Francisco Diez-Rivas 12/31/20/\61A4 = ê= } r a g z HF[(Hi in i..t 3.ss j
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BOARD AND COMMITTEE CHECKLIST
APPOINTEE: Erine /<,e o /y L Z -R, V+ s DA TE oF APPOINTMENT: /b '1 / 2e-o
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L etter ot Appointment TER M END : / '5//9o rRMLIrr. _h2.3//27
o Letter of Reappointm ent
o Cpl of Litter of Appoi ntment/R eappoi ntment
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o Böard and 'om m ittee Application (Completed ony,T 4 4 )
o Résum é/Curri culum Vi tae T 7 7
o Di versi ty Statistics Reporting (Completed on , ' 7
o O ath S c an o
Committee
REC E IVED
FEB -4 2020
IM P O R T AN T IN F O R M A TI O N FO R BO AR D AND CO M MI TTE E M EM B ER S B O O K
City Code Ordinance Section applica ble to the agency, board or committee
City Code Sections 2-21,2-22, 2-23, 2-24, 2-25, 2-26, 2-4 58 an d 2-4 59
/ County Code Section 2-11.1 - Confl ict of Interest and Code of Ethics Ordinan ce (as
am ended through Decemb er 2010)
Y Am en dm ents to the Code of Eth ics Ordi nan ce (Septem ber 2009 through July 2012)
✓Highlights of the Miam i-Dade County Ethics Code
/ Sunsh ine Law an d Public Records - Frequently Asked Questions
✓Mem oran dum - Solici tation by City Board and Committee Members
CITY OF MIAM I BE A CH „ . . „ •
OFFICE OF E CITY CLE RR? Citywide Permit Ap plication (Parking Department Form )
o Booklet - G uide to Sunshine Amendm ent & Code of Ethics for Public Officers and Employees
S c an O
can O
Received on.
o Source of Incom e Statem ent
o Acknowledgm ent of Financial Disclosure Re
/
o-o!V~S!TY STATISTICS REPORTl,N,G.-K~ file and ORIGINAL for Annual Report.
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Resig nation Letter Date Pro cessed Initials Scan O
Rem oval Letter due to absences Date pro cessed Initials Scan O
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FICLEROARD AND COMMIT TIES DATABASE\CHECKLIST MASTER\B&C Checklist 2015 MASTER.doc
We are committed to oroviding excellent public service and scíeiy to all who live. work and lay in our vibrant, tropical historic community.
M IA M I BEACH
City of Miami Beach, 1700 Con vention Center Drive, Miami Beach, Florida 33 l 39 www .miamibeachfl.gov
OFFICE OF THE CITY CLERK, Rafael E. Granado, City Clerk
Tel: 305.673.7411, Fax: 305.673.7254
Email: CiClerk@miamibeachfl.gov
January 24, 2020
Mr. Francisco Diez-Rivas
5660 Collins Avenue #2E
Miami Beach, Florida 33140
RE: General Obligation (G.O.) Bond Oversight Committee
Dear Mr. Francisco Diez-Rivas:
Congratulations! You have been appointed by Mayor Dan Gelberto the above-referenced Board or
Committee, for a term ending: 12/31/2020.
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 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 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.
7 91Ral:' G,anado
City Clerk
cc: Saul Frances, Parking Director
Maria Hernandez, 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)
We arBaklet eduideitiodhec@ten s bite Amen dmatsat eeantd é/ode tfeEthi stfo pl@ubl Offret srach Ems ployeesunity.
MIAM I BEACH
C ity of Miami Beach, 1700 Convention Center Dive, Mi ami Beach, Florid 3313 A¿www_miamibeachíi_gov
O FFI CE O F THE CI TY CLERK, Rafa el E. G ranado, City Clerk
Tel: 305.673.7411, Fax: 305.673.7254
Em ail: City Clerk@ m iam ibeachfl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Mr. Francisco Diez-Rivas
RE: General Obligation (G.O.) Bond Oversight 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: 12/31/2020.
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. .] -
Sworn to and subscribed before me this /1!
-
• o
*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 service and safety to all who live, work and play in our vibrant, tro pical, historic com m unity.
MI AI BE A CH
City of Miami Beach
l 700 Convention Center Drive
Miami Beach, Florida 33139
www._miamibegchf]_gov
CITY CLERK'S OFFICE
Telephone: 305.673.7411 Fax: 305.673.7254
Cit/Clerk@miamibeachfl.gov
Acknowledgement of fines/suspension for Board/Com mittee Members for failure to comply with Miami-
Dade County Financial Di sclosure Code Provision Code Secti on 2-11.1(i ) (2)
-- - a Board Member's Nam e: n u s &o Z)re - KUS
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.
Qne 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.
.>' \ » 7Y ..." •• Z 0 o.
Signature
\_~
Date ~
Updated: Thursday, December 28, 2017
Page 4 of 4
F:\CLER\$ALL\aFORMS\SOARD AND COMMITTEES'BC APPLICATION REVISED 06022014.docx
MIAMI-DAD,
EI SOURCE OF INCOME STATEMENT
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 for Tax Year Ending I Last-6 e First Name Middle Name/Initial
201s Tye? da ,.---
A-' 7 C S
Mailing Address - Street Number, Street Name, or P.O. Box
5o C l7ss 0e 2- '---
City, State, Zip
e( o 0Dai 3a oh 33
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
[] county
Department
Position or Title
Work address Work telephone on
Filing as a Board Member (check one)
[] county 52 unica:
(Municipality)
Board where serving
GO Bo-D OOxsrs+ uo.
Alternate address (if home address is exempt) I Work telephone I Term began on/ended on
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 of 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(Qr affirm) that the inform ation above is a true and correct statement.
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RECEIVED BY ELECTIONS DEPARTMENT:
wartsoE CEIVE D
D Electronic Copy
!
FEB -42020
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
OFFICE USE ONLY Accepted: Y / N Deficiency. Processed Date/initials. Scanned Date/initials:
138_SP-14 COE 2016
MA[/AA/rs /Vil. V\lbt+fi
Name:
DIVERSITY STATISTICS REPORTING
Fa-so Dez-#U s
Board/ Committee:
Appointment Date:
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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 O Female O
Race/Ethnic Categories
What is your race?
African-American/slack
í Caucasian'white
O Asian or Pacific Islander
[! Native-American/American Indian
L]ther-rint Race.
Do you consider yourself to be Spanish, Hispanic or Latino/a? Mark the "No" box if not
Spanish, Hispanic, Latino/a.
3o
kvee
Do you consider yourself Physically Disabled?
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C:\Users\CENTraN'AppData\local\Microsoft\Windows\Temoory intsrne: Files'Content.Outlook4NP4J9CNXC minority
information form 05-20-13 FINAL.doc
Updated: Monday, January 2, 2015