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Jesse Fleet 12/31/2018MIAMIBEACH 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 January 18, 2017 Mr. Jesse Fleet 855 Euclid Ave Miami Beach, FL 33139 SUBJECT: Human Rights Committee Dear Mr. Jesse Fleet: Congratulations! You have been appointed by the City Commission to named above fora term ending: 12/31/2018. If you are unable to accept this appointment, or have any questions, Clerk at 305.673.7411. Please read the enclosed materials carefully. Congratulations again and good luck. Regards, fael Granado City Clerk cc: Saul Frances, Parking Director Marcia Monserrat, City Liaison the agency, board or committee please call the Office of the City 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 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: Mr. Jesse Fleet RE: Human Rights 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. 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. Mr. Jesse Fleet Sworn to and subscribed before me this 493 day of4*J , 2017. C 460.0 Deputy Clerk s-A.tvAlaygc *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. A l City of Miami Beach 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.aov CITY CLERK'S OFFICE CityClerk@miamibeachfl.gov Telephone: 305.673.741 1 Fax: 305.673.7254 Acknowledgement of fines/suspension for BoardlCommittee Members for failure to comply with Miami - Dade County Financial Disclosure Code Provision Code Section 2-11.1(1) (2) Board Member's Name: e 55 r f • 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 more than $500, 60 days in jail or both. 2,3) (1" Signature Date Updated: Monday, April 20, 2015 Page 4 of 4 F:\CLER\SALL.aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 06022014.docx MIAMI2 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 Middle Name/Initial Mailing Address — Street Number Street Name, or P.O. Box 5(_ i 0 tOP?r . 106 City, State, Zip NA-\ MA. (3 c U( et 77t 5'1 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 Filing as an Employee (check one) Filing as a Board Member (check one) ❑ County DI Municipal: ct.t44A. 1642 e J (Municipality) Board where serving 1-1- Jrn4h �- ti 911 1-5 aLoYn vn -e-e Alternate address (if home address .* exempt) Work telephone Term began on/ended 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. 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 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 DI Municipal: ct.t44A. 1642 e J (Municipality) Board where serving 1-1- Jrn4h �- ti 911 1-5 aLoYn vn -e-e Alternate address (if home address .* exempt) Work telephone Term began on/ended 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. 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 _ F. S� L.1.c- '�'t{ � M \ IaNkt N1 U 3 %---.- c„--;- EL 77 V Cs pole., CN<lo t.14- P�5 c- N + Di I hereby swear (or affirthat the information above is a true and correct statement. Signature of Person Disclosing 1j2;/11— Date signed 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: MIAMI BE DIVERSITY STATISTICS REPORTING Name:LSSe���� Board / Committee: V m a h /245 Appointment Date: i / 5 17 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 Female D Race/Ethnic Categories What is your race? frican-American/Black Caucasian/white 0 Asian or Pacific Islander Native-American/American Indian 0 Other — Print Race: Do you consider yourself to be Spanish, Hispanic or Latino/a? Mark the "No" box if not Spanish, Hispanic, Latino/a. PfiNo 0 Yes Do you consider yourself Physically Disabled? 0 No 0 Yes C:\Users\OENTFraN`AppDatalLocaMlicrosaft\Windo'wslremoorary interne Fites\Content.outlook\+NP4J9CNX BC minc::ri(y information form 05-20-13 FWAL.doc Updated: Monday, January 26, 2015