Allison Stone 12/31/22MIAM!BEA CH
DATE OF APPOINTMENT: ------'------'-
Co»nié ointed by: C._Moc-l San@el,
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BOARD AND COMMITTEE CHECKLIST), )]
ll)/7 2000 APPOINTEE: Ilia }roe
BOARD/COMMITTEE: Diso..b;/,~ Awss
FOR SCANNER FOR CLERK STAFF
Scan o o Letter of Appointment
Scan o o Letter of Reappointment
0 mr1 teJ:b of Appointment/Reappointment e-mailed/ to Committee
scans ·fora~ Committee Acation (competeao,[2/7 2220
scano ·Resume/corcutoum vitae _J9//7 _/
o Diversity Statistics Reporting (Completed on_LI' z, 2olO
o Oath
Liaison on
RECEIVED
DEC 23 2020
IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
✓
✓
CITY OF MIAMI BEACH
OFFICE OE TE OTT CLERK
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 201 O)
✓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
Scan o
Scan o
Received on:
o Citywide Permit Application (Parking Department Form)
o Booklet - Guide to Sunshine Amendment & Code of Ethics for Public Officers and Employees
o Source of Income Statement
o Acknowledgment of Financial Disclosure Requirement
O DIVERSITY ST A TISTICS REPORTING Keep COPY in file and ORIGINAL for Annual Report.
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Scanned on:
CONCLUDED & RESIGNATION LETTERS
Term Expired Letter Date Processed Initials Scan o
Resignation Letter Date Processed Initials Scan o
Removal Letter due to absences Date processed Initials Scan o
F:\CLER\BOARD AND COMMITTIES DATABASE\CHECKLIST MASTER\B&C Checklist 2015 MASTER.docx
WVe are committed to providing excellent public service and safety to all who live, work, and play in our vibrant, tropical, historic community
MIAI BFACH
City of Miami Beach, 1700 Convention Cenler Drivo, Miami Bach, Horida 33139 yy¿y_miamibeachl]gay
OFFICE OF THE CITY CIERK, Ralaol E. Granado, City Clark
Tel: 305.673.741, Fa. 305.673.7254
Email: CiyClerk@miamibeachfl.gov
December 17, 2020
Ms. Allison Stone
4775 Collins Avenue #1905
Miami Beach, Florida 33140
RE: Disability Access Committee
Dear Ms. Allison Stone:
Congratulations! You have been appointed by Commissioner Mark Samuelianto 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. 7 411.
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
Valeria Mejia, 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 - Amendm ent 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
MIAM[BEACH
City of Miami Beach, 1/0O Convention Conlor Drive, Miami Beach, Florida 33139 ya_miamibeachll_go
OFFICE OF THE CITY CLERK, Rafaol E. Granado, City Clerk
Tel: 305.673.7411, Fx. 305.673.7254
Em ail: City Clerk@miamibeachfl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Ms. Allison Stone
RE: Disability Access 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 requirem ents 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.
Ca. k»e
Ms. Allison Stone
"">1 day of [coule 2020 5e
C harles D'Agostin
Deputy Clerk
pl ease 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.
MIAMI BEACH
City of Miami Beach
1 700 Convention Center Drive
Miami Beach, Florida 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 Ma bode
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (ch eck (/) 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 minimum of six months) in 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 minimum of six months) and I am based in an
office or other location of the business that is physically located in Miami Beach (fo r 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.
6.a. to»z
Signature
1Soi4 sr0é
/2/21/2020
Date I I
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of O physical presence or O online
notarzavon . mhts 2' aay or_pece_elogi. 2o20y. Allo,aloe_S_se
(City of Miami Beach Board/Com mittee Member ).
< sea's Liesce l> Produced ID
Form of Identification
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g.. sk SATCHELL $% ; wcoiuuisso # co 09a
%iJsS$ sees.43.2%1 8;¿iç Bonde Tru Notary Pubic Underwriters
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TARY SEAL)
Name of Notary, Typed, Printed, or Stamped
M IA M I-DAD E. ELI
Clear From Print Form
SOURCE OF INCOME STATEMENT
Section 2-11.1(0) 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 Name
2019 S1U
First Name
A-ou
Middle Name/Initial
L
Mailing Address - Street Number, Street Name, or P.O. Box
725 oNS AUE tt 7os
City, State, Zip
MIA+I 3RH FL 33//0
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)
[] county D 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 ]nunca: M IA-I Aca
(Municipality)
Board where serving
1Ly cs
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.O
I Name of Source of Income I Address I Description of the Principal Business Activity
Dis NC [ /200 k FA
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I hereby swear (or affirm) that the information above is a true and correct state#."" >l>
2le. tss
02/21/02d
Date sigríea'
RECEIVED BY ELECTIONS DEPARTMENT:
artcoy RECE IVE D
/ Electronic Copy
E 23 2020
CITY OF MIAM I BEACH
OFFI E IE OFT CLERK
REMEMBER TO PRINT, SIGN. AND SUBMIT TO THE OFFICE OF THE CITY CLERK VIA EMAIL OR HARDCOPY.
MIAMI BEACH
City of Miami Beach
l 700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibegchf],gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
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)
SroU }son ¿_
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, 6~ both.
A>e- Pe/U2o2o
Signature Date 7
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.
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F:\CLER\$ALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
MIAMI BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www._miamibeachf]_gov
OFFI CE OF THE CITY CLERK
Emai l: BC@m iamibe achfl_gov
Telephone: 305.673.7 411
DIVERSITY STATISTICS REPORT
5Tow9 A-Soy L
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
Tremale
O Other
O I prefer not to answer.
Race/Ethnic Categories:
What is your race?
D African American/Black
O Asian or Pacific Islander
O Caucasian/White
O Native American/American Indian
Ll Other - Print Race:
La1 prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
Yves
RN:refer not to answer.
Do you consider yourself Physically Disabled?
Rve
SI No
D I prefer not to answer this question.
Page 6 of 6
F:\CLER\$ALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.dccx
Updated: June 2020