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Yliana Gonzalez 12/31/19� � �� `� � � ' �'#,� � � �`�� r �� '�.a , E � � ,� �,. : � �. H�;�� y BOARD AND GOMIVIITTEE CHECKLIST APPOINTEE: �,�` i �� G ��N`��- % Z DATE OF APPOINTMENT: � ( � � /C� � BOARD/COMMITTEE: ��a� ��-tl°� Appointed by: ��'� �� FOR SCANNER SCan o �c�n o Scan o Scan o Scan o r.n �.,.;: c� :;,:� � �� L� �y � � m� � �.a Scan o FOR CL.ERK STAFF �� j / / // ` / o Letter �f Appointment TERIVI END: /�� ( � l ( ( � T�RM LIMIT: ��/ �r �� o Letter of Reappointment o C py � et /r of Appointment/Reappointment e-mailed to Committee Liaison on , , o Board and Committ e Application (Completed on ) o Resume/Curriculum Vitae � /� �� o Diversity Statistics Reporting (Compl�ted on o Oath ` " IMPORiAIVT INFORMATION FOR BOARD AND COMM(TTEE MEMBERS BOOK ✓ City Gode 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 20�9 through July 2012) -' ✓ Highlights of the Miami-Dade County Ethics Cade �," �� ✓ 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 Scan � o Acknowledgment of Financial Disclosure Requiremenfi o DIVERSITY STATISTiCS REPORTING p COPY in file an � /� //��' ' � �/ %� Received on: � Signed by /� ` L�!/i�i � �J te B rd or ommittee b Processed on: _ � / � By Employee: Date it I 's ice Staff Init� GINAL for Annual Report. � Scanned on: � /� l/ � By Employee: J Date �ity Cle ffice Staff Initials CONCLUDED & RESIGNATION LETTERS Ten�n Expired Letter Date Processed I Initials Scan o Resignation Letter Date Processed Initials Scan o � Removal Letter due to absences Date processed Initials Scan o F\CLER\SALL\BOARD AND COMMITTIES DATABASE\CHECKLIST NiASTERIB&C Checklist 2015 M,4STER.docx � .t_ :7i(?._..�f�.i,.�t:,: ...'Ci � .t� :.�i�DUC': ,.� .�_.,i,'.t .c:��'::hilC�L; .L�p -r �J!i: C'ic Ti�. �it _�f .�.�„� �,' ('�_:J:i„ h�..iOfiCii�f�R7iir7P�• �> �`�� i��l 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 June 29,2018 Yliana Gonzalez 200 Alton Road, Apt 503-N Miami Beach, FL 33139 RE: Senior Affairs Committee Dear Ms. Yliana Gonzalez: Congratulations! You have been appointed as a representative to the above-referenced Committee as selected by Rebecca Towers, for a term ending on 12/31/2019. 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 direct�y 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 as they concern your duties, responsibilities, and requirements as a board or committee member. Congratulations again and good luck. Regards /,�� Rafael Gr nado �'` City Cler cc: Saul Frances, Parking Director Diana Fontani, 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 excellent public seivice and safety to all who live, work and play in our vibrant, tropical, historic community. MIANlI BEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 331 39 www.miamibeachfl.aov OFFICE OF THE CITY CLERK, Rafael E. Granado, Ciiy Clerk Tel: 305.673.741 1, Fax: 305.673.7254 Email: CityClerk@miamibeachfl.gov Oath of Office Oath of Civility and Acknowledgements TO: Ms. Yliana Gonzalez RE: Senior Affairs 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 1 st, following the closing of the calendar year on which I have served. �, o« � c�� , Ms. Yliana Sworn to and subscribed before me this �� d� i�/_ / vCharl 'Agostin uty 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 p/ay in our vibrant, tropical, historic community. �� , . DfirERSi7`Y STATI5TIC5 REPORTING Narne: /��__�� 2�� ' Board / Committee: ��II��G�i� /��%�►� ��%�/ � � _ / / � � ` Appointment Date: ��/� i � Pursuant to City af Miami Beach Ordinance 2009-3632, the Ciiy is required to annually prepare and present a repori to the City Comrnission identirying the City's diversity statistics. This form allows board and committee applicants and members to voluntarily self-identify their race, ethnicity, disabfed status ana gender. Please check ihe appropriate box far each category: Gender: Ma(e � Female� RGce/Ethnic Caiegories What is your race? � �1 A.�rican-Amer�can!ofac� , rc CaucasianN^Jhiie ' �,sian or Pacific Isiand�r � Na�iva-�mericanlAmerican inc�ian t-. j Oth�r — Print Race: Do you consic{er yourself to be Spanish, Hispanic or Latinola : �?�:r,=: t: �e "No" u�� i` no� � Spun;s:�, ,'-r';�panic, LGfrr,c%G. � � ; iti o � �� : Do you consider yaurse(r Physica(ly Disabled? � �� i � Yes !�:�,J��,i�=�P17i=rc"J��4�C�)^C31-._cl:rl��::r;'..��.,�'�,r�J._.,'f.. �C.[?�_„;C._ �_ _. , . . _� � ., � � ifli!?(fT'c ttQ!l t!:�i(t': nJ-�l;-i,j �IRI,`-.�..tj0�v �i�,��a-:?.1. 4Ap�t,:�4,.laitU=r;�'._.:=0i=; �� , � ? ��.>��`�� . � � City of Miami Beach 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.a.� OFFICE OF THE CITY CLERK 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: { L;�.�1 c%�— ��.� x, Z��l� Z I understand that no later than Julv 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. -� ,; /r�,%ii' � � %� � � l f/��,�� i�__y� C�/ (x�� %�� /� - �igna`fure '' Updated: Thursday, December 22, 2016 Page 4 of 4 C:\Users\CLERQueRlDesktoplBC APPLICATION.docx FORM 1 STATEMENT OF Pleaseprintortypeyourname,maiiing � FINANCiAL INTERESTS address, agency name, and position below: LAST NAME -- FIRST NAME -- MII�DLE NAME : � J �"�ETr17 �-�..�E'_Z 1 i � C�'-1r1 � s• MAIL.iNG ADDRESS : ' ,� o � � \ �-S-rn �1�(] C,�..i� A-�}. � S c � — N � �y� ��.� � � r'_c'� [ _�.. � � :� `l �"1, cxN't'� — � � . �ITY : ZIP : COUNTY : r�.� a��-� �., �; �� -t-�,� �� .��r �.;�.�.�►� ��, NAME OF AGENC� : ,j �� l� Lk> ��' �i.:wl�- �v. i�i 1;;�2-�'1., 1��°�: t�l�,�1 �' L`�vf�'i � NAME OF OFFI�GE OR POSITION HELD OR SOUGHT : �t �E=lc;�, 2017 FOR OFFICE USE ONLY: J You are not limited to the space on the lines on this form. Attach additiona! sheets, if necessary. CHECK ONLY IF ❑ CANDIDATE OR �] NEW EMPLOYEE OR AP; 0,(NTEE � � � �� h **** BOTH PARTS OF THIS SECTION MUST BE COMPLETED **** DISCLQSURE PERIOD: THIS STATEMENT REFLECTS YOUR FINANCIAL INTERESTS FOR THE PRECEDING TAX YEAR, WHETHER BASED ON A CALENDAR YEAR OR ON A FISCAL YEAR. PLEASE STATE BELOW WHETHER THIS STATEMENT IS FOR THE PRECEDING TAX YEAR ENDING EITHER (must check one): ❑ DECEMBER 31, 2017 OR ❑ SPECIFY TAXYEAR IF OTHER THAN THE CALENDARYEAR: MANNER QF CALCULATING REPORTABLE INTERESTS: FILERS HAVE THE OPTION OF USING REPORTING THRESHOLDS THATAREABSO�UTE DOLLAR VALUES, WHICH REQUIRES FEWER CALCULATIONS, OR USING COMPARATIVE THRESHOLDS, WHICH ARE USUALLY BASED ON PERCENTAGE VALUES (see instructions for further details). CHECK THE ONE YOU ARE USING (must check one}: ❑ COMPARATIVE (PERCENTAGE) THRESHOLDS OR ❑ DOLLAR VALUE THRESHOLDS � PART A-- PRIMARY 50URCES OF INCOME [Major sources of income to the reporting persan - See instructions] I II I I I I I I I I I I I I (If you have nothing to report, write "none" or "n!a") NAME OF SOURCE SOURCE'S DESCRIPTION OF TNE SOURCE'S OF INCOME ADDRESS PRINCIPAL BUSINESS ACTIVITY r n. f' � ��.1:..� ��:J �1'F"i . JC:L �C:�� .��' l 1r �'; � Li� L.N PART B-- SECONDARY SOURCES OF INCOME [Major customers, clients, and other sources of income to businesses owned by the reporting person - See insfructions] (If you have nothing to report, write "none" or "nla") NAME OF BUSINESS ENTITY NAME OF MAJOR SOURCES ADDRESS OF BUSINESS' INCOME OF SOURCE � PART C-- REAL PROPERTY [Land, buildings owned by the reporting person - See instructionsJ (If you have nothing to report, write "none" or "n!a"} '�"1 �� S1—i� . PRINCIPAL BUSINESS ACTIVITY OF SOURCE FILING INSTRUCTIONS for when and where to file this form are located at the bottom of page 2. INSTRUCTIONS on who must file this form and how to fill it out begin on page 3. CE FORM 1- Efteclive: January t, 2017 (Continued on reverse side) PAGE t locorperated by rePerence in Rule 34-3.2Q2(1), EA.C. PART d— INTANGiBLE PERSONAL PRdPERTY [Stocks, bonds, certificates of deposit, eic. - See instructions] (If you have nothing to report, write "none" or "nia") TYPE OF INTANGIBLE BUSINESS ENTITY TO WHICH THE PROPERTY RELATES 4� G"lf'1 -� � ,�i � � i m ui � �� n a�iiu � PART E— LIABILITIES [Major debts - See instructions] (If you have nothing to repo�t, write "none" or "n/a") NAME OF CREDITOR ADDRESS OF CREDITOR `.