Terri Echarte 12/31/23nIAP,:' �t�^,A CH
BOARD AND COMMITTEE CHECKLIST
APPOINTEE: %C.rrr 1�e DATE OF APPOINTMENT:
BOARD/COMMITTEE: ` ^ ViS�i `'Appointed by:
FOR SCANNER FOR CLERK STAFF U //r�� T
Scan : o Letter of Appointment TERM END:. v 3/ /� ERM i.tMtT:
Scan C, Letter of Reappointment
U Copy o Lee of �printmenVReappoin5q7
ailed tTlw Committee Liaison on
Scan r,> o Board and Committee Application (Completed /
Scan c, o R6sume/Curriculum Vitae
o Diversity Statistics Reporting (Completed on U
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 17 2021 amended through December 2010)
✓ Amendments to the Code of Ethics Ordinance (September 2009 through July 2012)
✓ Highlights of the Miami -Dade County Ethics Code
CITY OF MIAMI BEACH ✓ Sunshine Law and Public Records — Frequently Asked Questions
OFFICE OF THE CITY CLERK ✓ 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 G Source of Income Statement
Scan O O Acknowledgment of Financial Disclosure Requirement
O DIV RSIT( STATISTICS REPORTING Keep COPY in file and ORIGINAL for Annual Report.
Received on: // Signed by X alAIV,
l
tel Bo or orr6rhittee r
Processed on: 711ByEmployee;
Date 7ft!'ffice taff Initials
Scanned on: / / By Employee:
Date M 019rk's4ffice Staff Initials
! ! i
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,\CLERWARD AND COMMITTIES DATABASOCHECK LIST MASTERIB&C Checklist 2015 MASTER.docx
City (it fta 111! 000 (1!, 11 -flw' Moqo I koti;,, I 1"i # t KN
yvLws n"UMIAZU'd
(XII(I '04 lit CAY (:it W, Whiel I Gitnukkj, 0y Ckot
11, las A Wib,:I r1,54
hwil k,izy
Oath of Office
Oath of Civility
and
Acknowledgements,
TO: Ms, Terri Echarte
RE: Budget Advisory 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: 12/31/2023,
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.
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
andlor 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, Te i Echarte
Sworn to and subscribed before me thi/-7 day of IYAIZ)
2021
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 Confer Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
EmaIL BCndmtarnfl)eachfI nov
Telephone; 305,673,7411
AEEQ&YJI QE AEEILIAIIQN W IIJ E CITY OF M 18 M I QLAQ11
STATE OF FLO
COUNTY OF M / A 6C
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (check (,/) all that apply):
dI am a resident of the City of Miami Beach for six months or longer.
El 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).
❑ I amafull-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 (1061) 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
statit are true.
X)/ d I
J,IAAJl� // h. ,. L
bignature
i
P1 ro- y "-,*W
Sworn to (or affirmed) and subscribed before me, by means of hysical presence or 0 online
notarization, this/ day ofkL�Vr"-'6C6 2(2 by
��_(City of Miami Beach Board/Committee Member).
X" Produced ID
Form of Identification
0 I y -
(NOTARY SEAL)
Sign re of N ry Public Charles J. DAgostin
NOTARY PUBLIC
Name of Notary, Typed, Printed, or Stamped STATE OF FLORIDA
Comm# GG168171
*w, Expires 12/14/2021
'A
City of Miami beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Telaphone� 305,673.7411
ECS '!"r fc,
Last Name
112ULKLEX-EUMULCMINT-M
-ra.,* )e'
FirstName 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:
Wale
Female
Other
I prefer not to answer.
Race/Ethnic Categories:
What is your race?
[:I African American/Black
Caucasian/white
sian or Pacific Islander
Native American/Amedcan Indian
Other - Print Race:
I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
F-R/No
prefer not to answer.
Do you consider yourself Physically Disabled?
e
s
e
'No'
I prefer not to answer this question.
Page 6 of 6
F CLF144ALLIREGIJBCAPDAND COMMITTEE APPLICATIONS FINAL DRAFTSIBOARD AND COMMITTEE APPLICATION REG FINAL.(k)cx
Updated: June 20r,24)
City of Miami Beach
1700 Convenlion Center Drive
Miami Beach, Florida 33134
rnianlkll�d"''
OFFICE OF THE CITY CLERK
Email: BCCQn11arnib(1achfl gav
Telephone: 305,673,7411
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�fe 1 r /V
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.
