Ricardo Barboza 12/31/22MIAMI BEACH
BOARD AND COMMITTEE CHECKLIST
APP01NTEE: ___ Q_, ...... c ..... 1"P __ �-�--.........._?_A __ DATE OF APPOINTMENT: ____ _
BOARD/COMMITTEE: ____ ?__.z, __ ',-{2.;--=.....SrJ ......... N __ ___..Nl:;::,.___ '.--L-__ Appointed by: ....,, _
FOR SCANNER
Scan o
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Scan o FOR CLERK STAFF I I o Letter of Appointment TERM END: \ '2...1 'Z>\ J 2.Dl,, 1-TERM LIMIT: ____ _
o Letter of Reappointment
o Copy of Letter of AppointmenUReappointment e-mailed to Committee Liaison on
o Board and Committee Application (Completed on _______ _,
o Resume/Curriculum Vitae
o Diversity Statistics Reporting (Completed on ______ _,
o 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
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 STATISTICS REPORTING Keep £QfY, 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 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
We ore comm,ff€'d to piov,d,ng excellent publ,c seMce and safety lo oil who live, work. ond ploy in our v,bront trop,col, h,s,onc community
1/13/2021
City Commission
12/31/26
1/21/2021
12/7/2020
1/23/2021
Digitally Signed/RB1/23/2021
1/25/2021
1/25/2021
l 44
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OF FIC E OF TH E CITY CLERK
Email:. EC@miamibeachfl_gov
Telephone: 305,673.741
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
STATE OF FLORIDA
C O UN TY OF OE<DZ-
l am in co m plian ce with the affiliation re quirem en t of Miami Beach City Code Sections 2-22 (4),
as (check (/) all that apply):
p( I a m a re sid ent of the City of Miami Beach for six months or longer.
[] [h a ve an ownership interest (for a minimu m of six months) in a business established in the
City of Miam i Beach (for a minimu m of six mon ths).
[ lam a full-time em ployee of a business (for a minimum of six months) an d l am based in an
office or other locati on of the business that is physically locat ed in Miami Beach (for a
mi ni m um of six m on t hs).
"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
state d in it are true.
D ate
,]
P rinte d N a m e
N O T A R Y
S w or n to (or affirmed) an d subscribed before m e, by m e an s of [ physical presence or online
not ar iz at ion , this 2ndday of January 201_by
Ricardo Barboza (Ci ty of Mi am i Beach Board/Committee Member).
X P rod uced ID FL Drivers License --------------- Form of Identification
P e rson al ly Kn o wn
Cao, D'qat
Signature of Notary PüBff
Charles J D Agostin
Name of Notary, T ype d , P ri nt e d , or Stamped
(N O T A R Y SE AL )
ha rtes J. DAgostin
NOTARY PUBLIC
STATE OF FLORIDA
Comm# GG168171
Expires 12/14/2021
X
Received on January 22, 2021Office of the City Clerk