" (attached) or
2. A "Financial Statement" (attached( or]
3. A Copy of the person's current Federal Income Tax Return
Failure to file, according to the Miami-Dade County Code Chapter 1, General Provision,
Section 1-5 may subject the person or firm to a fine not to exceed $500.00 or by imprisonment
in the county jail for a period not to exceed sixty days, or both.
C-)(o fly, bo a
Signature: Date:
F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC Application.doc