Herb Sosa 12/31/23MIAM IBE
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BOARD AND COMMITTEE CHECKLIST
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Scan o o Letter of Appointment TERM END: ·, Vl 'TERM LIMIT: [_. _[
Scan o o Letter of Reappointment
o ,""7°' Appointment/Reappointment e-mailed to committee Liaison on
o o rd and Committee Application (Completed on 1 I )
o Resume/corricutum vtae f) ] ]
o Diversity Statistics Reporting (Completed on_>, p) Oa
o Oath Scan o
RECEIVED
FEB 12022
CITY Or M
oriö 6 3„/,2M/BEACH
= CITY CLER
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
Scan o
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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 R
D VE SITY STATISTICS REPORTIN
Recaed on: T=. {èó_soca»y X a
NAL for Annual Report.
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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:\CLER\BOARD AND COMMITTIES DATABASE\CHECKLIST MASTER\B&C Checklist 2015 MASTER.docx
We ore committed to providing excellent public service and scfoty to all who live, work, and play in our vibrant, topical, historic community.
City of Miami Beach, 1/0O Cononlion Center Drive, Miami Boo«ch, Florida 33139 yew_IiaIiLggchf]_go
OFFICE OF THE CITY CLERK, Rafael E. Granado, City Clerk
Tel: 305.673.7411, Fax. 305.673.7254
Email: CityClerk@miamibeachfl.gov
December 21, 2021
Mr. Heriberto (Herb) Sosa
831 Ni nth Street
Miami Beach, Florida 33139
SUBJECT: LGBTQIA+ Advisory Committee
Congratulations! You have been reappointed by Commissioner Alex Fernandez 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: Decem ber 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.
Rl)d
Rafael Granado
City Clerk
cc: Monica Beltran, Parking Director
Nattaly Cuervo, 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 - Am en dm ent to City Code Section 2-22
Miami-Dade County Code Section 2-11.1- Conflict of Interest and Code of Ethics Ordinance
City Wi de Permit Application - (Parking Department Form)
Booklet - Guide to the Sunshine Amendment and Code of Ethics for Public Officers and Employees
City o f Mi a m i B e a ch, 1/OO Convention Conler Drive, Miami Boach, Florida 33 139 wyyNw._miamiboachf]_go
OFFICE OF THE CITY CLERK, Rofool E. Granado, City Clerk
Tol: 305.673.7411, Fox. 305.673.7254
Email: City Clerk@miamibeachfl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
T O: Mr. Heriberto (Herb) Sosa
R E : LG BTQIA+ Advisory Committee
I d o so le m n ly sw ea r o r affi rm to b e a r true faith, loyalty a n d alle gia nce to the Government of the United
S tates, the S tate of Florida , and the C ity o f M ia m i B e ach, and to pe rf orm all the d utie s of a m e m b e r of the
abo ve-m e ntio ne d b o ard o r co m m itt ee o f the C ity o f M ia m i B e a ch to w hich I hav e be e n app o inte d fo r a
te rm e nding : 12/31/2023.
T o m y col le agu e s an d to a ll o f tho se I rep re sent a nd se rve , I ple dge fa irn e ss, integ rity and ci vility, in all
a ctio ns taken a nd a ll com m unicatio ns m ade by m e a s a p ublic se rv ant.
I h a ve b e e n issu e d a cop y o f se cti o n 2-1 1 .1 of the M ia m i-D a d e C o u nty C o de (C o nfl ict o f In terest and
C o de of E thics O rdina nce), as w ell as F lo rid a C o m m issio n on E thics G u ide to the S u nshin e A m e nd m e nt
a nd C o de of E thics fo r P u b lic O ffi cers and u nde rstand that as a m e m b er o f a C ity o f M ia m i B e ach B o ard
a nd/or C o m m itt ee , I m ust com p ly w ith the fin anci a l d iscl osure* requirem e n ts o f M ia m i-D ade C o unty or the
S tate o f Flo rid a (de pe nding on the b oa rd or com m itt ee on w hich I serve ) on Jul y 1 st, fol lowi n g the cl o sing
o f the cale nda r year on w h ich I have se rv ed.
S w orn to and subscrib e d before m e this d 2 02 1
'Agostin
uty Clerk
*P le a se visit the C ity of M ia m i B e a ch w e b site at w w w .m ia m ib e a c hfl.g o v u n d e r C ity C le rk/B o a rd an d
C o m m itt ee s fo r a dd itiona l inform atio n rega rding the F ina nci a l D iscl osure R equirem e n ts.
