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Veronica Camacho 12.31.2017 City of Miami Beach,1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.aov OFFICE OF THE CITY CLERK,Rafael Granado,City Clerk Tel:(305)673-7411,Fax:(305)673-7254 November 30, 2015 Ms. Veronica Camacho 1000 South Pointe Drive#1902 Miami Beach, Florida 33139 SUBJECT: Miami Beach Commission For Women Dear Ms.Veronica Camacho: Congratulations! You have been appointed by Commissioner John E. Aleman to the agency, board or committee named above for a term ending: 12/31/2017. Pursuant to City of Miami Beach Code Section 2-22 (5)a: "Notwithstanding any other provision of the City Code or of any resolution, commencing with terms beginning on or after January 1, 2007, the term of every board member who is directly appointed by a member of the City Commission shall automatically expire upon the latter of: December 31 of the year the appointing City Commissioner leaves office or upon the appointment/election of the successor City Commission member." If you are unable to accept this appointment, or have any questions, please call the Office of the City Clerk at 305.673.7411. Please read the enclosed materials carefully. Congratulations again and good luck. Regards, Ra ael Granado City Clerk cc: Saul Frances, Parking Director Bonnie Stewart, City Liaison 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 City Wide Permit Application-(Parking Department Form) Booklet-Guide to the Sunshine Amendment and Code of Ethics for Public Officers and Employees MIAMIBEACH City of Miami Beach,1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.aov OFFICE OF THE CITY CLERK,Rafael Granado,City Clerk Tel:(305)673-7411,Fax:(305)673-7254 TO: Ms.Veronica Camacho RE: Miami Beach Commission For Women 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: 12/31/2017. 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 Officers 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 1st, following the closing of the calendar year on which I have served. Ms.Veronica Camacho Sworn to and subscribed before me this oay of , 2016. ift A 0 2o1-6. Deputy Cl°rk *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. MIAMI•DADE SOURCE OF INCOME STATEMENT COUNTY Disclosure for Tax Year Ending Last Name `First Name Middle Name/Initial 2014 e a (V-h 0 V C 2Y7 iO ,"fi g IrI -i Mailing Address—Street Number,Street Nam?,or P.O.Box . CODs D _ r � City,Stale,Zip ID Number !�<G X11 ch Ti. 3313 ' 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 ❑ County Board Member ❑ Municipal Board Member, Name of Municipality: MI u✓+'7 PD+2 a en Board where serving VIII I 6 5 I Or) ��r I0 0 Pic/e y'°.! Work address Work telephone Term began on 0 c. ,0(h7 Pat V ` / 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 & <<" (6/44 ,n/4- /ADO J. 100�.� ,��Is o �,�r�" / 0—v 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 1( ( ( C V t_V bpt C- : Print name Date signed OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/Initials: Scanned Date/Initials: 138 SP-14 2/13 I AtE/1'.CH 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) Board Member's Name: € - ►n r ! q r7c lje-c e�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: http://www.ethics.state.fl.us/ethics/forms.html 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 $500, 60 days in jail or both. 0466- nature ate Updated:Wednesday,April 09,2014 Page4of4 F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION,REVISED.docx M AM 1 m F DIVERSITY STATISTICS REPORTING Name: ve/ (M k C C C 6 ry—. -� Board / Committee: 0 nrAC,n Appointment Date: / Pursuant to City of Miami Beach Ordinance 2009-3632, the City is required to annually prepare and present a report to the City Commission identifying the City's diversity statistics. This form allows board and committee applicants and members to voluntarily self-identify their race, ethnicity, disabled status and gender. Please check the appropriate box for each category: Gender: Male I I] Female Race/Ethnic Categories What is your race? La African-American/Black Caucasian/White Asian or Pacific Islander La Native-American/American Indi n Other— Print Race: t-s, 14/G Do you consider yourself to be Spanish, Hispanic or Latino/a? Mark the "No"box if not Spanish, Hispanic, Latino/a. No 4k Yes Do you consider yourself Physically Disabled? ,No Yes C:\Users\CENTFraN\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\NP4J9CNX\BC minority information form 05-20-13 FINAL.doc Updated: Monday,January 26,2015