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Carolina Bolado 12/31/22 September 10, 2020 Ms. Carolina Bolado RE: Transportation, Parking and Bicycle-Pedestrian Facilities Committee Dear Ms. Carolina Bolado: Congratulations! You have been appointed by Commissioner Ricky Arriola to the above-referenced Board or Committee, for a term ending: 12/31/2022. 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. Regards, Rafael Granado City Clerk cc: Saul Frances, Parking Director Saul Frances, 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. Oath of Office Oath of Civility and Acknowledgements TO: Ms. Carolina Bolado RE: Transportation, Parking and Bicycle-Pedestrian Facilities 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: 12/31/2022. 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. Carolina Bolado Sworn to and subscribed before me this day of , 2020 ________________________________ Charles D'Agostin Deputy 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. 14th Sep Page 5 of 6 F:\CLER\$ALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx Updated: June 2020 BC@miamibeachfl.gov BOARD & COMMITTEE FINANCIAL ACKNOWLEDGEMENT STATEMENT 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) Last Name First Name Middle Initial 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. 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;” or 2. A “Statement of Financial Interests (Form 1)1;” or 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 Date 1 Members of the Planning Board and Board of Adjustment will be notified directly by the State of Florida, pursuant to F.S. §112.3145(1)(a), to file a Statement of Financial Interests (Form 1) with the Miami-Dade County Supervisor of Elections by 12:00 noon, July 1. Planning Board and Board of Adjustment members who file their Form 1 with the County Supervisor of Elections automatically satisfy the County’s financial disclosure requirement as a Miami Beach City Board/Committee member and need not file an additional form with the Office of the City Clerk. However, compliance with the County disclosure requirement does not satisfy the State requirement. Bolado Carolina I 9/10/2020 MIAMl-�E- giiJ SOURCE OF INCOME STATEMENT Section 2-11.1(i) of the County Ethics Code requires that certain employees and public officials file a llnanclal disclosure Statement on a yearly basis by July 1st of every year. Disclosure tor Tax Year Ending I Last Name First Name Middle Name/Initial 2019 Bolado Carolina Ivette Mailing Address -Street Number, Street Name, or P.O. Box 2939 Indian Creek Drive Apt 502 City, State, Zip Miami Beach, Florida 33140 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) D County D Public Health Trust D Municipal: (Municipality) Department Position or litle Employee ID Number Work address I Work telephone Employment began on/ended on Fifing as a Board Member (check one) D County 12]Municipal: Miami Beach (Municipality) Board where serving Transportation, Parking, and Bicycle-Pedestrian Facilities Committee Alternate address (if home address is exempt) I Work telephone (305)209-2282 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 Portfolio Media 111 West 19th Street Reporting for legal newswire New York, NY 10011 Law360 I hereby swear (or affirm) that the information above is a true and correct statement. �f.� Signature of Person DisclosinG RECEIVED BY ELECTIONS DEPARTMENT: D Hardcopy Dx Electronic Copy �l!,;J�� OFFICE USE ONLY Accepted: V / N Deficiency:, ___________ Processed Date/Initials: ______ Scanned Date/Initials: _____ _ 138_SP-14 COE 2016 Office of the City Clerk Received Sep 14, 2020 Page 6 of 6 F:\CLER\$ALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx Updated: June 2020 Email: BC@miamibeachfl.gov DIVERSITY STATISTICS REPORT Last Name First Name Middle Initial The following information is voluntary and has no bearing on your consideration for appointment. It is being asked to comply with City diversity reporting requirements. Gender: Male Female Other I prefer not to answer. Race/Ethnic Categories: What is your race? African American/Black Asian or Pacific Islander Caucasian/White Native American/American Indian Other – Print Race: I prefer not to answer. Do you consider yourself to be Spanish, Hispanic, or Latino/a? Yes No I prefer not to answer. Do you consider yourself Physically Disabled? Yes No I prefer not to answer this question. Bolado Carolina I