M IAM I E
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
RECEIVED
FEB 12022
CITY OF MIAMI 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):
/r1aní a resident of the City of Miami Beach for six months or longer. ) o-... G] L r,±1Bl±331]
□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 ------------------------
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).
[J9re (f [y[[eSS
3JS[Fess [(]]feSS
"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__ sociation.
Signature
rjur, I declare that I have read the foregoing docum~en~ that the facts stated in it
éf 6 ),zon
Printed Name
NOTARY
Sworn to (or affirme nd subscribed before me, by means of~ysical presence or online notarization,
.L ara ri# sr±9 }l2 hé 4o $o%
ach Board/Committee Member).
X roca«ea /y S l_'oo sc
Form of Identification
Sign
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%3p2ka.g5 ExPREs: Decombor 14, 2025
"íf;yj%"" Bonded mru Notary Public Underwriters
MIAMIBEAC
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfl,gov
OFFICE OF THE CITY CLERK
Email: 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) 506 La,
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,jil/ or both. ~Q
y „. 26 ),202-
Signature Date
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 COMMITT EE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITT EE APPLICATION REG FINAL.docx
Updated: June 2020
M IAM I
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachll,gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
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:
Dute
O Female
O Other
O I prefer not to answer.
Race/Ethnic Categories:
What is your race?
O African American/Black
O Asian or Pacific Islander
[ 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?
Eie
O I prefer not to answer.
Do you consider yourself Physically Disabled?
.Jves nt°
[lireter not to answer this question.
Page 6 of 6
F:\C LER \$A LL\RE G \B O A RD A ND C O M M ITT E E A P P LI C A TIO NS FIN A L D RA FTS \BO A RD A ND C O M M ITT E E A PP LI C A TIO N RE G FINAL .docx
U p da ted : Ju ne 20 20
MIAMl·DADE-
Em 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
2021 5 J
First Name
€
Middle Nam e/Initial
5
Mailing Address - Street Num ber, Street Name, or P.0. Box
¿3) <5561
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. D
Filing as an Employee (check one)
[] county [] Public Health Trust [] 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)
[] county Jkwmnieia )1)w-lt 1s Ack
(Municipality)
Board where serving Z6 Tl+ 0/,
Alternate address (if home address is exempt) 1 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 not be disclosed. If continued on a separate sheet, check here.[]
Name of Source of Income Address Description of the Principal Business Activity
<s( s/ <3) 91,k 72ay Her . I ,
I hereby swear (or affirm) that th@'inform ation above is a true and correct statement.
Signature of r
6,)-20U2
RECEIVED BY ELECTIONS DEPARTMENT:
ti or«cob ECEIVED □Electronic Copy
FEB 12022
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
OFFICE USE ONLY Accepted: Y / N Deficiency. Processed Date/Initials: Scanned Date/initials:
138_SP-14 COE 2016
IA CITYW IDE {CW ) BOARD & COMMITTEES
City of Miami Beach, PARKING DEPARTMENT PARKING APPLICATION
1755 Meridian Avenue, Suite 200/Mimi Beach, FL 33139/Ph: (305) 673-7505 or (305) 673-7000 ex4. 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 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
Date of Application:
Applicant Name: €/u
Board/Com mittee Name: sf/-7 aà /
Address. <53) 9377657 Re
EMail Address /06 0<@
Work Phone:
Preferred Contact Method:
Vehicle Information
Tas: -G<o
State:
Make:
Color:
Year:
Model:
/TG
Applicant sanatore: e '3),25
Please provide signed form to the <ing Department locate at 1755 'Meridian Avenue, 2d floor. Working
ho urs a re 8 :30 to 5 .0 0 p.m. or em a il to: ParkingReception@miamibeachfl.gov
e-mail subject: BOARD & COMMITTEE PARKING APPLICATION - APPLICANT NAME
P, ki D S · ar una epartment ection
PERMIT SYSTEM GARAGE ACCESS
Expiration Date: ID Card Serial #:
Issued By Print Name: Print Name:
Signature: 6 Signature: e
Date Issued: Date Completed:
.«ping ·man rar torms cw arts committees par+ugtorm,to rm upaare