Gail Harris 12/31/22BOARD AND COMMITTEE CHECKLIST
APPOINTEE: Aly, HE DATE OF APPOINTMENT: y27/7
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O AR D/C OM MI T TE E . '/nz / á_ Appointed y. /lac.n2_ near
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Scan o o Letter of Appointment TERM END: /2, 3//2Z TERM LIMIT: l7l >
o Letter of Reappointment 7 7
o Cdp¥..,_ 9.f /¿{):;}... (ppointmenUReappointment e-maile/d to
o Board and Committee Application (Completed on, _)0 ]
o Résumé/Curriculum Vitae
o Diversity Statistics Reporting (Completed on y ' ]
o Oath
Scan o
Scan o
Liaison on
Scan o
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✓
RECEIVED ✓
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JAN 27 2021 ✓
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CITY OF MIAM I BEA CH
✓
OFFICE OF THE CGY CLERK
✓
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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 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
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
Received on:
Processed on:
Scanned on:
O Acknowledgment of Financial Disclosure Requirement
O DIVERSITY STATISTICS REPORTING Keep COPY in file and ORIGINAL for Annual Report /4$7 .2e-
[/9)] 2[_e»enoree t CTTot ...- •..
T 1 Date
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.dccx
We ore committed to providing excellent service and safey io oll who five, work, and in our vibrant, topical, historic community.
City of Miami Beach, I7OO Convention Canter Drive, Miami Beach, Florida 33 139 yyw_miaIiboachfi_g
OFFKCE OF THE CITY CLERK, Rafael E. Granado, City Clerk
Tel: 305.673.7411, Fax 305.673.7254
Email: Ci/Clerk@miamibeachfl.go
January 14, 2021
Ms. Gail Harris
9 Island Avenue #2211
Miami Beach, Florida 33139
SUBJECT: Personnel Board
Dear Ms. Gail Harris:
Congratulations! You have been reappointed by the City Commission to the above referenced board or
committee, for a term ending: 12/31/2022.
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. Congratulations and good luck.
Respectfully,
Rafael Granado
City Clerk
cc: Monica Beltran, Parking Director
Michael Smith, 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
MIBE
City of Miami Beach, 170O Convention Center Drive, Miami Beach, Florida 33 139 yywy_miamibca chf_go
OFFICE OF THE CITY CLERK, Rafael E. Granado, Cy Clerk
Tel: 305.673.7411, Fax 305.673.7254
Email: CityClerk@miamibeachfl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Ms. Gail Harris
RE: Personnel Board
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. #so s
Ms. Gail Harris
Sworn to and subscribed before me this
*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.
C ity o f M ia m i B e a ch
1 700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305 .673 .7 411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
STATE OF FLORIDA
COUNTY OF ha, Pale
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as ( check ( ✓) all that apply):
[ tam a resident of the City of Miami Beach for six months or longer.
~e 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 (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 Er·.
Signatu~ . -Da_Jifu_/~,,:;2-J__,./,~~-~-----
#il lai s
Printed Name
NOTARY
Sworn to ( or affirmed) and subscribed befo re me, by means ~sica I presence or O online
notaraon. tos 27/a r )@/4@4_.2o2l»
}4CR?15 ciy of Mi am i each Boar/committee Member.
seen Ft_Deres Lese
or 6ridé#ication
RT2 -=
Name of Notary, Typed, Printed, or Stamped
(NOT ARY SEAL)
LA!a,, Charles J. DAgostin
@NOTARY PUBLIC
STATE OF FLORIDA
Comm# GG168171
eS Expires 12/14/2021
M IA M I-DAD E .
EEI SOURCE OF INCOME STATEMENT
Section 2-11.1(@) 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 fo r Tax Year Ending
2020
Last Name
/eR5
First Name a Middle Name/Initial
Mailing Address - Street Number, Street Name, or P.O. Box
91l
,íea 37
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 □Public Health Trust [ Municipal:
(Municipality)
Department
Position or Title Employee ID Number
Work address I Work telephone Employment began on/ended on
Filing as a Board Member (check one)
[ county [] Momita:. l/7a>_à m Dpde é
no 'zen e¢eo
Altern até address (if hom e address is exem pt)
7 Z,.2e 22i
W ork telephone
7t> a)ose
Term began on/ended on
/s up31/2z
List below every source of incom e you received, along with the addre ss and the principal activity of each source. Include your public salary. Place the sources of
incom e in descending order, with the largest source first. Examples of sources of incom e include: com pensation for services, incom e fro m business, gains fro m
pro perty 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 incom e of your spouse or any business partner need not be disclosed. If continued on a separate sheet, check here.[]
Name of Source of Income I Address I Description of the Principal Business Activity
4mi I tors,ls, 915 4ha 6elfe 4,
5e5 c i;
ka¢eue/@hl,, ad 6i
Jzk- 5erS ea8
1 5.erhy -
ffirm) that the information above is a true and correct statement.