Q= of the following forms must e 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 re than $500, 60 da s in jail, or both.
Si ature Date
1 Members of the Planning Board and Board of Adjustment will be notified directly by the State of Florida,
pursuant to F.S. §112.3145(1)(a), to file a Statement of Financial Interests (Form 1) with the Miami -Dade County
Supervisor of Elections by 12:00 noon, July 1. Planning Board and Board of Adjustment members who file their
Form 1 with the County Supervisor of Elections automatically satisfy the County's financial disclosure
requirement as a Miami Beach City Board/Committee member and need not file an additional form with the Office
of the City Clerk. However, compliance with the County disclosure requirement does not satisfy the State
requirement.
Page 5 of 6
F9CLER%$ALLSREG\6OARD AND COMMITTEE APPLICATIONS FINAL DRAFTSIBOARD AND COMMITTEE APPLICATION REG FINAL.d«:x
Updated: June 2020
Clear From Print Form
""C�UCE OF INCOME STATEMENT
SM
Section 2-11,1(1) of the County Ethics Code requires that certain employees and public officials file a financial disciosum Statement on a yearly basis by July 1st
of every year.
..... _
Dtsefosure for Tax Year Ending Lara Name trst Nome MMMe Name/intim
2020 Echarte Terri K
Mefto Adtbress — Street Nranber, Street Name, or P.O. Box
3000 Royal Palm Ave
City, State, Zip
Miami Beach, FL 33140
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. EI
Rft as an Emp (cho& cool
[Q County ❑ Public Health Trust C] Municipal:
tMrin(clPailtYl
Department
PesyHon or Title
Empfoyee ID Number
Work address
Work telephone
Employment began ordended on
County
Budget Advisory Committee
E] Municipal: City of Miami Beach
(Murdelpality)
2/20
LU
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 anothgr
person for your benefit. However, the income of your spouse or any business partner need not be disclosed_ If contlnued on a separate sheet, check here. v
Name of Source ol Inc me
Address
DaaWm of Um t ndpat Bush� Actlift
Diversified Florida Investment
Fort Lauderdale, FL
real estate investment
Corp
GTGM LLC
3000 Royal Palm Ave., MB
real estate holding co
SRA Orlando Properties LLC
Miami Beach, FL
real estate limited partnership
Charles Schwab
Coral Gables, FL
interest/dividends on personal
Marcus Bank
marcus.com
savings and investments
I herebv swear (or affirm) thpt the information above Is a true and correct statement, RECEPJED By ELECTIONS WARTMEW-
Lj
°``c°p%CEIVED
O Electron)
n OfP onDis NOV 17 2021
Dateslgned CITY OF MIAMI
ENIEMSER T01 V41114'f, SIGN AND St VAIT TO THE O FK11E OF THE OTi CLERK VIA EM41L OR FiAF1 (1'(
)' �f
�AI®��II�IIM
x. t t ... CITYWIDE (CW) BOARD & COMMIT FEES
City at Miami peach, PARKING DEPARTMENT PARKING APPLICATION
I 7.55 Merullun Avenim, "Suitt¢ 700/Miofoi Bouch, rt 33 139/f1h (3051673-7505 or 13051 67;3 7000 rept Q00
A citywide (CW) parking permit is honored of 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, 1 will be responsible to pay a $10.00 replacement fee.
Board Member Information
Date of Application: /I 1
GARAGE ACCESS
Applicant Name: 6„rl ff
ID Card Serial #:
Board/Committee Name:
li
S v --r rr, -7u #C e..
Address: xao & 0'
�/ •
OA
''
E -Mail Address: .
$-I e
. co
Work Phone: 305_ 7 �' 0
Home Phone Ai
Cell Phone:,395-_ r 0
Preferred Contact Method:
Vehicle Information
Tag: IrV /4 0 Color:
State: FL Year: 201q
Make: 41—, Model: v
Applicant Si nature: -6
Please provide signed form to the Parking Department located at 1755 Meridian Avenue, 211 floor. Working
hours are 8:30 to 5:00 p.m. or email to: ParkingReception@miamibeach$f,cgcsv
e-mail subject: BOARD & COMMITTEE PARKING APPLICATION — APPLICANT NAME
Parkina Department Section
PERMIT SYSTEM
GARAGE ACCESS
Expiration Date:
ID Card Serial #:
Issued By Print Name•.
Print Name:
Signature: AK
Signature: -e
Date Issued:
Date Completed: