Valerie Navarrete 12/31/23B O A R D A N D C O M M ITT E E C H E C K L IS T
J · ¡11/ APPOINTEE:_v }<ti' !rd!rift' A TE OF APPOINTMENT:
FOR SCANNER
Scan s
Scan a
FOR CLERK STAFF
o Letter of Appointm ent
o Lefter of Reappointment
o CP9)18)3}8/e of Appointment/Reappointment e-mailed to Committee Liaison on
Scan o
Scan o
Scan c
Tero»veo. """ no»owr- ?"
o Board and Committee Application (Completed on 1
o Résumé/Curriculum Vitae
o DOiversity Statistics Reporting (Completed on 01/05/2022
o Oath
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
Received January 5, 2022 County Code Section 2-11.1 - Conflict of Interest and Code of Ethics Ordinance (as
Office of the City Clerk 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
Scan O
Scan O
O Citywi de Permit Application (Parking Departm ent Form)
O Booklet -- Guide to Sunshine Amendment & Code of Ethics for Public Officers and Employees
o Source of Income Statement
Received on.
Scanned on.
O Acknowledgment of Financial Disclosure Requirem ent
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Date ,Board,or Committee Member
1/5/2022 fa D'] at
Processed on._ty Employee: __.r._ --· ,----------
Date 5Çity Clerk's Office Staff Initials
1/5/2022 loo.a '9oath,
-_ 0/@€.
Date City Clerk's Office Staff Initials
CONCLUDED & RESIGNATION LETT ERS
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
FICLERBOARD ANDO COMMIT TIES DATABASE\CHECKLIST MASTER\B&C Checklist 2015 MASTER. docx
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City of M iam i Beach, I/OO Corvontion Centt Diva, Mam Each, Hoda 33139 yr_y_mu±mils_a±fl_av
OFFKCE OF THI CITY CIERK, Ralal É. Granodo, Chy Clord
1el. 305.673.7411, Fax. 305.673.7254
Émail CityClotk@miamibooc hfl go »v
Oath of Offi ce
0ath of Civility
and
Acknowledgements
TO: Ms. Valerie Navarrete
RE: Police/Citizens Relations 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 rep re sent 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 comp ly 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. Valerie Navarrete
Swom to and subscribed before me this. 0 day or Jan 9o${22
Chartes 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.
MI A/BEA« CH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email:. BC@miamibeachf\.gov
Telephone: 305.673.7411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
STATE OF FLORIDA
COUNTY OF MIAMI-DADE
am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4), as (check
(/) all that ap ply ):
lam a resident of the City of Miami Beach for six months or longer.
Home Address 1LL_¿..'_, lo__.2C L
7
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).
[]a[Te f ]JS]fess.
[1S][SS, J(]([fes
o lam a full-time employee of a business (for a minimum of 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 months).
[[3mm of [[f S,1[]@ S r
HJ[[gs,S (S(]f@Sb5
"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 sole 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
Ol O.9o
Signature
Do±,,
Printed Name
Date
NOTARY
Swom to (or affirmed) and subscribed before me, by means of ?physical presence or on line notarization,
mis5th day ot January 2022 y Valerie Navarrete
(City of Miami Beach Board/Committee Member).
FL Drivers License X Produced ID
Form of Identification
E22 .
.gsijig¿, CHARLES J. DAGOSTIN $$ ; McoMssoN # HH 16s7os
,Jed„.sé ExP RE S: Decem ber 14, 2025 ·;¿' ponded Tu Notary Public Underwriters ii 1any
Signatue gf_Notary Puhljç_ _,, Uharles J' 'gosIn
(NO ARY SEAL)
Name of Notary, Typed, Printed, or Stamped
MIAM··· EI
Cl ear From Print Form
SOURCE OF INCOME ST ATEM ENT
Se ction 2-11.1() of th e County Ethics Code requires that certain employees and publ ic official s file a financial disclosure Statem ent on a yearly basis by July 1st
of every year.
Di scl osure for Tax Year Ending I Last Name First Nam e Middle Name/initial
2020 fl4 voe re /a c ce e
Ma iling Address - Stßum be r, Street Name, or P.O. Box
1(t/ i no 20 (
City, State, Zip
y0, • eo f- 33 78f
lf your home address is your mailing address, and your home address is exempt from public records purs uan t to Fla. Stat. $119.07, read
instructions on the following page and check Hel e.
Filing as an Emp loyee (ch eck one)
[J county I Public Health Trust [] Municipa l:
(Municipality)
Departm ent
Position or Title Employee ID Number
W ork address !Work telephone Employment began on/ended on
Filing as a Board Member (check one)
DJ county [J Municipal:
(Municipality)
Boa rd wh ere servi ng
foca/ cd«o,o cela o--.-lle
AIterate address [if hom e address is exem pt) I Wò ri< telephone I Term began on/ended on
List below every sour c e of income you received, along vith the address and the pri ncip al activity of each source. Indude your public salary. Place the sources of
income in descending order, with the largest source first. Ex am pl es of sources of income indude: compensation for services, income from business, gains from
property dealings, interest, rents, dividends, pensions, IRA distributions, and social security payments. Aso, 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, A continued on a separate sheet, check here. []
Name of Source of Income Address Description at the Principal Business Activity
ia e,J £ ( 8o0 o -o 0¢., o e o (dc
IO 4to 1] )o
I hereby sw ear (or affirm) that th e information above is a true an d co rrect stat em en t. do....
