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Diego Machado 12/31/18CITY OF MIAMI BEACH BOARD AND COMMITTEE APPLICATION FORM NAME: Machado Diego Last Name First Name Middle Initial HOME ADDRESS: 1325 15 terr apt. 4 Miami Beach Florida (FL) 33139 Apt No. Home No./Street City State Zip Code PHONE: 3052974125 Home Work Business Name: dgm.machado@gmaii.com Position: Law Student Email Address Address: Street City State Zip Code 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 Yes • Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six (6) months: No • Are you a registered voter in Miami Beach: No • (Please circle one): I am now a resident of: South Beach • I am applying for an appointment because I have special abilities, knowledge and experience. Please list below: Art Management and Housing • Are you presently a registered lobbyist with the City of Miami Beach? No Please list your preferences in order of ranking [1] 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) Choice 1: Disability Access Committee Choice 2: Affordable Housing Advisory Committee Choice 3: Transportation, Parking, Bicycle -Pedestrian Facilities Committee * Board members are required to file Form 1 — "Statement of Financial Interest" with the State. If you seek appointment to a professional seat (e.g., lawyer, architect, etc.) on the Board of Adjustment, Design Review Board, Historic Preservation Board or Planning Board, attach a copy of your currently -effectively license, and furnish the following information: Type of Professional License License Issuance Date License Number License Expiration Date 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: No Years of Service: 2. Present participation in Youth Center activities by your children No if yes, please list the names of your children, their ages, and which programs. List below: • Have you ever been convicted of a felony: No If yes, please explain in detail: • Do you currently have a violation(s) of City of Miami Beach codes: No • Do you currently owe the City of Miami Beach any money: No • Are you currently serving on any City Boards or Committees: No • What organizations in the City of Miami Beach do you currently hold membership in? If yes, please explain in detail: If yes, please explain in detail: If yes, which board? • I am now employed by the city of Miami Beach: No Which department? • List all properties owned or have an interest in, which are located within the City of Miami Beach: Gender: Male 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 opportunity reporting requirements. Race/Ethnic Categories What is your race? Mark one or more races to indicate what you consider yourself to be. Other Other Description: Are you Spanish/Hispanic/ Latino? Mark the "No" box if not Spanish/ Hispanic/ Latino. Yes Physically Challenged: No 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 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, Article VII — of the City Code "Standards of Conduct for City Officers, Employees and Agency Members." I Diego Machado agreed to the following terms on Received in the City Clerk's Office by: Name of Deputy Clerk Control No. Date M0WA WAIIIN AW ,jVjD, City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139 www.miamibeachfi.gov OFFICE OF THE CITY CLERK, Rafael E. Granada, City Clerk Tel: 305.673.7411, Fax: 305.673.7254 Email: CityClerk@miamibeachfl.gov May 8, 2017 Mr. Diego Machado 1325 15 Terr, Apt 4 Miami Beach, Florida (FL) 33139 RE: Disability Access Committee Congratulations! You have been appointed by Commissioner Ricky Arriola to the above -referenced Board or Committee, 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 as they concern your duties, responsibilities, and requirements as a board or committee member. Congratulations and good luck. Res, Raf el Granado City Clerk cc: Saul Frances, Parking Director Valeria Mejia, City Liaison ENCLOSURES: Oath of Office/Oath of Civility/Acknowledgements City Code/Ordinance section applicable to agency, board or committee City Code Sections 2-22, 2-23, 2-24, 2-25, 2-26, 2-458 and 2-459 Ordinance No. 2006-3543 - Amendment to City Code Section 222 Miami -Dade County Code Section 2-11.1 - Conflict of Interest and Code of Ethics Ordinance Citywide 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. MIAM-1-BEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139 www.miamibeachfl.gov OFFICE OF THE CITY CLERK, Rafael E. Granada, City Clerk Tel: 305.673.7411, Fax: 305.673.7254 Email: CityClerk@miamibeochfl.gov Oath of Office Oath of Civility and Acknowledgements 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. To my colleagues and to all of those I represent and serve, I pledge fairness, integrity and civility, in all actions taken and all communications made by me as a public servant. I hereby acknowledge that 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 that I understand that as a member of the above -referenced City of Miami Beach Board 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. r\Diego Machado Sworn to and subscribed before me this_day of Me y 12017 G/kk5 5 j_5J5 Deputy Clerk We are committed to providing excellent public service and safety to all who live, work and play in our vibrant tropical, historic community. .01i t r 1 a City of Miami Beach 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfi.gov CITY CLERK'S OFFICE Telephone: 305.673.7411 Fax: 305.673.7254 Cit,vClerk@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(1) (2) Board Member's Name: 'J yi L) it Chi_k4 G 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)" 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. Sig Updated: Monday, April 20, 2015 Page 4 of 4 F:ICLERIQALUaFORMS16oARD AND COMMITTEES\6C APPLICATION REVISED 00022014.00CX Date MIAMI B EAC Name: DIVERSITY STATISTICS REPORTING 'I <- c1 C.) mtko_kJo - Board / Committee: t�)t arc, be I Appointment Date: / `7 C.C9_SS 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: Malev Female Q Race/Ethnic Categories What is your race? African-American/BlaclK Caucasian/White Asian or Pacific Islander Native-American/American Indian "*�ther — Print Race: Do you consider yourself to be Spanish, Hispanic or Latino/a? Mark the "No" box i; not Spanish, Hispanic, Latinofa. No Yes Do you consider yourself Physically Disabled? LZA No Yes v:�.0 BrSir,.ENTt=r2"dL�.nin�ta�LGi;ci'1�'�ICrOSGiiI`rt;tYldGt•,'S1T2mpOrar�' �(1[�ftt,-'1i �t�cSt,CCiliu!1C.�t.JtYr}Q�t�l�if�-�'�`�,:,N�:�� r+ifiGiltt^ information form 05.20-13 FIN AL,doc Updated: Ntonday, January 25, 20115 MIMI®DADS SOURCE OF INCOME STATEMENT Section 2-11.1(1) 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 EndingLast Name First Name Middle Name/Initial 2016 \1 11 K Qjyllx CPOi Mailing Address — Street Number, Street Name, or P.O. Box 1321 1� hP� City, State, Zip If your home address is your mailing address, and your home address Is exempt tram puDllc recoras pursuant to Na. alai. '31 ia.0 r, 1udu instructions on the following page and check here. ❑ Filinn as an Fmninvee (check nnel County F1 Public Health Trust ❑ Municipal: (Municipality) Department Position or Title Employee ID Number Work address Work telephone Employment began on/ended on Filina as a Board Member (check one) 0 County Municipal: (Municipality) Board where serving 6 i Alternate address (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 narsnn for vni it hanafit_ Hnwaver_ the income of vour soouse or anv business Dartner need not be disclosed. If continued on a separate sheet, check here.❑ Name of Source of Income Address Description of the Principal Business Activity I hereby swear (or affirm) that the information above is a true and correct statement. Signature ofp'Nson Disclosing RECEIVED BY ELECTIONS DEPARTMENT: ❑ Hardcopy ❑ Electronic Copy OFFICE USE ONLY ,Accepted: Y / N Deficiency: Pror_.essed Date/Initials: Scanned Date/Initials: 138 SP -14 COE 2016