Lauren Foster 12/31/22BO A RD A N D CO M M ITTEE C HECKLIST
AP P o NT e . A u PxJ Foi?
BOARD/COMMITT EE: (_ G-ß"( t
FOR SCANNER FOR CLERK STA 'F
Scan o
Scan o
DATE OF APP OI NTMENT . 'I/20/2021
Appointea y. /A Fe J eu)e 2
Scan o
Scan o
Scan o
o Letter of Appointment
o Letter of Reappointment
° 8jo%459er of Appointment/Reappointment e-mailed to
o Board and Committee Application (Completed on l/3/2022
o Résumé/Curriculum Vitae 1/14/2022
o Diversity Statistics Reporting (Completed on _
o Oath
TERM END: 12/31/22 _____ TERM LIMIT: 12/31/29
Committee Liaison on
Received January 14, 2022
Office of the City Clerk
Scan o
IMPORTANT INFORMATION FOR BOARD AND COMMITT EE 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
o Source of Income Statement
Scan o
Scanned on:
o Acknowledgment of Financial Disclosure Requirement
O DIVERSITY STATISTICS REPORTII ep,CPY in file and ORIGINAL for Annual Report.
Received on:!!l.{tJ:.. /z O 2-2-- Signed by X .¡..;..._-=--------- [oe Board or Com nlllee Member
1/1 3/2022 Ciao, '«get [roceSSed On.by bmp[0Ve€,
Date , 9ly Jerk's office stait initials
1/14/2022 aoa D' goat
[Sy[rpQ/@c,
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
Removal Letter due to absences Date processed Initials Scan O
F:ACLER\BOARD AND COMMITTIES DATABASE\CHECKL.IST MASTERIB&C Checklist 2015 MASTER.docx
M IA M I BEACH
City of Miami Beach, 1/OO Convention Conter Drive, Miami Boach, Horida 33 139 wwyw._Iiamnibca chl].go
OFFICE OF THE CITY CL ERK, Rafool E. Granado, City Clerk
Tol: 305.673.7411, Fax. 305.673.7254
Email: CiyClerk@miamibeachll.gov
January 13, 2022
Ms. Lauren Foster
800 WEST AVENUE
MIAMI BEACH, FL 33139
RE: LGB TQIA+ Advisory Com mittee
Dear Ms. Lauren Foster:
Congratulations! You have been appointed by Commissioner Alex Fernandez to the above-referenced
Board or Committee, 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 as they concern your duties, responsibilities, and
requirements as a board or committee member.
Congratulations again and good luck.
7
Rafael Granado
City Clerk
cc: Monica Beltran, Parking Director
Nattaly Cuervo, 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
City of Miami Beach, )/0) Conon fers vive, Mami Ex.h, 1 d a 33139 wwiarlbcachll.go
OF CE OF THE CITY CIERK , Rall E. Grana do, City Clord
fol: 305.673.741, Fax. 305.673 7254
Email. City.Clerk@miarboochfl. gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Ms. Lauren Foster
RE: LGBTQIA+ 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: 12/31/2022.
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
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 calenda, yea, on which I have secved. ~----
Ms. Lauren Foster
swom to and suscned tetor e me his /_ cay oÜU 2oz
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.
' y
I • + ' / i'\
City of Miami Beach
I 700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLER K
Em ail: BC@m iamibeachfl.gov
Telephone: 305.673.7411
PECEIVED
IAN 18 2072
I OF MIAMI BEACH !orici@ii
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
STATE O F FLO RIDA
CO UNTY O F M IA M I-DADE
I am in com pliance with the affiliation requirement of Miami Beach City Code Section s 2-22 (4), as (check
(/) all th at apply):
X lam a resid ent of th e City of Miami Beach for six months or lon ger.
-- Are A, ,O 22? Home Adaros e0o eT /Vd#q) /1É. e /
o I have an ownership interest (fo r a m inim um of six months) in a business established in the City of
M iam i Beach (fo r a minim um of six months).
Nam e of Business lv_.,__/,_-'--A-_,_ _
Pp [me,, [[re 3
r.1 I am a full-tim e em ployee of a business (fo r a m inimum of six months) and I am based in an office or
other location of the business that is physically located in Miam i Beach (fo r a minim um of six months).
DJ3r )f Py]Pe,S-
HA][SS J\([fo$3
"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 have read the foregoing docum ent
""T8 91, ,o2
Signature Date
l_. Fos7x
Printed Nam e
NO TARY
Sworn to (or affi rm ed) and subscribed befo re me, by mean s ofrh y sical pre sence or u on line notarization,
this J3 day or 5 .2022b y @ F-)
________ (City of Miami Beach Board/Comm ittee Mem ber).
Produced ID
Form of Identification
_\] Pers; ay Kn own
ii. ESTN DONALD KELLY
¡t-œ~<.¡;\ Notary Public. State of Florida
ii{ a i} commission # Hi 055992 %#$f y commn. ères or 22, 204
'jded through National Notary Asr.
Si gn at ure Notary_P ublic Jo ] s h Cl
Nam e of Notary, Typed, Printed, or Sta
7 [/\ , ' [
City of M iam i Beach
1700 Convention Center Drive
Miami Beach, Flor ida 33139
www.miamibeachfl ,gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.741I
DIVERSI TY STATI STICS REP OR T
ros7 e 2.
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.
G e nd e r:
[_IMate X rente
O Other
D I prefer not to answer.
R ac e/E thn ic C ateg o ri es:
W ha t is yo ur rac e ?
O African American/Black
L) Asian or Pacific Islander
X) Caucasian/white [_y Native American/American Indian
O Other - Print Race: ------------ º I prefer not to answer.
D o yo u co nsid e r yo u rself to be S p anish , H ispan ic, or Latino/a?
ves
d o
[_ t prefer not to answer.
D o yo u co nsid er yo u rself P hysically D isab led?
_)os
fio
Lb refer not to answer this question.
Page 6 of 6
F:\CLER\$ALL.\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
• I
City of Miami Beach
17 0 0 C o nventio n C e nter Drive
Mi a m i Bea ch , Flor id a 3 3 13 9
www.miamibeachll. gov
O FFIC E O F TH E C ITY C LERK
Email: BC@m i am i b eachfl.gov
Telephone: 30 5.6 7 3.7 4 11
BOAR D & COMM ITTEE FINAN CIAL ACK NOWL EDGEMENT STATE MEN 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)
_Pus/
Last Name First Name Middle Initial
l understand that no later than July_1,of each year all members of Boards and Committees of the City of Miam i
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. / J
_ o s'2oz2-
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.
Page 5 of 6
F:\CLER\$ALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.dccx
Updated: June 2020
M IA M l·DA D E.
&III
Clear From Print Form
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 Name
2020 /oT
First Name
LU-r "t"
Malling Address - Street Number, Street Name, or P.O. Box oo vu€sr
City, State, Zip>
7 ll
If your home address is your mailing address, and you home address is exempt from public records pursuant to Fla. Stat. §119.07, read
instructions on the following page and check Hele.
Filing as an Employee (check one)
O County D Public Health Trust O Municipal:
(Municipality)
Department
Position or Title Employee ID Number
Work address I Work telephone Employment began on/ended on
Filing as a Board Member (check one)
O County O Municipal:
(Municipality)
Board where serving
Alternate address (if home address is exempt) I Work telephone I Term began on/ended on
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 noi be disclosed. If continued on a separate sheet, check here. D
Name of Source of Income Address Description of the Principal Business Activity
UN 4xP » loo ) u) /2h /Au DncTo o
E -I)1S /\f//) F,_ 21 L&} ,uó
/
I hereby swear (or affirm) that the information above is a true and correct statement. e Ek
Signature of Person Disclosing
o/3/022
Date signed I
RECEIVED BY ELECTIONS DEPARTMENT:
O Hardcopy
IX Electronic Copy
Received January 14, 2022
Office of the City Clerk
REMEMBER TO PRINT, SIGN, AND SUBMIT TO THE OFFICE OF THE CITY CLERK VIA EMAIL OR HARDCOPY.
CITYWI DE (CW) BOARD & COMM ITTEES lg.lg
or ct o rs sos«s. eowoo ow«war PAR KING APPLIC A TION ¡ I. /A#I#
PARKING 17 5 5 M er idia n Aven ue, Suite 200/Mi am i Beoch , fl 33 139 /Ph . (305) 673-7505 0 (305) 6/3 7 000 e4 . 6200
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 or der 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 lo 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
lo 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
oe leo coi/13/2o22
et«son - tue peni
Board/C om mittee Name:
Address: 1
E Moil Address:
W o rk Phone: Home Phone
cosos25 C8 1u5 Preferred Contaci Method:
Vehicle Informatio
fa: r re 19 a2
2 o State : Year:
Make: Model:
A pplic ant Sign atu re: 6
Please provide signed form to the Parking Department located at 1/55 Meridian A ven ue, 2 fl oor. W orking
ho urs are 8:30 to 5.00 p.m . or email to: ParkingReception@miamibeachfl.gov
e-mail subiect: BOARD & COMMITTEE PARKING APPLICATION - APPLICANT NAME
p, ·ki D ar mna epartment ection
PERM IT SY STEM G A RAGE A CCES S
E xpi ration Dale: ID Card Serial #.
lssued By Print Name Print Nome' --
Signature: Signature: e
Date lssued: Date Com plete d: ·-
s