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Barbara Montero 05/31/2014 tl I ANM 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 3/18/2014 Barbara Montero 1900 Sunset Harbour Drive #2208 Miami Beach, Florida 33139 SUpJEM Community Relations Board Congratulations! You have been reappointed by Commissioner Michael Grieco to the above referenced agency, board or committee for a term ending: 5/31/2014. If you are unable to accept this appointment, please notify the City Clerk's Office at (305) 673-7411. Please read the enclosed material carefully. Again, congratulations and good luck. Sincerely, Raf el E. Granado City Clerk cc: Saul Frances, Parking Director Lynn Bernstein 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, 2-2458, 2-459 Ordinance 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 Employees 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.Qov OFFICE OF THE CITY CLERK,Rafael Granado,City Clerk Tel:(305)673-7411,Fax:(305)673-7254 TO Barbara Montero RE: Community Relations Board 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: 5/31/2014. 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 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 w ich I have served. cod Barbara Montero Sworn to and subscribed before me this day of , 2014. 7.' Silvia Prieto Deputy Clerk *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. /—\/V\ 1 LAWJ CITY OF MIAMI BEACH OARD AI►JD CITTEE APPLICATION FORM NAME: Last Name First Name,,),, Middlrtia l � � 1 j1 ,n l HOME ADDRESS: • a��a-�--� Apt No. House No./Street City State Zip Code PHONE: O- (0 ') -7 O( ��1 � 7� �Z. � I��► 5�5 �� Home Work Fax Email address Business Name: Position: Address: No. Street City State Zip Code Professional License(describe) Expires: Attach a copy of the license 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:YesG-6No 0 • Demonstrate an ownership/interest in a business in iami Beach for a minimum of six(6) months: Yes or No ❑ •Are you a registered voter in Miami Beach:Yes or No ❑ --�- • (Please circle one): I am now a resident of: North Beach South Beach iddle Beach • I am applying for an appointment because I have special abilities, knowledge and expen nce. P ease ist below: •Are you resent) a registered lobbyist with the City of Miami Beach?Yes 0 or No`®' Y presently 9 Y tY Please list your preferences in order of ranking ['I]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 ❑Marine Authority. 0 Art in Public Places Committee 0 Miami Beach Commission for Women ❑Beautification Committee ❑Miami Beach Cultural Arts Council ❑Board of Adjustment* ❑Miami Beach Human Rights Committee 0 Budget Advisory Committee 0 Miami Beach Sister Cities Program ❑Capital Im rovements'Pro'ects Oversight Committee 0 Normandy Shores Local Govemment Neigh. Improvement ❑Committee on the Homeless ❑Parks and Recreation Facilities Board 0 Committee for Quality Education in MB 0 Personnel Board ❑Community Development Advisory ❑Planning Board* Community Relations Board 0 Police Citizens Relations Committee ❑Convention Center Advisory Board ❑Production Industry Council 0 Debarment Committee ❑Public Safety Advisory Committee ❑Design Review Board* ❑Safety Committee 0 Disability Access Committee ❑Single Family Residential Review Panel ❑Fine Arts Board 0 Sustainability Committee ❑Gay, Lesbian, Bisexual and Trans ender GLB ❑Transportation and Parking Committee ❑Golf Advisory Committee ❑Visitor and Convention Authority ❑ Health Advisory Committee ❑Waterfront Protection Committee ❑Health Facilities Authority Board 0 Youth Center Advisory Board ❑ Hispanic Affairs Committee ❑Historic Preservation Board ❑Housing Authority ❑.Loan Review Committee *Board Required to File State Disclosure Form 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:Yes❑No❑ Years of Service: 2. Present participation in Youth Center activities by your children Yeso No 0. 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: F:\C:L`�R`, A!L\aF ARMS\PGARC AhdD COMMIT EEC\BC App1'cat'o,).doc •Have you ever been convicted of a y: Yes ❑ or No If yes, please explain ail: • Do you currently have a violation(s) of City of Miami Beach codes: Yes ❑ or No 2/1f yes, please explain in detail: • Do you currently owe the City of Miami Beach any money: Yes D or No If yes, explain in detail • Are you currently serving on any City Boards or Committees: Yes ❑ or 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: Yes ❑or NOB!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): 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 o portunity reporting requirements. Gender: ❑ Male F ale 7white Etl%iiic Origin: Check one only (1) (Not of Hispanic Origin):All persons having origins in an of the original eo les of Europe,North Africa or the Middle East. 9 P 9 Y peoples P . ❑ 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. r' Physically Challenged: Yes 0 or N Employment Status: Employe 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: o Prohibition from directly or indirectly lobbying city personnel (Miami Beach City Code section 2-459). o Prohibition from contracting with the city(Miami-Dade County Code section 2-11.1). o 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). o 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, icle VII—of the City Code "Standards of onduct r City Officers, Em loyees and Agency Members." . Of O a 's Signature ate Name of Applicant(PLEASE PRINT) Please attach a copy of your resume to this application NOTE: Applications,will remai n file.f a.period of.one(1)calendar year. Received in the City Clerk's Office by: Date:_/ /2010 Control NO." Date: // /20 Name of Deputy Clerk MIAMI- DE SOURCE OF INCOME STATEMENT Disclosure for Tax Year Ending Last Name Rot Name Middle Name/Initial '2 0/ ,1--;> - �'� . Mailing Address—Street Number,Street Name,or P.O.Box 42-.L0 City,State,Zip ID Number If your home address is your mailing address,and you 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 ❑ 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 t o 1 -✓��-t�x l�J I C.c. hereby swear(or affirm)that the information above is a true and correct statement. RECEIVED BY ELECTIONS DEPARTMENT: ❑ Hardcopy ❑ Electronic Copy ignature of person disclosing name Da4si&E�d OFFICE USE ONLY P.ccepfed Y / !�I !�?i!%I_r;C : °r0CeSSed D2t°'Iri:ia!s: SCam°e D3 cll^ItialS: 138 SP 2113 MIAMIBEACH: city of Miami Beach, 1700 Convention Center Drive, Miami Beach,Florida 33139, www.rniomibeachfl.aov CITY CLERK Office CityClerk @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. 2-11 .1(i) (2) Board Member name: -� 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 thatthe 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 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. Agnre: Date: