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Charlotte Tomic 12/31/22BOARD AND COMMITTEE CHECKLIST APPOINTEE: ____________________________________ DATE OF APPOINTMENT: ______________ BOARD/COMMITTEE: ____________________________ Appointed by: ___________________________ FOR SCANNER FOR CLERK STAFF Scan ○ ○ Letter of Appointment TERM END: _______________ TERM LIMIT: _____________ Scan ○ ○ Letter of Reappointment ○Copy of Letter of Appointment/Reappointment e-mailed to Committee Liaison on _____________ Scan ○ ○ Board and Committee Application (Completed on ) Scan ○ ○ Résumé/Curriculum Vitae ○Diversity Statistics Reporting (Completed on ) Scan ○ ○ 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 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 ○Citywide Permit Application (Parking Department Form) ○Booklet – Guide to Sunshine Amendment & Code of Ethics for Public Officers and Employees Scan ○ ○ Source of Income Statement Scan ○ ○ Acknowledgment of Financial Disclosure Requirement ○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 City Clerk’s Office Staff Initials Scanned on: ______________________ By Employee: ________________________________________________ Date City Clerk’s Office Staff Initials CONCLUDED & RESIGNATION LETTERS Term Expired Letter Date Processed Initials Scan ○ Resignation Letter Date Processed Initials Scan ○ Removal Letter due to absences Date processed Initials Scan ○ F:\CLER\BOARD AND COMMITTIES DATABASE\CHECKLIST MASTER\B&C Checklist 2015 MASTER.docx 11/10/20Charlotte Tomic Homeless Committee Ricky Arriola 2 years12/20 11/10/20 12/31/2022 12/31/2025 11/10/2020 11/10/2020 11/10/2020 11/10/2020 11/10/2020 November 08, 2020 Ms. Charlotte Tomic 3801 Collins Avenue Miami Beach, Florida 33140 SUBJECT: Committee on the Homeless 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 Maria Ruiz, 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: Ms. Charlotte Tomic RE: Committee on the Homeless 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. Charlotte Tomic 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. 10 November Mi 1BE City of Mi am i Beach 1700 Convention Cente: Drive Micn: each, Elida 2212%° OFFICE OF THE CITY CLERK Email:. BC@miamibeachf_co Telephone: 305.673.7411 AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH STATE OF FL~ COUNTY OE ADO1 I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4), as (check (/) all that apply): ~ I am a resident of the City of Miami Beach for six months or longer D I have an ownership interest (for a mínimum of six months) ín a business established in the City of Miami Beach (for a minimum of six months). D I am a full-time employee of a business (for a mínimum 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 it are true. c , - . -__ _ L 9]-o Signature Date __Ag@tr rt_ Printed Name NOTARY Sworn to (or affirmed) and subscribed before me, by means of O physical presence or O online 9th November notarization, this day of Charlotte Tomie (City of Miami Beach Board/Committee Member). o ' y X Produced ID FL Driver's License Form of Identification Personally Known Ciao4 'get Signature of Notary Public Charles J D'Agostin Name of Notary, Typed, Printed, or Stamped (NOT ARY SEAL) 1AR!o., C harles J. DAgostin «)NOTARY PUBLIC STATE OF FLORIDA z. Comm# GG168171 id?TS Expires 12/14/2021 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. Tomic Charlotte 11/10/20 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 Mailing Address – Street Number, Street Name, or P.O. Box City, State, Zip 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: _________________________________________________ (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 SOURCE OF INCOME STATEMENT OFFICE USE ONLY Accepted: Y / N Deficiency:________________________________ Processed Date/Initials:__________________ Scanned Date/Initials: __________________ RECEIVED BY ELECTIONS DEPARTMENT: *Hardcopy *Electronic Copy 138_SP-14 COE 2016 I hereby swear (or affirm) that the information above is a true and correct statement. _______________________________________________________________________ Signature of Person Disclosing _________________________ Date signed Clear From Print Form 2019 REMEMBER TO PRINT, SIGN, AND SUBMIT TO THE OFFICE OF THE CITY CLERK VIA EMAIL OR HARDCOPY. Tomic 3801 Collins Ave Miami Beach, FL 33140 Miami Beach, FL 33140 Tomic Communications 3801 Collins avenue, miami Beach, FL 33140Public Relations Social Security 3801 Collins Avenue, Miami Beach, FL 33140Retirement income 11/10/20 Charlotte x X Received November 10, 2020 Office of the City Clerk 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. Tomic Charlotte x x x x   11/10/20 Charlotte Tomic Homeless Committee 3801 Collins avenue, miami Beach, FL 33140 ctomic@aol.com 9178825243 3055312576 9178825243 cell white 2013 335iBMW BSBG17 FL Charlotte Tomic