Diego Lopez Medina 2016MIAMI -DARE OUTSIDE EMPLOYMENT STATEMENT
For Full-time County and Municipal, Employees
Full-time County (including Public Health Trust) and municipal employees engaging �t must file an annual disclosure report
by July 1st of each year, in accordance with Section 2-11.1(k)(2) of the Miami -Dade
Disclosure for Tax Year Ending Last Name Fir G — I f" 1: 49 Middle Name/Initial
2016 Lopez Medina Dietty M.
Mailing Address — Street Number, Street Name, or P.O. Box 1OF ICE OF THE Mf CLE'RK
275 N.E. 18th Street, #1701
City, State, Zip
Miami, FL 33132
If your home address is exempt from public records pursuant to Florida Statutes §119.07, please see note on the following page and check here. ❑
Filing as an Employee (check one)
County ❑ Public Health Trust ❑ Municipal Miami Beach
(Municipality)
Department
Division
Capital Improvement Projects
$8,000.00
Position or Title
Employee ID Number
Work telephone
Capital Projects Coordinator
20579
(305) 673-7071
Please list the sources of outside employment (including self-employment), the nature of the work, and the total amounts of money or other
compensation you received for each source of outside employment. If no income or compensation was received from a particular outside
employment, enter zero (0) for that organization in the section below. If continued on a separate sheet, check here. ❑
Name and Address
of the Source of Outside Income
Nature of the
Work Performed
Total Amount of Money or
Compensation Received
Axiom Engineering, Inc.
10211 W. Sample Rd. #101, Coral Springs, FL 33065
Forensic engineering inspections to structures and
preparation of reports based on inspections findings
$8,000.00
I hereby swear (or affirm) that the information above is a true and correct statement.
(I _� - Fi i ) 2U,�
Date signed
RECEIVED BY ELECTIONS DEPARTMENT:
❑ Hardcopy
❑ Electronic Copy
OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/Initials: Scanned Date/Initials:
13801-22 COE2016