� Q.._'c1 -� . � � ��,,� �� PART F— INTERESTS IN SPECIFIED BU5INESSES [Ownership or positions in certain types of businesses - See instructions] (ff vau have nothina to reoort. write "none" or "n(a") N�1ME OF BUSINESS ENTITY AQDRESS OF BUSINESS ENTITY PRWGPAL BUSINESS ACTIVI7Y POSlTfON HELD WITN ENTITY I OWN MORE THAN A 5% INTEREST IN THE BUSINESS BU5INESS ENTITY # 1 -"Yl ��'� @ �:x� P —Yl:�.rl 'Q `'r ��-e., '`Y� v�.-ti �. BU5INESS ENTITY # 2 NATURE OF MY OWNERSHIP INTEREST �-y-� �w'-� . , � � � �� PART G — TRAINING For elected municipal officers required to complete annuai ethics training pursuant to section 112.3142, F.S. ❑ 1 CERTIFY THAT i HAVE COMPLETED THE REQUIRED TRAINING. � � � _ THROUGH G ARE CONTINUE SEPARATE SHEET, PLEASE CHECK HERE ❑ ,, , IF ANY OF PARTS A � � � �� D ON A� � � � �� SIGNATURE OF FILER: CPA or ATTORNEY SIGNATURE ONLY �I If a certified public accountant licensed under Chapter 473, or aftorney Signature: I in good standing with the Florida Bar prepared this form for you, he or �-? ' t;� she must complete the following statement: ',% , ; ; F / L � `' �� ` ' I, ___________ re ared the CE -----• P P � � � C� " Form 1 in accordance with Section 112.3145, Florida Statutes, and the -- — -- �-------- — — -- instructions to the form. Upon my reasonable knowledge and belief, the r� disclosure tierein is #rue and correct. Date S'rgned: CPA/Attorney Signature: ---`1 � 2 �\�3 WHAT TO FILE: After completing all parts oF this form, includina sianina and datinq it, send back only the first sheet (pages 1 and 2) for filing. If you have nothing to report in a particular section, write "nane" ar "nla" in that section(s). NOTE: MULTIPLE FILING UNNECESSARY: A candidate who files a Form 1 with a qualifying officer is not required to file with the Commission or Supervisor of Elections. Facsimiles will not be accented -------- I date Signed: � � �� FILING II�STk�Tc1'ioNs: WHERE TO FILE: If you were mailed the form by the Comrnission on Ethics or a County Supervisor of Elections for your annual disclosure filing, return the form to that location. Local officerslemplayees file with the Supervisor of Elections of the county in which they permanentiy reside. (If you do not permanently reside in Florida, file with the Supervisor of the county where your agency has its headquarters.) State officers or specified state employees file with the Commission on Ethics, P.O. Drawer 15709, Tallahassee, FL 32317-57Q9; physical address: 325 John Knox Road, Building E, Suite 200, Tallahassee, FL 32303. Candidates file this form together with their qualifying papers. To determine what category your position falis under, see page 3 of instructions. i inuini ii ii uiiuu i i i u uiiiriii ni ina WHEN TO FILE: Initialty, each local officedemployee, state officer, and specified state employee must file wifhin 30 days of the date of his or her appointment or of the beginning of employment. Appointees who must be confirmed by the Senate must file prior to confirmation, even if that is less than 30 days from the date of their appointment. Candidafes must file at the same time they file their qualifying papers. Thereafter, file by July 1 following each calendar year in which they hold their positions. Finally, file a flnal disclosure form (Form 1F} within 60 days of leaving o�ce or empioyment. Filing a CE Form 1 F(Finai Statement of Financial Interests) does not relieve the filer of filing a CE Form 1 if the filer was in his or her position on December 31, 2016. CE FORM 1- Effective: January 1, '2017. PAGE 2 Incorporated by reference in Rule 34-8.202(1), F.�.C.