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Liliana Martinez 12/31/23%,I,\ I AAA ..-"w AC. BOARD AND COMMITTEE CHECKLIST APPOINTEE. I � �/._ DATE OF APP OIN BOARD/COMMITTEE: �S phi"✓= C 4y% ef/C S Appointed by: FOR SCANNER FOR CLERK STAFF/ / Scan o o Letter of Appointment TERM END:/i TERM LIMIT:/�y//--- 7 Scan o o Letter of Reappointment o p tter of Appointment/Reappointment e-mailed to Committee Liaison on Scan o o Board and omm�tee Application (Completed on Scan o o Resume/Curriculum Vitae / l o Diversity Statistics Reporting (Completed on )� Scan o o Oath IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK RECEIVED ✓ 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 NOV 10 2021 amended through December 2010) ✓ Amendments to the Code of Ethics Ordinance (September 2009 through July 2012) CITY OF MIAMI BEACH ✓ Highlights of the Miami -Dade County Ethics Code OFFICE OF THE CITY CLERK 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 Scan o o Source of Income Statement Scan o o Acknowledgment of Financial Disclosure Requirement O DIVERSITY STATISTICS REE/PORT NG Ke p PY in file and ORIGINA for 'nual Report a Received on: Y � /Signed by X Date Boar r C mmittee em ro Processed on: By Employee: Date CI �erk'ffice Staff Initia �l Scanned on: / By Employee: Date I v Clerk',5� ice 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 MASTEMB&C Checklist 2015 MASTER.docx Al BEACH City of Miami Beach, 1700 C onvonik)n C onlo Dtfvo, Wain! Flkmch, fi larkla 331:39,' %^orrrw.miam t c[ fl.gcN OFFICE Of IHE C UY CLERK, Rafael E. Granado, City Cfofk. Td, 30 5.673.141 1, Fax 305.673.7254 Emil. C RyC=lark@.m1xym&whtl.gae November 09, 2021 Ms. Liliana Martinez 1225 Marseilles Drive #21 Miami Beach, Florida 33141 SUBJECT: Hispanic Affairs Committee Congratulations! You have been reappointed by Commissioner Ricky Arriola to the above referenced, board or committee named above, for a term ending: 12/31/2023. Pursuant to City of Miami Beach Code Section 2-22 (5) a, "Notwithstanding any other provision of the City Code or of any resolution, commencing with terms beginning on or after January 1, 2007, the term of every board member who is directly appointed by a member of the City Commission shall automatically expire upon the latter of: December 31 of the year the appointing City Commissioner leaves office or upon the appointment/election of the successor City Commission member." 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. Reg . ;q Rafael Granado City Clerk cc: Monica Beltran, Parking Director Leonor 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 M I A, P0 I B E A C.0 H City of Miami Beach, 1700 �nvontion Cbrkm t.7rive, Mom! Beach, I loMa 3313'1 www.miarnibeachil.gov OFFICE OF THE CITY CLERK, Rafmt E. C-ir mocks, City Ckwk 1e1: 3055.673.7411, Fa)c 305.673.7254 Emit Ct rk n1 amil lrll.:gav Oath of Office Oath of Civility and Acknowledgements TO: Ms. Liliana Martinez RE: Hispanic Affairs Committee 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: 12/31/2023. 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. 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. Ms. Liliana Marf ez Sworn to and subscribed before me this j (day of , 2021 Ch,pp& D'Agostin /,,-'Deputy Clerk *Please visit the City of Miami Beach website at www.miamibeachfi.gov under City Clerk/Board and Committees for additional information regarding the Financial Disclosure Requirements. City of Miami Beach 1700 Convention Center Drive Miami Beach, Florida 33134 OFFICE OF THE CITY CLERK Email: B�miamibeachfl.gov Telephone: 305.673.741 1 AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH STATE OF FLO I � � Mac COUNTY OF i 1 ,. I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4), as (ch ck (J) all that apply): m a resident of the Cit of Miami Beach for six months or longer. Y 9 ��l have an ownership interest (for a minimum of six months) in a business established in the ' y of Miami Beach (for a minimum of six months). 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 (105/o) 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. dqf p nalties of perjundeclarthat I have read the foregoing document and that the facts t ' A are true. inatjure Date �h f A10A9A` 7 i �- nted Name NOTARY Sworn to (or affirmed) and subscribed before me, by means ofXpysical presence or ❑ online notarization, this [U day of A/r� �--' � 202 by Z-1 /,f�h �L l ,�0&7 e—f- (City of Miami Beach Board/Committee Member). / J r , - V CV -r- r Produced ID � •� (�/��- �-`�4�� S-, Form of Identification Pe II Kno (NOTARY SEAL) Signature ofWdtary Publi Name of Notary, Typed, Printed, or Stamped /\A I ANA EAC H City of Miami Beach 1700 Convention Center Drive Miami Beach, Florida 33139 www.miamibeochfl,Qov OFFICE OF THE CITY CLERK Email: BC anmiamibeachfl.gov Telephone: 305.673.74.1 1 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) ,A L , L 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. Faflurp. to file one of these forms, pursuant to the Miami -Dade County Code, may subject the person to a fine of no h o e than $500, 60 day4 in jj, or both. Signature r/,/D, -- Date 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:\CLER\$ALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx Updated: June 2020 WM 1,11.1 DE SOURCE OF INCOME STATEMENT .1,11.1 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 Last Name Fir t Name Middle Name/initial 2020 � H 4-041 k) a Mailing Address — Street Number, Street ame, or P.O. Box 122.EX City, State, Zip g 14) 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 HRe. Filing as an Employee (check one) Ej County, ❑ Public Health Trust r.1 Municipal: (Municipality) Department Position or Title Employee ID Number Work address Work telephone Employment began ontended on Filinn ac n Rnmrrl R/lamhar i,h.A, —1 w , P County Municipal• (Municipality) Board where serving e, iS / -/V/ C P ' Alternate address (if home addreil is exempt) Work telephone Term beganp' niendedion 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 I Address I Description of the Principal Business Activity I I herwear (or affirm) that the inf matin Bove " .#rue and correct statement A 10 � . Sidnature of Person Disclosing I ( - i V -- aN-( Date signed RECEIVED BY EL Hardcopy Electronic CN01V 10 2021 (CITY OF MIAMI BEACH OFFICE OF THE CITY CLERK REMEMBER TO PRINT, SIGN, AND SUBMIT 1-0 THE OFFICE OF THE CITY CLERK VIA EMAIL OR HARDCOPY. MIAMI BEACH City of Miami Beach 1700 Convention Center Drive Miami Beach, Florida 33139 www.miamibeachfl.gov OFFICE OF THE CITY CLERK Email: BC(c�miamibeachfl.gov Telephone: 305.673.741 1 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: Male Female Other I prefer not to answer. Race/Ethnic Categories: What is your race? African American/Black Asian or Pacific Islander Caucasian/White �3 Native American/Americann) Indian Other — Print Race: I prefer not to answer. Do you nsider yourself to be Spanish, Hispanic, or Latino/a? I Yes No I prefer not to answer. Do you consider yourself Physically Disabled? 9. es No I prefer not to answer this question. Page 6 of 6 F:\CLER\$ALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx Updated: June 2020 MIAMI BEACH CIIYWIDE (CW) BOARD & COMMITTEES 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 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: 1 acknowledge that should my access card be lost, stolen or damage, 1 will be responsible to pay a $10.00 replacement fee. Rnnrel Mrm mk ar Infnrmntinn Date of Application: ,,,,, 10 _ 2 o L Applicant Name: �. t x 0 �, -e_+I Z . Board/Committee Name: I l A i r.A 1Z-5 i •r[.:. L= - Address: Address: 1 Z Z5 A-5e�t fZ S T;> �,v AN 22- 1 }�n�A�l i A--, E -Mail Address: Work Phone: Please provide signed form to the Parking Department located at 1755 Meridian Avenue, 2"d floor. Working hours are 8:30 to 5:00 p.m. or email to:.ParkingReception@miamibeachfi.gov e-mail subject: BOARD & COMMITTEE PARKING APPLICATION - APPLICANT NAME Home Phone Cell Phone:C� _ Preferred Contact Method: VphirlA Infnrmrytinrn Tag: ' e -1 Color: �. t State: fi D A Year: © -4-Ir Make:(' X41^V Model: Applicant Signature: e Please provide signed form to the Parking Department located at 1755 Meridian Avenue, 2"d floor. Working hours are 8:30 to 5:00 p.m. or email to:.ParkingReception@miamibeachfi.gov e-mail subject: BOARD & COMMITTEE PARKING APPLICATION - APPLICANT NAME Pnririnn nanrortmont 4Zartinn PERMIT SYSTEM GARAGE ACCESS Expiration Date: ID Card Serial #: Issued By Print Name: Print Name: Signature: K Signature: -e Date Issued: Date Completed: