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Alberto Ravelo 12/31/24BOARD AND COM MITTEE CHECKLIST aoree._hlrf felo ore or AeroreNr BOARDICOMMIT TEE: FOR SCANNER Scan Scan 12/31/24 to Committee Liaison on Scan Scan Scan FOR CLERK STAFF Letter of Appointment Letter of Reapointrrent $f$4pf($ Jetter ot AppointmeReappointment e-mailed Boaro a@ Cormttee ppcator (Completed on "" Resume/Curriculum Vitae 2/2/2022 Dversty Statistics Reporting Completed on) Oath IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK '~" w Received February 2, 2022 Office of the City Clerk ¥ v ¢ v City Code Ordinance Section applicable to the agency. board or comrrttee Cty Code Sectons 2-22,2-23,2-24 2-26, 2-458 and 2.459 County Code Secton 2.11.1 - Conflict of interest and Code of Ethcs Ordnance (as amended through Oecember 2010) Amendments to the Code ot Ethics Ordnance (September 2009 through July 2012) Highlights of the Miami- Dade County Ethics Code Sunstune Law and Pubic Records - Frequently Asked Questions Memorandum - Solicita tion by City Board and Committee Members Scan a Scan O Citywide Permit Applicatgn (P arki ng D epa rtment Form} O Boklet - Guide to Sunshine Amendment & Cade of Ethi cs ta: Pup Officers and Employees 3 Source of Income Statement O Acknowledgment of Financial hisclo DIVERSITY STATISTICS e Requirement) and ORI GIN AL for Annual Report. Scanned on CONCLUDED & RES IG NA TIO N L E T T E R S ran eaces eer l Removal Letter due to absences Processed Dat e pro cessed Initials S can 3 Initials S can Inwva ls #KC£ C IE CITY CIrRs:, tolosi t. Grans±, Cay CGaul 1al 30$ 6/3./411, fa» 305 473224 Lmal .@Cl eli amso.hfl.gv January 20, 2022 Mu Al tgt o Favel0 5838 Coll«s Ave pt 9G Mdam !each, Florids 33140 D ear r up ert o R avelo. Congatlations! 'You have been appointed by the City Commission to the agency. board or commuttos named atove tor a term ending 12/31/2024. If you ate unabte to accept this appointment or have any questions please call tte Office of the C ty Cetk at 305 673 7411 Pt@ase ead the enclosed materials carefully as they concern yout duties, responsibilities, and requirements as a board or committee m emb er Rafael Granado CIty Clerk cc Monica Beltran, Parkin g Director Brandi Re&dick. City Liaison ENCLOSURES: O ath a! Of fi ce/O ath of City'knowledge ments City C ode/O rdina nce section a pplicable to agency. board o r committee City ode Sect0 2-22, 2-23,2-24 2-25, 2-26, 2-458 and 2.459 O rdn anc e No 2006-3543 - Amendment to City C ode Section 2-22 MA«am -Da de County Ccde Section 2-11 1-Confict of Interest snd Code of Eth«cs Ci ty 'de Permit App lication • {P arkin g Department Form) ok le t - Guide to the Sunshine #Amendmen t and C ade f E thic s for Public Officers an d Employees FACT CO THE CITY CLARK, Rall f. Geo9de, City Ck 1ol. 305 6737411, fa 3 0 6/1.7254 mat Cm.Cel.esautes hl. g Oath oft Office Oath of Civility and Acknowledgements TO M: theta Ravelo RE Cultural Arts Cour.il l d o solemnly sw @ at or affirm ta teat true faith loyal ly and allegiance to th e Government of the United Stat es, the State cf Flori da and the City of M iam i Beach, and to perform all the dates of a mem ber of the above mentioned boari or comm ittee of the City of M4ari Beach to whit:h have teen appointed for a term end ing. 12/31/2024. To my colleagues and to alt of those l represent and serve, pledge fairness integrity and civility in all actions taken and all communications made by me as a public servant I havo been issued a copy f section 2-11 1 l 1e Mami-ade County Code (Conti:t at Interest and Code of Ethics Ordinance). as well as Florida Commi ssion cn Ethics Guide to the Sunshine Amendment and Co de of tU1ics filr Phblk:: O ffr cêrs and ,md<;1írsl;ind 1tt~f: <ils à member o! a è it¡• ".:i f Miami Jì~èh &ard and!ca Ccmmwttee, I mu st com ply with the financial disclosure' requirements ot Miam i-Da de Ccinty cr the State úf Florida {depending cn the board or committee on which I serve} on July 1st, 1gthe closing of the calendar year on which l have served o<ay ·Please visit the City of Miami Beach website at wsww mwa mube achi l.gov under City Clerk/Board and Committees for additional information regarding the Financial Disclosure Requirements MCHAEL , G0NG0 WY COM44sS4ON G3 $65671 EXPI RES: A0u t 14, 223 C ity of Mi am i Beach 73 C.ow6ntion rive Miami Be sch , Fland 33139 OFFICE OF THE OIY CLERK €ma. BCg@y mamvachi gay Talep one. 305.673.7411 Received February 2, 2022 Office of the City Clerk AFFIDAVIT O F A F FI LIA TI ON WI TH THE CITY OF M IA MI BEACH ST4TE OF FLORIDA COUNTY OF MIAMI-OADE t am in compliance with the afflianon requirement af Miar each City Code Sections 2-22 {4) as {check (/4 all that app%y) si lam a resident of the City of tam Beach tar six months or longer k' Hame ddress.kdd d'lorn" I have an ownersnup interest (for a mnurnum of six months} in a business established in the City ut Miami Beach ifot a minimum of six months) n1 lam a fuli-time employee of a busin ess for a minimum a f sx msntts} and am based in an office or other locatian of the business that is physically located in Miami Beach (for a minimum of six mo nths1 Name of 8usinessA Iii } ML /A+AL, E 3 3 (7 nership interest means the wn orsbp cf ten percent (10%) 0 more (inc!sdng tte ownersnp of 10 % or more of tho autstanding capital stock} in a busiess Busiess" means any sole proprietorship, sponsorship, corporatkon, mites liability company or other entity or business 0ssçietm re that I have read the foregoing document and that the facts stated in t Pennted Name NOTARY Swmn to (or affirmed) and subscribed tefore me by means at?physical presence or .u online notarzatn. e ms sou __Asa4_ 2o2_y , . ......., l City of tam Beach Bçard;Cmittee Member) Produced ID form ct iden tification i@me of Notary T ype d Printe d, or tamped E H City of Miami Beach '7 Carenton Celer Drive 331 OHFCE OF THE CITY CLERK Ena BG@naube ahf.gov lalephone. 305.673.7411 DIVERSITY STATISTICS REPORT ·······. .. . . A/EL_O l/ Last Name First Name i@aie initial The toilowing information is voluntary and has no bearing on your consideration for appointment It is being asked comply with City diversity reporting requirements Gender; &0 a te .J Female o her DC prefer not to answer Race/Ethnic Categories: What is your race? DIAtnican American/Black Asian or Pacific Islander Caucasian/White [Native moncan/American Indian [yQther -- Print Race. - [lpreter not to answer Do you consider yourself to be Spanish, Hispanic, or Latino/a? d ves Jo [l prefer not to answer Do you consider yourself Physically Disabled? lv a 'lt prefer not to answer this question Page 6cf6 + £LER SALI RÉGBCD» ME MT1EE 4BAINS F At DRAT'TB3AR3 AD CC3MAI#TEE #PLIA 'IN RE G FINAL, SEcx c9te$ 3une 202 City of Miami Beach N70 Convention Center Drive Mi Beach. Florida 33139 OFFICE OF THE CITY CIE&K Emoit. Telephone: 305 673 7411 BOARD & COMMITTEE FINANCIAL ACKNOWLEDGEMENT STATEMENI 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) Middle Initial t understand that no later than July_1,gf 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 foliowing forms must be tiled with the City Clerk of Miami Beach, 700 Convention Center Drive Miami each, Florida, no later than 1200 noon of July 1, of each year 1 A 'Source of Income Statement." or 2 A"Statement of Financial Interests Form 1)',' or 3 A Copy of your latest Federal Income Tax Return - pursuant to the Miami-Dade County Code may subject the person to a fine or both 'Members of the Planning Board and Board of Adjustment will be notifed directly by the State of Fonda pursuant to F.S. $112 3145(1)(a), to file a Statement of Financial Interests {Form t) with the Miami-Dade County Supervisor of Elections by 1200 noon. July 1 Planning Board and Board of Adjustment members who file the Form 1 with the County Supervisor of Elections automatically satisfy the County's financial disclosure requirement as a Miami Beach Cty 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 5016 GAER'SAL!REG/BA8D A#t CM!Ms7TEE APA HING F MAL ORF TS£MARO AND«CAT£E APPLICATE HE G FINAL 00¢« Ip4at0d June 202¢ M.·l·A···.· .... M ... ·.,.·.Di-. ' .. · Emr SOURCE O F INC O M E STATEMENT Sect9n 2-11 14 cl the ourty £twzs de reties tat certain mp4aye@s ad pt !fzals file a trancat distlosure Statemert ca a weary ass trul y 'st ot every year 0isctasure tor Tax Year Ending 2021 Last tame First lame 4 v €Lo AL€or iww a@rs - stet iiaer suer nae, Gr • a 58 38 CULL1Ms Ar Middle tame initial V/ City, Stat, Zin ./\} .... t kft,tf K?:s ~ ... ~-¡~C,{4· FC,_, 3 fdL/ O " . . Jj '' .. ,-.,.-·····--------·~--------------· tt your home aduress s your mailing ax#dress, and ycur tame address ts exempt from publr: records pursuant to Fla. Stat. $119.07. read instructions on the foawin; page and check here. [] Filing as an Employee (check one) [] county [ Public Heal th Trust [ Mun i cip al. Department sitien ar Tit#e Work address Empl oyee ID tumber j l*Ja«-k l¢1ílï)lt-01'io hoooooop . pogogggogo»oooooooeo oego.gpppp Eupoyment began on/ended on Filing as a Board Memb er (check one) DJ county ard where serving Hf¿in began o/ended an by l!)/ ¢- RECEIVED 8Y ELECTIONS DEPARTMENT. worco RECEIVED Electronic Copy FEB 3 2022 C ITY OF MI AM I BE A CH OFFIEg£ 'HAE I CLERk OFFICE USE ONLY KA&Ad /A Deter ·3£ a A1£70°% 1BE City of Mimi Besch, PARKING DEPARTM ENT CITYWIDE {CW) BOARD & COMMITTEES PARKING APPLICATION A citywide {CW ] par king permit is honored at metered parking spaces and restricted residential zon es parking spaces, A CW parkin g permit IS NOT honored in prohibited areas. An Access Card will provided to you for City Hall Garage (G?] access. IMPORTANT NOTE: Yout vehicle license plate serves as your "parking permit". In order to avoid any unnecessary enforcement actions, it is imp ortant that our record s reflect the most current and accurate information regarding your vehicle license plate. inaccurate and/or outdated vehicle information may lead to the issuance oh parking citation(s) and/or the towing of your vehicle . Please note that this new access card CA NNOT be hole punched or perfor ated in any manner. To use the new cord 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, stole n or damage, I will be responsible to pay a $10.00 replacement fee. pplican! s Pease provide signed form to the Parking Dearment locoed an 1755 Meridian Avenue, 2 " floor Working /hours are 8:30 1o 5.00 •• r eel t: ParkingReception@miamibeachfl,gov l email subject: BOARD & CO MMITTEE PARKI N G APPLICATION - APPL ICAN T NA ME I GARAGE ACCESS 'i Card Serl # Sgnature « Dote {Completed f og gioiioeob . ¢ooooo«op,o,,po $%41\9¢