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BOARD AND COMMI (I EE CHECKLIST
APPOINTEE: T V" CSa2 DATE OF APPOINTMENT: 11130117
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BOARD/COMMITTEE: AS co 'M5.5)bn-/ Appointed by: �''L}A4114 r
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FOR SCANNER FOR CLERK STAFF
Scan o o Letter of Appointment
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of f of Appointment/Reappointmennt e-mailed to Committee Liaison
Scan o oC and and ommlttee A plication (Completed on
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Scan o o REsumd'/Curriculum Vitae
o Diversity Statistics Reporting (Completed on
Scan o o Oath
IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
✓ City Code Ordinance Section applicable tothe 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
0 Citywide Permit Application (Parking Department Form)
O Booklet — Guide to Sunshine Amendment & Code of Et hics for Public Offfi ars and Employee
o Source of Income Statement
O Acknowledgment of Financial Disclosure Requirement
O DIVERSITY STATISTICS REPORTING Keep C0 `f in file and ORIGINAL for Annual Report.
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v Date Board or Committee Member
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Resignation Letter
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IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
✓ City Code Ordinance Section applicable tothe 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
0 Citywide Permit Application (Parking Department Form)
O Booklet — Guide to Sunshine Amendment & Code of Et hics for Public Offfi ars and Employee
o Source of Income Statement
O Acknowledgment of Financial Disclosure Requirement
O DIVERSITY STATISTICS REPORTING Keep C0 `f in file and ORIGINAL for Annual Report.
fZ 7711A 7 Signed by
v Date Board or Committee Member
Processed on: 01- 0 _ — By Employee:
Dat Pity
s 0 ice `�` Initials
Scanned on: By Employee: . *,• rDate s Oi Stai—i Initials
ACL M-Sil(-NA IN LET TEKO
Term Expired Leger
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Resignation Letter
(Initials
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Date Processed
Removal Letter due to absences Date processed ( Initials Scan 0
r-:k.CLER\BOARD AND CONIMF71 IES DAT'AS AS-EEkCHECKLIST P.0 TER\B€C Ch=cklist 2? t5 Ih.doc:
City of Miami Beach
1700 Convention Center Drive,
Miami Beach, Florida 33139,
vAww. m is m i beach FI.aov
CITY CLERK'S OFFICE
Telephone: 305.673.741 1 Fax: 305.673.7254
CityClerk@miamibeachfl.cov
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)
Board Member's Name: TVor ),,f,5(?W
I understand that no later than July 1, of each near 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)°
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 5500, 60 days in jail or both.
Signature
Updated: Monday, April 20, 2015
Page 4 or 4
F:\CLER\3ALL\aF0Rrv1S\B0ARD AND COMIMI I tt EES\BC AFPLICAT10i` REVISED 06022014.1am,
Date
X v /;�V.
MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139 vvww.miamibeochfl.aov
OFFICE OF THE CITY CLERK, Rafael E. Granado, City Clerk
Tel: 305.673.741 1, Fax: 305.673.7254
Email: CityClerk@miamibeachfl.gov
December 05, 2017
Ms. Tiva Leser
4630 Royal Palm Ave.
Miami Beach, Florida 33140
SUBJECT: Miami Beach Commission For Women
Congratulations! You have been reappointed by Commissioner John Aleman to the above referenced,
board or committee named above, for a term ending: 12/31/2019, effective January 1 st, 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.
Regardy
Raael Granado
City Clerk
cc: Saul Frances, Parking Director
Michele Burger, 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 vvww.miamibeachfl.aov
OFFICE OF THE CITY CLERK, Rafael E. Granada, City Clerk
Tel: 305.673.741 1, Fax: 305.673.7254
Email: CityClerk@miamibeachfl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Ms. Tiva Leser
RE: Miami Beach Commission For Women
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: 12/31/2019.
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.
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, fo4jowing the closing
of the calendar year on which I have served.
1 Ms. Tiva Leser"'
Sworn to and subscribed before me this F day of Tc,,) , 2019
_�/ b . ____
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.
M, 1
AMI B FAk,-,
DI'V'ERSITY STATISTICS REPORTING
Name:
Board /Committee: / ` �S O 7 �0,-�-v�
Appointment Date: fl 1 3o /-7
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 0 Female Q
Race/Ethnic Categories
What is your race?
African-American/Black
Caucasian/White
Asian or Pacific Islander
LD Native-American/American Indian
Other — Print Race: _... _
Do you consider yourself to be Spanish, Hispanic or Latino/a?
Spanish, Hispanic, Latinos,
No
Yes
Do you consider yourself Physically Disabled?
01- 'No
Q Yes
information fc,rn 05-20-13 FIi�IALdoc
Updated: Monday, January 26.2,01,E