Francisco Diez-Rivas 12/31/22MIAM(BEACH
BOARD AND COMMITTEE CHECKLIST
APPOINTEE: aero , i).¡.< -;?, .,,.,_,. DA TE OF APPOINT!J!.Eá ¡-_,_.., ¡/ :2.0 '- ~-
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BOARD/COMMITTEE: 6Q í ue rg im Coo Appointed by: .///#y a mud- saé
rRwunwmr. [2/3//s FOR SCANNER
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RECEIVED
FEB 16 2021
FOR CLERK STAFF
setter of Appointment
o Letter of Reappointment
o op9y ,9f/$%,_9°, Nrointmen/Reappointment e-mailed to Committee
• 5fa rlg 6or#irritée'houe tcor»eeu » 2//e_/99y2y
o Résumé/Curriculum Vitae
oDiversity Statistics Reporting (Completed on 202/_f_
Oath 7
TERM END: / z/317kc,22
Liaison on
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 CITY OF MIAMI BEACH
OFFICE OF THE CITY CLE RK
d citywide Permit Application (Parking Department Form)
o Booklet - Guide to Sunshine Amendment & Code of Ethics for Public Officers and Employees
d source of Income Statement
e Acknowledgment of Financial Disclosure Requiremen
DIVERSITY STATISTICS REPORTING Kee çoP Mean ORIGINAL tor Annual Report.
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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:\CLER\BOARD AND COMMITTIES DATABASE\CHECKLIST MASTER\B&C Checklist 2015 MASTER.docx
Ve are committed to providing excellent public service and safety to all who live, work, and ploy in our vibrant, tropical, historic ccmmuniy.
City of Miami Bech, ?:Cr#n Ct. :Ea± 'lr±13343 __:_cuiccEE_A!CL:
OFFKCE OE THE CTY CLERK Raf3l E. Granado. iy erk
I±: 205.73.721.7ax. 235.72.725%
Lii. Ci.e#kâi:mie-zh.gr
February 11, 2021
Mr. Francisco Diez-Rivas
5660 Collins Avenue #2E
Miami Beach, Florida 33140
SUBJECT; General Obligation (G.O) Bond Oversight Committee
Dear Mr. Francisco Diez-Rivas:
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
Maria 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
City sé Mi am i Beach , :c r ±Et •• cEc 'Er±ns:43¿y-ni__!_.E{¿y_y
OFFIC E OF THE CT CLERK Raf5l E. Gr3nad:, .iy <Clerk
1±: 305.73.721.5a¢ 305.72.724
Email. C sayCkeui:mtec:hi.gr-
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Mr. Francisco Diez-Rivas
RE: General Obligation (G.O.) Bond Oversight 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 w ith 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. 77
Mr. Francisco Diez-Rivas
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.
M ¡\U BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 3313%
OFFICE OF THE CITY CLERK
Email: @riamgigaachíl_ace
Telephone: 305.673.7411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
STATE OF FLORIDA
COUNTY OF 9>€
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as ( check (/) all that apply):
0 I am a resident of the City of Miami Beach for six months or longer.
O 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;n1t _
· /65 ls .2 oz /
Signature Date
.ruco. 9ye2-i 2es
Printed Name
NOTARY
f Sworn to (or affirmed) and subscribed before me, by means of 0 physical presence or□online
notarization, this .IS_ day of _kb_a_j 2021_by an«'so AA Die ± gs
(City of Miami Beach Board/Committee Member).
Produced ID
Form of Identification
L Personally Known
s +
Signature of}Notary Public
Name of Nbtary, Typed, Printed, or Stamped
g¿jg., JOHANNA MAMANI à MwY cos1oN # GG 213352
±},_hg9kas ExREs:May 1,2022
"jji?" Bonded Thru Notary Public Underwriters
u .BEAC'
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florido 33139
www.miamibsachf],aov
OFFICE OF THE CITY CLERK
Email: 3@niarnibeach{]_go
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 () (2)
ee a, - /yd+Jo A.