%lela
Signature of Person Disclosing
/l r Date signeá
RECEIVED BY ELECTIONS DEPARTMENT:
[ Hardcopy RECEIVED
[ Electronic Copy
JAN 2 7 2021
CITY OF MIAMI BEACH
OFFICE OF THAE OTY CLERK
OFFICE USE ONLY Accepted: Y I N Deficiency: Processed Date/Initials: Scanned Date/Initials:
138_SP-14 COE 2016
IA
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachtl._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)
kaei= Last Name
6A.l /
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: --
tú4"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. 2I
Daí 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 additionál form with the Office
of the City Clerk. However, compliance with the County disclosure requirement does not satisfy the State
requirement.
Page 5 of 6
F:\CLER\$ALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL .docx
Updated: June 2020
CITYW IDE (CW ) BOARD & COMMITTEES
City of Miami Beach, PARKING DEPARTMENT PARKING APPLICATION
1755 Meridian Avenue, Suite 200/Miami Beach, FL 33139 /Ph: (305) 673-7505 or (305) 673-7000 ext. 6200
A citywide (CW) parking permit is honored at metered parking spaces and restricted residential zones
parking spaces. A CW parking permit IS NOT honored in prohibited areas. An Access Card will be
provided to you for City Hall Garage (G7) access.
IMPORTANT NOTE: Your vehicle license plate serves as your "parking permit". In order to avoid
any unnecessary enforcement actions, it is important that our records reflect the most current and
accurate information regarding your vehicle license plate. Inaccurate and/ or outdated vehicle
information may lead to the issuance of parking citation(s) and/or the towing of your vehicle.
Please note that this new access card CANNOT be hole-punched or perforated in any manner. To use
the new card please hold the card at close proximity to the reader until the gate opens. You may need
to try the other side of the card. Please ensure you hold the entire surface of the card against the reader
until the gate opens.
ACKNOWLEDGEMENT: I acknow ledge that should m y access card be lost, stolen or
dam age, I will be responsible to pay a $10.00 repl acement fe e.
B o a rd M e m b e r In fo rm a tio n
Date of Application: //27/2/
Applicant Name: Ga,) 4llr3
Board/Committee Name[/5,54zed g¿,
Address: s - . i 2 64. 1 33rs%
E-Mail Address: a.G>7
W ork Phone:
5 S 7-
Cell Phone: al Preferred Con tact Method: [I/· 7. u>ls
V e h icl e In fo rm a tio n
Tag:
State:
Make:
Color:
Year:
Model:
ll-ed
2o77
5o-
Applicant Signa ture: es #A
Please provide signed form to the Parking Department located at 1755 Meridian Avenue, 2° floor. W orking
hours are 8:30 to 5:00 p.m. or email to: P a rk in g R e ce p tio n @ m ia m ib e a ch fl .gov
e -m a il su b je ct : B O A RD & C O M MI TTE E P A R KING APPLICATION - APPLICANT NAM E
Parkina D s
PERMIT SYSTEM GARAGE ACCESS
Expiration Date: ID Card Serial #:
Issued By Print Name: Print Name:
S ign a ture: es Signature: es
Date Issued: Date Com pleted:
f:\ping\$man\rar\forms \cw boards&committees parkingform.doc form updated 9/26/2017
C ity o f M ia m i B e a ch
1700 Convention Center Drive
Miami Beach, Florida 33139
www .miamibeach]_gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
DIVERSITY STATISTICS REPORT /A,- 6l /
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:
L yat e
L4Female
O Other
O I prefer not to answer.
Race/Ethnic Categories:
What is your race?
O African American/Black L Asian or Pacific Islander
Lf Caucasian/White
O Native American/American Indian
O Other - Print Race: ------------ □I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
L?ves
Livo
D I prefer not to answer.
Do you consider yourself Physically Disabled?
Pye»
Lío
O 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