Jessica Londono 12/31/22\_,, J
MIBE
BOARD AND COMMITTEE CHECKLIST
APPonree. )ta LadO oArE or APo NrM Nr. I[i)2[
BOARD/COMMITTEE: ß]¡ß/levt lt #k Appointed by: U l ~~
ro sces roscEwsrwrr E/3/h)2 p)/3)/,
Scan o Letter of Appointment TERM END. /z/- _la>ERM LIMIT: 1_'//d 'f
Scan o o Letter of Reappointment
o Cob Y. ,if /L!ä!e, _ .5- r ppointmenUReappointmen~:iled to Committee Liaison on
Scan o o Boä,á and Committee Application (Completed on / 3/ ~ /
Scan o o Résumé/Curriculum Vitae <") L
I
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o Diversity Statistics Reporting (Completed on zLu't '
Scan o o Oath
RECEIVED
FEB 08 2021
CITY OF MIAMI BEACH
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
OFFICE OE THE ;TY CLERK
o Citywide Permit Application (Parking Department Form)
o Booklet -- Guide to Sunshine Amendment & Code of Ethics for Public Officers and Employees
Scan o
Scan o
o Source of Income Statement
Received on:
Scanned on:
11,,137"3 "
, Daz
Processed on: 2i r X By Employee:
D9te 9/f132]_ eyertoree
Date
O Acknowledgment of Financial Disclosure Regui
..1. -. .--
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 MASTERdocx
We ore committed to providing excellent pubic service and safety io al who five, work, and in oer vibrant, topical, historic community.
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City of Miami Beach, 1/OO Convention Center Drive, Miami Beach, Florida 33139 yyy_miamnibachf_ga
OFFICE OF THE CITY CLERK, Rafel E. Gran ado , Cmy Clerk
Tel: 305.673.7411, Fax 305.673.7254
Email: CityCl erk@miamibeachfl.gov
January 14, 2021
Ms. Jessica Londono
1100 Venetian Way #1 F
Miami Beach, Florida 33139
SUBJECT: Human Rights Committee
Dear Ms. Jessica Londono:
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
Lana Hernandez, 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
• >
1B
City of Miami Beach, 7OO Convention Center Drive, Miami Beach, Florida 33 139 yaw_migm_bgg chf_ge
OFFICE OF THE CITY CLERK, Rafael E. Gran ado, Cy Clerk
Tel: 305.673.7411, Fax. 305.673.7254
Ema il: CiyClerk@miamibeachfl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Ms. Jessica Londono
RE: Human Rights 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* 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. --- =- L
Ms. Jessica Londono
Sworn to and subscribed before me this „,5-ge
*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.
\_, ./
MIAIBE
City of Miami Beach
l 700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Em ail: BC@miamibe achfl_gov
Telephone: 305 .673 .7 41 l
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
gr#9/2ea [) 2N)= COUNTY OF, l tt /[)l
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as ( check ( ✓) all that apply):
T )Q. 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 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 "=-= 1/]z 57la Luc- Date
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of ¾hysical presence or□online
oorzao». a.fa_[eh4o?t»
cTe s s ¡¿- ,,_ ½ Î ~~º (City of_ Miami Beach Board/Committee Member).
X roa@cea / U)ove? L,ee
Form of Identification
Signat
(NOTARY SEAL)
Charles J. DAgostin
kg, NOTARY PUBLIC
sTATe o FLORIDA
/ com m# GG168171
Expires 12/14/2021
v _J
IA 1B H
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfl_goy
OFFICE OF THE CITY CLERK
Email: BC@m iamibeachfl_gov
Telephone: 305. 673 .7 411
BOARD & COMMITTEE FINANCIAL ACKNOWLEDGEMENT STATEMENT
Acknowledgement of fines/suspension for Board/Committee Members for failure to comply with Miami-
La .,"77 %
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
"or o wasss o so arsa se ~ - . - . --~---__..>
Signature Date
2//u
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.
