Carlos Gutierrez 12/31/22BOARD AND COMMITTEE CHECKLIST
AP P O IN T E E : @""OS"""@ DATE OF APP OINTM ENT: 12/16/2021
B O A RD /C OM M IT T EE: Program for Public Information (PPI) _App ointed by: Navor Dan@oboe
FOR SCANNER
Scan o
Scan o
Scan o
Scan o
Scan o
FOR CLERK STAFF
o Letter of Appointment TERM END: 01/01/2022 TERM LIMIT: 12/31/2022
o Letter of Reappointment
o Copy of Letter of Appointment/Reappointment e-mailed to Committee Liaison on
12/16/2021
o Board and Committee Application (Completed on 12/16/2021
o Résumé/Curriculum Vitae
o Diversity Statistics Reporting (Completed on 12/16/2021
o Oath
Received Dec 16, 2021
Office of the City Clerk
RECEIVED
DEC 1 7 2021
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
C ITY OF M IA M I B E A C H o Citywide Permit Application (Parking Department Form)
O F FIC E O F TH E C ITY C L E R K o Booklet - Guide to Sunshine Amendment & Code of Ethics for Public Officers and Employees
Scan o
Scan o
Received on:
o Source of Income Statement
O Acknowledgment of Financial Disclosure Re43//!"
O DIVERSITY STATISTICS REPORTI
12/16/2021 _Signed by } \(cs,
Date
and ORIGINAL for Annual Report.
Processed on:11001 By Employee: «
Date City Clerk's Office Staff Initials
sa ne a o 12/102021 »oree faca'gr
Date City Clerk's Office 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:\C LER\BO A R D A ND CO M M ITT IES DATA BASE\C HEC KLI ST M A STER\B&C Checklist 2015 M A STER.docx
M IAM I BEACH
City of Miami Beach, 1/OO Convention Cantor Divo, Miami Boach, Horida 33 139 yywy_miamiboachll.goy
OFFICE OF THE CITY CLERK, Rafool E. Granado, City Clerk
Tol: 305.673.7411, Fax. 305.673.7254
Email: CityClerk@miamibeachll.gov
Decem ber 16, 2021
Mr. Carlos Gutierrez
5101 Collins Ave, Apt 9H
Miami Beach, FL 33140
SUBJECT; Program for Public Information (PPI) Committee
Congratulations! You have been reappointed by Mayor Dan Gelberto the above referenced, board or
committee named above, for a term ending: 12/31/2022.
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 appointm ent/election of the successor City Commission member."
If you are unable to accept this appointment, or have any questions, please call the Of fice of the City
Clerk at 305.673.7411. Please read the enclosed materials carefully.
Congratulations and good luck.
Regarlìf.
Rafal ra nado
City Clerk
cc: Monica Beltran, Parking Director
Amy Knowles, 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 an d 2-459
Ordinance No. 2006-3543 - Am endm ent to City Code Section 2-22
Miami-Dade County Code Section 2-11.1-Con flict of Interest and Code of Ethics Ordinance
City Wi de Permit Application - (Pa rking Department Form)
Booklet - Guide to the Sunshine Amendment and Code of Ethics for Public Officers and Employees
MI M l
City of Miami Beach, 1/OO Convention Conter Drive, Miami Booch, Horida 33139 yyywy_miamibaachf]_goy
OFFKCE OF THE CITY CLERK, Rofaol E. Granado, City Clerk
Tel: 305.673.7411, Fox. 305.673.7254
Email: CityClerk@miamibeachfl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Mr. Carlos Gutierrez
RE: Program for Public Information (PPI) 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 with the financial disclosure requirem ents of Miami-Dade County or the
State of Florida (depending on the board or committee on which I serve) o ollowing the closing
of the calendar year on which I have served.
Sworn to and subscribed before me this 2021
Charles D'Agostin
Deputy Clerk
*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.
1/A\Ml B H
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305 .673 .7 411
RECEIVED
DEC 1 7 2021
CITY OF MIAMI BEACH
OFFICE OE 4E CITY CLERK
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
STATE OF FLORIDA
COUNTY OF MIAMI-DADE
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4), as (check
(✓)all that apply):
o I am a resident of the City of Miami Beach for six months or longer.
p[pf J\]]f,
fil" 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).
Name of Business Coldwell Banker Realty_- Gutierrez Group/G Group
Business Address 1682 Jefferson Avenue Miami Beach, Florida 33139
o 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).
[]q r T [P S
[I S [[e ,S J(]]f@ S S
"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 so/e proprietorship, sponsorship, corporation, limited liability company, or other
entity or business association.
I declare that I have read the foregoing document and that the facts stated in it
December 16, 2021
Date
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of physical presence or o online notarization,
this 16 day of December , 20_21_by Carlos Gutierrez
_________ (City of Miami Beach Board/Committee Member).
ktinti«dittetttitiiittilenti«l~
Produced ID
Form of Identification
gt¿"i., ELLEN BE RKMAN
SY: < Notary Public · Stat ot Foti4a
¿l ê commsso ¢ GG 172763
z My comm Epes Jan 7. 2022
(NOT ARY SEAL)
Siguaty é of Notary Public
Ell . Berkman
Name of Notary, Typed, Printed, or Stamped
M IA M l·DAD E. EmII SOURCE OF INCOME STATEMENT
Section 2-11.1(@) 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
2020 Gutierrez Carlos G
Mailing Address - Street Number, Street Name, or P.O. Box
1701 North Treasure Drive, TH1
City, State, Zip
North Bay Village, Florida 33141
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 a nd ch ec k Heil e.
Filing as an Em ployee (check one)
□County □Public Health Tru st [] Municipal:
(M unicipality)
Department
Position or Title Employee ID Number
Work address I Work telephone Employment began on/ended on
Filing as a Board M em ber (check one)
□County [] Municipal: City of Miami Beach
(M unicipality)
Board where serving
Program for Public Information (PPI)
Alternate address (if home address is exempt) I Work telephone I Term began on/ended on
305-710-9655 2021
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. O
Name of Source of Income Address Description of the Principal Business Activity
Coldwell Banker Realty 1682 Jefferson Avenue Real Estate Sales
Miami Beach, Florida 33139
e information above is a true and correct statement.
Date signed
RECEIVED BY ELECTIONS DEPARTMENT:
O Hardcopy
QJ' Electronic Copy
Received December 16, 2021
Office of the City Clerk
REMEMBER TO PRINT, SIGN, AND SUBMIT TO THE OFFICE OF THE CITY CLERK VIA EMAIL OR HARDCOPY.
M IA/\/\1
City of Miami Beach
1 700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfl.gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
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)
Gutierrez Carlos G
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.
to file one of these forms, pursuant to the Miami-Dade County Code, may subject the person to a fine
han $500 O days in jail, or both.
,;----_
December 16, 2021
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:ICLER\$ALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
11A\4/
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachll.goy
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
DIVERSITY STATISTICS REPORT
Gutierrez Carlos G
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:
[CJ Male
O Female
O Other
L Mprefer not to answer.
Race/Ethnic Categories:
What is your race?
O African American/Black
O Asian or Pacific Islander
["} Caucasian/white
O Native American/American Indian
O Other - Print Race: -------------
LI prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
(J ves
Io
O I prefer not to answer.
Do you consider yourself Physically Disabled?
ves
Gho
O I prefer not to answer this question.
Page 6 of 6
F:\CLE R \$A LL\R E G \B O A RD A ND CO M M ITT E E A P P LI C A TIO NS FIN A L D RA FTS \BO A RD A ND CO M M ITT E E A P P LI C A TIO N RE G FINA L.dccx
Updated: June 2020
/\/\//\/\/\/ WI DE (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 e4. 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: 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
D ate of A pplication: 12/16/2021
A pplicant N am e: C arlos G uteirrez
Board/C omm i ttee N am e: Pro gram fo r Public Info rm ation (P P I)
A ddress: Hom e: 1701 North Treasure Drive, TH1 North Bay V illage, Florida 33141
W ork: 1682 Jefferson A venue M iam i Beach Florida 33139
E-M ail A ddress: C arlos@ G G M iam iRE .com
W ork Phone: H om e Phone
C ell Phone: 305-710-9655 Preferred Contact Method: Text
Vehicle Information
Ta g : LR ZH 53 Color: Black
State: Florida Year: 2013
Make: Infiniti Model: G37
Applicant Si nature:
Please provide signet torm Department located at 15 5 Meridian Avenue, 2d floor. Working
hours are 8:30 to 5:00 p. . . arkingReception@miamibeachfl.gov
e-mail subject: BOARD & COMMITTEE PARKING APPLICATION - APPLICANT NAME
p, ·ki D S ar Ina epartment ection
PERMIT SYSTEM GARAGE ACCESS
Expiration Date: ID Card Serial #:
Issued By Print Name: Print Name:
Signature: Signature:
Date Issued: Date Completed:
..p mg man roar toms cw oatds commmtees par mgtorm.doc