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Allison Stone 12/31/21 AA I AAA 1 B E AC ,r4H BOARD AND COMMITTEE CHECKLIST APPOINTEE: ,41// S6t151-0A-P-e- DATE OF APPOINTMENT: (/7/ BOARD/COMMITTEE: /7`-M C- Appointed by: ,-)1-‘7 coi -S/U FOR SCANNER FOR CLERK STAFF 7, --7-- (4)-1 Scan o o Letter of Appointment TERM END: TERM LIMIT: _ 471-1363 Scan o o Letter of Rea.pointment o .ry : e'er 419 da�f'(J,4ppointment/Reappointment --mailed to Committee Liaison on iir Scan o o Board and Committee Application (Completed on 7 J 0 Scan o o Resume/Curriculum Vitae ��� �-, o Diversity Statistics Reporting (Completed on /r '�\ (� 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) FEB -6 2020 ✓ Highlights of the Miami-Dade County Ethics Code ✓ Sunshine Law and Public Records— Frequently Asked Questions CITY OF MIAMI BEACH ✓ Memorandum -Solicitation by City Board and Committee Members OFFICE OP 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 0 o Source of Income Statement Scan 0 0 Acknowledgment of Financial Disclosure Requirement o DIVERSITY STATISTICS REPORTING KeCOP ' ile and ORIGINAL for Annual Report. Received on: 0�� g()).--0 Signed by Xep Date Bo- c or o mitt-- ,_ ber Processed on: 69 A/ OBy Employee: , D to I y .d'r Office Staff Initials Scanned on: `�` ) ,)-00-0 By Employee: All Date City erk' ince Staff Initi Is scanned CONCLUDED & RESIGNATION LETTERS Term Expired Letter Date Processed Initials Scan 0 Resignation Letter Date Processed Initials Scan 0 Removal Letter due to absences Date processed Initials Scan 0 F:\CLER\BOARD AND COMMITTIES DATABASE\CHECKLIST MASTER\B&C Checklist 2015 MASTER.docx We are committed to providing excellent public service and safely to all who live, work, and play in our vibrant, tropical. historic community. MIAMI 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: 305.673.741 1, Fax: 305.673.7254 Email: CityClerk@miamibeachfl.gov January 17, 2020 Ms.Allison Stone 4775 Collins Avenue#1905 Miami Beach, Florida 33140 SUBJECT: Affordable Housing Advisory Committee Dear Ms. Allison Stone: Congratulations!You have been reappointed by the City Commission to the above referenced board or committee, fora 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. Congratulations and good luck. Respectfully, Rafael Granado City Clerk cc: Saul Frances, Parking Director Alba Tarre, City Liaison ATTACHMENTS: Letter of Appointment Oath 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 Ordinance 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.Granado, 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.Allison Stone RE: Affordable Housing Advisory 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. Ms.A ison Stone 44. Sworn to and subscribed before me this day of ,'2020 har/'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. MIAMI BEACH City of Miami Beach 1700 Convention Center Drive Miami Beach, Florida 33139 www.miamibeachfl.gov CITY CLERK'S OFFICE CityClerk@miamibeachfl.gov Telephone: 305.673.7411 Fax: 305.673.7254 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: A LL S) OAIc= 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. 0 5/20 0 / Signature Date Updated:Thursday,December 28,2017 Page 4 of 4 F:\CLER\SALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 06022014.docx MIAMI•DADE SOURCE OF INCOME STATEMENT COUNTY 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 Last Name First Name Middle Name/Initial 2019 370A)6 fi LL(St r/ Mailing Address—Street Number,Street Name,or P.O.Box /77-- Ave- ftm 5 City,State,Zip Mi/kikti i - / FL 3l1-10 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.❑ g as an Employee (check one) un Public Health Trust E Municipal: (Municipality) Department Position or Title Employee ID Number Work address Work to-.•.le Employment began on/ended on Filing as a Board Member(check one) E County ►® Municipal: G p I /"►r Ct r 8 a-c-1N (Municipality) Board where serving • Alternate address(if home address is exempt) Work telephone 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 palm` 1L33/3 / kov/P ` ,(12k Gip inC , t,e, �� /260 #/Y� I hereby swear(or affirm) h the rrformat(efi above is a true and correct sta ement. RECEIVED BY ELECTIONS DEPARTMENT: ❑ Hardcopy LiElectronicElectronic R Signature of Person Disclosing FEB -6 2020 ©40Ca40z0 CITY OF MIAMI BEACH Date signed tjFr='1^r CITY CLERK OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/Initials: Scanned Date/Initials: 138 SP-14 COE 2016 MIAMI BEACH DIVERSITY STATISTICS REPORTING Name: A ( OA) S 1-07) � Board / Committee: A /-/-/—C Appointment Date: 1 /7 0-0d'es 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 U9 Femal Race/Ethnic Categories What is your race? [D African-American/Black 16:1° Caucasian/White i;�:r ,,,?r.T. l; ,;;•,: -.der NI Native-American/American Indian 0 Other- Print Race: • Do you consider yourself to be Spanish, Hispanic or Latino/a? Mark the "No"box if not Spanish, Hispanic, Latino/a. frNo D Yes . Do you consider yourself Physically Disabled? bKlo Yes C:\Users\CENTFraN.AppData\Local\Microsoft\Windows\T=moorary Internet Fites\Content.outlook\NP4J9CNX'SCmincrity information form 05-20-13 FINAL.doc Updated: Monday,January 26,2015