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Veronica Camacho 12/31/2015 K—� City of Miami Beach 1700 Convention Center Drive,Miami Beach' Florida 33139, OFFICE OF THE[nr cLsm( Rafael Grono6o City Clerk Tel: (30J)ur3-741l' Fax: (305)o73-7254 01-13-2014 ' Veronica Camaoho 1OOO South Poine Drive#1Q02 Miami Beach, Florida 33139 Hispanic Affairs Committee Congratulations! You have been appointed b« Commissioner Joy Malakoff to the ogenoy, board or committee named above for eterm ending: 12/31/2015. Pursuant tmOrdinance No. 2OO8-3543' commencing with terms beginning onorafter January 1, 2007, the term of board members who are directly appointed by a member of the City Commission ahe|| 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 queationo, please call the City Clerk's Office at 305-673-7411. P|memm read the enclosed materials carefully. Congratulations again and good luck. Sincerely, Rifae| E. Gnanddo City Clerk � cc: Saul Frances, Parking Director Nannette Rodriguez ATTACHMENTS: Letter of Appointment Oath City Code/Ordinance section opp|ioob|o to agenoy, board or committee City Code Section 2'22, 2'23, 2-24, 2'25, 2-20. 2-458 and 2-459 Ordinance No. 2000'3543 -Amondrnent to City Code Section 2-22 Miami-Dade County Coda Section 2-11.1 -Conflict of Interest and Code of Ethics Ordinance City Wide Permit Application -(Park|ng Department Form) Booh|at-Guide to the Sunshine Amendment and Coda 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 Granado,City Clerk Tel:(305)673-7411,Fax:(305)673-7254 TO: Veronica Camacho 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: 12/31/2015. 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 Offl'cers and u ndersta nd 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 st, following the closing of the calendar year on which I have served. Veronica Camacho Sworn to and subscribed before me this C7 day of �-� �� 2014 w R G� Silvia Prieto 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. We are cgTmi�ed to��o�'dinn�exdcelentAu is of 'n,and s�fet tc�all wl�o Ifve, workk anti play in our.vibrp►�t pro�ir�al historic cot1�►munity. e a com i e 10 ,n9 exc en u is service an so o all w o eve, wor,on a m our vibran, rd :c ustonc commune A � t' MIAMI BEACH RO A P.D A N =tIT Ax 'is _ A'_ <o�,J .' CAM CA 0 Veron ( nq I C I cl, Last Name First Name Middle Initial �D ryitan( &ec(_ch R, Home Address �Ciity, q 2 State Zip Code 3�3 �3 Home Telephone Work Telephone Cellular Telephone Email address CL V,erc� I66 P.Q a Business Name Occupation Business Address I �� City /� ;� State Zip Code Professional License(describe): 242AC-d �S J�fk _.Y:� ) J �tOU(-u-r—Expires: 3 6, 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 or No • Demonstrates ownership/interest in a business in mi Beach for a minimum of six months: Yes 411 or No • Are ou registered voter in Miami Beach: Yes�or No Y 9 • I am now a resident of: North Beach Zh South Beach Middle Beach • I am applying for an appointment because I have special abilities, knowledge d experience. Please list below: - ,(� L 1 rC 1 1� I u S GrS d V I << Ce- tO b-e-CCrn-t Y eW�-e- i rt✓&IY-e (r- rr\-,y • 66m rrW n 1E , Are you presently a r eg i ste r ed lobbyist ist with the City of Miami Beach? Yes or No , Please list your preferences in order of ranking [1] first choice [2] second choice, and [3] third choice. Please note that only three 3 choices will be observed by the City Clerk's Office. ❑Ad Hoc Charter Review and Revision Board ❑Debarment Committee 0 Miami Beach Human Rights Committee ❑Ad Hoc Committee Centennial Celebration ❑Design Review Board* ❑Miami Beach Sister Cities Program 0 Ad Hoc Committee Flooding Task Force ❑Disability Access Committee ❑Normandy Shores Local Government Neighborhood Improvement 0 Affordable Housing Advisory Committee ❑Fine Arts Board ❑Parks and Recreation Facilities Boar _ . rt in Public Places Committee ❑Gay,Lesbian,Bisexual and Transgender ❑Personnel Board 7. Enhancement Committee GLBT Beautification Committee ❑Golf Advisory Committee ❑Planning Board ❑Bicycle-Pedestrian Adviso Committee 0 Health Advisory Committee 0 Police Citizens Relations Committee ❑Board of Adjustment* ❑Health.Facilities Authority Board ___ _ ______ _❑.Prod uction_Ind ust ._Council... ❑Budget Advisory Committee glispanic Affairs Committee 0 Safety Committee 0 Capital Improvements Projects Oversight ❑Historic Preservation Board ❑Single Family Residential Review Panel Committee 0 Committee on the Homeless ❑Housing Authority ❑Sustainability Committee ❑Committee for Quality Education in MB ❑Loan Review Committee ❑Tennis Advisory Committee 0 Community Development Advisory Committee ❑Marine Authority ❑Transportation and Parking Committee 0 Community Relations Board 0 Miami Beach Commission for Women ❑Visitor and Convention Authority ❑Convention Center Advisory Board ❑Miami Beach Cultural Arts Council ❑Youth Center Advisory Board ❑Waterfront Protection Committee * Board members are required to file Form 1 -"Statement of Financial Interest"with the State. If you seek appointment to a professional seat (e.g., lawyer, architect, etc.) on the Board of Adjustment, Design Review Board, Historic Preservation Board or Planning Board, attach a copy of your currently-effectively license, and furnish the following information: P-4-6 i 65+c5c-2: saw S Type of Professional License hr S 50 G1Ci-74=1. License Number S L I (ol 3 License Issuance Date i + + 3 �-O License Expiration Date <,.Le0 � o Page 1 of 4 -� F:\CLER\$ALL\aFORMSr\BOARD AND COMMITTEES\BC APPLICATION 46 BOARDS 12-16-2013.doc -rte C/� ` `� CQ 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 U No Dates of Service: 2. Present participation in Youth Center activities by your children: Yes U No 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 U or No 10 If yes, please explain in detail: • Do you currently have a violation(s)of City of Miami Beach Code?Yes 0 or N If yes, please explain in detail: • Do you currently owe the City of Miami Beach any money?Yes U or No U If yes, explain in detail: •Are you currently serving on any City Board or Committee?Yes ID or No If yes,which board/committee? • 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 CD or No 4t1 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): 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 U Female Race/Ethnic Categories What is your race? ID African-Am erican/B lack I Caucasian/White Asian or Pacific Islander ative-American/American Indian I Other—Print Race: G Page 2 of 4 F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION 46 BOARDS 12-16-2013.doc Do you onsider yourself to be Spanish, Hispanic or Latino/a? Mark the"No"box if not Spanish, Hispanic, Latino/a. Yes Do you consider yourself Physically Disabled? &No ZI 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). • 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 8B 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 ACCORDING of 01fal 14 V , I cc P. C6 che pplicant's Signature Dat Name of Applicant(PLEASE PRINT) z .7 Received in the City lerk's Office by: v 33 Y / Name of Deputy Clerk Control No. 6ate 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 F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION 46 BOARDS 12-16-2013.doc fv A/M 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 Board/Committee Members for failure to comply with Miami- Dade County Financial Disclosure Code Provision Code Section 2-11.1(i) (2) 9 Board Member's Name: c C- 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. 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 they may have been recently appointed. 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: hftp://www.ethics.state.fl.us/ethics/forms.htmi 3. A Copy of your 2013 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$500160 days in jail or-bofh. S nature Ddte Updated:Monday,December 16,2013 Page 4 of 4 F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION 46 BOARDS 12-16-2013.doc STATE OF FLORIDA -- -F- o� DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION r• - DIVISION OF REAL ESTATE 850-487-1395 1940 N. MONROE ST. •� � - TALLAHASSEE FL 32399-0783 CAMACHO, VERONICA PATRICIA 1000 SOUTH POINTE DRIVE UNIT 1902 MIAMI BEACH FL 33139 I STATE OF FLORIDA AC# 29713 6 Congratulations! With this license you become one of the nearly one million DEPARTMENT OF BUSINESS AND Floridians licensed by the Department of Business and Professional Regulation. I 6 PROFESSIONAL REGULATION Our professionals and businesses range from architects to yacht brokers,from boxers to barbeque restaurants,and they keep Florida's economy strong. I SL3 216 2 3 5 08/23/12 12 8 0 515 7 8 Every day we work to improve the way we do business in order to serve you bette4 For information about our services,please log onto www.myfloridalicense.com. REAL. ESTATE SALES ASSOCIATE There you can find more information about our divisions and the regulations that CAMACHO,- VERONICA PATRICIA impact you,subscribe to department newsletters and learn more about the Department's initiatives. Our mission at the Department is:License Efficiently,Regulate Fairly.We constantly strive to serve you better so that you can serve your customers. IS LICENSED under the provisions of-ch.475 Fs. Thank you for doing business in Florida,and congratulations on your new license! Expiration date:-SEP. 30, 2014 L12082302892 DETACH HERE THIS DOCUMENT HAS A COLORED BACKGROUND AC#629716;. � ��--. � � _ STATE OF FLORIDA DEPARTMENT OF .BUSINESS AND PROFESSIONAL REGULATION `DEPAR ! DIVISION OF REAL ESTATE SEQ#L12082302892 . . - LICENSE NBR 108/23/2012 1.128051578 ISL3216215 The SALES ASSOCIATE Named: below -IS LICENSED Under the provisions of " Chapter 475 FS. - - Expiration date: SEP.-.30,.: 2014 CAMACHO: VERONICA PATRICIA I 1000 SOUTH ..POINTE DRIVE UNIT 1902 MIAMI BEACH FL. 33139 f RICK SCOTT KEN LAWSON GOVERNOR SECRETARY D15PLAY-A5 REQUIRED BY LAW s NCV� • - } �• r0 ` Z N 7: ca N �+ O p r > Ll u' No . k "' °iADE SOURCE OF INCOME STATEMENT Disclosure for Tax Year Ending Last a First Name Middle Name/Initial -'1XR4 L' /'�// C14 \--- 1 :7 V Mailing Address—Street Number,Street Name,or P.O.Box City,State,Zip ID Number 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.F] 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 ❑ County Board Member Municipal Board Member, Name of Municipality: 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 -V 6-Or nz I hereby swear(or affirm)that the information above is a true and correct statement. RECEIVED BY ELECTIONS DEPARTMENT. ❑ Hardcopy ❑ Electronic Copy Signature of person disclosing Co C Print name Date signed OFFICE USE ONLY Accepted: Y/ N Deficiency: Processed Date/Initials: Scanned Date/Initials: 138 SP-14 2/13 N\I ANA I B EAC H City of Micmi Beach, 1700 Convention Center Drive, Miami Beach,Florida 33139, �MN.miamibeacnA.cov CITY CLERK Office CihjClerk@miamibeachfl.gov Tel:305.673.741 1 ,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 2-1 1.1(i) (2) Board Member name: 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 thatthe members of City Advisors 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 Clerk of Miami Beach, 1700 Convention Center Drive, Miami Beach; Florida, by July 1, 2010. 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. ignature: Date: