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Christina LaBuzetta 12/31/23BOARD AND COMMITTEE CHECKLIST APPOINTEE: DATE OF APPOINTMENT: BOARD/COMMITTEE: Appointed by: FOR SCANNER FOR CLERK STAFF Scan ○ ○ Letter of Appointment TERM END: TERM LIMIT: Scan ○ ○ Letter of Reappointment ○Copy of Letter of Appointment/Reappointment e-mailed to Committee Liaison on Scan ○ ○ Board and Committee Application (Completed on ) Scan ○ ○ Résumé/Curriculum Vitae ○Diversity Statistics Reporting (Completed on ) Scan ○ ○ 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 ✓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 ○Citywide Permit Application (Parking Department Form) ○Booklet – Guide to Sunshine Amendment & Code of Ethics for Public Officers and Employees Scan ○ ○ Source of Income Statement Scan ○ ○ Acknowledgment of Financial Disclosure Requirement ○DIVERSITY STATISTICS REPORTING Received on: Signed by X Date Board or Committee Member Processed on: By Employee: Date City Clerk’s Office Staff Initials Scanned on: By Employee: Date City Clerk’s Office Staff Initials CONCLUDED & RESIGNATION LETTERS Term Expired Letter Date Processed Initials Scan ○ Resignation Letter Date Processed Initials Scan ○ Removal Letter due to absences Date processed Initials Scan ○ F:\CLER\BOARD AND COMMITTIES DATABASE\CHECKLIST MASTER\B&C Checklist 2015 MASTER.docx Keep COPY in file and ORIGINAL for Annual Report. Christina LaBuzetta 1/25/2022 Production Industry Council Commissioner Kristen Rosen Gonzalez 01 / 25 / 2022 Document Ref: VAEW9-YDNFB-4CPS2-HMXB5 Page 1 of 6 12/31/23 12/31/25 Received January 25, 2022 Office of the City Clerk 12/5/2021 N/A 1/25/2022 1/25/2022 1/25/2022 January 25, 2022 Ms. Christina LaBuzetta 301 Ocean Dr, Apt 305 Miami Beach, FL 33139 SUBJECT: Production Industry Council Congratulations! You have been reappointed by Commissioner Kristen Rosen Gonzalez to the above referenced, board or committee named above, for a term ending: 12/31/2023. 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, Rafael Granado City Clerk cc: Monica Beltran, Parking Director Veronica Hennig, City Liaison ATTACHMENTS: 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 - Amendment to City Code Section 2-22 Miami-Dade County Code Section 2-11.1 - Conflict of Interest and Code of Ethics Ordinance City Wide Permit Application - (Parking Department Form) Booklet - Guide to the Sunshine Amendment and Code of Ethics for Public Officers and Employees Document Ref: LPZCS-GFADV-AVLXF-LRK7O Page 1 of 2 Oath of Office Oath of Civility and Acknowledgements TO: Ms. Christina LaBuzetta RE: Production Industry Council 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. Christina LaBuzetta Sworn to and subscribed before me this ______ day of ______, 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. 25 Jan Document Ref: LPZCS-GFADV-AVLXF-LRK7O Page 2 of 2 M IA M I BEACH City of Miami Beach 1700 Convention Center Drive Miami Beach, Florida 33139 OFFICE OF THE CITY CLERK Email: BC@miamibeachfl.gov Telephone: 305.673 7411 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): ✓I am a resident of the City of Miami Beach for six months or longer. Home Address 301 Ocean Blvd. #304, Miami Beach, FL 33139 ✓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 Location Resources, Inc. Business Address 311 Lincoln Rd. #305, Miami Beach, FL 33139 o 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 ------------------------- HS[mes (]]resS "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 document and that the facts stated in it are true. 1/25/2022 Signature Christina LaBuzetta Date Printed Name NOTARY Sworn to (or affirmed) and subscribed before me, 9'm ans of o physical presence o~ine notarizatio_n, .2$..JAU+2 _ shU /zettA (City of Miami B ach Board/Committezember). ( ( ),,jo p ,2 <3 z RR, cRLE SJ.DAGOSTN 2 Produced ID I tv _ LO-é}j"$, wcouussíoN # H 1es7s Form of Identification [j,,&i xP RE s:Dember 14, 202 5 nown 2 ";jig Bonded Tu Notary Public Underwriter s (NOT ARY SEAL) Signatu Document Ref: VAE W9-YD NFB-4CPS2-HMXB 5 Page 2 of 6 Gender: Male Female Other I prefer not to answer. Race/Ethnic Categories: What is your race? African American/Black Asian or Pacific Islander Caucasian/White Native American/American Indian Other – Print Race: I prefer not to answer. Do you consider yourself to be Spanish, Hispanic, or Latino/a? Yes No I prefer not to answer. Do you consider yourself Physically Disabled? Yes No I prefer not to answer this question. Email: BC@miamibeachfl.gov DIVERSITY STATISTICS REPORT 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. Page 6 of 6 F:\CLER\$ALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx Updated: June 2020 LaBuzetta Christina S Document Ref: VAEW9-YDNFB-4CPS2-HMXB5 Page 3 of 6 BC@miamibeachfl.gov 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) Last Name First 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 than $500, 60 days in jail, or both. 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.docx Updated: June 2020 LaBuzetta Christina S 1/25/2022 Document Ref: VAEW9-YDNFB-4CPS2-HMXB5 Page 4 of 6 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 First Name Middle Name/Initial Mailing Address – Street Number, Street Name, or P.O. Box City, State, Zip If 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 here. £ Filing as an Employee (check one) * County * Public Health Trust * Municipal: _________________________________________________ (Municipality) Department Position or Title Employee ID Number Work address Work telephone Employment began on/ended on Filing as a Board Member (check one) * County * Municipal: _________________________________________________ (Municipality) Board where serving Alternate address (if home address is exempt)Work telephone 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 not be disclosed. If continued on a separate sheet, check here. £ Name of Source of Income Address Description of the Principal Business Activity SOURCE OF INCOME STATEMENT OFFICE USE ONLY Accepted: Y / N Deficiency:________________________________ Processed Date/Initials:__________________ Scanned Date/Initials: __________________ RECEIVED BY ELECTIONS DEPARTMENT: * Hardcopy * Electronic Copy 138_SP-14 COE 2016 I hereby swear (or affirm) that the information above is a true and correct statement. _______________________________________________________________________ Signature of Person Disclosing _________________________ Date signed 2021 (305) 604-8888 Christina 1/25/2022-12/31/2023 311 Lincoln Rd. #305 Miami Beach, FL 33139 301 Ocean Dr. #304 Miami Beach, FL 33139 4 Photo/Film Support Services (Company Principal) Location scouting/management work in film and photo industries. Freelance location scouting/management Production Industry Council Location Resources, Inc. Miami Beach, FL 33139 S City of Miami Beach 301 Ocean Blvd. #304 LaBuzetta 1/25/2022 Document Ref: VAEW9-YDNFB-4CPS2-HMXB5 Page 5 of 6 X Received January 25, 2022Office of the City Clerk    1/25/2022 Christina LaBuzetta Production Industry Council 301 Ocean Dr. #304, Miami Beach, FL 33139 christina@locationresources.com 305-604-8888 305-794-2873 Cell White 2018 CR-VHonda FL KPGW87 Document Ref: VAEW9-YDNFB-4CPS2-HMXB5 Page 6 of 6