Deborah Ruggiero 12/31/19\1
BOARD AND COMMITTEE CHECKLIST
APPO1NTEE L1:WIC;
BOARD/COMMITTEE: nogiP FIG
FOR SCANNER
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FOR CLERK STAFF
o Letter of Appointment
o Letter of Reappointment
o Cpy� ot ftof Appointment/Reappointment --mailed to Committee Liaison on
DATE OF APP
Appointed by:2-4
TMENT:
TERM END: f l3 1 ///
TERM LIMIT:
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o Board and Committee Application (Completed on
o Resume/Curriculum Vitae
o Diversity Statistics Reporting (Completed on
o Oath
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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)
✓ 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 — Guide to Sunshine Amendment & Code of Ethics for Public Officers and Employees
o Source of Income Statement
o Acknowledgment of Financial Disclosure Requirement
o DIV RSITY STATISTICS REPORT t G Keep COP file and ORIGINAL for Annual Report.
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By Employee:
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Staff Initials
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CONCLUDED & RESIGNATION LETTERS
Term Expired Letter Date Processed
Resignation Letter Date Processed
Removal Letter due to absences Date processed
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F:\CLER\$ALL\BOARD AND COMMITTIES DATABASE\CHECKLIST MASTER\B&C Checklist 2015 MASTER.docx
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MIAMIBEACH
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
February 21, 2018
Ms. Deborah Ruggiero
7356 Gary Ave
Miami Beach, Florida 33141
SUBJECT: Transportation. Parkina. Bicycle -Pedestrian Facilities Committee
Dear Ms. Deborah Ruggiero:
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.
Respectfull
Raf el Gra ado
City Clerk
cc: Saul Frances, Parking Director
Saul Frances, 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 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. Deborah Ruggiero
RE: Transportation, Parking, Bicycle -Pedestrian Facilities Committee
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 1st, following the closing
of the calendar year on which I have served.
Sworn to and subscribed before me this / day of
4
2018
rrt ; ::'��In
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.
MIAM) 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:1 -jT'atIft 1`t / (9PP
1 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.
1,1Wis
Signature , " / Date
Updated: Thursday, December 28, 2017
Page 4 of 4
F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 06022014.docx
SOURCE OF INCOME STATEMENT
Section 2-111(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
2016
Mailing Address — Stre
NumbeWt. 0616
r StrName, or P.D. Box
itv6.
1CL
g1
First Name
X44 -
Middle Name/Initial
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 ars Employee (check one)
fI County 7 Public Health Trust J Municipal:
Department
Position ar Title
Work address
Filing as a Board member (check one)
County
Byafd where s ing
5-1
Al ernate addr-ss d home address is exempt)
(
a)
Work telephone
Ytunicipal: Q1T� c4
(Municipality)
Employee ID Number
Employment began an/ended an
k It-
lit/
AE
(Municipa
Work telephone
Term began on/ended an
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
AGN o
17s6Valoi,
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I hereby swear (or affirm) that th
mation abode is a true and correct statement.
Signature of Person Disclosing(
4✓9 /fR
Daife signec(
Description of the Principal Business Activity
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RECEIVED BY ELECTIONS DEPARTMENT:
❑ Hardcopy
Electronic -Copy
OFFICE 11SE ON! Y Accepted: Y / N Deficiency:
38 SP -14 COE?C1a
Processed Date/Initials: Scanned Date/Initials:
t\/\1AIV\ �bEACH
DIVERSITY STATISTICS REPORTING
Name: )
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Board / Committee: t�'rik� till L
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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 Li Female CSP
Race/Ethnic Categories
What is your race?
African-American/Black
Caucasian/White
Asian or Pacific Islander
Native-American/American Indian
rP Other — Print Race:
Do you consider yourself to be Spanish, Hispanic or Latino/a ? Mark the "No" box if not
Spanish, Hispanic, Latino/a.
,IZNo
D Yes
Do you consider yourself Physically Disabled?
No
Yes Yes
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inforrnation form 05-20-13 FIN:AL.dcc
Updated: Monday, January 25. 2015