Jaedra Wedel 12/31/23BOARD AND COMMITTEE CHECKLIST'
APPOINTEE t%( t 1 DATE OF APPOINTMENT: €,�"
BOARD/COMMITTEE:
Appointed by: � . , '�r� ��. A ` r
FOR SCANNER FOR CLERK STAFF)
Appointment
Scan o o Letter of A � �
pp TERM L.ND:
Scan o o Letter of Reappointment
o =ano
of AppointmentlReappointment e -ma' ed to Committee Liaison on
v)
Scary o o oarteeApp Dation{Completed on
Scan o o Resume/Curriculum Vitae
o Diversity Statistics Reporting (completed on,/-
Scan o o Oath
IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
i ✓ 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
CSI L Y MIAMI BL AC,[ I ✓ Sunshine Law and Public Records -- Frequently Asked Questions
C FFICL_ + ,t:..1 t9E 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 Q Q Source of Income Statement
Scan Q o Acknowledgment of Financial Disclosure Requirement
O D VERSITY STATISTICS REPORTING Keep COPY In file .ityd ORIGINAL_ for Annuat Report.
a C �
Received on: �� Signed by
Date Boum= r uoii ille--Wmb
Processed on: .~ By Employee: ,� 8
ate CI ` Cle�` Qffice lal
Scanned on: By Employee: �.
Date ity Cl rk Office Staff Initials
mr, ---
Term Expired Letter Date Processed Initials Scan O
---- —Letter Cute Processed
Resignation Letterr- Initials scan p
Removal Letter due to absences _._ Date processed Initials Scan o
F:ICLERIBOARD AND COMMITTIES DATABASE\CHECI(LIST MASTEMB&C Checklist 2096 MASTER.docx
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MIAMIBEACH
City of Miami Beach, 17€10 Convention Ceniar Drivo, Miami &aach, I lorida 33139 w+ww rniarnibeachfl.aav
OFFICE Of THE CITY CLERK, Rafael E. Granodo, City Clerk
Tel: 305.673-7A 11, Fax: 305.673.7254
Email: CiiyCte @miamibewhfl.gov
November 09, 2021
Ms. Jaedra Wedel
65 Washington Avenue #26
Miami Beach, Florida 33139
SUBJECT: Animal Welfare 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.
Regards,
Rafa GrVao
City Clerk
cc: Monica Beltran, Parking Director
, 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
1700 Convenlion Conler Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
C-iiiail:B@C(iiii�iaiiiibc,.achfl.gov
Telephone: 305.67�7411
STATE OF FLORIDA
COUNTY OFC -2
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (check (,/) all that apply):
I
tfI am a resident of the City of Miami Beach for six months or longer.
1 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).
El 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 ton 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
state it are,true
ature Date
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by rneans of El physical presence ornline
notarization, this _day of , 20_by, 1�4 L, /(,—
Produced ID
__(City of Miami Beach Board/Committee Member),
�/Z`"X:,% Z- l Cly Se
rm of Identification
Personally Known
. ...................... Charles, gsy,,SEAL)
Signartu e of Notary Pub 4'a �5 N'',r NOTARY PUBLIC
....... STATE OF FLORIDA
Name of Notary, Typed Printed, or StVlped C c)m rTi# GG 168171
! Expires 12/14/2021
rDisclosure for Tax Year Ending Last Name First Name Middla Namolinitial
2020
Milling Address – Street Number, Street Name, or P.O. Box
100 14 1 614ro ! ,!' 'a _
If your home address is your mailing address, and your home address is exempt from public records pursuant to Fla. Stat. §119-ttt, read
instructions on the following page and check toe.
Filing as an Employee (check one)
County Public Health Trust] Municipal:
(Municipality)
Department
Position or Title
Employee lD Number
Work address
Work telephone
Employment began on/ended on
Filing as a Board Member (check one)
County Municipal:
-" (Municipality)
Board where serving )
An
Alternate address (if home address is exempt)
telephone
an onienaea on
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 d,sciosed, If continued on a separate sheet, check here, Q
Name of Source of Income
Addross
Description of the Principal Business Activity
{�f i . �� L 4�) /1 rS' �
Y 1 fit rr� ' 7G` t � ✓ `� l �i`
t710 SS Ci 4` .
I hereby swear (or affirm) that the info
1 I
Signature 6f Person Disclosing
Date signed
tion above is a true and correct statement
RECEIVED BY ELECTIONS DEPARTME1 T _._.—_
D Hirelcopy RF GEIVED
(-J Electronic Copy
DEC 0 9 2021
CITY 0F'MIAMI BEACH
t7F IGF, DE 1HE r%ITY CLERK
1F:t_f IE I't`iLFF,' TO . R)i',IT SIGH, F HID S1_iDNIII TO THE OFFICE OF TIME CITY C'1E-RK VIA WAR OR i-1,ANDCOPY,
City of Miami 1300ch
1700 Convention Center Drive
Miami Beach, Florida 33139
�v✓w,mianiiits����i�l.cloy ,� ,,
OFFICE OF THE CITY CLERK
Entail; BCcrti�eacM.aov
Telephone:305,673,7A11
BOARD & CSTAIEMEBI
Acknowledgement of finestsuspension for Board/Committee Members for failure to comply with Miami -
Dade County Financial Disclosure Code Provision Code Section 2-11.1(i) (2)
Y x h
e
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
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
a�l r:1CLLRi$ALI_ARECi1p4ARDAND COMMITTEE APPLICATIONS FINAL DRAFTSWARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated June 2020
I
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M -, , 0 - I - 01, , ", m�
OFFICE OF THE CITY CLERK
441"N , 1
0
Email: Q.Cnmiamibeachflxjov
Telephone: 305,673,7411
DIVERSITY STATISTICS REF'- RT
Loi? cla 0(-)(Jco -D
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
Z?Femaie
Other
I prefer not to answer,
Race/Ethnic Categories:
What is your race?
African American/Black
011,'Asian or Pacific Islander
Caucasian/White
Native American/American Indian
Other — Print Race:
I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
�--J Yes
No
I prefer riot to answer.
Do you consider Yourself Physically Disabled?
Yes
No
I prefer not to answer this question.
Page 6 of 6
r:\CLFR\$ALLNREG\13OARD AND COMMITTEE APPLICATIONS FINAL DRAFISWARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated, June 2020
y CITYWIDE (CW) BOARD & COMMITTEES
PN
City of Miami Reach', PARKING DEPARTMENT PARKING APPLICATION
1755 Meridion Avenue, Suite 200/Miami G'ecrrh rt. 33139/Ph (305) 673-7505 or 105) 673-7000 eA 6200 PARKING
A citywide (CW) parking permit is honored at metered parking spaces and restricted residential zones
parking spaces.A CW parking permit 6'_NOT honored in prohibited areas. An Access Card will be
provided to you for City Mall Garage (G7) access,
IMPORTANT OTE: 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 hale-punched or perforated in any manner. To use
the new card please hold the card at close proximity to the reader until the grate opens. You may need
to try the other side of the card. Tease ensure you hold the entire surface of the carol against the reader
until the gate opens;
ACKNOWLEDGEMENT: 1 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. �}
j"-
Applicant Name;
Borard/Crarnmittee %lame.
'Airn
Address: ,
E-Mail Address;
Work Phone. Home Phone
Cell Phone: < _._.-c = — Preferred Contract Mo liod:
Vehicle; Informatiorit
Tag: Calor'
urate year-
make: Model_..
Applicant Sicinature:
Plc osr provide signed form to Iho Parking Department located at 1755 Meridian Avenue, 2,3 fluor, Working
Boars are 8,303 to 5.00 p.m. or ern ail to: ar eg e i r���_
e-mail jrtb' c#: COM 17YEE PARKING APPLICATION - APPLICANTNAME
_
Parkin Qeport ent Sectio
PERMIT SYSTEM '
Ex iratiran C�atr;;
GARAGE ACCESS _
ID Cara Serial
Issued By PriJ0rrar .
Print Nome:
Signature; K
Si
Date Issued:
Coate Cor ple ed;
(J/00 .r.R"p({ (Ji I. (i CM1'f U(i 1