Carolina Jones 12/31/22APPOINTEE:
BOARD AND COMMITTEE CHECKLIST
AA.AL.. ooreoraron«ce. //y1/2/
acts, Re a bi- BOARD/COMMITTEE:'' Appointed by.
c e l2/312 . /2/31/3 FOR SCANNER
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RECEIVED
FOR CLERK STAFF
Letter of Appointment
Letter of Reappointment
e fl)'!_ ti;¡;/ :J. f ppointmenVReappoíntment e-maíleó to Committee
o oara na Imittee Application (Completed on_ _ )
,, Résumé/Curricufum Vitae w &:.I: 1 ~ -
o Diversity Statistics Reporting , 2/2j
o Oath
Liaison on
JAN 4 2022
IMPORTANT INFORMATION FOR SOARD AND COMMITTE E 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 2459
• 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
Y Sunshine Law and Public Records Frequently Asked Questions
• Memorandum - Solicitation by City Board and Committee Members CITY OF MIAMI BEACH
OFFICE OF THE CITY CLE RK o Citywide Permit Application (Parking Departmen t Form)
Scan Oo
Scan O
Received on:
Processed on:
Scanned on.
O Booklet -- Guide to Sunshine Amendment & Code of Ethics for Public Officers and Employees
O Source ot Income Statement
O Acknowledgment of Financial Disclosure Requirement
O DIVERSITY STATISTICS REPORTING Keep çoPy in file and ORIGINAL for Annual Report
3c2.z _saneasyX (k
L /Date/
L Lt r » By Employee: --l---,;C-A"l---r-+-------------
1
/ /tJ¡ ),~ByEmpfoyee:~~~_.,.:::;...__-
Date
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
+CL±RBOARD AND COMMIT TIES DAI ABASE\CHECKLIST MASTER&C Checklist 2015 MAS1ER.docx
M IAM I BF.ACH
City of Miami Beach, 1Z OO C on vention Conter Dr ive, Miami Boach, Horida 33 139 www_miamibachllgov
OFFICE OF THE CITY CLERK , Rafael E. Gran ado, City Clerk
Tl: 305.673.7411, Fax. 305.673.7254
Email: CityClerk@miamibeochfl.gov
December 14, 2021
Ms. Carolina Jones
1101 Stillwater Drive
Miami Beach, Florida 33141
SUBJECT: Parks and Recreational Facilities Board
Congratulations! You have been reappointed by Mayor Dan Gelber to 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 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,
l
Rafael Granado
City Clerk
cc: Monica Beltran, Parking Director
Cynthia Casanova, City Liaison
ATT ACHMENTS:
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 - Am endm ent to City Code Section 2-22
Miami-Dade County Code Section 2-11.1- Conflict of Interest and Code of Ethics Ordinance
City Wi de Permit Application - (Parking Department Form)
Booklet - Guide to the Sunshine Amendment and Code of Ethics for Public Officers and Employees
F iC H O TH GTYCALRK Kalal E Granodx, Cay .kd
1el 39.3 7a11, fax 305.673 7254
(ma# Ct.Clari@iambsocht.go
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Ms. Carolina Jones
RE: Parks and Recreational Facilities Bo ard
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 wh ich 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
andi 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 wh ich I serve) on July 1st, following the closing
of the calendar year on which I have served.
Ms. Carolina Jones
Sworn to and subscribed before me !hi~ day of i) ,2021
"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.
City of Miami Bea ch
700 Convetin Cet Drivc
M ia m i each, florda 33139
OFFICE OF THE STY CLERK
Email: 3g@riamibeachf .go
Telephon e: 305.673.7411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
STATE OF FLORIDA
COUNTY OF MIAMI-DADE
I am in complian ce with the affiliation requirement of Miami Beach City Code Sections 2-22 (4). as (check
(/) all that apply):
r lam a resident of the City of Miami Beach for six months or longer.
a 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).
[gap Pg,me,
Hg ¡ne ,, qd{e5
lam a full-time employee of a business (for a minimum ot six months) and l am based in an office or
other location of the business that is physically located in Miami Beach (for a minimum of six mont hs)
[}3ff f pggrei
Pys4mess „[dfeSb3
"Ownership interest" means the owne rship of ten percent (10%) or more (including the ownership of
10% or more of the outstanding capital stock) in a business.
