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Alejandro Dominguez 12/31/2015 City of Miami Beach, 1700 Convention Center Drive,Miami Beach,Florida 33139,W&W.miamibeachfl.gov OFFICE OF THE CITY CLERK,Rafael Granado,City Clerk Tel: (305)673-7411,Fax:(305)673-7254 01-21-2014 Alejandro Dominguez 5401 Collins Ave. Apt. 526 Miami Beach, Florida 33140 M � Police Citizens Relations Committee Congratulations! You have been appointed by Mayor Philip Levine to the agency, board or committee named above for a term ending: 12131/2015. 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, Rafael E. Cranado City Clerk cc: Saul Frances, Parking Director ' Chief R. Martinez AT'TACHMENT'S: 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 f=orm) Booklet-Guide to the Sunshine Amendment and Code of Ethics for Public Officers and Employee i We are committed to providing excellent public service and safely to all who live,work and play in our vibrant,tropical,historic community. OD 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 TO Alejandro Dominguez RE: Police Citizens Relations 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. 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 s a member of a City of Miami Beach Board and/or Committee, I must comply wit a financial disclosure equirements of Miami-Dade County or ithe State of Florida (depending on th and or committee on hich I serve) on July 1, following the closing of the calendar year on which I have served. Alejandro Dominguez Sworn to and subscribed before me thisZI day of ' 2014. b�j --mada odwm Deputy Clerk J *Please visit the City of Miami Beach website at www.miamibeachfl.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. CITY OF MIAMI BEACH MIAMI BEACH R D N D Cr f,'XM . 119"T E 'PL.,aI , XrION WVI1 'P NAME: Dominguez Alejandro A Last Name First Name Middle Initial HOME ADDRESS: 526 5401 Collins Avenue Miami Beach FL 33140 Apt No. Home No./Street City State Zip Code PHONE: 3059842148 3053755600 domingueza17 @yahoo.com Home Work Fax Email Address Business Name: Miami-Dade County Legislative Delegation Position: Delegation Director Address: 1032 111 NW 1 st Street Miami FL 33128 No. Street City State Zip Code Professsional License(describe): Expires: Au%ac'h a cosuy bhv.ficense Pursuant to City Code section 2-22(4)a and 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. • Resident of Miami Beach for a minimum of six(6)months: Yes • Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six(6)months: No •Are you a registered voter in Miami Beach.- Yes •(Please circle one): I am now a resident of: Middle Beach • I am applying 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? 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.(Regular Boards of City) Affordable Housing Advisory Committee Loan Review Committee Art in Public Places Committee Marine Authority Beautification Committee Miami Beach Commission for Women Board of Adjustment* Miami Beach Cultural Arts Council Budget Advisory Committee Miami Beach Human Rights Committee Capital Improvements Projects Oversight Committee Miami Beach Sister Cities Program Committee for Quality Education in MB Normandy Shores Local Gov't Neigh.Improvement Committee on the Homeless Parks and Recreation Facilities Board [1] Community Development Advisory Personnel Board Community Relations Board Planning Board* Convention Center Advisory Board [3] Police Citizens Relations Committee Debarment Committee Production Industry Council Design Review Board* Safety Committee Disability Access Committee Single Family Residential Review Panel Fine Arts Board Sustainability Committee Gay,Lesbian,Bisexual and Transgender(GLBT) Tennis Advisory Committee Golf Advisory Committee Transportation and Parking Committee Health Advisory Committee Visitor and Convention Authority Health Facilities Authority Board Waterfront Protection Committee Hispanic Affairs Committee Youth Center Advisory Board [2] Historic Preservation Board Youth Center Advisory Board Housing Authority Note: If applying for Youth Advisory Board, please indicate your affiliation with the Scott Rakow Youth Center: 1. Past service on the Youth Center Advisory Board: No Years of Service: 2. Present participation in Youth Center activities by your children No if yes, please list the names of your children,their ages,and which programs. List below: Child's name: Age: Program: Child's name: Age:_ Program: Have you ever been convicted of a felony: No If yes, please explain in detail: • Do you currently have a violation(s)of City of Miami Beach codes: No If yes, please explain in detail: • Do you currently owe the City of Money Beach any money: No If yes, please explain in detail: •Are you currently serving on any City Boards or Committees: No If yes,which board? •What organizations in the City of Miami Beach do you currently hold membership in? Name: Title: Name: Title: • List all properties owned or have an