Mayor Bower 12/31/18MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139 www.miamibeachfl.aov
OFFICE OF THE CITY CLERK, Rafael E. Granado, City Clerk
Tel: 305.673.7411, Fax: 305.673.7254
Email: CityClerk@miamibeachfl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Ms. Matilde Bower
RE: Committee on the Homeless
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 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 boardor committee on which I serve) on July 1st, following the closing
of the calendar year on which I have served.
Sworn to and subscribed before me this? day of0� , 2 7
C 'rI •'Ag ostin
Deputy Clerk
*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.
MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139 www.miamibeachfl.aov
OFFICE OF THE CITY CLE K, Rafael E. Granado, City Clerk
Tel: 305.673.7411, Fax,: 305.673.7254
Email: CityClerk@miarnibeochfl.gov
August 16, 2017
Mayor Matilde Bower
1442 Jefferson Ave
Miami Beach, Florida33139
RE: Committee on the Homeless
Dear Mayor Bower:
Congratulations! Youi have been appointed by Commissioner Micky Steinberg to the above -referenced
Board or Committee, fpr 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 m ember 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 again and good luck.
Regards,
Rafz 1O tiado
City Clerk
cc: Saul Frances, Parking Director
Maria Ruiz, 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 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 excelent public service and safety to all who live, work and play in our vibrant, tropical, historic community.
r' 1t
t, 1
City of Miami Beach
1700 Convention Center Drive,
Miami Beach, Florida 33139,
www.miamibeachfl.aov
CITY CLERK'S OFFICE CityCler'kCmiamibeachfl.gov
Telephone: 305.673.741 1 Fax: 305.673.7254
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: 1 1Of
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, Floriela, 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 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.
Updated: Monday, April 20, 2015
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BOARD AND COMMITTEE CHECKLIST
/1/v'/OR /1.44- ..rOL koDATE OF APPOINTMENT: lei/ /5-1 /
Comer e 1 f/.e
MI TTEE:O e -/e.)3 Appointed by: (70. '1 /u5,O (
FOR CLERK STAFF
o Letter of Appointment
o Letter of Reappointment
o Copy of Letter of Appointment/Reappointment e-mailed to Committee Liaison
o Board and Committee Application (Completed on
o Resume/Curriculum Vitae
o Diversity Statistics Reporting (Completed on
o Oath
)
IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
✓ City Code Ordinance Section applicable to the agency, board or committee
✓ City Code Sections 2-21, 2-22, 2-23, 2-24, 2-25, 2-26, 2-458 and 2-459
✓ County Code Section 2-11.1 — Conflict of Interest and Code of Ethics Ordinance
amended through December 2010)
✓ Amendments to the Code of Ethics Ordinance (September 2009 through July 2012)
✓ Highlights of the Miami -Dade County Ethics Code
✓ Sunshine Law and Public Records — Frequently Asked Questions
✓ Memorandum - Solicitation by City Board and Committee Members
o
Citywide Permit Application (Parking Department Form)
o Booklet J Guide to Sunshine, Amendment & Code of Ethics for Public vi Officers and Employee:
O Source of Income Statement
o Acknowledgment of Financial Disclosure Requirement
p DIVEE1SITY STATISTICS REP • RTING Keep COY in =tie and ORAL for Annual Report.
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Term Expired Letter
Resignation Letter
Removal Letter due t.6.2 sences
Date
Signed by A
By Employee:
By Employee:
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City
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F:ICLERtBOARD AND COMMIT !IES D,A T ASASE\CHECKLIST M STER B&C Checklist 2015 1h.docx
MIAMI•DADE SOURCE OF INCOME STATEMENT
td�UL'If'(
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
2016
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.
Filing as an Employee (check one)
0 County C] Public Health Trust E Municipal:
Department
Position or Title
Work address
Filing as a Board Member (check one)
Q County
Board where serving
Alternate address (if home address is exempt)
Municipal:
(Municipality)
Employee ID Number
Work telephone Employment began on/ended on
Work telephone
(Municipality)
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 1
I hereby swear (or affirm) that the information above is a true and correct statement.
Signature of Person Disclosing
Date signed
OFF! `E USE ONLY Accepted: V / �I Deficiency:
138 SP -14 �COE2016 Accepted:
_.,. - Deficiency: _'
Prnces.Fe i nota/Initials:
RECEIVED BY ELECTIONS DEPARTMENT:
❑ Hardcopy
❑ Electronic Copy
Scanned Date/Initials:
elk MIAMIBEALH
NAME: Bower
Last Name
Mayor Matilde
First Name
CITY OF MIAMI BEACH
BOARD AND COMMITTEE APPLICATION FORM
Middle Initial
HOME ADDRESS: 1442 Jefferson Ave Miami Beach Florida
Apt No. Home No./Street City State
PHONE: 305-531-7908 ittam39@hotmail.com
Home
Work Email Address
Business Name: Position:
Address:
Street
33139
Zip Code
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: Yes
• (Please circle one): I am now a resident of: South Beach
• 1 am applying for an appointment because I have special abilities, knowledge and experience. Please list below:
• 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 (31.
choices will be observed by the Citv Clerk's Office. (Regular Boards of City)
Choice 1: Committee on the Homeless
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:
• Have you ever been convicted of a felony: N^ 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?
Name Title
Tuesday Morning Breakfast Club
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:
Property
1442 Jefferson Ave
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. 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 truthfulne f the application and have received, read and will : by Chapter 2, Article
VII — of the City Code "Standards of Conduct f. .ty Officers, Employees and Agency Members."
I Mayor Matilde Bower agreed to the following terms on
0.61/4/7 Received in the City Clerk's Office by:0//43Name of Deputy Clerk Control No. Date r
MIAW\ LB BE 7'
DIVERSITY STATISTICS REPORTING
Name: /V+'
Board / Committee:
Appointment Date:
Do\ LlJi: �G✓�/Fa2
Comm fAe /-1/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: Male Female
Race/Ethnic Categories
What is your race?
African-American/Black
Caucasian/White
LJ Asian or Pacific islander
Native-American/American Indian
L.J. Other — Print Race:
Do you consider yourself to be Spanish, Hispanic or Latino/a? Mark the "No" box i; not
Spanish, Hispanic, Latino /a.
EDNo
AYes
Do you consider yourself Physically Disabled?
>No
Yes
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information form 05-25-13 F?N;=..L.doc
Up at d: Monday, January- 23. 2015