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Sixto Acea 12_31_18"' t E AC H k'' BOARD AND COMMITTEE CHECKLIST APPOINTEE: �( k�® C > DATE OF APPOINTMENT: BOARD/COMMITTEE:-��1��1/pS Appointed by: (/UMC 6r��i(U'✓ FOR SCANNER FOR CLERK STAFF Scan o o Letter of Appointment TERM END: th ?,TERM LIMIT: Scan o o Letter of Reappointment o C'7/11 of rLftof Appointment/Reappointment e-mailed to Committee Liaison on Scan o o Board and Committee Application (Completed on ) Scan o o Resume/Curriculum Vitae K o Diversity Statistics Reporting (Completed on Scan o o Oath Scan C C Source of Income Statement Scan C C Acknowledgment of Financial Disclosure Requirement © C DIVERSITY STATISTICS REE/PORTING E Received on: U �b Signed by X d % Dat �/ a Processed on: b / l 0 Y Employee: B Em to ee: �te ` I Scanned on: ( r By Employee: Date City in file and ORIGINAL for Annual Report. ce Staff Initials scanned CONCLUDED & RESIGNATION LETTERS Term Expired Letter IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK Initials Scan C ✓ City Code Ordinance Section applicable to the agency, board or committee C'1 ✓ City Code Sections 2-21, 2-22, 2-23, 2-24, 2-25, 2-26, 2-458 and 2-459 Removal Letter due to absences ✓ County Code Section 2-11.1 — Conflict of Interest and Code of Ethics Ordinance (as j"- I amended through December 2010) ✓ Amendments to the Code of Ethics Ordinance (September 2009 through July 2012) ✓ Highlights of the Miami -Dade County Ethics Code e,' rt ✓ Sunshine Law and Public Records — Frequently Asked Questions I Memorandum - Solicitation by City Board and Committee Members C Citywide Permit Application (Parking Department Form) `-4 C Booklet -- Guide to Sunshine Amendment & Code of Ethics for Public Officers and Employees Scan C C Source of Income Statement Scan C C Acknowledgment of Financial Disclosure Requirement © C DIVERSITY STATISTICS REE/PORTING E Received on: U �b Signed by X d % Dat �/ a Processed on: b / l 0 Y Employee: B Em to ee: �te ` I Scanned on: ( r By Employee: Date City in file and ORIGINAL for Annual Report. ce Staff Initials scanned CONCLUDED & RESIGNATION LETTERS Term Expired Letter Date Processed Initials Scan C 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 corn mo�� MIAMIBEACH City of Miami Beath, 1700 Convention Center Drive, Miami Beach, Florida 331 39 www.miomibeachfl.gov OFFICE OF THE CITY CLERK, Rafael E. Granada, City Clerk Tel: 305.673.7411, Fax: 305.673.7254 Email: CityClerk@miamibeachfl.gov July 26, 2018 Mr. Sixto Acea 1750 James Ave. Apt. 4B Miami Beach, FL 33139 RE: Senior Affairs Committee Dear Mr. Sixto Acea: Congratulations! You have been appointed by the City Commission to the agency, board or committee named above for a term ending: 12/31/2018. 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 Granado City Clerk 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 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 www.miamibeachfl.gov 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: 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: 12/31/2018. 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, fQllctyving the closing of the calendar year on which I have served. I/I 1/� 11 Mr. Sixto Acea Sworn to and subscribed before me this �_ day of 2018 Ch9A9X 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. N',IAAA I BEACH City of Miami Beach 1700 Convention Center Drive Miami Beach, Florida 33139 www.miamibeachfi.gov CITY CLERK'S OFFICE Telephone: 305.673.7411 Fax: 305.673.7254 CityClerk@miamibeachfl.gov 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: (;6X k Av"o 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. 94 Signature Updated: Thursday, December 28, 2017 Page 4 of 4 F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 06022014.docx g x -hr Date Name: 1-1 DIVERSITY STATISTICS REPORTING 5;�h A -%A Board / Committee: Appointment Date: A -e e cL '!5-e_njo�( A t` T"ec,�C5 00mytk47e - 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 tt N) Female Race/Ethnic Categories What is your race? ID, African-American/Black Caucasian/White Asian or Pacific Islander 1:31 Native-American/American Indian Z) Other — Print Race: Do you consider yourself to be Spanish, Hispanic or Latino/a-, .Lark the "ilk" box if not Spanish, Hispanic., Latincla. 1-1 No ISO, — Yes 7 Do you consider yourself Physically Disabled? rV No 'InYea" information form C&20-13 FINA L.doc Updated: Monday, Januailj 2�, 201 -S