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 fonns 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 more than\$690, 60 days in jail, or both. 7 4sao
Signature T Date
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:\CLERISALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTSIBOARD AND COMMITTEE APPLICATION REG FINALdocx
Updated: June 2020
M5AME-
EE@EE? SOURCE OF INCOME STATEMENT
Section 2-11.1(i) of the County Ethics Cade requires that certain employees and public officials file a financial disclosure Statement on a yearly basis by July 1st
of every year.
Disclosure far Tax Year Ending
.-a..,
Fi rst fame Middle ?lame/Initiai
2020 raacvs<o 4 .
Mailing Address - Sireet Number, Street flame, or P.O. Box
5eo Coli+ts G va ewer 2€
City, Sta te, Zip
n2, éoc . rL 33/4o
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 hera. []
Filing as an Employee (ch eck one)
[] cou; []Pu±tic Health Trust [] Municipal: at tt± t n! z it ¢ a asas fa
(Municipality)
Dep artm ent
Position or Title Empioyee iù umber
/ork address [Work telephone Employment began on/ended on
I
F ling as a Boar d M em ber {check one)
[] county r,7gicia±; LI Nass +r+. Cty o haai E3 4e
(unicipality)
Board where serving
Uenst·HT
Aiiernaie address (if home address is exempt}
nit+tg<é I Work telephone Term began on/ended on
List below every source of income you received, along with the address and the principal activity oi each source. Include your public salary. Place the sources of
income in descending order, with the largest source first Examples oí sources of income include: compensation for serices, 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 oí your spouse or any business partner need not be disclosed. ¿í continued on a separate sheet, check here.[]
Name of Source of Income Address Description of the Principal Business Activity
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aífir} that the information above is a tue and correct statement.
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Date signed
RECEIVED BY ELECTIONS DEPARTMENT:
yartso» RECEIVED
' EIectromic Copy
FEB 16 2021
CITY OE +AM I BEACH
OFER. E TCLERK
OFF{CE iISE ONLY Aceted: Y I N! Deficiency. Pror=ssad Date/initials. Scanned Date/initiais:
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City of Miami Beach
1700 Convention Center Drive
Mia mi each, Florida 33139
www.miamibeachíl.gov
OFFICE OF THE CITY CLERK
Em ail: C @miamibeachflgoy
Telephone: 305.673.7411
DIVERSITY STATISTICS REPORT
prez -ca - yr ycCo
First Name
%,
Last 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:
í Male
Ll remale
(loner
O I prefer not to answer.
Race/Ethnic Categories:
What is your race?
D African American/Black
O Asian or Pacific Islander
[BT Caucasian/white
D Native American/American Indian
Ly other- Print Race.
O I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
ves
JNo
D I prefer not to answer.
Do you consider yourself Physically Disabled?
Ives
T o
O I prefer not to answer this question.
Page 6 of 6
F:ACLERISALLIREGIBOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS'BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
CITYWIDE (CW) BOARD & COMMITTEES
l y h à A
cy sf Miami see±, PARKING DEPARTMENT PARKING APP[[CATON
1755 Meridian Avenue, Suite 200/Miami Beach, FL 33139/Ph. (305) 673-7505 or (305) 6737000 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 or 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 cord 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:
Applicant Name:
Fars a A. ea -c s
Board/Committee Name: rO ou ov rssT Coi{é
Address:
5GG0 Coll4s oe m in i' deal FL 33//0 (ca se)
E-Mail Address: FD?2 ss er av , Cr
Work Phone: 305- 477-06Go Home Phone os-2r 3 u?
Cell Phone: 305-2-36/3 Preferred Contact_Method·,
C sos 2t-u3
Vehicle information
Tag: Pr uz€ Color: rA
State: Year: V
Fero 2e22
Make: curo Model: K5
Applicant Signature: e
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@miomibeachfl.gov
e-mail subject: BOARD & COMMITTEE PARKING APPLICATION - APPLICANT NAME
Parkina D
PERMIT SYSTEM GARAGE ACCESS
Expiration Date: ID Card Serial #:
Issued By Print Name: Print Name:
Signature: es Signature: es
Date Issued: Date Completed:
s
±
PARKING
f:\ping\Sman \rar\forms\cw card&committees crkingtom do fon udsed 9262017