Clare McCord 10/31/22BOARD AND COMMITTEE CHECKLIST
ArrowrEeE: AArf -Cg 2_> 12/5/2021
DATE OF APPOINTMENT:
BOARD/COMMITTEE: Ad Hoc Resiliency Projects CO""}'ppointed by: Commissioner Samuelian
FOR SCANNER
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FOR CLERK STAFF
o Letter of Appointment
o Letter of Reappointment
o OP)[9JPtler of Appointment/Reappointment e-m ailed to
12/5/2021
o Board and Com mittee Application (Com pleted on
o Résumé/Curriculum Vitae 1/10/2022
o Diversity Statistics Reporting (Completed on
o Oath
TERM END. I0/31/2022 TERM LIMIr. I0/31/2022 -------
Committee Liaison on
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IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
City Code Ordinance Section applicable to the agen cy, board or com mittee
Received January 10, 2022 V City Code Sections 2-21, 2-22, 2-23, 2-24, 2-25, 2-26, 2-458 and 2-459
Office of the City Clerk Y County Code Section 2-11.1-- Con flict of Interest an d Code of Ethics Ordinance (as
amen d ed through Decemb er 2010)
V Amen dmen ts to the Code of Ethics Ordinance (September 2009 through July 2012)
Highlights of the Miami-Dade County Ethics Code
/ Sunsh ine Law and Public Records - Frequently Asked Questions
Mem orandum - Solicitation by City Board an d Com mittee Members
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O Citywi de Permit Ap plication (Parking Depar tm ent Form )
O Booklet - Guide to Sunsh ine Am endm en t & Code of Ethics for Public Officers an d Employees
O Source of Income Statement
Received on:
Date
Scanned on.
O Ackn owl edgment of Finan cial Disclosure Requirement
O DIVERSITY STATISTICS REPORTING '- COPY in fite and ORIGINAL for Annual Report.
uons» so»»X €.55,"da€
Date Board or Committee Member
1/10/2022 Ciao. D'peto
Fr9çgSSed On._E}y Empl0/ee. •
3Sy Clerk's office Start Initials
1/10/2022 Chaoa ?'goth [y lrD0/ce, Le.--
City Clerk's Office Staff Initials Date
CONCLUDED & RESIGNATION LETTERS
Term Expired Letter Date Processed Initials Scan O
Resignation Letter Date Processed Initials Scan O
Rem oval Letter due to absences Date processed Initials Scan O
F:ACLER\BOARD AND COMMIT TIES DATABASE\CHECKLIST MASTER\B&C Checklist 2015 MASTER.docx
We are corawted t prov'dig excellent pub!c service and saloiy to ci who live, work, and play io our vb;rt, ooical, {ßstc comity
M IAM I BEACH
City of Miami Beach, 1/OO Convention Conler Drive, Miami Boach, Florida 33 139 yyNwy_miaribachll.gov
OFFICE OF THE CITY CIERK, Raf0ol E. Granado, City Clerk
Tol: 305.673.7411, Fax. 305.673.7254
Email: CiClek@miamibeachll.gov
December 17, 2021
Ms. Clare McCord
145 Jefferson Ave Unit 417
Miami Beach, FL 33139-3301
RE: Ad Hoc Neighborhood Resiliency Projects Advisory Committee
Dear Ms. Clare McCord:
Congratulations! You have been appointed by Commissioner Mark Samuelian to the above-referenced
Board or Committee, for a term ending: 10/31/2022.
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 as they concern your duties, responsibilities, and
requirements as a board or committee member.
Congratulations again and good luck.
7e
Rafael Granado
City Clerk
cc: Monica Beltran, Parking Director
, City Liaison
ENCLOSURES:
Oath of Office/Oath of Civility/Acknowledgements
City Code/Ordinance section applicable to agency, board or committee
City Code Sections 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
City Wide Permit Application - (Parking Department Form)
Booklet - Guide to the Sunshine Amendment and Code of Ethics for Public Officers and Employees
MIA+IBEA .H
City of Miami Beach, 1ZOO Convention Center Drvo, Miami Loach, Florida 33139 wx.miamibachfl gay
O FFICE OF THE CITY CL ERK, Rof aol E. Granado, Cy Cl erk
Tel: 305.673.7411, Fax. 305.673.7254
Email: CitCl erk @mi am ibeach fl.go v
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Ms. Clare McCord
RE: Ad Hoc Neighborhood Resiliency Projects Advisory 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
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 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 sen1ed" /ÎÍ , Í) " , "
5 fe2
(_/ . Ms. Clare McCord
sworn to and subscribed before me ti 1Oh a r Jan ,2022
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.