interest in,which are located within the City of Miami Beach: • I am now employed by the city of Miami Beach: No Which department? • Pursuant to City code Section 2-25(b):do you have a relative who is employed by the City of Miami Beach?Check all that apply. Identify the 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 federal equal opportunity reporting requirements. Gender: Male Ethnic Orgin:Check one only(1) Hispanic Physically Challenged: No Employment Status: Employed 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 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. "I hereby attest to the accuracy and truthfulness of the application and have received,read and will abide by Chapter 2,Article VII—of the City Code"Standards of Conduct for City Officers,Employees and Agency Members." I Alejandro Dominguez agreed to the following terms on 1/25/2013 3:34:53 PM Aft Received in the City Clerk's Office by: Dat / /2013 Control No. Date: Name of Deputy Clerk I i Alejandro (Alex) A. Dominguez 5401 Collins Avenue,Apt. 526,Miami Beach,FL. 33140 ♦ (305)984-2148 dominguezal7 @yahoo.com Experience Miami-Dade County Legislative Delegation Miami, FL. February 2009-Present Delegation Director Serve as liaison between Miami-Dade County Commission and Miami-Dade County Legislative Delegation. Assist the Delegation in formulating public policy initiatives and assessing countywide critical legislative priorities such as meals for senior citizens and funding for community organizations like the League Against Cancer and the University of Miami Center for Autism and Related Disabilities. Work with individual delegation members on projects, issues, and events in Tallahassee and in their districts. Organize and manage delegation meetings on legislative and budgetary priorities. Create and distribute regular communication via the "Delegation Brief'weekly email to delegation members and stakeholders locally and statewide as well as manage communication through social networking sites. Organize, staff, and provide policy information for special Delegation meetings in Tallahassee that address specific issues such as the Port Tunnel Project in 2009. Work with state agency officials to manage Delegation priority issues, such as funding for the Jackson Health System. Work with contract lobbying team and County Attorney's Office to incorporate the Miami-Dade County Commission's critical issues into the Delegation's general priorities. Build and maintain relationships with all Delegation Members; and legislators from around the state, to facilitate policy action. Cuban American National Foundation/Foundation for Human Rights in Cuba Miami, FL. April 2008—February 2009 Director of Fundraising and Membership Development Developed and executed a membership and major donor fundraising strategy that included corporate outreach and donations. Created and managed a list of major donors to facilitate short term and long term fundraising activities and planning. Successfully organized and managed fundraising events such as annual gala and silent auction and annual luncheon. Updated membership development and communication procedures and organized young professional events to promote membership and organization's issues and activities. In the course of planning fundraising activities, effectively integrated.my understanding of the distinctions of 501(c)3 and 501(c)4 organizations. Florida Association of REALTORS@ Tallahassee, FL. February 2007—April 2008 South Florida Political Coordinator Responsible for REALTORS@ Political Action Committee (RPAC) fundraising activities and ensuring local boards followed federal and state fundraising procedures to successfully meet the National Association of REALTORS@ fundraising goal of$2.5 million dollars from Florida in 2007. Worked with Director of Political Operations, RPAC Trustees, local board executives and governmental affairs directors to promote member participation in fundraising activities and grassroots involvement in the political process, with special emphasis on RPAC supported candidates and issue initiatives. Served as field policy liaison to local REALTORS@ boards, worked with REALTORS@ Public Policy Representatives to prepare comprehensive I policy briefings for forums, panels and other presentations to REALTORS and the public, throughout South Florida, with particular focus on the 2007 tax reform initiative. Tom Gallagher for Governor Campaign/Bill McCollum for Attorney General Miami, FL. September 2005—November 2006 Regional Field Director—Miami Dade and Monroe Counties Managed campaign operations in Miami-Dade and Monroe Counties. Organized and managed phone bank operations, volunteer recruitment and goal implementation, incorporated grassroots leadership into daily campaign operations, event planning and advance, coordinated interaction with state and local officials, acted as a surrogate for Tom Gallagher, and Bill McCollum in the general election, at community events. Florida House of Representatives—Speaker's Legislative Fellowship Program Tallahassee, FL. September 2004—July 2005 Legislative Fellow—Local Government Council Served as a technical analyst to committee chair and legislators under the jurisdiction of the House Local Government Council. Researched and prepared staff analyses, reports, legislation, and amendments as well as responded to inquiries from various stakeholders and advocates. Florida House of Representatives-State Representative Julio Robaina Miami, FL. Jan. 2003-Dec. 2003 Legislative Assistant Maintained appointment calendar and organized scheduling of meetings. Assisted constituents through contact with the appropriate federal, state, or local government agencies. Researched and prepared formal correspondence, reports, talking points, issue briefs, speeches, and legislative analyses. Researched relevant issues on an ad hoc basis.Attended local functions or community gatherings within the district. Education Florida State University,Tallahassee, FL. Masters in Public Administration,August 2005 Honors: • Speaker's Fellowship Program—Florida House of Representatives • Pi Alpha Alpha Honor Society—Public Administration Activities: • Public Administration Graduate Association, International Student Representative • Rock the Vote • Volunteer—Bush-Cheney'04—Assisted in general activities and events in Tallahassee statewide campaign headquarters Florida International University, Miami, FL Bachelors in Arts, Psychology, December 2001 Minor in Political Science Honors: • Dean's List: Fall 1998, Fall 1999, Fall 2000, Fall 2001 • Psi Chi Psychology Honor Society, 2001 Activities: • Political activity organizer, FIU law school petition drive • Participated in various community service activities such as fundraising, toy drives and canned food drives • FIU Behavior Analysis Laboratory, Spring 1999 Laboratory Assistant Worked in animal division of Behavior Analysis Laboratory during Stimulus Equivalence study. Conducted experiment schedules with rats and collected and recorded relevant data from the experiment; responsible for care and feeding of animals. Training Miami-Dade County Supervisory Leadership Development Program Miami-Dade County Professional Development Certification Program Miami-Dade County Communications Certificate Program Community Involvement/Organizations History Miami—Flagler Street Society Beacon Council New Leaders Task Force Young Professionals for the Miami Lighthouse for the Blind Committee Member Miami-Dade Metropolitan Planning Organization Bicycle and Pedestrian Advisory Committee National Association of Latino Elected and Appointed Officials Member Miami-Dade County Legislative Days Liaison Board MI®°'ODE SOURCE OF INCOME STATEMENT Disclosure for Tax Year Ending Last Name First Name Middle Name/initial 201 -2)- - '��6 0 m F L)--<--2-- TjgN Mailing Address—Street Numb ,Street Name,or .Box 776- 5,7,Zj,, Ml'&kt4' 06165'4A 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.❑ Filing as an'Employee aunty 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 C� -h r p Work address ST ��� Work telephone Term beg n on 3 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 lvie1),/ Description of the Principal Business Activity i ft'' --�e U n / I Nv� /s .¢�7" 3310 equ I!4 ✓N I hereby swear(or affirm)t —�- above is a t ue and correct statement. RECEIVED BY ELECTIONS DEPARTMENT: ❑Hardcopy ❑ Electronic Copy Signature of person disclosing ale j-'q�j D 6?'D 0 6: / 0 Print name Datt sign d OFFICE USE ONLY Accepted: Y/ Pl Detid'-ncr: Processed Scanned Date/Initials: '133-SP-14 2/13 I t k -A"`H /V\/kdB E City cf Warri Beach, 1700 Convention Center Drive, Miami Beaclh,Flcrida 33 139, n is n i^eac n 7.cv,, CITV, CIEQKOf�ic CiyClerk @micmibeacncl.gov 'Tel:305.67 3.7 41 1 ,Fcx:305.673.725 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. --- - - - - - understand that no later than JULY 1 OF EACH YEAR all members of Boards and Commi«ees of the City of Miami Beach, including those of a purely advisory nature, are required to comply with Miami-Dade County Disclosure Requirements. This meansthatthe members of City Advisory Boards, whose sole or primary responsibility is to recommend legislation or give advice to the City Commission,must 1'iie,even though you may have been r e c'lly appointed. You must file one of the folo��ring with the ' r ' amt; c' . 1700 �. � I ,, .� Ci � Clergy: o� iV;i � a n� Convention Center Drive. Milami Beach. f tar ida. by July 1. 2010. "Source Of Income Stateme nt(a«aGhed) Or % A inank., Statemen (F—_ched( orj 3. Copy of the person's current 1=;.deral Income Tax Retum Failure to file, according to the N iami-Dade County Code Chapter 1, Genera( Provision, Section 1-5 ma subject t he peg son or firm n to a fine not to exceed 6500.00 or mprisonment In ' e county jail for a period not to exceed sixtyf days, or born. Jianature: Cte: