Jamie Guirola 12/31/22BOARD AND COMMITTEE CHECKLIST
APPOINTEE: ____________________________________ DATE OF APPOINTMENT: ______________
BOARD/COMMITTEE: ____________________________ Appointed by: ___________________________
FOR SCANNER FOR CLERK STAFF
Scan ż ○Letter of Appointment TERM END: _______________ TERM LIMIT: _____________
Scan ż ○Letter of Reappointment
ż Copy of Letter of Appointment/Reappointment e-mailed to Committee Liaison on
_____________
Scan ż ż Board and Committee Application (Completed on )
Scan ż ż Résumé/Curriculum Vitae
ż Diversity Statistics Reporting (Completed on )
Scan ż ż Oath
IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
9 City Code Ordinance Section applicable to the agency, board or committee
9 City Code Sections 2-21, 2-22, 2-23, 2-24, 2-25, 2-26, 2-458 and 2-459
9 County Code Section 2-11.1 ± Conflict of Interest and Code of Ethics Ordinance (as
amended through December 2010)
9 Amendments to the Code of Ethics Ordinance (September 2009 through July 2012)
9 Highlights of the Miami-Dade County Ethics Code
9 Sunshine Law and Public Records ± Frequently Asked Questions
9 Memorandum - Solicitation by City Board and Committee Members
ż Citywide Permit Application (Parking Department Form)
ż Booklet ± Guide to Sunshine Amendment & Code of Ethics for Public Officers and Employees
Scan ż ż Source of Income Statement
Scan ż ż Acknowledgment of Financial Disclosure Requirement
ż DIVERSITY STATISTICS REPORTING Keep COPY in file and ORIGINAL for Annual Report.
Received on: _______________________ Signed by X________________________________________________
Date Board or Committee Member
Processed on: ______________________ By Employee: ________________________________________________
Date Cit\ Clerk¶s Office Staff Initials
Scanned on: ______________________ By Employee: ________________________________________________
Date Cit\ Clerk¶s Office Staff Initials
CONCLUDED & RESIGNATION LETTERS
Term Expired Letter Date Processed Initials Scan ż
Resignation Letter Date Processed Initials Scan ż
Removal Letter due to absences Date processed Initials Scan ż
F:\CLER\BOARD AND COMMITTIES DATABASE\CHECKLIST MASTER\B&C Checklist 2015 MASTER.docx
12/31/22 12/31/25
11/12/2020
11/12/2020
11/12/2020
11/12/2020
11/12/2020
11/12/2020
November 08, 2020
Mr. Jamie Guirola
801 15th Street Apt. 106
Miami Beach, FL 33139
SUBJECT: LGBTQ Advisory Committee
Congratulations! You have been reappointed by Commissioner Ricky Arriola to the above referenced,
board or committee named above, 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.
Congratulations and good luck.
Regards,
Rafael Granado
City Clerk
cc: Saul Frances, Parking Director
Morgan Goldberg, 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
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Mr. Jamie Guirola
RE: LGBTQ 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: 12/31/2022.
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.
________________________________
Mr. Jamie Guirola
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.
12th Nov
MI A MI BE H
City of Miami Beach
1 700 Convention Center Drive
Mi a mi Beach , Flor ida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305 .673 7411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
STATE OF FLORIDA
COUNTY OF DADE
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as ( check ( ✓) all that apply):
D I am a resident of the City of Miami Beach for six months or longer.
D I have an ownership interest (for a minimum of six months) in a business established in the
City of Miami Beach (for a minimum of six months).
')5' I am a full-time employee of a business (for a minimum of six months) and I am based in an
office or other location of the business that is physically located in Miami Beach (for a
minimum of six months).
"Ownership Interest" means the ownership of ten percent (10%) or more (including the
ownership of 10% or more of the outstanding capital stock) in a business.
"Business" means any sole proprietorship, sponsorship, corporation, limited liability company,
or other entity or business association.
Under penalties of perjury, I declare that I have read the foregoing document and that the facts
stated in itar!rue.
1r2rozo
-------------- Sign ature Date
Jamie Guirala
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of ] physical presence or [nline
.. . . 12th. November notarization, this 'lay of
Jamie Guirola (City of Miami Beach Board/Committee Member).
,20-by
X Produced ID FL Drivers License
Form of Identification
Personally Known
Ciao 'aeut
Signature of Notary PßRe
Charles J. D'Agostin
Name of Notary, Typed, Printed, or Stamped
(NOT ARY SEAL)
3Mg!«,_ Charles J. DAgostin
Œ) NOTARY PUBLIC
&¿ TATE OF FLORIDA
Comm# GG168171
Expires 12/14/2021
£
* * *
* *
£
OFFICE USE ONLY Accepted: Y / N Deficiency:________________________________ Processed Date/Initials:__________________ Scanned Date/Initials: __________________
138_SP-14 COE 2016
REMEMBER TO PRINT, SIGN, AND SUBMIT TO THE OFFICE OF THE CITY CLERK VIA EMAIL OR HARDCOPY.
SOURCE OF INCOME STATEMENT
Clear From Print Form
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
2019
Last Name First Name Middle Name/Initial
Guirola Jamie P
Mailing Address – Street Number, Street Name, or P.O. Box
2275 Biscayne Blvd. Apt. 703
City, State, Zip
Miami, Fl 33137
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.
Filing as an Employee (check one)
County Public Health Trust Municipal:
(Municipality)
Department
Position or Title Employee ID Number
Work address Work telephone Employment began on/ended on
Filing as a Board Member (check one)
County ✔ Municipal: Miami Beach
(Municipality)
Board where serving
LGBTQ Advisory
Alternate address (if home address is exempt) Work telephone
954-622-6111
Term began on/ended on
01/01/18- present
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
Channel 6- WTVJ NBC6
NBCUniversal
15000 SW 27th St
Miramar, FL 33027
News/Media
I hereby swear (or affirm) that the information above is a true and correct statement.
Signature of Person Disclosing
11/12/2020
Date signed
RECEIVED BY ELECTIONS DEPARTMENT: * Hardcopy * Electronic Copy