Signature of Person Disclosing
Date signed
RECE NED BY ELECTIONS DE P ARTMENT:
[]Hard cop y
Electronic Copy
Received January 5, 2022
Office of the City Clerk
Rf'Ml"MRF.R TO PR.I~. SIGN. ANll SU6MIÎ TO íHE OFFlŒ º...':''.e CHY CLERK WA EMNL OH HARDCOPY
City o f Miami Beach
I70O Convention Center Drive
Miami Beach, Florido 33139
www.miamibeachfl.gov
OFFICE OF TH E CITY CLER K
Email: BC@miamibeachf]_gov
Telephone. 305.673.7411
BOAR D & COM MITTE E FINAN CIAL ACKN OWL EDGE MENT STA TEME NT
A c k n o wl e d g em e n t o f fi n es/su sp en s ion fo r B oard/C om m itt ee em bers for failure to com ply wi th M iam i-
D a d e C o u n ty Fi na n cial Di scl osure C od e Pr o visi o n C ode Secti on 2-11.1(i) (2)
Last Name First Name Middle Initial
I understand that no later than Jul y 1, of each year all membe rs of Boards and Com mittee s 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 pust be filed with the City Clerk of Miami Beach, 1700 Con vention Center Drive,
Miami Beach, Fl or ida, no later than 12.00 noon of July 1, of each year:
1. A"Source of Incom e Statement;" or
2. A"Statement of Financial Interests (Form 1)1," or
3. A Copy of your latest Federal Income Tax Retum.
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.
d@au.b «r>
Signature Date
' Mem bers 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 (For 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
requiremen t as a Miami Beach City Board/Committee member and need not file an additional form with the Office
of the City Cler k. However, compliance with the County disclosure requirement does not satisfy the State
re quirem en t .
Pge 50l 6
+ V:FA(LRCGIOARD AN C - APIA TONS FINAL DORAIT G3AID MU GAMM I Y-±- A#HI REG FIRALdox
updated: June 202U
\IA MIBEA H
City of M iami Beach
1700 Convention Cen te r Drive
Mi a m i Beach, Fl orido 3313 9
www_migmibeach[l _gov
O FFICE OF TH E CI TY CL ER K
Email: BC@miamnibeachf!_gov
Telephone: 305.673.7411
DIVERSITY STATISTICS REPORI
UA V Re te 1 e
La st N a m e First Na m e Middle Initial
Th e follo wi ng inf or m at ion is voluntar y an d has no be arin g on your consideration for app ointm ent. It is being
asked to comply with City diversity repor tin g requirements.
Gender:
(CJ Mate
LQ remale
(l on er
D I prefer not to answer.
Race/Ethnic Categories:
What is your race?
El Af rican Am erican /B lack
El A sian or Pacific Islander
El Caucasian/white
Ll Native American/American Indi an
[] other Print Race.
O I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
EN- ves
(No
Ll prefer not to answer.
Do you consider yourself Physically Disabled?
Llves
ho
L l¡prefer not to answer this question.
Page G of6
FACLERSALLREGIBOARD AND COMMITTEE APLICATIONS FINAL DRAFT SB OARO AND COMMIT IL APPLICATION REG FINAL.d&xx
Updated: Jun e 2020
\[A A/\[B E, CIwDE (Cw) BO AR D & CO MM I TTE ES
cy et ve«i tsea, PRkawc PAR t N r PAR KING AP PLICA[ION
1755 Met&idian Avenue, Suite 200/Mi 0i Beach, FI 33139/Ph. (305) 673-7505 0 (305) 673-7000 ex4 6200
A citywide (CW) parking permit is honored at metered parking spaces and restricted residential zones
parking spaces. A CW parking permi t IS N O T honored in prohibited areas. An Access Card will be
provi ded to you for City H al l G ara ge (G 7) access.
IMP O RTAN T N O TE : Your vehicle license plate serves as your "parking permit". In order to avoid
any unn ecessary enforcement actions, it is important that our record s rellect 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 ol your vehicle.
Please note that this new access cord CANNOT be hol e punch ed or perforated in any manner . Io use
the new card please hold the card at close proximity to the reader until the gate opens. You may need
lo try the other side of the card. Please ensure you hold the entire surfa ce of the cord against the reader
until the gate opens.
A C K N O W LE D G E ME N T: I a ck n o wl ed g e th a t sh o u ld m y a cce ss card be lo st, stole n or
d a m a g e , I w ill be re sp o nsible to pay a $10.00 replaceme nt fee .
Board Member Information
Dote of Application: O t.O S . »O Q
Ap plicant Nam e: /r t& fl 4 U 9 e re C T
E Moil Address:
W ork Phone: Home Phone
Cell Phon e: )2. Slo -Y 2 Preferred Conta ct Method: a- 1 0
Vehicle Information
Tag: nU Q o7 Color: C ..,I O,,_., ¡<>,,o_;_ ~p
State: - Y ear: 20o 1
Make: Hl40)) Model: ¡oca0
Applicant Sianature:
Please provide signed form to the Parking Departm ent locate d at 1755 Meridian Avenue, 2"d floor . Working
hours are 8:30 to 5:00 p.m. or email to: ParkingReception@miamibeachfl.gov
em ail su bj ect: BO A RD & CO MM ITTE E PARK IN G A PPL ICA TI O N -- A PPLICA N T N A M E
p, kG D rtm S a r 1na ea ent ecfon
PERMIT SYSTEM GARAGE ACCESS
Expiration Dole: ID Card Serial #t:
Issued y Print blam e: Pint lame.
Si gn at ur e. 5 Signature: as
[a t ls ne d
,,. ate om pleted.
«io
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