Jamie Adams 6/30/20PJiI AP✓AIBEACH
BOARD AND COMMITTEE CHECKLIST
APPOINTEE: 4�? S DATE OF APPOINTMENT: / //�
BOARD/COMMITTEE: Q r Appointed by: ae,,-�-sc,,,e k�S
FOR SCANNER FOR CLERK STAFF
Scan o o Letter of Appointment TERM END: J � ERM LIMIT: IO �V
Scan o o Letter of Reappointment
o of r of Appointment/Reappointment e-mailed to Committee Liaison on
Scan o o Board and Committee Application (Completed on ce /l )
Scan o o Resume/Curriculum Vitae
o Diversity Statistics Reporting (Completed on
Scan o o Oath
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
RECEIVED amended through December 2010)
✓ Amendments to the Code of Ethics Ordinance (September 2009 through July 2012)
AUG 27 2019 ✓ Highlights of the Miami -Dade County Ethics Code
✓ Sunshine Law and Public Records — Frequently Asked Questions
v/Memorandum - Solicitation by City Board and Committee Members
CITY OF MIAMI BEACH
OFFICE OF. THE CITY CLERK O Citywide Permit Application (Parking Department Form)
o Booklet — Guide to Sunshine Amendment & Code of Ethics for Public Officers and Employees
Scan o o Source of Income Statement
Scan o o Acknowledgment of Financial Disclosure Requirement
o DIVERSITY STATISTICS REE/PORTING
Received on: z / Signed by X
Date B(
Processed on: f)'97 /)
By Employee:
Date //
Scanned on: ? 7 ! / By Employee:
Date
1:41
Keep COPY in file and ORIGINAL for Annual Report.
Committee Member
c'ffice Staffmi��
ice Staff Initials
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
6
FACLER\BOARD AND COMMITTIES DATABASE\CHECKLIST MASTER\B&C Checklist 2015 MASTER.docx
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 331 39 www.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
August 27, 2019
Ms. Jamie Adams
1455 N. Treasure Drive #4R
North Bay Village, FL 33141
RE: Committee for Quality Education in Miami Beach
Dear Ms. Jamie Adams:
Congratulations! You have been reappointed to the above -referenced Board or Committee as a
representative for Treasure Island Elementary School PTA, for a term ending on 06/30/2020.
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
Xeginning 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 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 Granado
City Clerk
cc: Saul Frances, Parking Director
Dr. Leslie Rosenfeld, 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 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: Ms. Jamie Adams
RE: Committee for Quality Education in Miami Beach
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: 06/30/2020.
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.
s. Jamie Adams
Sworn to and subscribed before me this v day of 2019
Karl osti
uty 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.
MIAMIBEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfl.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:
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.
Signature
Updated: Thursday, December 28, 2017
Page 4 of 4
F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 06022014.docx
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Date
M ! / -`,N11 BEACH
DIVERSITY STATISTICS REPORTING
Name; Avq � —
Board / Committee:
Appointment Date:
�� 0
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 U Female
Race/Ethnic Categories
What is your race?
African-American/Black
IETCaucasian/White
Asian or Pacific Islander
Native-American/American Indian
ID Other — Print Race:
Do you consider yourself to be Spanish, Hispanic or Latino/a? Mark the `'No" box if not
Spanish, Hispanic, Latino/a.
E3 No
0 Yes
Do you consider yourself Physically Disabled?
U No
0 Yes
C:1UsersiCFNTFraN\AppUata\Local''Microsoitiv/irdo�j;s\Temporary interna Files\Con4Lent.Outlook\NP^-JgCNkABC minority
information form 05-20-13 FtNAL.doc
Updated: Niondav, January 26, 2015