Madeleine Romanello 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 10, 2017
Ms. Madeleine Romanello
890 NE 72nd Terrace
Miami, Florida 33138
SUBJECT: Transportation, Parkins, Bicycle -Pedestrian Facilities Committee
Dear Ms. Madeleine Romanello:
Congratulations! You have been appointed by to the agency, 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 again and good luck.
Regards,
Raffael Granado
City Clerk
cc: Saul Frances, Parking Director
Saul Frances, 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
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. Madeleine Romanello
RE: Transportation, Parking, Bicycle -Pedestrian Facilities 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 y 1st, fo owing the closing
of the calendar year on which I have served.
Ms. Madeleine Romanello
Sworn to and subscribed before me this day of P?,h , 2017
7"......
_1"14101J
Deputy Clerk ` 4 fr .(,
*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.
MIAMI•DADE
COUNTY
SOURCE OF INCOME STATEMENT
Sec,:ion 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
12nmah
First Name
Middle Name/Initial
Mailing Address — Street Number, Street Name, or P.0. Box
City, State, Zip
A7 Z
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 (check one)
County 111 Public Health Trust J Municipal:
(Municipality)
Department
Position or Title
Employee ID Number
Work address
Work telephone
Employment began on/ended an
Filing as a Board Member (check one)
County
Municipal:
42.42t 641
(Municipality)
Board where serving
Alternate addre
if home address is 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
P. -
/e l
` ce.tA_.:
?�
3
3 /3
Ova 1r— ,/
I hereby swear (or
th. t the inform
%/ a ve is a true and correct statement.
Sign.ure of Person Disclosing
Date signed
RECEIVED BY ELECTIONS DEPARTMENT:
❑ Hardcopy
Electronic Copy
OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/Initials: Scanned Date/initials
!3a SF -14 CCE 201e
ICI
City of Miami Beach
1700 Convention Center Drive,
Miami Beach, Florida 33139,
www.miamibeachfl.gov
CITY CLERK'S OFFICE
Telephone: 305.673.7411 Fax: 305.673.7254
CityClerk@miamibeachfl.gov
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: U e- r
0 yr a. h0/is
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 on
of no more tha
these forms, pursuant to the Miami -Dade County Code, may subject the person to a fine
0, 60 days in jail or both.
Updated: Monday, April 20, 2015
Page 4 of 4
F:\CLER\SAL L\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 06022014.docx
Date
MIAMI BEA
Name:
DIVERSITY STATISTICS REPORTING
Board / Committee:
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Appointment Date: 1 /0// 7
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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 aliows 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 -A Female
Race/Ethnic Categories
What is your race?
Li African-American/Black
Caucasian/White
Asian or Pacific Islander
11 Native-American/American Indian
D Other — Print Race:
Do you consider yourself to be Spanish, Hispanic or Latino/a? Mark the "No" box if not
Spanish, Hispanic/ Latino/a,
2-Yt\lo
ED Yes
Do you consider yourself Physically Disabled?
CAUsersiCENTFraN\AppData\Local\Microsoft!Windows\Temooran/ Internet Pi!es\content.Outiook\NP4J9CNXABC f-ninority
information form 05-20-13 FINAL.doc
Updated: Monday, January 28. 2015