Florencia Jimenez-Marcos 12/31/21{A A
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BOARD AND COMMITTEE CHECKLIST .
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R E C E IV ED
JAN 2 1 2020
FOR CLERK STAFF
o Letter of Ap poi ntm ent T ER M END:
o Letter of Reappointment
° 7f %/1333 m a n so«sosa r ,r e s s cras a -»
• an~Comritee Alcaon (cometea on ///._2?
o Résumé/Curriculum Vitae
o Di versi ty Statistics Repo rti ng (Completed on y
o Oath
Liaison on
IM PO RT ANT IN FO R M ATI O N FO R BO ARD AN D CO M MI TT EE MEM BERS BO O K
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, 2-4 58 and 2-4 59
/ County Code Section 2-11.1 - Confi ct of Interest and Code of Ethi cs Or di n ance (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
CITY OE MIAMI BEACH
OFFF +E CITY CLER!o Citywide Permit Application (Par king Department Form)
o Booklet - Guide to Sunshine Amendment & Code of Ethics for Public Officers and Employees
o Source of Income Statement S can O
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Processed on:
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o Acknowledgment of Financia! Disclosure Requirement
O DIVERSI TY STA TISTICS R ~O RT~=c~p;~_-""' /?_Jo, ses»±!
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Resignation Letter Date Processed Initials Scan O
Removal Letter due to absences Date processed Initials Scan O
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We are committed to providing excellent public serice ad scíeiy to all who live, work, and lay in our vibrant trooicci historic community.
MIA M I BEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139 www .miamibeachfl.gov
OFFICE OF THE CITY CLERK, Rafael E. Granado, City Clerk
Tel: 305.673.7411, Fax: 305.673.7254
Email: CityClerk@miamibeachfl.gov
January 17, 2020
Ms. Florencia Jimenez-Marcos
4444 Alton Road
Miami Beach, Florida 33140
RE: Art in Public Places Committee
Dear Ms. Florencia Jimenez-Marcos:
Congratulations! You have been appointed by the City Commission to the agency, board or committee
named above for a term ending: 12/31/2021.
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.
Rafael'Granado
City Clerk
cc: Saul Frances, Parking Director
Brandi Reddick, 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.
M IA M I BEACH
City of Miami Beach, 1700 Convention Center Drive, Miomi Beach, Florido 33139 www .miomibeochfl gov
OFFICE OF THE CITY CLERK, Rafael E. Granado, City Clerk
Tel : 30 5.6 7 3.7 4 11 , Fo x. 30 5 .673.7254
Em a il: C ityC le rk@ m ia m ib eachfl.g o v
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Ms. Florencia Jimenez-Marcos
RE: Art in Public Places 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: 12/31/2021.
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 1st, following the closing
of the calendar year on which I have served.
Sworn to an d subscribe d before me this Zí 2020
Deputy Clerk
I/
*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 com m itted to pro viding excellent public serv ice and safety to all who live, work and play in our vibrant, tropical, historic com m unity
MI AMIBE ACH
City of Miami Beach
l 700 Convention Center Drive
Miami Beach, Florida 33139
www_miamibeach[]_gov
CITY CLERK'S OFFICE
Telephone: 305.673.7411 Fax: 305.673.7254
Ci#yClerk@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)
es.raw-mt-rs Nan.. }lo0cia Jlaeoa- /tCOS
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 "Statem ent 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
22/70 2
Date
Updated: Th ursday, Dece mber 28, 2017
Page 4 of 4
F:\CLER\$ALL\aFORMS\BOARD AND COMMITT EES\BC APPLICATION REVISED 06022014.docx
S O U R C E O F IN C O M E S TAT E M E N T
Section 2-11.1(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 fo r Tax Year Ending I Last Nam e First Nam e Middle Name/Initial
201 Jas-4?a Po€.
Maili ng Address - Street Number, Street Nam e, or P.O. Box
HI/4( /-os í2...l)
City, State, Zip
+ • + ( Al, f 3 /o V(p, +
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. D
Filing as an Employee (check one)
[] Municipal:
Department
Position or Title Employee ID Number
Work address Employment began on/ended on
[Municipal:
,
[] county G y of- 1 $9ct
(Municipality)
Board where serving
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Alternate address (if home address is exempt) I Work telephone . . . , ,¡ Term began on/ended on
30 5 - 20/-ele]J0,s 2 E
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 oí 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 Description of the Principal Business Activity
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I hereby swear (or affirm) that the informatiun above is a true and correct statement. wove "Hg9S PP»a
[ Hardcopy
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Date signed
CITY OF MIAMI BEACH
OFFICE O TE CITY C LE R K
OFFICE USE ON!Y Accepted:. Y / N Deficiency. Processed Date/initials: Scanned Date/initials:
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DIVERSITY STATISTICS REPORTING
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Name:
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 Fera K
Race/Ethnic Categories
What is your race?
Af rican-American/lac
L2caucasianNwhite
[!Asian o: Pacific Islander
[¿Native-American/American Indi an
LÀ th er- Print Race.
Do you consider yourself to be Spanish, Hispanic or Latino/a? Mark the "No" box if not
Spanish, Hispanic, Latino/a.
e
S4ves
Do you consider yourself Physically Disabled?
f ves
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information form O5-20-13 FINAL.dc
Updated: Monday, January 28.2015