Carolina Cuadros 12/31/23Scan o
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BOARD AND COMMITTEE CHECKLIST
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o Bo4rd and Committee Application (Completed on '.J: )
o Résumé/Curriculum Vitae J/ : /
o Dversty statistics Reporting (completed on. o_ y)0)__à
o Oath hh F a / Scan o
RECEIVED
JAN 26 2022
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 201 O)
✓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
CI T Y O F MI A M I BEACH
OFFI;E (E T4E CITY CLEB'@jtywide Permit Application (Parking Department Form)
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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
ISTICS REPORTING Keep çPy in file and ORIGINAL for Annual Report.
Received on: _ __,_,___ ,....__._~-Signed by X ~ - \!\C, ·
ate (_ e Me / 2o 22er e s » 77 7 2EEa / '2 a /22reo· <
7 r Date ice Staff Initials
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CO N C LUD ED & RESIG ATIO N LETTER S
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 DATA BASE\CH EC K LI ST M A STER\B&C Checklist 2015 M A STER.docx
te are committed to providing excellent
MI M l
C ity of M iam i Beach, 1/OO Convention Conter Driva, Miami Bouch, Forida 33139 yyyy_miaIiLeach[l_goy
OFFICE OF THE CITY CLERK, Rofol E. Gran ado, City Clerk
Tel: 305.673.7411, Fax. 305.673.7254
Ema il: CityClerk@miamibeachll.gov
January 21, 2022
M r. C arolina C uadros
1902 SE 14th Cir
Hom estead, FL 33035
SUBJECT: Senior Affairs Committee
Dear Mr. C aro lina Cuadros:
C ongratulations! You have been reappointed by the City Commission to the above referenced board or
com m ittee, for a term ending: 12/31/2023.
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 m aterials carefully. Congratulations and good luck.
R espectfully,
R afa el G ranado
City C lerk
cc: Monica Beltran, Parking Director
Luis C allejas, City Li aison
ATTACHMENTS:
Letter of Appointment
Oath
C ity C ode/O rdinance section applicable to agency, board or committee
City C ode Section 2-22, 2-23, 2-24, 2-25, 2-26, 2-458 an d 2-459
O rdinance No. 2006-3543 - Am en dm ent to City Code Section 2-22
Miam i-Dade C ounty Code Section 2-11.1 - Conflict of Interest and Code of Ethics Ordinance
C ity Wi de Permit Application - (P arking Department Form)
Booklet - G uid e to the Sunshine Amendment and Code of Ethics for Public Officers and Employees
M l M l
City of Miami Beach, 1ZOO Convention Conlar Driva, Miami Boach, Horida 33 139 y¿yy_miamibgchfl_goy
OFFICE OF THE CITY CLERK, Rafael E. Granado, City Clerk
Tel: 305.673.7411, Fox. 305.673.7254
Email: CityClerk@miamibeachfl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO : M r. Carolina Cuadro s
R E: Senior Affairs Comm ittee
I do solem nly sw ear or affirm to bear true faith, loyalty and allegiance to the Govern ment 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-m entioned board or com m ittee of the City of Miami Beach to which I have been appointed for a
term ending: 12/31/2023.
To m y colleagues and to all of those I represent and serve, I pledge fairn ess, integrity and civility, in all
actions taken and all comm unications m ade by m e as a public servant.
I have been issued a copy of section 2-11.1 of the M iami-Dade County Code (Conflict of Interest and
Code of Ethics Ordinance), as well as Florida Commission on Ethics Guide to the Sunshine Amendment
and C ode of Ethics fo r Public Officers and understand that as a m ember of a City of Miami Beach Board
and/or C om m ittee, I m ust com ply with the financial disclosure requirem en ts of Miami-Dade County or the
State of Florida (depending on the board or comm ittee on which I serve) on July 1st, following the closing
of the calendar year on which I have served.
M r. Carolina Cuadros
Sw orn to and subscribed before m e this ;;;.J
1
..
'
*Please visit the City of Miam i Beach website at www .m iamibeachfl.gov under City Clerk/Board and
C om m ittees fo r additional information regarding the Financial Disclosure Requirements.
M IAM IB H
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
R EC EIVED
JAN 26 2022
CITY OF M IAM I BEACH
OFFICE OF THE CITY CLERK
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.
{m J\]]fo 3
o 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).
[Jar9 ([ [ys1mes,S
Business Address ------------------------
-,;( 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 Busies 'elk ------------------------
Business Address_Joo/161.607le_goo,_2bah, 33r0
"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
aretrue,,p., @,E.,[ bdhe 'nho o Oc,Ooo%-
Signature Date
rola oedro)
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of ~sica! presence or□online notarization,
2e a )A , » ('Ae ola CAo
(City of Miami Beach Board/Committee Membehgmmeeeeeeeeem-em (' / s f) A--é~5po1 ,0-~ ... ~~•:¥~.. -· CHARI.ES J. DAGOSTIN
Produced _ y7 'ZS/_ [$$? wrcouussroNu nsrs
Form of identification l%?slit&is ExPRes: December 14, 202s
%%ff!"°' Bonded Thru Notary Public Un derwrit ers
(NOTARY SEAL)
Name of Notary, Typed, Printed, or Stamped
M IA M IB E H
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfl.gov
OFFICE OF THE CITY CLERK
Emai l: BC@miamibeachfl.gov
Telephone: 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)
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. J
bndue {oe le» /l2G/ 2o »
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. $112.3145 1 )(a), to file a Statement of Financial Interests (Form 1) with the Miami-Dade County
Supervisor of Elections by 12:00 noon, July 1. Planning Board and Board of Adjustment members who file their
Form 1 with the County Supervisor of Elections automatically satisfy the County's financial disclosure
requirement as a Miami Beach City Board/Committee member and need not file an additional form with the Office
of the City Clerk. However, compliance with the County disclosure requirement does not satisfy the State
requirement.
Page 5 of 6
F:ICLER\$ALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
M IA M l·DA D E-
EII SOURCE OF INCOME STATEMENT
Section 2-11.1(i) of the County Ethics Code requires that certain em ployees and public offi cials file a financial disclosure Statem ent on a yearly basis by July 1st
of every year.
Disclosure fo r Tax Year End ing I Last Nam e First Nam e Middle Nam e/Initial
2021 (tudh ('er ulo
M aili ng Address - Stre et Num ber, Stre et Nam e, or P.O. Box
(02 6 t- ur
Ci~1Zip
eo)ecl l 1 3303$
If your hom e address is your m ailing address, and your hom e address is exem pt fro m public re cords pursuant to Fla. Stat. $119.07, read
instructions on the follow ing page and check here. D
Filing as an Employee (check one)
[] county [] Public Health Trust [] Municipal:
(M unicipalit y)
Departm ent
Position or Titl e Em ployee ID Num ber
W ork address I W ork telephone Em ployment began on/ended on
Filing as a Board Member (check one)
[] county [] Municipal: 1fion e h .
(M unicipality)
Board w here serving
2no Dpt+no
Altern ate add re ss (if hom e ad dress is exem pt) I W ork telephone ¡ Term began on/ended on
List below every source of incom e you received, along with the address and the principal activity of each source. Include your public salary. Place the sources of
incom e in descending order, with the largest source first. Exam ples of sources of incom e include: com pensation fo r services, incom e fro m business, gains fro m
pro pert y dealings, interest, rents, dividends, pensions, IR A distributions, and social security paym ents. Also, include any source of incom e received by another
person for your benefit. How ever, the incom e of your spouse or any business partner need not be disclosed. If continued on a separa te sheet, ch eck here.[]
Nam e of Source of Incom e Addre ss Description of the Principal Business Activity
Sul 4O u0 05+6o/ oO o rom 6i l De5ose H\a no
A rn i e a ch ,r L 33 i4 0 ' 8
I here by sw ear (or affi rm ) that the inform ation above is a true and corre ct statem ent.
Signature of Person Disclosing
Date signed
RECEIVED BY ELECTIO NS DEPARTMENT:
O Hardcopy BECEIVED
O Electronic Copy
JAN 26 2022
CITY OF MIAMI BEACH
OFFICE USE ONLY Accepted: Y / N Deficiency: Pro cessed Dat e/initials: Scanne d Date/initial s:
138_SP-14 COE 2016
M IA M IBE H
City of Miami Beach
17 00 Convention Center Drive
Miami Beach , Flor ida 33139
www_miamibeachl],_gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.6 73.7 411
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.
Gender:
Zí ae
O Female
O Other
O I prefer not to answer.
Race/Ethnic Categories:
What is your race?
O African American/Black
Dl Asian or Pacific Islander
O Caucasian/White
O Native American/American Indian O Other- Print Race: _
DI I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
Zí ve.
No
O I prefer not to answer.
Do you consider yourself Physically Disabled?
ves z1
O I prefer not to answer this question.
Page 6 of 6
F:\C LER \$ALLIREG \BO ARD AND CO M M ITT EE APPLI C ATIO NS FINAL DRAFTS\BOARD AND CO MMITT EE APPLICATION RE G FINAL.docx
Updated: June 2020
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