Imani Warren 12/31/23BO A RD AND COMMITTEE CHECKLIST
APPOINTEE: "aL."a""@ DATE OF APPOINTMENT: Jan. 10, 2022
BOARD/COMMITTEE:Black Advisory Miami Beach Commissioner Fernandez ppointed by.
FOR SCANNER
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FOR CLERK STAFF
o Letter of Appointment
o Letter of Reappointment
o Copy of Letter of Appointment/Reappointment e-mailed
1/712022
12/31/23 TERI END.T ERI LIMIT.
12/31/29
to Committee Liaison on
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o Board and Committee Application (Completed on """?O?
o Résumé/Curriculum Vitae
o Diversity Statistics Reporting (Completed on 1/10/2022
o Oath
Received January 10, 2022
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
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o Citywide Permit Application (Parking Department Form)
o Booklet -- Guide to Sunshine Amendment & Code of Ethics for Public Officers and Employees
o Source of Income Statement
o Acknowledgment of Financial Disclosure Requirement
O DIVERSITY STATISTICS REPORTING Keep çoPy in file and ORIGINAL for Annual Report.
1/10/2022 Si db X Imani Em onie Warren/IEW ](Pp\/] ()[],,)[][](}( )/
Scanned on:
Date Board or Committee Member
1/10/2022 Caoba D'aeato [ressed on._b y Limpl0/0€. 4
Date City Clerk's Office Staff Initials
1/10/2022 Ca»bu 'peut
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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 RD A ND CO M M ITT IES DA TA BA SE\CHE C K LI S T M A STERIB&C Checklist 2015 M A STER.docx
Wte o re committed to o ro v ding excellent svice and to ail wh o five, work, and pla y in our vibrant, to pica! historic community.
City of Miami Beach, I/OO Convention Conler Drive, Miami Booch, Florida 33 139 yyywy.miaIrib_achf]_go
OFFICE OF THE CITY CLERK, Rofal E. Granado, City Clerk
Tel: 305.673.7411, Fax. 305.673.7254
Email: CiyClerk@miamibeochfl.gov
January 06, 2022
Ms. Imani Warren
1840 James Ave
Miami Beach , Florida 31319
RE: Black Affairs Advisory Committee
Dear Ms. Imani Warren :
Congratulations! You have been appointed by Commissioner Alex Fernandez to the above-referenced
Board or Committee, for a term ending: 12/31/2023.
Pursuant to City of Miami Beach Code Section 2-22 (5)a:
Notw ithstanding any other provision of the City Code or of any Resolution, commencing with
term s beginning on or after Jan uary 1, 2007, the term of every board m em ber who is directly
appointed by a m em ber of the C ity C om m ission shall autom atically expire upon the latter of:
Decem ber 31 of the year the appointing C ity Com m issioner leaves office or upon the
appointm ent/election of the successor C ity C om m ission m em ber.
If you are unable to accept this appointm ent, or have any questions, please call the Of fice of the C ity
C lerk at 305.673.7411.
P lease read the enclosed m aterials carefully as they concern your duties, responsibilities, and
requirem ents as a board or com m ittee m em ber.
C ongratulations again and good luck.
a
R afael G ranado
City C lerk
cc: M onica B eltran, P arking Director
Li ssette A rrogante, C ity Liaison
ENCLOSURES:
O ath of Office/O ath of C ivility/A cknow ledgem ents
C ity Code/O rdinance section applicable to agency, board or com m ittee
C ity C ode S ection s 2-22, 2-23, 2-24, 2-25, 2-26, 2-458 an d 2-459
O rdinance No. 2006-3543 - Amendment to C ity C ode S ection 2-22
M iam i-Dade C ounty C ode Section 2-11.1 - C onfli ct of Interest and Code of Ethics
City Wi de Perm it Appl ication - (P arkin g D epartm ent Form )
Booklet - G uid e to the Sunshine A m endm ent and C ode of Ethics fo r Public O fficers and E m ployees
C ity of Miami Beach, 1ZOO Convention Conler Driva, Miami Boach, Eorida 33 139 y¿yywy_miamiboachl]_go
OFFICE OF THE CITY CLERK, R0fool E. Granado, City Clerk
Tel: 305.673.7411, Fax. 305.673.7254
Email: City/Clerk@miamibeachfl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Ms. Imani Warren
RE: Black Affairs 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
term ending: 12/31/2023.
