Jesse Fleet 12/31/22M IA M I BEACH
B O A R D A N D C O M M IT T E E C H E C K L IS T
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R E CE IVE D
FEB O 8 2021
FOR CLERK STAFF
o Letter of Appointment
o Letter of Reappointment
o ff')Qº'/':Jö';;;. ,' A,,po;ntmenUReappo;ntmen/ e-ma;led to Committee
o oar@ an@ Committee Application (completed on/_, _3o /20 3/
• Resumercorcutoum v a e Q// 2,, '
o Diversity Statistics Reporting (Completed on z du</)]
o Oath
Liaison on
CITY OF MIAM I BE A CH
OEE=EOTCLERK
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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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 STATISTICS REPORTING
2/~202...\ Signed by X. ---r1-_,,,_ _
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Date
Processed on:
Scanned on:
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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:\C LER\BOA R D AND CO M M ITT IES DATA BASE\C HEC KLI ST M ASTER\B&C Checklist 2015 M ASTER .dccx
We are com mitted to oroviding excellen t public serice and safety to all who live, work, and play in our vibrant, tropical, historic community
M IA M I BEACH
C ity o f M ia m i B e a ch , 170O Convent ion Cen ter Dri ve, Miami Beach, Florida 33 139 yyy_mi am i ba chf]go
OF FICE OF THE CITY CL ERK, Rafael E. Granado , City Clerk
Tel: 305 .673.7411, Fax 305.6 73.72 54
Email: CiyClerk@miamibeachfl.gov
January 14, 2021
Mr. Jesse Fleet
855 Euclid Ave
Miami Beach, FL 33139
SUBJECT: Human Rights Committee
Dear Mr. Jesse Fleet:
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
ATT ACHMENTS:
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
M IA M I BEACH
City of Miami Beach, 170O Convention Center Drive, Miami Beach, Florida 33139 wyw_miamibachf]go
OFF ICE OF THE CITY CLERK, Rafael E. Gr anado, City Clerk
Tel: 305.673.7411, Fax 305.673.7254
Email: CiNyClerk @mi amibeach fl.go v
Oath of Office
Oath of Civility
and
Acknowledgements
T O : M r. Je sse Fleet
R E: H um an R ig hts C om m ittee
I do so le m n ly sw ear or affi rm to bear true faith, loyalty and allegiance to the G overn m ent of the U nited
States, the State of Florida, and the C ity of M iam i Beach, and to perf orm all the duties of a m em ber of the
above-m entione d board or com m ittee of the C ity of M iam i Beach to w hich I have been appointed fo r a
term end ing : 12/31/2022.
T o m y co llea g ue s and to all of those I represent and serv e, I pledge fairn ess, integrity and civility, in all
actio ns taken and all com m unications m ade by m e as a public serv ant.
I ha ve be e n issued a copy of section 2-11.1 of the M iam i-D ade C ounty C ode (C onflict of Interest and
C od e of Ethic s Or di nance), as w ell as Florida C om m ission on Ethics G uide to the Sunshine Am endm ent
and C od e of Ethics fo r Public O ffi cers and understand that as a m em ber of a C ity of M iam i Beach Board
and/or C o m m itt ee, I m ust com ply w ith the financi al discl osure* requirem ents of M iam i-Dade C ounty or the
State of F lo rida (depending on the board or com m ittee on w hich I serv e) on Jul y 1st, follo wi ng the closing
of the cale ndar year on w hich I have serv ed. l M r. Jesse Fleet
Sw orn to and subscribed befo re m e this 8'/A. day of f~2021
Tl,7 >
*P lease visit the C ity of M ia m i Beach w ebsite at www .m iam ibeachfl.gov under City Clerk/Board and
C o m m itt ees fo r additional inform ation regarding the Financial Di sclosure R equirem ents.
M IA M I BEACH
City of Miami Beach
l 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,,,
COUNT Y or [Li d DD
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (check(✓) all that apply):
iz{ 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
stated iis re true.