"Business" means any sole proprietorship, spo nsorship, 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 stated in it
are true. [},,1-
u b o. ZZ
[ Signature
Printed Name
NOTARY
.(City of Miami Brach Board/Committee Member) · ye<e
Name of Notary, Typed, Printed, or Stamped
(NOTAR Y SEAL )
gif¿, CHARLES J. DAGO STNN $$";; c ou ssioN # HH 16s7os
$,9%.5; ExPIREs: Decem ber 14, 2025 "íj ?" Bonded Thru Notary Pub lic Und erwrit er s
City of Miami Beach
700 Convention Center Drive
Miami Beach, florid0 33139
www_mgm¿beg¿hfi ggy
OFFICE OF THE CITY CLEK
fmail: _@niarbeg_Al_g9y
Telephone 305.673.7411
BOARD & COMMITTE E FIN AN CIAL AC KN OWL ED GEMEN T STATEMEN T
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)
Last Name First Name Middle Initial
l understand that no later than Jul 1oíeah 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)';" 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 $00, 60 days in jail, or both.
(- e 3e z2
Signature Date
'Members of the Planning Board and Board of Adjustment will be notified directly by the State of Florida,
pursuant to F.S. $112.3145(1)(a) to file a Statement of Financial Interests (Form 1) with the Miami-Dade County
Supervisor of Elections by 1200 noon, July 1. Pianning Board and Board of Adjustment members who file their
Form 1 with the County Supervisor of Elections automatically satisfy the County's financial disclosure
requirement as a Miami Beach City Board/Committee member and need not file an additional form with the Office
of the City Clerk. However, compl iance with the County disclosure requirement does not satisfy the State
requirement.
Page 5 0t 6
F:CLERSALL'RE GBOAFD ANO COM!GI IEE APPLICATIONS FINAI DRAT TSBOARD AND COMMITTEE APTL+CA'KN HES +NAL 0ox
Upda ted June 2020
City of Miami Beach
I700 Convention Cente: Drive
Miomi Beoch, florido 33139
vw ri amib ech!i,gov
OFFICE OF THE CITY CLERK
Email: SC@namibeachgg
Telephone; 305 673.7411
DIVER SITY STATISTICS REPORI
Last Name First Name Middle Initial
The following information is voluntary and has no bearing on your consideration for appointment. It is being
asked to comply with City diversity reporting requirements.
Gender:
J Male
LO remale
( omer
El refer not to answer.
Race/Ethnic Categories:
What is your race?
D African American/'Black
LJ Asian or Pacific Islander
[ZO Caucasian/white
[lNative American/American Indian
[}Other- Print Race.
[lt prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
ZO ves
J o
Lltprefer not to answer.
Do you consider yourself Physically Disabled?
ves
&0x
Llorefer not to answer this question
Page 6 of 6
F-CLERSALLRE C'SARD AND CO»!TTEE APPLICATONS FWAL DHAFT$BOARD NNDO COMMITTEE APPACATION HEG FINAL doc
Upda ted: June 2020
Clear From Print Form
SOURCE OF INCOME STATEMENT
Section 2-11.1j of the County Ets Coe renuires tal e:tar emplcyees and publc off6ca/s fle e fnaia islcsure Statement cn a jeay tasis 'by Jy 1st
of every year
Oiscl~ure tor fax Year Ending ¡Lasl Na me
2020 JaA>
First Name
@asi6•
Middle Name/initial
l>I«,d
Mailing Address - Street Number, Street Name, or P.0, Box
lot v'+re
City., State, Zip
2 t9o
----------
f your tame address is your maing address, and your home address is exempt rm public records pursuant to Fla. Stat. 81'907, read
instructions on the following page and check Hele.
