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Cecilia Velasco 12/31/18MIAMIBEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.aov OFFICE OF THE CITY CLERK, Rafael Granada, City Clerk Tel: (305) 673-7411, Fax: (305) 673-7254 Email CityClerk@miamibeach.gov January 25, 2017 Ms. Ana Cecilia Velasco 9111 E. Bay Harbor Drive Bay Harbor Islands, Florida 33154 SUBJECT: Hispanic Affairs Committee Congratulations! You have been reappointed by Commissioner Michael Grieco to 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, R fael Gran do City Clerk cc: Saul Frances, Parking Director Katherine Gonzalez, 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.aov OFFICE OF THE CITY CLERK, Rafael Granada, City Clerk Tel: (305) 673-7411, Fax: (305) 673-7254 Email CityClerk@miamibeach.gov TO: Ms. Ana Cecilia Velasco RE: Hispanic Affairs Committee 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 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 Iserve to-�Iyt, fol�the closing of the calendar year on which I have served. s. Ana Cecilia Velasco Sworn to and subscribed before me this day of 1_fL15 2017 a Deputy Clerk *Please visit the City of Miami Beach website at www.miamibeachfi.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. M1 B F A"'k�l DIVERSITY STATISTICS REPORTING Name: eat /1, V ��S(L� Board / Committee: Appointment Date: 4/ CID, // 05_11� 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 U Female Race/Ethnic Categories What is your race? African-American/ Blau CaucasianMthite Asian or Pacific islander Native-American/American indian ED Other — Print Race: Do you consider yourself to be Spanish, Hispanic or Latino/a? Mark the `,No" box, it snot Spanish, Hispanic, Latinota, No Yes Do you consider yourself Physically Disabled? No Yes c:AUserslCNTi raN1 �l rr DOr r; Internet �rr(Jata� AGa„M1,. �.5G1ittV�lindoblSlr r1 v information form 05-20-13 FINAL.doc Updated: Monday, Januar; 25, 2015 _*A'0` /.I.l HB City of Miami Beach 1700 Convention Center Drive, Miami Beach, Florida 33139, www. m i o m i beat h FI .00v CITY CLERK'S OFFICE Telephone: 305.673.7411 Fax: 305.673.7254 CityClerk@miamibeachfl.aov 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) a Board Member's Name: OAlq C44 �,� vim/ S� d 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)" 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 Updated: Monday, April 20, 2015 Page 4 of 4 F:\CLER\SALL\aFORNIS\BOARD AND COMiMITTEES\BC APPLICATION REVISED 06022014.docx ""®' 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 Ending Liast, Name First Name Middle Name/Initial 2016 S0—D CA VBG( eC° Ica Mailing Address — Street Number, Street Name, or P.O. Box City, Stet®, Zip If vour home 331 is vour 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. ❑ Filinm as an Ellnlnlovee (check one) 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 Qt Municipal: t AA44 ' (Municipality) Board where serving (n� 0i5 Pat iit� �`�� er it (10 Yo #7c��e� Alternate address (if home address is exempt) I 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 nerson for vour benefit. However. the income of vour spouse or anv business partner need not be disclosed. If continued on a separate sheet, check here.❑ Name of Source of Income Address Description of the Principal BusinessActivity A7602) I hereA swear (or Dah signed OFFICE USE ONLY Accepted: Y / N Defici 138 SP -14 COE 2016 is a true and correct statement. RECEIVED BY ELECTIONS DEPARTMENT: ❑ Hardcopy ❑ Electronic Copy Processed Date/Initials: Scanned Date/Initials: