Liliam Lopez 12/31/23M IAM I BEACH
BOARD AND COMMITTEE CHECKLIST
APPOINTEE: Liliam M. Lopez DATE OF APPOINTMENT. 12/06/2021
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scan> o Letter of Appointment TERM END:Z' TERM LIMIT: /' /= k>
Scan o o Letter of Reappointment [2y]'./3'/ovo»wronrovoent ·mates o corroe- uaso o
Scan o o'6are4#a és#itee Application (Completed on. )
Scan o o Résumé/Curriculum Vitae / 1 7¡1_,/ J ,1¡.
o Diversity Statistics Reporting (Completed on_/a_ / t _L),
Scan o o Oath
RECEIVED
DEC 15 2021
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
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
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 REPORTING Keep COP Y in file and ORIGINAL for Annual Report]
Received on. 12/06/2021 _Signea X 'l
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Date
CONCLUDED & RESIGNATION LETTERS
Term Expired Letter Date Processed Initials Scan o
Resignation Letter Date Processed Initial6 Scan O
Removal letter due to absences Date processed Initiais Scan o
F:\CLER\BOARD AND COMMIT TIES DATABASE\CHECKLIST MASTER\B&C Checklist 2015 MASTER. do0cx
We ore committed to providing excellent public service and sale»y to all who live. work and play in our vbront, topical, historic comm unity
M IA M I BEACH
City of Miami Beach, 1/OO Convention Conter Drive, Miami Boa ch, Horida 33139 yywy_miamibcachl].go
OF FICE OF THE CITY CL ERK , Rafael E. Gr an ado, Ciiy Cl erk
Tol: 305.673.7411, Fox. 305.673.7254
Email: CityClerk@miamibeachll.gov
D e cem be r 06 , 202 1
M s. Li liam Lopez
4200 A lton R oad
M ia m i Bea ch, FL 3314 0
SUBJECT: Miam i Beach Com m ission For W om en
C o ng ratulatio ns! Y ou have been reappointed by Com m issioner Kristen Rosen Gonzalezto the above
referenced , boa rd or com m itt ee nam ed above, fo r a term ending: 12/31/2023.
Pursuant to C ity of M iam i Beach C ode Section 2-22 (5) a, "N otw ithstanding any other provision of the
C ity C ode or of any resolution, com m encing w ith term s beginning on or after January 1, 2007, the term of
eve ry bo a rd m em b er w ho is directly appointed by a m em ber of the C ity C om m ission shall autom atically
expire up o n the latt er of: D ecem ber 31 of the year the appointing C ity C om m issioner leaves office or
upon th e app ointm en t/el ection of the successor C ity Com m ission m em ber."
If you are unab le to accept this appointm ent, or have any questions, please call the Offi ce of the City
C le rk at 305.6 7 3.7 411. Please read the encl osed m aterials carefully.
C o ngratulations and good luck.
"e
R afL ranado
C ity C lerk
cc: M onica Be ltran, Parking Di rector
V eronica Paysse, C ity Li aison
ATT A C HM ENTS:
Lett er of A ppointm e nt
O ath
C ity C ode/Or di nan c e section ap plic abl e lo agency, board or com mi tt ee
C ity C o de Section 2-22, 2-23, 2-24, 2-25, 2-26, 2-458 an d 2-459
O rdina nce N o . 20 06-3543 - Am en dm ent to C ity C ode Section 2-22
M ia m i-D a de C o unty C ode Section 2-11.1 - C on flict of Interest and C ode of Ethics O rdinance
C ity Wi de Pe rm it Ap plic ation - (P arking D epartm ent Form )
Bo okl et - G uid e to the Sunshine A m endm ent and C ode of Ethics fo r Public Offi cers and Em ployees
M IA M I BEAC H
City o f M iam i Beach , I7O Convantion Cantor Drive, Miaml Boch, Florida 33 139 www.miambeauc.bl.go!
OFFKCE OF THE CII'Y CIERK, Rafool E. Gronado, Ciy Clork
Tol: 305.673.7411, Fax 305.673.7254
Email: Ciykouk@mlomboochl.go
Oath of Office
Oath of Civility
and
Acknowledgements
TO : Ms. Li liam Lopez
RE: Miam i Beach Com m ission For W om en
J do solem nly swear or affi rm to bear true faith. loyalty and allegiance to the Govern m ent 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-m entioned board or com m ittee of the City of Miami Beach to which I have been appointed for a
term ending: 12 /3 1/20 23 .
To m y colleagues and to all of those I represent and serve, I pledge fairn ess, integrity and civility, in all
act ions taken and all com m unications made by m e as a public serv ant,
I have been issued a copy of section 2-11, 1 of the M iami-Dade County Code (Conflict of Interest and
Code of Eth ics Or di n an ce), as well as Florida Comm ission on Ethics Guide to the Sunshine Am endm ent
and Code of Ethics fo r Public Officers and understand that as a member of a City of Miami Beach Board
and/or Com m ittee, I m ust com ply with the financial disclosure " requiremen ts of M iam i-Dade County or the
State of Florida (depending on the board or comm ittee on which I serve) on July 1st, fo llowing the closing
of the calendar year on which I have serv ed.
Sworn to an d subs cribe d before m e this _
p lease visit the City of M iam i Beach website at www.m iamibeachfl.gov under City Clerk/B oard and
Com m ittees for additional information regarding th e Financial Disclosure Requirem ents
MIAH . Em? SOURCE OF INCOME STATEMENT
Section 2-11.1(i) of the County Ethics Code requires that certain employees and public officials file a financlal discl osure Statem ent on a yearly basis by July 1st
of every year.
Dlsclosure for Tax Year Ending ¡ Last Name First Name Mi ddl e Name/lnitlal
2020 Lopez Lliam M
Malling Address -· Street Num ber, Street Nam e, or P,0, Box
4200 AIton Road
City, State, Zip
Mlami 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 Hele.
Fillng as an Employee (check one)
[] county I] Public Health Trust [] Municipal:
(Municipality)
Departm ent
Position or Title Employee ID Num ber
Work address ¡ Work telephone Employment began on/ended on
Filing as a Board Member (check one)
DJ county E] Municipal: City of Miami Beach
(M uni cipal ity )
Board where serv ing
Commission and Wom en
Al tern ate addre ss (lt hom e addre ss ls exem pt ) I Work telephone ¡ Term began on/ended on
305- 534-1903 1201/2021
List below every so urce of incom e you recei ved, along with the address and the principal activity of each sour ce. Include your public salary, Place the sources of
incom e in descen ding order, with the largest so urce first. Examples of so urce s of incom e include: com pen sa tion for services, incom e from business, gains from
prope rty dealing s, interest, ren ts, dividen ds, pensi on s, IRA distribu ton s, and soci al secur ity payments. Also, include any source of income recei ved by anot her
person for your benefit. However, the incom e of your spouse or any business partner need not be disclosed, It continued on a separate sheet, check here. L]
Name of Source of Inc ome Address Description of the Principal Business Activity
South Florida Hispanic Chamber of Commerce 333 Ath ur Godfrey, 8pg4. 6uta 300 Presiden/CEO
Miami Beach, FL 33140
Condominium 2457 Collins Ave. Apt 701 Rental Property
Miami Beach, FL 33140
I hereby swear (or affirm) that the Information above is a true and correct statement.
dei. "%, n, :
nlure ot Ponson lsc ,[ nr-
12/06/2021
Dato sign ed
cv P EECP S PN:
[ Hardcopy
tues9P1 5 2021
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
REMEMBER TO PRINT, SIGN, AND SUBMIT TO THE OFFICE OF THE CITY CLERK VIA EM AIL OR HARDCOPY.
M IA M I BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email:. B C @m iam i b each f.g ov
Telephone: 305.673.7411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
S T A T E O F F LO R ID A
C O U N T Y O F M IA M I-D A D E
I a m in com p lia nce w ith the affi liatio n requirem e nt of M iam i Beach C ity C ode Section s 2-22 (4), as (check
(/) all that apply ).
o I am a reside nt of the C ity of M iam i B each for six m onth s or longer.
H o m e A ddr e ss 420 0 Al ton R oa d. M ia m i Be ach, FL 33140
u have an ow ne rship In te rest (for a m inim u m of six m o nths) in a busine ss established in the C ity of
M ia m i B e a ch (fo r a m in im um of six m onths).
S o uth F lorid a Hispanic C ha m be r of C om m erce [[a m e f [[8]m@Si
B usiness A dd ress 333 A rthur G odfr ey R oad . Su ite 300., M ia m i Be ach, FL 33140
o I am a full-tim e em p lo ye e of a business (fo r a m in im um of six m o nths) and I am based in an offi ce or
othe r lo ca tio n of the bu sin e ss that is physica lly located in M ia m i Beach (fo r a m inim um of six m on ths ).
[yap9 tf P 11 g]me 8S
[1JS/me ss (]([fess
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 busin ess associ a tion.
U n d er pen al ti e s of perjur y , I de cl are th at I have read the foregoi ng docum en t an d that th e fact s stat ed in it
""{ta. 92,#,," sora/7"" t/r ose
Li lia m M . Lo pe z
P ri nte d N ame
N O TA R Y
S w o rn to (or affi rm e d) an d su b scribed befo re m e , by m ea ns of o physica l pre sence or o online notarization,
we ]aay or.)Ee .2 lo» Ly114L.ogz_
} (Ci ty of M ia mi Be ach B oard /C omm i ttee M em ber ).