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* 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. Imani Warren
Sworn to and subscribed before me this 10 day of 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.
1\lAMI
City of Miami Beach
1 700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305 .673 .7 411
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):
os I am a resident of the City of Miami Beach for six months or longer.
Home Address 1840 James Ave #3. Miami Beach FL
□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 N/ A -------------------------
Business Address ------------------------- N/A
□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).
Name of Business _
Business Address _
"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 penalties of perjury, I declare that I JWaªd the foregoing document and that the facts stated in it
are true. .9h) %4 · "e «o·s hu Jan. 10, 2022
Signature Date
Imani L.Warren (Emonie)
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of physical presence or□online notarization,
this 1 0t11cJay of January , 20~by __ i_m_a_n_i_E_m_o_n_i_e_w_a_rr_e_n _
(City of Miami Beach Board/Committee Memb@)yemsmmmnm mm.oeme;g
Georgia Driver's License ¿ié, CHARLES J. DAGOSTIN
$? h$" "? w co so H 1sros
éph9is ExPREs: pecomber 14, 2025
$jéê Bonded Tu Notary Public Underwritors
X Produced ID
Form of Identification
Personally Known
Ciao 'get (NOTARY SEAL)
Signature of Notary Public
Charles J. D'Agostin
Name of Notary, Typed, Printed, or Stamped
1 A i
City of Miami Beach
17 00 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfl.goy
OFFICE OF THE CITY CLERK
Email: BC@miamibeachíi.gov
Tel eph on e: 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)
Warrwn Imani / Emonie
First Name
L
Last 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.
Failure to file one of these forms, pursuant to the Miami-Dade County Code, may subject the person to a fine
of no more th9n $500, 60 days in jg! Poth- du hf-- van. 10, 2022
Signature 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.
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F:ICLER\$ALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
M IAM I
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www_miamibeachl], gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
DIVERSITY STATISTICS REPORT
Warren Imani / Emonie L
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:
LlMate
2Oremale
· O Other
Dl I prefer not to answer.
Race/Ethnic Categories:
What is your race?
DO African American/Black
O Asian or Pacific Islander
LI Caucasian/white
O Native American/American Indian O Other- Print Race: _
O I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
lves
2Jo
O I prefer not to answer.
Do you consider yourself Physically Disabled?
ves
X2 Ro
O I prefer not to answer this question.
Page 6 of 6
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Updated: June 2020
M\1 AMl
City of Miami Beach, PARKING DEPARTMENT
1755 Meridian Avenue, Suite 200/Miami Beach, FL 33139/Ph: (305) 673-7505 or (305) 673-7000 e1. 6200
CITYWIDE (CW) BOARD & COMMITTEES
PARKING APPLICATION
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: Jan . 10, 2022
A pplicant N am e: Im ani / Em onie L W arren
Board/C om m ittee N am e: Im ani L.W arre n (E m onie )
A ddress: 1840 Jam es A ve #3. Mi am i Beach FL
E-M ai l A ddre ss: lm anilatifa hw arren@ gm ail.com
W ork Phone: Hom e Phone
Cell Phone: 215-678-4526 Preferred Contact Me#k'/ email
Vehicle Information
Tag: CPR9303 Color: Black
State: Georgia Year: 2017
Make: Nissan Model: Rouge n -
ass. fa„d.lo- %cf--
Please provide signed form to ffie Parking Department located at 1755 Meridian Avenue, 2d floor. Working
hours are 8:30 to 5:00 p.m. or email to: ParkingReception@miamibeachfl.gov
e-mail subject: BOARD & COMMITTEE PARKING APPLICATION- APPLICANT NAME
P ·ki D ar una epartment ection
PERMIT SYSTEM GARAGE ACCESS
Expiration Date: ID Card Serial #:
Issued By Print Name: Print Name:
Signature: Signature: e
Date Issued: Date Completed:
s .
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