Ivan Cano 12/31/2014 City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida.33139,www.miamibeachfl.aov
OFFICE OF THE CITY CLERK, Rafael Granada,City Clerk
Tel: (305)673-7411, Fax: (305) 673-7254
Email CityClerk @miamibeoch.gov
06-11-2013
Ivan Cano
1300 Ocean Drive #3A
Miami Beach, Florida 33139
SUBJECT_ Hispanic Affairs Committee
Congratulations! You have been appointed by Commissioner Jerry Libbin
to the agency, board or committee named above for a term ending: 1213112014.
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,
or
Rafael E. Granado
City Clerk
cc: Saul Frances, Parking Director
Nannette Rodriguez
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.
MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139,www.miamibeachfl.gov
OFFICE OF THE CITY CLERK, Rafael Granada, City Clerk
Tel: (305)673-7411, Fax: (305)673-7254
Email CityClerk @miamibeach.gov
TO Ivan Cano
RE: Hispanic Affairs 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: 12/31/2014.
1 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 the Florida Commission on Ethics Guide to the Sunshine Amend-
ment 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 ithe 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.
Ivan Cano
Sworn to and subscribed before me this )/ day of , 2013.
Silvia Prieto
Deputy Clerk
`Please visit the City of Miami Beach website at www.miamibeachfi.gov under City Clerk/Board and Comm
for additional information regarding the Financial Disclosure Requirement
We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical,historic community.
MIAMIBOARD AND COMMITTEE APPLICATION FORM
C /\-A() � � (t
Last Name First Name Middle Initial
3o6 n s v� ,.� �/0 3 4�:� ...: N� C 3 3 /-3
Home Address City State Zip Code
3os' 3i J' ,- 2 (-,9 3 IVAtJgCIANo'& e- c1 G.. Ly•c cw�
Home Telephone Work Telephone Cellular Telephone Em addres
11
Business Name Occupation
Business Address City State Zip Code
Professional License(describe): Expires:
q Please attach a copy of currently effective professional license.
Pursuant to City Code section 2-22(4)a & b: Members of agencies, boards and committees shall be affiliated with the City;
this requirement shall be fulfilled in the following ways: a. An individual shall have been a resident of the City for a minimum of six
months; or b. An individual shall demonstrate ownership/interest for a minimum of six months in a business established in the City
for a minimum of six months.
• Resident of Miami Beach for a minimum of six (6) months: Yes Z1 or No
• Demonstrates ownership/interest in a business in Miami Beach for a minimum of six months: Yes 1:3 or Noa
• Are you a registered voter in Miami Beach: Yes M or No ID
• I am now a resident of: North Beach ID South Beach 0 Middle Beach
• I am appl ing for an appointment because I have special abilities, knowledge and experience. Please list below:
• Are you presently a registered lobbyist with the City of Miami Beach?Yes ZI or No
Please list your preferences in order of ranking [1] first choice [2] second choice, and [3] third choice. Please note that
oniv three 3 choices will be observed by the City Clerk's Office.
❑Affordable Housing Advisory Committee ❑ Fine Arts Board ❑ Normandy Shores Local Government
Neighborhood Improvement
❑Art in Public Places Committee ❑ Disability Access Committee ❑Parks and Recreation Facilities Board
❑ Beautification Committee ❑Gay, Lesbian, Bisexual and Transgender ❑ Personnel Board
Enhancement Committee GLBT
❑Bicycle-Pedestrian Advisory Committee ❑Golf Advisory Committee ❑ Planning Board
❑Board of Adjustment* ❑ Health Advisory Committee ❑ Police Citizens Relations Committee
❑Budget Advisory Committee ❑ Health Facilities Authority Board ❑ Production Industry Council
ti ❑Capital Improvements Projects Hispanic Affairs Committee ❑Safety Committee
Oversight Committee
❑Committee on the Homeless ❑ Historic Preservation Board ❑Single Family Residential Review Panel
❑Committee for Quality Education in MB ❑ Housing Authority ❑Sustainability Committee
❑Community Development Advisory ❑ Loan Review Committee ❑Tennis Advisory Committee
❑Community Relations Board ❑ Marine Authority ❑Transportation and Parking Committee
❑Convention Center Advisory Board ❑ Miami Beach Commission for Women ❑Visitor and Convention Authority
❑ Debarment Committee ❑ Miami Beach Cultural Arts Council ❑Youth Center Advisory Board °O
❑ Design Review Board* ❑ Miami Beach Human Rights Committee ❑Waterfront Protection Committee
❑ Miami Beach Sister Cities Program
Page 1 of 4
°O Note: If applying for Youth Center Advisory Board, please indicate your affiliation with the Scott Rakow Youth Center:
1. Past service on the Youth Center Advisory Board: Yes LJ No LJ Dates of Service:
2. Present participation in Youth Center activities by your children:Yes�J No Z3
If yes, please list below the names of your children,their ages and the programs in which they participate:
Child's name: Age: Program:
Child's name: Age: Program:
• Have you ever been convicted of a felony?Yes Ll or No Ga If yes, please explain in detail:
• Do you currently have a violation(s)of City of Miami Beach Code?Yes[_—a or NoLr.;.-JI If yes, please explain in detail:
• Do you currently ow the City of Miami B any money?Yes or No If yes, explain in detail:
•Are you currently serving on any City Board or Committee?Yes or No If yes,which board/committee?
L T
• In what organization(s)in the City of Miami Beach do you currently hold membership?
Name Position
Name Position
• List all properties owned or in which you have an interest within the City of Miami Beach:
•Are you now employed by the City of Miami Beach?Yes ID or No
Which department and title?
• 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.
If"Yes," identify person(s)and department(s): lam/
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 City diversity reporting requirements.
Gender: Male Female
Race/Ethnic Categories
What is your race?
ID African-American/Black
ID Caucasian/White
ID Asian or Pacific Islander
ID Native-American/American Indian
ID Other—Print Race:
Page 2 of 4
Do you consider yourself to be Spanish, Hispanic or Latino/a?Mark the "No"box if not Spanish, Hispanic, Latino/a.
No
4—l-I Yes
Do you consider yourself Physically Disabled?
I�No
�l Yes
NOTE: IF APPOINTED,YOU WILL BE REQUIRED TO FOLLOW CERTAIN LAWS THAT APPLY TO CITY BOARD/COMMITTEE
MEMBERS.THESE LAWS INCLUDE, BUT ARE NOT LIMITED TO:
• 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).
o Prohibition from lobbying before the 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).
• 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).
• Sunshine Law - Florida's Government-in-the-Sunshine Law was enacted in 1967. Today, the Sunshine Law regarding open
government can be found in Chapter 286 of the Florida Statutes. These statutes establish a basic right of`access to most
meetings of boards,commissions and other governing bodies of state and local governmental agencies or authorities.
• Voting conflict–Form 813 is for use by any person serving at the county, city or other local level of government on an appointed or
elected board, council, commission, authority or committee. It applies equally to members of advisory and non-advisory bodies
who are presented with a voting conflict of interest under Section 112.3143, Florida Statutes.
Upon request, copies of these laws may be obtained from the City Clerk.
I HEREBY ATTEST TO THE ACCURACY AND TRUTHFULNESS OF THE APPLICATION; AND I HAVE RECEIVED, READ AND
WILL ABIDE BY CHAPTER 2, ARTICLE VII, OF THE MIAMI BEACH CITY CODE, ENTITLED "STANDARDS OF CONDUCT FOR
CITY OFFICERS, EMPLOYEES AND AGENCY MEMBERS AND ALL OTHER APPLICABLE COUNTY AND/OR STATE LAWS AND
STATUTES ACCORDINGLY."
L,6 Zcl 3 1
Applicant's S' ature Dat Na a of Applicant(PLEASE PRINT)
Received in the City Clerk's Office by J
Na e of 6eKuty Clerk Contr I No. Date
PLEASE REMEMBER TO ATTACH A CURRENT RESUME, PHOTOGRAPH AND A
COPY OF ANY APPLICABLE PROFESSIONAL LICENSE.
ATTACH ADDITIONAL SHEETS, IF NECESSARY, TO PROVIDE REQUIRED
INFORMATION.
Page 3 of 4
MIAMI BEACH
City of Miami Beach
1700 Convention Center Drive,
Miami Beach, Florida 33139,
www.miamibeachfl.gov
CITY CLERK'S OFFICE CityClerk @miamibeachfl.gov
Telephone: 305.673.7411 Fax: 305.673.7254
Acknowledgement of fines/suspension for Bo s for failure to comply with Miami-
Dade County Financial Disclosure Code Provision Code Section 2- 1 ') (2) ,
Board (,-N ame: � .
I under no later than July 1, of each year all members of ards and Committees of the City of
Miami luding those of a purely advisory nature, are re red to comply with Miami-Dade County
Financi re Requirements. This means that the m ers of City Advisory Boards, whose sole or
primary bi i recommend legislation=-or advice to the City Commission, must file, even
though they may=have_been recently_ppeiM
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"
For your convenience, the form is attached. The form can also be downloaded at:
http://www.miamidade.gov/elections/Library/source of income statement.pdf
2. A "Statement of Financial Interests (Form 1)"
For your convenience, the form is attached. The form can also be downloaded at:
http://www.ethics.state.fi.us/ethics/forms.htm1
3. A Copy of your 2012 Federal Income Tax Return
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.
It
Signature Date
F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC Application revised 5-22-13 FINAL.doc
Updated:Thursday,May 30,2013
Page 4 of 4
MIAMI- SOURCE OF INCOME STATEMENT
Disclosure for Tax Year Ending Last Name First Name �tn�olea3/ �t
C Ay\6 kjC- VN G,
Mailing Address—Street Number,Street Name,or P.O.Box
City,State,Zip ID Number
6 , --)►-\ -3 31 31
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.
Filing as an Employee
County Employee Municipal Employee, Name of Municipality:
Position held or sought
Department where employed
Work address Work telephone Term began on
Filing as a Board Member p�
County Board Member ® Municipal Board Member, Name of Municipality: Ca.u,�,;. W.O'J'
Board where serving
Work address Work telephone Term began on
List below every source of income you received,along with the address and the principal activity of each source.Include your public salary.Place
the sources of income in descending order,with the largest source first.Also, include any source of income received by another person for your
benefit. However,the income 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
I hereby swear(or affirm)that the information above is a true and correct statement. RECEIVED BY ELECTIONS DEPARTMENT:
❑ Hardcopy
pp ❑ Electronic Copy
Si re of person disclosing
Print name Date signed
OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/Initials: Scanned Date/Initials:
138 SP-14 2/13