Gloria Salom Conclusion LetterMIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139 v, �ww.miamibeachfl.gov
OFFICE OF THE CITY CLERK, Rafael E. Granado, City Clerk
Tel: 305.673.741 1, Fax: 305.673.7254
Email: CityClerk@miamibeachfl.gov
February 24, 2017
Ms. Gloria Salom
815 North Shore Drive
Miami Beach, FL 33141
SUBJECT: Disability Access Committee
Dear Ms. Gloria Salom:
Your membership on the above committee has concluded. The City Commission has requested that I
convey to you its appreciation for your contributions of time and effort, resulting in the successful
functioning of this Committee, and for the interest shown by you throughout your service on it. The work
that you and your fellow committee members have done is greatly appreciated.
Respectfully,
afa- -nado
City Clerk
cc: Saul Frances, Parking Director
Valeria Mejia, City Liaison
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
Email CifyClerk@miamibeach.gov
December 21, 2016
Ms. Gloria Salom
815 North Shore Drive
Miami Beach, FL 33141
SUBJECT: Disability Access Committee
Congratulations! You have been reappointed by Commissioner Kristen Rosen Gonzalezto the above
referenced, board or committee named above, for a term ending: 12/31/2018.
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 and good luck.
Regards,
At i
afael Granado 1
rri City Clerk
cc: Saul Frances, Parking Director
Valeria Mejia, 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 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.gov
OFFICE OF THE CITY CLERK, Rafael Granado, City Clerk
Tel: (305) 673-7411, Fax: (305) 673-7254
Email CityClerk@miamibeach.gov
TO: Ms. Gloria Salom
RE: Disability Access 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: 12/31/2018.
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 C of Miami Beach Board
and/or Committee, I must comply with the financial disclosure* requir- i -Dade County or the
State of Florida (depending on the board or committee on which I se 1st, following the closing
of the calendar year on which I have served.
Ms. Gloria Salom
Sworn to and subscribed before me this 2/
day of --)AtvJ 201
-.)✓4/30nz
Deputy Clerk 5.4't-vA-Toet E
*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 committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community.
MIAMIDADE
COUNTY
SOURCE OF INCOME STATEMENT
Section 2-11.1(i) of the County Ethics Code requires that certain employees and public officials file a financial disclosure Statement on a yearly basis by July 1st
of every year.
Disclosure for Tax Year Ending
2016
Last Name First Name
4-t.OM (ADP-
Mailing Address — Street Number Street Name, or P.O. Box
queru
City, State, Zipumti ` V t
Middle Name/Irntial
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. 0
n
-- -
al County Public Health Trust • Municipal:
(Municipality)
Department
Position or Title
Employee ID Number
Work address
Work telephone
Employment began on/ended on
Filing as a Board Member (check one)
❑ County
unicipal: I Prd % t
(Municipality)
Board where serving
ISA-BiLl'(`r 4w€ss Com,,,1r-1- e•E.
Alternate address (if home address is exempt)
Work telephone
3c$ 10.14039
Term b gan on/ended on
01111
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. Examples of sources of income include: compensation for services, income from business, gains from
property dealings, interest, rents, dividends, pensions, IRA distributions, and social security payments. 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
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above is a true and correct statement.
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Date gned
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RECEIVED BY ELECTIONS DEPARTMENT:
❑ Hardcopy
❑ Electronic Copy
OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/Initials:
138 SP -14 COE 2016
Scanned Date/Initials:
'MN id BE
City of Miami Beach
1700 Convention Center Drive,
Miami Beach, Florida 33139,
www.miamibeachfl.gov
CITY CLERK'S OFFICE CityClerk@miamibeachfl.gov
Telephone: 305.673.741 1 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:
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"
2. A "Statement of Financial Interests (Form 1)"
3. A Copy of your latest 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 mo an $500, 60 days in jail or both.
Si nature
Updated: Monday, April 20, 2015
Page 4 of 4
F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 06022014.docx
((31111
Date
IA/V\1 BE
Name:
DIVERSITY STATISTICS REPORTING
Board / Committee:
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 1 Female
Race/Ethnic Categories
What is your race?
African-American/Black
LJ Caucasian/VVhite
Asian or Pacific Islander
ative-American/American Indian
Other — Print Race: 34EFf-ZiPer
Do you consider 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?
7No
LD Yes
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information form 05-20-13 FINAL.fic.)c
Updated: Monday, January 26, 2015