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Betsy Mateu 12/31/18MIAMIBEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov OFFICE OF THE CITY CLERK, Rafael Granada, City Clerk Tel: (305) 673-7411, Fax: (305) 673-7254 Email CityClerk@miamibeach.gov November 15, 2016 Ms. Betsy Mateu 5230 Alton Raod Miami Beach, Florida 33140 SUBJECT: Committee for Quality Education in Miami Beach Congratulations! You have been reappointed by Mayor Philip Levine 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, 7 Rafael Granado City Clerk cc: Saul Frances, Parking Director Dr. Leslie Rosenfeld, 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 Granada, City Clerk Tel: (305) 673-741 1, Fax: (305) 673-7254 Email CityClerk@miamibeach.gov TO: Ms. Betsy Mateu RE: Committee for Quality Education in Miami Beach 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: 1213112018. 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 1 st, following the closing of the calendar year on which I have served. -t ✓ " " -Ms. Betsy Mateu Sworn to and subscribed before me this / / day of�� 201' 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. IM MIAMI BEACH NAME: Mateu Betsy Last Name HOME ADDRESS: 5230 Alton Raod Apt No. PHONE: (305) 794-6515 CITY OF MIAMI BEACH BOARD AND COMMITTEE APPLICATION FORM First Name Middle Initial Miami Beach Florida Home No./Street City State emateu@Miami.edu Home Work Business Name: University of Miami Position: Address: Coral Gables Street City 33140 Zip Code Email Address Florida 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: Yes • (Please circle one): I am now a resident of: Middle Beach • I am applying for an appointment because I have special abilities, knowledge and experience. Please list below: North Becon PA Committee. Ensures children attend MB public schools. • 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: Committee for Quality Education in Miami Beach Choice 2: Choice 3: * 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 Number License Issuance Date 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: Child Name Age Program • 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 If yes, please explain in detail: • Do you currently owe the City of Miami Beach any money: No If yes, please explain in detail: • Are you currently serving on any City Boards or Committees: Yes If yes, which board? Quality Education Committee • What organizations in the City of Miami Beach do you currently hold membership in? Name Quality Education Committee member • 1 am now employed by the city of Miami Beach: No Title North Beach elementary co-chair Which department? • List all properties owned or have an interest in, which are located within the City of Miami Beach: Property 5230 Alton RD Miami Beach fl 33140 Gender: Female 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. White Other Description: Are you Spanish/Hispanic/ Latino? Mark the "No" box if not Spanish / Hispanic / Latino. No 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 Betsy Mateu agreed to the following terms on Received in the City Clerk's Office by: Name of Deputy Clerk Control No. Date \1if \i EACHL_ 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 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(1) (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)" A Copy of your latest Federal Income Tax Return F re to file one of these forms, pursuant to the Miami -Dade County Code, may subject the person to a fine fSiqmo e than $500, 60 days in jail or both. ature to Updated: Monday, April 20, 2015 Page 4 of 4 F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 06022014.docx MMIDSOURCE 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 Last Name First Name Middle Name/initial 20161 ell ej Mailing Address - Street Number, Street Name, or P.O. Box City, State, Zip 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. ❑ Fling as an Employee (dwdk oke) County ❑ Public Health Trust Q Municipal: (Municipality) Department Position or Title Employee ID Number Work address Work telephone Employment began on/ended on as a ward member (check ono ` []County Municipal: zi ( n� I (Municipality) Board where serving _ �c Alternate address (if home dress is exempt)(,,,-17orkteephone Tgan on/ended on 7o;l, 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 anothff 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 (✓l ! �'l r /�c�l�� � s I here b ear (or affirm) that the information above is a true and correct statement. Signature of Person Disclosing J� I l6 2dl '�-- Date signed RECEIVED BY ELECTIONS DEPARTMENT. ❑ Hardcopy Electronic Copy OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/Initials: Scanned Date/Initials: 138_SP-14 COE 2016