Annabel Delgado-Harrington 12/31/19.WPI BEACH
BOARD AND COMMITTEE CHECKLIST
APPOINTEE: ANNA -be( °%i' i i ter -4 /✓DATE OF APPOINTMENT:
Appointed by: 6j7-/ COA/144 <SS/OA✓
FOR SCANNER FOR CLERK STAFF / .3/
Scan o o Letter of Appointment TERM END: P/3///, TERM LIMIT: ,�
Scan o o Letter of Reappointment
o Gs}py�Qfette of Appointment/Reappointment e- aile• to Committee Liaison on
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BOARD/COMMITTEE: bef3
Scan 0
Scan 0
Scan 0
Scan 0
Scan 0
Received on:
Processed on:
Scanned on:
o Boar and Committee Application (Completed on
o Resume/Curriculum Vitae
o Diversity Statistics Reporting (Completed on
o Oath
S 6 )
11
IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
cm'✓ City Code Ordinance Section applicable to the agency, board or committee
a_..+f ✓ City Code Sections 2-21, 2-22, 2-23, 2-24, 2-25, 2-26, 2-458 and 2-459
<c) ✓ County Code Section 2-11.1 — Conflict of Interest and Code of Ethics Ordinance (as
amended through December 2010)
✓ Amendments to the Code of Ethics Ordinance (September 2009 through July 2012)
.t ✓ Highlights of the Miami -Dade County Ethics Code
i~
✓ 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 Ethics for Public Officers and Employees
o Source of Income Statement
o Acknowledgment of Financial Disclosure Requirement
o DIVERSITY STATISTICS REPORTING Keep COPY in file and ORIGINAL for Annual Report.
3 (4• TOL'
Date
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Date
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Signed by X
By Employee:
By Employee:
B9%a� or mittee -.• •er
Office St
itials
Date City C1- ' 's Office Staff Initials
=� �"'K
ID
CONCLUDED & RESIGNATION LETTERS
Term Expired Letter Date Processed
Resignation Letter Date Processed
Removal Letter due to absences Date processed
Initials Scan 0
Initials Scan 0
Initials Scan 0
F:\CLER\$ALL\BOARD AND COMMITTIES DATABASE\CHECKLIST MASTER\B&C Checklist 2015 MASTER.docx
MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 331 39 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
February 21, 2018
Ms. Annabel Delgado -Harrington
1079 NE 90 St.
Miami, Florida 33138
SUBJECT: Desian Review Board
Dear Ms. Annabel Delgado -Harrington:
Congratulations! You have been reappointed by the City Commission to the above referenced board or
committee, 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. Congratulations and good luck.
Respectfully,
Rafael Gra ado
City Clerk
cc: Saul Frances, Parking Director
James Murphy, 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.
MIAMI BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfl.aov
CITY CLERK'S OFFICE CityClerk@miamibeachfl.gov
Telephone: 305.673.7411 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(i) (2)
Board Member's Name:
/v/vg-h.e /)-167f-clo
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)"
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.
G Zo
Signature Date
Updated: Thursday, December 28, 2017
Page 4 of 4
F:\CLER\BALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 06022014.docx
MIAMI-DADE
SOURCE 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
0-01-7 1 AO9 - 2e NIcorvN ANNIA-efft.
Middle Name/Initial
Mailing Address — Street Number, Street Name, or P.O. Box
t O1-1 NE- all) ST
City, State, Zip
(A r 3312
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. ❑
Fig as an Employee (check one)
E Coun l Public Health Trust fl Municipal:
Department
Position or Title
Work address
Filing as a Board Member (check one)
fl County Municipal:
Board where serving
1 1 + 1VIat% PeoPileP
Alternate address (if home address is exempt)
(Municipality)
Work telephone
Employee ID Number
Employment began on/ended an
pi (AM t GH i& 12CVlEvQ
(Municipality)
Work telephone
Term began on/ended on
JAN W (9 -
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 far 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.E
Name of Source of Income Address Description of the Principal Business Activity
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I hereby swear (or affirm) that the information above is a true and correct statement.
Signature of Person Disclosing
0).0.-1/oIe'
Date signed
OFFICE LIEF ONLY Accepted: Y / N Deficiency:
135 SP -14 COE 2016
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RECEIVED BY ELECTIONS DEPARTMENT:
❑ Hardcopy
E -Electronic -Copy
Processed Date/Initials:
Scarred Date/Initials:
MIAMI BEACH
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: 305.673.741 1, Fax: 305.673.7254
Email: CityClerk@miamibeachfl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Ms. Annabel Delgado -Harrington
RE: Design Review Board
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, following the closing
of the calendar year on which I have served.
Ms. Annabel Delgado -Harrington
Sworn to and subscribed before me this t day of
C�Char D'Agostin
uty Clerk
2018
*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.
/\/\1AM BEACH
DIVERSITY STATISTICS REPORTING
••• Name: Palma( worm,0 - N-�r'vr/1G�Vvv1
Board / Committee: Trl fr1014 vi laNar
Appointment Date: • -20iib
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 L i
Race/Ethnic Categories
What is your race?
p2rican-American/Black
L,. CaucasianiWhite
P Asian or Pacific Islander
Native-American/American Indian
L. Other — Print Race: V I
Do you consider yourself to be Spanish, Hispanic or Latino/a? ,Marr: the "No" box if not
Spanish, Hispanic, Latino/a.
CD 11:kc
Do you consider yourself Physically Disabled?
is Yes
C:\USers'\CENTFraNLAppData\ ocar,Microsoft\Windows`rernoorary Int -me Flies\Content.outlook\NPeU9CNME3C minority
information form 05-20-13 FINAL.doc
Updated: Monday, Januan/ 26. 2015