MIA M I BEA H
Ci ty of Miami Beach
1700 Convention Center Drive
M iam i Beach , Flor ida 33 13 9
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
A F F ID A VI T O F A F FI LI A T IO N WI TH T H E C IT Y OF MI A MI BE A CH
STATE OF FLORIDA
COUNTY OF MIAMI-DADE
l am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4), as (check
(/) all that appl y):
1am a resident of the City of Miami Beach for six months or longer.
wen-was» )4s Se#too Hoe, Ou1 413, 8 3 38 9 na 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).
en- osa.. C-Copo é¿os&íj
eses Ases. )S2A kgw ) Kn, Sr2 Z,V, K<31$
. )
o lam 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).
[]a9mm9 of PS][P@S-
[[gff}es (qdfeSS-
"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.
Under penaltîe~o erjury, I declare that I have read the foregoing document and that the facts stated in it
are true 5 9 /),) }/ ]
- u- /U (O 2 z
ignature Date
Cee F LC-Cao>
Pr in ted N am e
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of }p h y sic al presence or o online notarization,
1U u q January ooy
(City of Miami Beach Board/Committee Member).
FL Drivers License X Produced ID
Form of Identification
P er s o n a lly Kn o wn
Ciao 'pet
Sign atu re of N otary Public
Charles. J D'Ag ostin
(NOTARY SEAL}
Name of Notary, Typed, Printed, or Stamped
hg., CHARLES J. DAGOSTN
É? M Y COMM I S SI ON # HH 165705
.&is EXPIRES: Decem ber 14, 2025
êjg Bonded mu Notary Public underwriters
1/\/AMI BE
City of Miami Beach
1700 Convention Center Dr ive
Miami Beach, Florida 33139
www ._miamibe achll.goy
OFFlCE OF THE CITY CLERK
Emai l: BC@m iamibeachfl.gov
Telephone: 305.673.7411
DIVERSITY STATISTICS REPORT
CAee
La st N am e First Nam e Middle Initial
Th e fol lo wi n g inform a tion is vol un t ary an d ha s no be ar ing on your consi deration for app ointment. It is being
aske d to com p ly with C ity diversi ty rep or tin g re q ui rem en t s.
Gender:
l Mae
2l remale
(Cl oh er
O I prefe r n o t to an sw e r.
Race/Ethnic Categories:
What is your race?
Ll Arican American/Black
O A sia n o r P a cific Isla n d e r
Í caucasian/white
Ll N a tive American/American Indian
[j O the r -- P ri n t R a c e .
O I pre fe r n o t to a nsw e r.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
lves P o
O I prefer not to answer.
Do you consider yourself Physically Disabled?
L ves >yo
L lit prefer not to answer this question.
Page 6 of 6
FACLER SALLRE GOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.doc
Updated: June 2020
MIAMI BE H
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeach!l.gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
BOARD & COMMITTEE FINANCIAL ACKN OWLE DGE MEN T STATEMENT
Acknowledgement of fines/suspension for Board/Committee Members for failure to comply with Miami-
Dade County Financial Disclosure Code Provision Code Secti on 2-11.1(i) (2)
Last Name First Name Middle Initial
l underst and that no later than July1, of each year all mem bers of Boards and Com mittees of the City of Miami
B e a ch , in cl u d ing th o se of a pur el y ad visor y nature, are req u ired to comply wi th Miami-Da de County Financ ial
Di sc lo s ure Requirements.
One of th e follo wi n g form s must_be filed with the City Clerk of Miami Beach , 1700 Convention Center Drive,
M iam i B e a ch , Fl o ri d a , no later th a n 12:0 0 n o on of July 1, o f ea ch y e ar:
1. A "S o u rce of In com e S tatem e n t;" or
2 . A "S ta te m e n t of F in a n c ial In te re sts (Form 1)!" or
3 . A C o p y of yo ur la te st Fe de ra l In co m e T a x R etu rn .
