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Sixto Acea 12/31/19r BOARD AND COMMITTEE CHECKLIST APPOINTEE: rk�0CG� BOARD/COMMITTEE: DATE OF APPOINTMENT: �/JV/ U Appointed by: 2e r % (JM41-7,-S4 oAl FOR SCANNER FOR CLERK STAFF j�� Scan o o Letter of Appointment TERM END: (/ TERM LIMIT: Scan o o Letter of Reappointment o py of tter of Appointment/Reappointment e-mailed to Committee Liaison on Scan o o Board and Committee Application (Completed on 97/r Scan o o Resume/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 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 (as amended through December 2010) .. c ✓ 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 L,j . O Citywide Permit Application (Parking Department Form) CC C O Booklet — Guide to Sunshine Amendment & Code of Ethics for Public Officers and Employees Scan O cc;Z `.-O Source of Income Statement Scan C O Acknowledgment of Financial Disclosure Requirement O DIVERSITY STATISTICS REPORTI OPY in file and ORIGINAL for Annual Report. Received on: _t2 Signed by X Date U fro Processed on: � / By Employee: atte ffice Staff In' ials Scanned on: � L B Em to ee: ■��Y p Y - Date ffice Sta F Initials aNhu CONCLUDED & RESIGNATION LETTERS Term Expired Letter Date Processed Initials Scan O Resignation Letter Date Processed Initials Scan O Removal Letter due to absences Date processed Initials Scan o F:\CLER\$ALL\BOARD AND COMMITTIES DATABASE\CHECKLIST MASTER\B&C Checklist 2015 MASTER.docx 1/Ve are committed to providing excelient public service and safety to all who live. '-work. and play in Our vibrant, tropical, historic cornmunihy MIAMIBEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139 www.miamibeachfl.aov OFFICE OF THE CITY CLERK, Rafael E. Granada, City Clerk Tel: 305.673.7411, Fax: 305.673.7254 Email: CityClerk@miamibeachfl.gov January 17, 2018 Mr. Sixto Acea 1750 James Ave. Apt. 4B Miami Beach, FL 33139 RE: Affordable Housina Advisory Committee Dear Mr. Sixto Acea: Congratulations! You have been reappointed by the City Commission to the agency, board or committee named above for a term ending: 12/31/2019. 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. Regard 1 Rafael Granado City Clerk cc: Saul Frances, Parking Director Alba Tarre, City Liaison ENCLOSURES: Oath of Office/Oath of Civility/Acknowledgements 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 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: 305.673.7411, Fax: 305.673.7254 Email: CityClerk@miamibeachfl.gov Oath of Office Oath of Civility and Acknowledgements TO: Mr. Sixto Acea RE: Affordable Housing Advisory Committee 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. 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 board or committee on which I serve) on July 1st, f Ilowing the closing of the calendar year on which I have served. /? n 4 Mr' Sixto pcea Sworn to and subscribed before me this day of 2018 Ch D'Agostin puty 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. City of Miami Beach 1700 Convention Center Drive Miami Beach, Florida 33139 www.miamibeachfl.aov CITY CLERK'S OFFICE Telephone: 305.673.7411 Fax: 305.673.7254 CityCIerk@miamibeach FI. 9ov 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: >X �� (.�— I understand that no later than July 1, of each vear 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 $500, 60 days in jail or both. Signature 4 Updated: Thursday, December 28, 2017 Page 4 of 4 F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 06022014.docx Date MIAMI•DADE SOURCE OF INCOME STATEMENT L01611011111 Section 2-11.1(1) of the County Ethics Code requires that certain employees, public officials, and consultants file a financial disclosure Statement on a yearly basis by July 1st of every year. For the last year of service, file SOI -F. Disclosure for Tax Year Ending Last Name (or, Consultant or Consulting Firm name) First Name Middle Name/Initial 2017 Martinez Wil Mailing Address — Street Number, Street Name, or P.O. Box 4455 Meridian Avenue City, State, Zip Miami Beach, FL 33140 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) ❑ County ❑ Public Health Trust ❑ Municipal: Department Position or Title Work address Filing as (check one) ❑ County Board ❑ Municipal Board: City of Miami Beach (Municipality) Employee ID Number Work telephone Employment began on/ended on ❑ Consultant for County or Municipal Agency (Municipality) Board where serving or name of County or Municipal Agency Consultant is providing professional services to Parks and Recreation Commitee Alternate address (if home address is exempt) Work telephone (305) 458-6233 Term began on/ended on 1/17/2018 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 Meridian Partners, LLC 1000 5th Street Suite 200 Information Technology Miami Beach, FL 33139 professional services I hereby swear (or affirm) that the information above is a true and correct statement. Signature of Person Disclosing 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 2018 SOURCE OF INCOME INFORMATION Required by the Miami -Dade County Code, Section 2-11.1(1) The term INCOME shall include, but is not limited to, the following items: wages, salaries; tips; bonuses; commissions & fees; dividends, interest; profits from businesses and professions; your share of profits from partnerships and small business corporations; pensions, annuities & endowments; profits from the sale or exchange of real estate, securities or other property, including personal residence; rents and royalties; your share or estate or trust income, including accumulated distributions; alimony, separate maintenance or support payments; prizes, awards and gifts; fees as an Executor, Administrator or Director; disability retirement payments; workmen's compensation, insurance; damages; social security payments, etc. FILING INSTRUCTIONS A "Source of Income Form," (SOI) or a signed copy of the personal income tax forms may be filed to satisfy the filing requirement for County/Public Health Trust employees, municipal employees, advisory board members, and consultants providing professional services to the County or a Municipality who are not required to file under State law. State filers who also hold County or Municipal positions (for example, State filers who also serve on County or Municipal boards) meet the County financial disclosure requirement by filing a copy of their state form with the Miami -Dade County Elections Department or their Municipal clerk. The Source of income Form must be filed yearly no later than 12:00 noon of July 1st. Consultants file within thirty (30) days of execution of a contract arising out of competitive negotiations and prior to any payments from the County, municipalities or other agencies and thereafter on a yearly basis no later than 12:00 noon of July 1st. For the last year of service, file "Final Source of Income Form "(SOI -F). The SOI and SOI -F should not be used as a substitute for State Form 1 or State Form 1F for those required to file under state requirements. Filers whose address is exempt pursuant to Fla. Stat. §119.07 must provide an alternate address such as a business address or the address of the board if the filer serves on a board. This form must be filed by July 1st of each year and should not be used as a substitute for State Form 1 for those required to file under state requirements. For the last year of service, file SOI -F. Example (Review sources of income above; note- no monetary amount required). Name of Source of Income Address Description of Principal Business Activity Place of employment Address where employed Salary Rental Property 123 Anywhere Street Rental income Miami, FL 00000 Social Security Social Security office closest to Social Security income your zip code Miami -Dade County (including Public Health Trust) Personnel and Advisory Board members shall file completed forms with: Miami -Dade Elections Department Attn: Financial Disclosure Section 2700 NW 87th Avenue Miami, FL 33172 or at: financial.disclosures@miamidade.gov or P.O. Box 521550 Miami, FL 33152-1550 Municipal Personnel and Advisory Board Members shall file completed forms with their respective Municipal Clerk. For further information, Miami -Dade County and Public Health Trust employees may contact the Miami -Dade Elections Department Financial Disclosure Section via telephone at 305-499-8413 or via email at financial.disclosures@miamidade.aov. Municipal employees may contact their respective Municipal Clerk's Office. Note RE: Florida Statutes §119.07: The role of our office is to receive and maintain forms filed as public records. If your home address is exempt from disclosure and you do not wish your home address to be made public, please use your office or other address for your mailing address. The following persons are exempt from disclosing their home addresses: active or former law enforcement personnel, including correctional and correctional probation officers, personnel of the Department of Children and Family Services whose duties include the investigation of abuse, neglect, exploitation, fraud, theft, or other criminal activities, personnel of the Department of Health whose duties are to support the investigation of child abuse or neglect, and personnel of the Department of Revenue or local governments whose responsibilities include revenue collection and enforcement or child support enforcement; firefighters; justices and judges; current or former state attorneys, assistant state attorneys, statewide prosecutors, or assistant statewide prosecutors; county and municipal code inspectors and code enforcement officers. COE 2018 MJAM1'BFA(_"H1� DIVERSITY STATISTICS REPORTING Name: 431 -�+O Board / Committee: Appointment Date: 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 l)g Female Race/Ethnic Categories What is your race? African-American/Black Caucasian/White Asian or Pacific Islander Native-American/American Indian Other -- Print Race: Do you consider yourself to be Spanish, Hispanic or Latino/a? `0a;r^: th6 " h'o" Ua,: if not Spanish, Hispanic, Latino/d. No Yes Do you consider yourself Physically Disabled? No Yes ' Ussr. r�9NTFr " ,AppD P, cr s .,V l nd , °;s e .o 1:f!,' Int:; f c,r Pilef cn'c, t i:,,i� ti �; "�,P-" N, . C. 5'tv a 2 +1� 2tElit.00ar,�Ji o Oi ,v i �� i7..,n 3r . 1 , S',l„ 1,. �-,•` �.�'<�� r ,.f�',, ..., information form 05210-13 FINAL.doc Updated: Monday, January 25, 2015