Page 5 of 6
F:\C LE R \$A LL\R E G \B O A R D A N D C O M M ITT E E A P P LI C A T IO N S FIN A L D R A FT S\BO A R D A N D C O M M ITT EE APPLI C A TIO N RE G FIN A L.dccx
Updated: June 2020
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MIAMl·DADE-
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 for Tax Year Ending I Las\ Name %za Middle Name/Initial
2020 _A5 0o
Maili ng Address - Stre et Num ber, Street Nam e, or P.O. Box
[IO \v?ed e l IF
City, State, Zip MA t:"L 33)31
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.Dl
Filing as an Employee (check one)
[] County [ Public Health Trust [] Municipal :
(Municipality)
Depart m ent
Position or Title Employee ID Number
Work address I Work telephone Employment began on/ended on
Filing as a Board Member (check one)
[] County [] Municipal: M(6M 2ecd-
(Municipality)
Board where serving A\A (o Ccl
Alternate address (if home address is exempt) %?"Gas "««-
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. Exam ples of sources of incom e include: com pensation fo r services, income from business, gains from
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.[]
I Nam e of Source of Incom e I Address I Description of the Principal Business Activity
ala Saa (&0o %
MM3 9 8gt %
I hereby swear (or affirm) that the information above is a true and correct statement.
== -= Signature of Person Disclosing
218/34
Date signed
RECEIVED BY ELECTIONS DEPARTMENT:
[ Hardcopy RECEIVED
[ Electronic Copy
FEB 08 2021
CITY OF MIAM I BEACH
OFFICE OF THE CITY CLERK
OFFICE USE ONLY Accepted: Y / N Deficiency. Processed Date/initials: Scanned Date/initials:.
138_SP-14 COE 2016
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IA\+4B H
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 331 39
www.miamibegcht]_gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
]„AwO k#tek
DIVERSITY STATISTICS REPORT
Acca
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:
Late
frenale
O Other
O I prefer not to answer.
Race/Ethnic Categories:
What is your race?
O African American/Black
D Asian or Pacific Islander
Sr caucasian/white
fl Native American/American Indian
O Other- Print Race: _
O I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
0ves z..e
Do you consider yourself Physically Disabled?
~
DYes
No
I l prefer not to answer this question.
Page 6 of 6
F:\CLER\$ALL\REG\BOARD AND COMMITT EE APPLICATIONS FINAL DRAFT S\BOARD AND COMMITT EE APPLICATION RE G FINAL .docx
Updated: June 2020
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MIAMI EACH CITYWIDE (CW) BOARD & COMMITTEES
City of Miami Beach, PARKING DEPARTMENT PA RK IN G A PPLIC A TIO N
1755 Meridian Avenue, Suite 200/Miami Beach, FL 33139/Ph: (305) 673-7505 or (305) 673-7000 ext. 6200
ta
PARKING
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 my access card be lost, stolen or
dam age, I will be responsible to pay a $10.00 replacement fe e.
B o a rd M e m b e r In fo rm a tio n
Dae of Application: 2\/2{
Applicant Name: (ea Lcl O
Board/Com mi ttee Nam e: [l «po (_n(
Address: (6 \2e ho [u64 )F («tu 6l 33/
Mail Address J boa?/ C oat(·
W ork Phone: Home Phone
con Pone: 36 4 4o46- Preferred Contact Method: el
V e h icl e In fo rm a tio n
Ta g: ESG 464 Color: 2l 0
State: t t ds Year: 2074
Make: fe l o Model: Y
~ :::::::--.
Ap plicant Signature: es -
Please provide signed form to the Parking Depar tment located at 1755 Meridian Avenue, 2° floor. Working
hours are 8:30 to 5:00 p.m. or email to: Pa rk in g R e ce p tio n @ m ia m ib e a chfl.g o v
e -m a il su b je ct : B O A R D & CO M M ITT E E P A R K IN G A P P LI C A TI O N - A PP LI C A N T N A M E
P a rki n a D -
PERMIT SYSTEM GARAGE ACCESS
Expiration Date: ID Card Serial #:
Issued By Print Name: Print Name:
Signature: Signature: e
Date Issued: Date Completed:
s
f\ping \$mon \ror\forms \cw boords&committees porkingform.doc form updated 9/26/2017