Sara de los Reyes 12_31_19I t\.A I B L (_o H
BOARD AND COMMITTEE CHECKLIST
APPOINTEE: de -/QS Ae�_S DATE OF APPOINTMENT:
BOARD/COMMITTEE: ,AAIi Vk1' �WellrlWel
-,Appointed by:
FOR SCANNER FOR CLERK STAFF COW f ee /
Scan o o Letter of Appointment TERM END: (� / TERM LIMIT:
Scan o o Letter of Reappointment
o Co t�tf/eytf Appointment/Reappointment e- aIle/d top Committee Liaison on
Scan o o Board and CommNNcatl�n (Completed •nittee A li /l �O
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Scan o o Resume/Curriculum Vitae
o Diversity Statistics Reporting (Completed on /d a` ;- )
Scan o o Oath
Scan o
Scan o
emoranaum -
mmee Mem
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 DIVERSITY STATISTICS REE/PORTIN Keep COPY in file and OR L for Annual Report.
Received on: �0/C-)-S / Signed by X
D to rd Qr Committee Me be
Processed on: By Employee:
atep� � y ffice Initi I
Scanned on: 0 l By Employee:
Date ity CI s Offi a Staff Initials
"TRnned
CONCLUDED & RESIGNATION LETTERS
Term Expired Letter
Date Processed
IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
co
Date Processed
✓
City Code Ordinance Section applicable to the agency, board or committee
Date processed
Initials Scan o
✓
City Code Sections 2-21, 2-22, 2-23, 2-24, 2-25, 2-26, 2-458 and 2-459
C1
a✓
County Code Section 2-11.1 — Conflict of Interest and Code of Ethics Ordinance (as
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amended through December 2010)
✓
Amendments to the Code of Ethics Ordinance (September 2009 through July 2012)
rn
✓
Highlights of the Miami -Dade County Ethics Code
✓
Sunshine Law and Public Records — Frequently Asked Questions
Scan o
Scan o
emoranaum -
mmee Mem
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 DIVERSITY STATISTICS REE/PORTIN Keep COPY in file and OR L for Annual Report.
Received on: �0/C-)-S / Signed by X
D to rd Qr Committee Me be
Processed on: By Employee:
atep� � y ffice Initi I
Scanned on: 0 l By Employee:
Date ity CI s Offi a Staff Initials
"TRnned
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:ICLER\SALL\BOARD AND COMMITTIES DATABASE\CHECKLIST MASTERIB&C Checklist 2015 MASTER.docx
, :n ; -e committed to pr0vi00r'Q E !211F DLDRc service and so!ehr to all, who five 101101k and plc,y in our v bront tropico,. historic communihy
MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139 www.miamibeachfl.ao_v
OFFICE OF THE CITY CLERK, Rafael E. Granada, City Clerk
Tel: 305.673.741 1, Fax: 305.673.7254
Email: CityClerk@miamibeachfl.gov
October 05, 2018
Ms. Sara de los Reyes
1800 Sunset Harbour Drive #901
Miami Beach, Florida 33139
RE: Animal Welfare Committee
Dear Ms. Sara de los Reyes:
Congratulations! You have been appointed by Commissioner Mark Samuelianto the above -referenced
Board or Committee, for a term ending: 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 directly
appointed by a member of the City Commission shall automatically expire upon the [after 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 Granado
City Clerk
cc: Saul Frances, Parking Director
Elias Gonzalez, 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 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 vwwv.miamibeachfl.gov
OFFICE OF THE CITY CLERK, Rafael E. Granada, 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. Sara de los Reyes
RE: Animal Welfare 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 1 st, following the closing
of the calendar year on which I have served. _
IF t aJ CtA JA# --O
Ms. Sara de los Reyes
Sworn to and subscribed before me this V" _dav of, -Q LC,,2018
eputy Clerk
*Please visit the City of Miami Beach website at www.miamibeachfi.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.
MBEACH
/[�%��\\ I -�/ \M
DIVERSITY STATISTICS REPORTING
Name:
Board / Committee:
Appointment Date:
s,
C,0/t&4,-J*12
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,20
11,
Race/Ethnic Categories
What is your race?
L__ rican-Amerlcan/Biack
CaucasianNVhite
Asian or Pacific Islander
Native-American/American indian
Other - Print Race:
Do you consider yourself to be Spanish, Hispanic or Latino/a? Mark File "No" box if not
Spanish, Hispanic, Latino/d.
-� N oo
� es
Do you consider yourself Physically Disabled?
F fro
Yes
ice. AUssrstv�i�'d�ri-"u
information farm 35-20-13 F1NA,L.doc
updated: OAondP_y, January 25. 20,5
{
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33134
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:
OS
e
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.
&_- "j-1—
Signature
Updated: Thursday, December 28, 2017
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