Failure to file on e of th e se form s, pu rs u an t to th e Mi am i -D a d e C o un t y C o d e , m a y sub j e ct the per s on to a fine
of no more J99n $500, 69,9%y"%J%9 both. ~-~·) /cJéx_ __ 1_,__/_1_a-'-/_2_Z-~·-- _
Si Date
' Members of the Planning Board and Board of Adjustm ent 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 Election s by 12:00 noon , July 1. Planning Board and Board of Adjustm ent member s wh o file their
Fo rm 1 wi th th e C o un t y S up er vi sor of El e ct ion s a uto matically satisfy the County's finan cial disclosure
re q u ire m e n t as a M ia m i B e a ch C ity B o a rd/C o m m itt e e m e m b e r a nd ne e d n o t fil e an additional form with the Office
of the C ity C le rk. H o w e ve r, co m p lia n ce w ith the C o un ty disclo su re re q u ire m e nt do e s n o t sa tisfy the S ta te
re q ui rem e nt.
Page 5 of 6
F:CLERISALLIREGIBOARD AN D COMMITTEE AP PL I C A TI ON S FINAL DRAFTS\BOARD AN D COMMIT TEE AP P L I C A TION REG FINAL .docx
Updated: Jun e 2020
SOURCE OF INCOME STATEMENT
Section 2-11.1(i) 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 Last Nat,, a :
2020
First Name c Middle~e/lnitial
Mailing Address - Street Number, Street N 1e, or P.O. Box
74 Je.+&von ON it
313
lf 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 lele.
Filing as an Employee (check one)
[J county [] Public Health Trust E] Municipal:
(Municipality)
Departm en t
Position or Title Employee ID Number
Work address I Work telephone Employment began on/ended on
Filing as a Board Member (check one)
E] county RMunicipal:
(Municipality)
Board where serving f
dg_Éç@lez ±suas¡ hdo,,_égo. ... I
Alternate address (if home address is exempt) Work telephone Term began onlended on
305072-(3o
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, []
Name of Source of Income Address Description of the Principal Business Activity
hcte o tus CA PO/A&x 1 ele4qOfe sse eArewe 5rs.
CC@ ou< 1 o 4232 _o o_\
+I'6\d+ -_
\po Rf po po o(bes
I hereb "
Date signed
RECEIVED BY ELECTIONS DEPARTM ENT:
[ ] Hardcopy
X Electronic Copy
Received January 1 0, 2022
Office of the City Clerk
. . .
REMEMBER TO PRINT, SIGN, AND SUBMIT TO THE OFFICE OF THE CITY CLERK VIA EMAIL OR HARDCOPY.
C ity of Miami Beach, PARKING DEPART MENT
1755 Meridian Avenue, Soito 200/Miami Beach, FL 33139/Ph: (305) 673-7505 or (305) 673-7000 ex4. 6200
CITYWIDE {CW) BOARD & COMMITTEES
PARKING APPLICATION
A citywide (CW} parking permit is honored al 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 [G/) access.
IMPORTANT NOTE: Your vehicle license plate serves as your "parking permit". In order lo 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 perlorated in any manner. To use
the new card please hold the card at close proximily 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 acknowl edge that should my access card be lost, stolen or
damage, I will be responsible to pay a $10.00 replacement fee.
Board Membe r information
Date of Application:
1
/¡.~t;=· ~¡-
2
-. -2-----------------------------.
Appolcat Nam e: C • 1Coe
Work Phone: Home Phone -
cell Phone 30- Prefer red Contact Method:
Vehicle information oooo ooo oooe oooo o
Tse T I G& color
State: Year:
Make: Model:
i-----':-;'--~~~'----:1,,=.=.-""-~-b'- .. -·:.~ ,.¿;_l___:,,,·~-:Q=-=. =------------
Please provide signed(tr... fo the Parking )eparlment located at 1755 Meridian Avenue, 2" floor. Working
hours are 8:30 to 5:00 p.m. or email to: ParkingReception@migmibeachfl.gov
e-mail subject: BOARD & COMMITTEE PARKING APPLICATION -- APPLICANT NAME
P ·ki D ts ·ti grking 'eparimen econ
PERMIT SYSTEM GARAGE ACCESS
Expiration Date: ID Card Serial tt:
Issued By Print Name: Print Name:
Signature: e6 Signature: e
Date lssued: Date Completed:
. ph an tar' trmcw böo td. commmh es portorm.+ fi
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