2 /g/o2y
Signatu e Date 1
J55 F-er
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of~ysical presence or□online
notarization, this day Of,ZO_Doy
)es3e [e94 .cy or Mari seach ora/committee Memen.
X< eoaoaao f [-ers -Age
Form of Identification
Na
(NOT ARY SEAL)
Charles J. DAgostin
NOTARY PUBLIC
ST ATE OF FLORIDA
"ßk/> Comm# GG168171
Expires 12/14/2021
MIAM I BEACH
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: 305.673.7 411
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)
Ft= Jes, s
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.
e of these forms, pursuant to the Miami-Dade County Code, may subject the person to a fine
00, 60 days in jail, or both.
Signature Date
2/8/es
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:ICLER\$ALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRA FTSIBOARD AND COMMITTEE APPLICATION REG FINAL.dccx
Updated: June 2020
M IA M l·DAD E- EI SOURCE OF INCOME STATEMENT
Section 2-11.1 (i) 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 First Name Middle Name/Initial
a0zo Fl -JG ~
Mailing Address - Street Number, Street Name, or P.O. Box
5 u-ID A€ , ±1 0 6
o.sue.7» ,
712q NA-\,
If your hom e address is your m ailing addre ss, and your hom e addre ss is exem pt fro m public records pursuant to Fla. Stat. $119.07, read
instructions on the follow ing page and check here. O
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)
D County []Municipal: C M E .
(Municipality)
Board where serving
l.2..
Alternale address (if home address is exempt) I Work telephone I Term beg~ded on
3o5 a+ Se€
List below every source of incom e you received, along with the address 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 income include: compensation for 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 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
U Ns7 0-(0 ~
I hereby sw ear (or ~t th e inform ation ab ove is a true and correct statement
Signature of Person Disclosing
2 [/2e 2
Date signed
RECEIVED BY ELECTIONS DEPARTMENT:
[ Hardcopy RECEIVED
D Electronic Copy
FEB O 8 2021
CITY O F MIAMI BE A CH
OFFICE OF HIE OT CLER K
OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/Initials: Scanned Date/Initials.
138_SP-14 COE 2016
M IA M I BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeach[l.gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
DIVERSITY STATISTICS REPORT
Ff Jesse ~
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:
3íiae
O Female
loner
D I prefer not to answer.
Race/Ethnic Categories:
What is your race?
D African American/Black
')Asian or Pacific Islander
lJ Caucasian/white
O 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?
Dyes
T No
O I prefer not to answer.
Do you consider yourself Physically Disabled?
ves
do
O I prefer not to answer this question.
Page 6 of 6
F:ICLER\$ALL\REGIBOARD AND COMMITTEE APPLICATIONS FINAL DRA FTS\BOARD AND COMMITTEE APPLICATION REG FINAL.dccx
Updated: June 2020
M IA M I BEACH CITYWIDE (CW) BOARD & COMMITTEES a 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 PARKING
A cityw ide (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 acknowledge that should my access card be lost, stolen or
damage, I will be responsible to pay a $10.00 replacement fee.
Board Member Information
Date of Application: =//o2
Applicant Name: J€, fa=
Board/Committee Name: H+.Ra.C-
Address: s ¡DO A , (lt6 , 1g 220
E-Mail Address:
Work Phone: Home Phone
Cell Phone: ?o< 9\+G +c Preferred Contact Method:
Vehicle Information
Tag: 6Aw As os («G Color: Pu-v
State: F Year: 1 -
Make: v.A Model: eso A
I " <q -\ -
Applicant Signature: es
Please provide signed form to the Parking Department located at 1755 Meridian Avenue, 2d floor. Working
hours are 8:30 to 5:00 p.m. or email to: ParkingReception@miamibeachfl.gov
e-mail subjec t: BOARD & COMMITTEE PARKING APPLICATION - APPLICANT NAME
Parking Department Section
PERMIT SYSTEM GARAGE ACCESS
Expiration Date: ID Card Serial #:
Issued By Print Name: Print Name:
Signature: es Signature: es
Date Issued: Date Completed:
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