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Bon ded thr ou gh Nation al Notary Assn,
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(N O TA R Y SE A L)
N a m e of N otary , Typ e d, Printe d , or S tam ped
M IA M I BEACH CITYWIDE (CW) BOARD & COMMITTEES La cwy o+ tan»sí seo«d, PARkio rARrNr PARKING PPLICA[ION
1755 Morldlan Aonue, Suite 200/Miami Beach, FL 33139/Ph: (305) 673-7505 or (305) 673-7000 ox1. 6200 PARKING
A cilywide (CW) parking permi t is hon or ed at m etered parking spa ces and restricted residen tial zon es
par king spaces. A CW parking permit IS NO T honor ed in proh ibited are as. An Access Card will be
pro vided to you for Cily Hall G ara ge (G 7) access.
IM PO RTA NT N O TE: Your veh icle licen se plate serves as your "pa rking permit", In order to avoid
any unnecessary enfo rcem ent actions, it is important that our records reflect the most current and
accurate info rm ation regard ing your vehicl e licen se pl ate. Inaccurate and/ or outdated vehicle
inform ation may lead to the issuance of parking citation(s) and/ or the tow ing of your vehicle.
Please note that this new access card CA NN OT 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 surfa ce of the car d against the reader
until the gate opens.
A CKN O W LE DG EM EN T: I acknowledge that should m y access card be lost, stolen or
damage, l will be responsible to p a y a $10.00 replacement fee.
Board Member information
Date of Application: 12/06/2021
Applicant N am e: Li liam M. Lopez
Board/Com m ittee N am e: Commission of Women
A ddress: 4200 Alton Road. Miami Beach, FL 33140
EMail A ddress: [topez@sflhcc.com
W ork Ph on e: 305-534-1903 Home Phone
Cell Phone: 305-562-9220 Pre ferred Contact Method:
Vehicle information
Tag: JXVT32 Color: White
State: FL Year: 2018
M ake : Lincoln M odel: MKZ
Applicant Sianat ure: es
Please pro vide signe d form to the Parking Department located at 1755 Meridian Aven ue, 2" floor. W orking
hours are 8:30 to 5:00 p.m. or emai l to: ParkingReception@miamibeachfl.gov
e-mail subject: BOARD & COMMITTEE PARKING APPLICATION - APPLICANT NAME
Park ina D epa rt m ent Sect ion
PERMIT SYSTEM GARAGE ACCESS
Expi ration Date: ID Card Serial #:
Issued By Print Name: Print Name:
Si gnat ure: e Signa ture: í
Date issued: Date Completed:
y l i n Hl Hl#à ll r d th3hi/ana llh""hitlh Il"a 'i ahi tUl
M IA M I BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miam ibeachfl,goy
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)
Lopez Liliam M.
Last Name First Name Middle Initial
I understand that no later than dul1of 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.
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 $500, 60 days in jail, or both.
#«-t9, St n
12/02/2021
Date
1 Members of the Planning Board and Board of Adjustment will be notified directly by the State of Florida,
pursuant to F.S. $112.3145(1)(a), to file a Statement of Financial Interests (Form 1) with the Miami-Dade County
Supervisor of Elections by 12:00 noon, July 1. Planning Board and Board of Adjustment members who file their
Form 1 with the County Supervisor of Elections automatically satisfy the County's financial disclosure
requirement as a Miami Beach City Board/Committee member and need not file an additional form with the Office
of the City Clerk. However, compliance with the County disclosure requirement does not satisfy the State
requirement.
Page 5 of 6
F:CLER$ALLREGBOARDO AND COMMIT TEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
M IA M I BEACH
City of Miami Bea ch
1700 Convention Center Drive
Mi ami Beach, Florida 33139
wwwmiamibeachfl.gov
OFFICE OF THE CITY CLERK
Em al l: BC@miamlbeachf.gov
Telephone: 305.673.7411
DIVERSITY STATISTICS REP OR I
Lopez Liliam M
Last Name First Name Middle Initial
The fo llow ing info rm ation is voluntary and has no bearing on your consideration fo r appointment. It is being
asked to com ply with C ity diversity reporting requirem ents.
Gender:
J al e
J remate
O O ther
[l 1 prefer not to ans w er.
Race/Ethnic Categories:
What is your race?
O Afr ica n Am erican/Black
O A sian or Pacific Islander
] C auca sian /whi te
O Native Am erica n/Am erican Indian
Lo ther - Print R ace.
O I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latinola?
gyves
o
O I prefer not to answ er.
Do you consider yourself Physically Disabled?
Ives
R o
D I prefer not to answer this question.
Page 6 of 6
F:CLER$ALLREGBOARD ANDO COMMITTEE APPLICATIONS FINAL DRAFTS'BOARD AND COMMITTEE APPLICATION REG FINAL.docx
U pd ated: Jun e 2020