Filing as an Employee (check one)
DJ county [] Public Health Trust [ Municipal :
(Municipality)
Department
Position or Title Employee I Number
Work address I Work t~ephooo Employment began on!ended on
-------·- - - --
Filing as a Board Member (check oner
[J couny D Municipal: ft st
{Municipality)
02rd where serving
Aterate address {it home address is exempt
List beow every source of iroome you received along witr the adcress and the principal activity of eact source lcde your pubic saary Pace the sources of
income in descencirg order witt the large st source irst. Examp les of souroes c? ino me include: compensaton o services, income from busness. gains from
prope rty deaings, nnleest, rents. cvidencs. persins, IRA distritutions. ard social security paymerts. Aiso, include any source cf income received by anojeg
person fr you eneft However, the incoro of ypor spouse r ay business pate need ot be disclosed ff continued on a seperate sheet. check here. Ll
Nam of Source of Income Address Description of the Principal Business Activity
4u piled i),~;-.--<-- fop?
o< cc Hee t, .A 'l '2 $,Ai€> »r- ,,
I hereby swear ior affirm} that the informat ion above is a true and correct statement. • Signature cf Person Oisclosing
/3e [2
Date signed
caso sp¡@i±jh±i
7Hardcopy VED
1rarer fK 4 2022
CITY OF MIAMI BEACH
OFFICE OFTH
REMEMBER TO PRINT, SIGN. AND SUB8MIT TO THE OFFICE OF THE CITY CLERK VIA EMAIL OR HARDCOPY
C ITY W ID E (C W ) B O A R D & COMMITTEES ta City of Miami Beach, PARKING DEPARTMENT PARKING APPLICATION
1755 Mcrdia Aeue. Sute 200/ami eo:h, FL 33139/. 1305$ 673.7505 6 1305 673.700 e1 6290 PARKING
A citywide (CW} parking permit is honored ot metered parking spaces and restricted residential zones
parking spa ces A C W par ki ng per mi t I5 NOT hon or ed in prohibited are as. An Access C ard 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 ovoid
any unnecessary en for cem ent action s, it is important that our records reflect the most current and
accurate informat ion reg ar di ng your vehicle license plote. Ina ccurate and/or outdated veh icl e
inform ation m ay lea d to th e issuance of parking citation{s} and/or the towing ol your veh icle.
Please note that this new access cord 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 m ay need
lo try the oth er side of th e card. Ple ase ensure you hol d the entire surtace of th e card against the reader
until th e gate opens.
ACKNOWLEDGEMENT: l acknowledge that should my access card be lost, stolen or
damage, I will be responsibl e to pa y a $10.00 replacement fee.
Board Member Information
D ot e of Application: D) 3 202
Applicant Name. A ?eLs 4 ' _$a
Board/Com mittee Name; PR? $ kR 6non
Address: \¢! fL-AT? bd• M G
E-Mail Address: ca?eins e +,b- u'
Work Phone: Home Phone
Cell Phone: ,, e 17 2 333° Preferred Contact Method: X03
Vehicle Information
Teg: Ro 5 3 Color: a2y
State: FL Year: 2o -¥
Mocke: > Model: G 3
Applicant Sia n oture.
(a
Please provide si g ned form to the Parking D epar tm ent located at 1755 M eridia n A venue, 2 fl oor . W orki ng
hours are 8:30 to 5.00 p.m. or emoi l to: ParkingReception@miamibeachfl,gov
e-mail subject: BOARD & COMMITTEE PARKING APPLICATION - APPLICANT NAME
Parking De pa rt m en t Section
PERMIT SYSTEM GAR AGÉ ACCESS
fxpira)ion Date ID Cord Serial #
lssued By Print Nam e
ea -··· int foe , ..
Signature Signature.
Date lsued Date Completed
f l9a in+on Tl·.·t.»t„nl' I « 3e ¡di d » be.
Fl o r id a owveR u cE se
+ f
aJ520-109-70-869-0
JONES
2CAROLINA ISLAND
+ 1101 STILLWATER DR
MIAM BEACH, FL 33141-1025
± 0oe 10/09/1970 +ssx F SAFE DRIVER
a ex 10/09/2026 16+Gr 5'09"
12sr NONE 9aN NONE
4a iss 08/29/2018
500 X63180 8291492
Operation of a motor vehicle constitutes
consent to any sobriety test required by law.
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