Andres Asion 12/31/22M l IBE
BOARD AND COMMITTEE CHECKLIST
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BOARD/COMMITTEE: Daul_ct Ad[inert Appointed by.
-...J -------------
DATE OF APPOINTMENT:
FOR SCANNER
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FOR CLERK ST AFF
o Letter of Appointment TERM END: TERM LIMIT: _
o Letter of Reappointment
o Copy of Letter of Appointment/Reappointment e-mailed to Committee Liaison on
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o Board and Committee Application (Completed on _
o Résumé/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
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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 REPORTIN Keep COPY in file and ORIGINAL for Annual Report. -
Received on:
Processed on: yj d/2/ By Employee: • .Likar.. T ol e 5añiniias
Scanned on: [\y ln7][)[)\/}},
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
WVe are committed to providing excellent public service and to all who live, work, and ploy in out vibrant, tropical, historic community.
1/13/2021
City Commission
12/31/22 12/31/24
1/20/2021 1/20/2021
1/28/2021
1/28/2021
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City of Miami Beach, 1700 Conn!ion Conter Drie, kami Each, For:da 33139 2y¿.miamibcach!]go:
OFFICE OF THE CITY CL ERK, Rafaal E. Granado, C y Clerk
Tel: 305.673.711, Fax 305.673.7254
Email: CityClerk@miamibcochfl.gov
January 14, 2021
Mr. Andres Asion
1000 S. Pointe Drive, Apt 2204
MIAMI BEACH, FL 33139
SUBJECT: Board of Adjustment
Dear Mr. Andres Asion:
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 305.673.7411.
Please read the enclosed materials carefully. Congratulations and good luck.
Respectfully,
Rafael Granado
City Clerk
cc: Monica Beltran, Parking Director
Steven Williams, 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 Ap plication - (Parking Department Form)
Booklet - Guide to the Sunshine Amendment and Code of Ethics for Public Officers and Employees
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City of Miami Beach, /00 Convention C onter Driva, Miami Booch, Hlorida 33139 y¿ywy_miamnihgachl].gov
OFFICE OF THE CITY CIERK, Rafael E. Granado, Ciy Clerk
Tel 305.673.7411, Fax: 305.673.7254
Email: City/Clerk@miamibeach ll.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Mr. Andres Asion
RE: Board of Adjustment
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.
r Mr. Andres Asion
Sworn to and subscribed before +Z]
*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.
MIAMI BE H
City of Miami Beach
1700 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
owe9"% :D. COUNTY OF om» e
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 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 /íabílíty 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. _ I i .} +/l #± -= < 5lo
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of□physical presence or□online
±A,c ro» notariz/ation, this _.;2y_ day of r~ . 2~ by
__ .,,. (City of Miami Beach Board/Committee Member).
7 acoto o»o-7-oo-P
Name of Notary, Typed, Printed, or Stamped
s2. sg$%"i¿., CARMEN B, HERNANEZ
£.$ %3 wcouiíilóif \#hi%f li) %%2kas xts:.Avoua,202
%%£,i" onded Thru Notary Public Underwriters
X
MIAM I-DAD E.
El 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 for Tax Year Ending
2020
Middle Name/Initial
O eo ":" "r City, State, Zip
If your home address is your mailing address, and your home address is exempt from public records pursuant to Fla. Stat. $119.07, read
instructions on the following page and check here. D
Filing as an Employee (check one)
[] county D Public Health Trust [] Municipal:
(Municipality)
Department
Position or Title Employee ID Number
Work address I Work telephone Employment began on/ended on
Filing as a Board Member (check one)
[] county
(Municipality)
Board where servin
Alternate address (if home address is exempt) Work telephone Term began on/ended on
List below every source of income you received, along with the address and the principal activity of each source. Include your public salary. Place the sources of
income in descending order, with the largest source first. Examples of sources of income include: compensation for services, income from business, gains from
property dealings, interest, rents, dividends, pensions, IRA distributions, and social security payments. Also, include any source of income received by another
person for your benefit. However, the income of your spouse or any business partner need not be disclosed. If continued on a separate sheet, check here.[]
Name of Source of Income Address Description of the Principal Business Activity
«@tede
mata: t slle o qt€s\Sul &al Elle Sle» ta.:.t33(3/
I hereby swear (or affirm) that the information above is a true and correct statement. .:..--
Date signed
RECEIVED BY ELECTIONS DEPARTMENT:
O Hardcopy
O Electronic Copy
OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/Initials: Scanned Date/Initials: _
138_$SP-14 COE 2016
1/28/2021
X
Received on January 28, 2021Office of the City Clerk
M IA /V\IB E
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfl.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)
Läst Nam e 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 ore than $500, 60 days in jail, or both. i
-Date------+ff---=---<~'<1--t---d-_( ---
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
MIAMIBE
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www. miam ibeachfl.gov
OFFI CE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7 411
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:
nt
O Female
O Other
O I prefer not to answer.
Race/Ethnic Categories:
What is your race?
O African American/Black
O Asian or Pacific Islander
O Caucasian/White
L )Native American/American Indian
ll other - Print Race: _t!is@a
Llt prefer not to answer. 7
Do you consider yourself to be Spanish, Hispanic, or Latino/a? e.
LJNo
O I prefer not to answer.
Do you consider yourself Physically Disabled?
LDxes
L No
O I prefer not to answer this question.
Page 6 of 6
F:ICLER\$ALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020