Diane Connolly Graham 12/31/23M IA M I BEACH
BOARD AND COMMITTEE CHECKLIST
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Scan o o Letter of Reappointment "7 ' ' yr //%Py "/ "fy' woo«owe»resonant ·mates o corr» tao or
Scan o (gs,4aka Committee Application (Completed on__ _ )
scan o o Resume/curriculum vitae 2/?/
o Diversity Statistics Reporting (Completed or_, t O>>
Scan o o Oath '
RECEIVED
FEB 3 2022
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLE RK
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
Scan o
Scan o
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 Requirement
o IVERSITY STATISTICS R
Recaed o:d ,21od sones y
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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
WVe are committed to providing excellent public service and safety to all who live, work, and play in our vibrant, tropical, historic community.
M IA M I BEACH
City of Miami Beach, 1ZOO Con v ent ion Conter Drivo, Miami Boach, Florida 33 139 www_miamibgachll.goy
OFFICE OF THE CITY CLERK, Rafaol E. Gran ado, Cy Clerk
Tol: 305.673.7411, Fax. 305.673.7254
Emal l: City Clerk@miamibeachll.gov
Jan uary 21, 20 22
M s. D eA nne C o nnolly G raham
65 15 SW 26th Street
M iram a r, Flo rida 33023
SUBJECT; Black Affairs Advisory Committee
C o ngratulations! Y o u have been reappointed by Mayor Dan Gelberto the above referenced, board or
com m itt ee na m ed above, fo r a term ending: 12/31/2023.
Pu rsuant to C ity of M iam i Beach C ode Section 2-22 (5) a, "N otw ithstanding any other pro vision of the
C ity C ode or of any resolution, com m enci ng w ith term s beginning on or after Jan uary 1, 2007, the term of
eve ry boa rd m em b er w ho is directly appointed by a m em ber of the C ity C om m ission shall autom atically
expire up on the la tt er of: D ecem ber 31 of the year the appointing C ity C om m issioner leaves offi ce or
upon the appo intm e nt/election of the successor C ity C om m ission m em ber."
If yo u are unab le to accept this appointm ent, or have any questions, please call the Office of the City
C le rk at 30 5.67 3.7 411. Please read the encl osed m aterials carefully.
C o ngratulatio ns and good luck.
R ega rds,
R afae l G ranad o
C ity C le rk
cc: M o nica Be ltran , Parking Di rector
Li ssett e A rro g a nte, C ity Li aison
ATTACHMENTS:
Lett er of A ppo intm e nt
O ath
C ity C o de/O rdinance section applicable to agency, board or com m ittee
C ity C o de Se ction 2-22, 2-23, 2-24, 2-25, 2-26, 2-458 and 2-459
O rdina nce N o. 20 06-3543 - Amendment to C ity C ode Section 2-22
M ia m i-D ade C o unty C ode Section 2-11.1- C onfli ct of Interest and C ode of Ethics Ordinance
C ity Wi d e Perm it Ap plication - (Par ki ng D epartm ent Form )
Boo klet - G uide to the Sunshine A m endm ent and C ode of Ethics fo r Public Offi cers and Em ployees
M IAM I BEACH
City of Miami Beach, 1/0O Convention Conter Drive, Miami Beach, Horida 33 139 yyyw._miamibeachllgov
OFFICE OF THE CITY CIERK, Rafool E. Granado, City Clerk
Tol : 305.6 7 3.7 4 11, Fox. 305.6 7 3.72 54
Email: CiNyClerk@miamibeachfl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
T O : M s. D eA nn e C o nno lly G raha m
R E : B lack A ff a irs A d visory C o m m ittee
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
o f the cale nd a r year on which I have served.
rah
S w orn to and subscrib ed befo re m e t~s -J-.:::....,.j r..... day o¡:eb,_022
/ H?>
*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 dditio na l info rm atio n rega rding the F in a ncia l D iscl osure R equirem e n ts.
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
RECEIVED
FEB 3 2022
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):
o I am a resident of the City of Miami Beach for six months or longer.
Home Address -------------------------
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).
Name of Business _
Business Address _
K 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 locate in Miami Beach (for a minimum of six months).
[ame of [ysinesS[ ll I\d { l' Ill''
sousess Aaaress -„la, ,>, Lio¡ lack
"Ownership Interest" means the ownership {¡ en 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.
u that I have read the foregoing document and at the facts stated in it
a 22-
d;1{1±de.} 3¿"..
D at e
r/\
Printed Name
NOTARY
Sworn to (or affrmped) and subscribed
0
before me~ r:ieans ~cal presence or online notari,ation, ..a/c r 3 [Dué Coa l!y bak A
Produced ID
(C~ of Mi mi Beach Boar~/Com7e M:~ber).
J e 3 y »4u arada n
Form of Identification /i~•····<\ MYCOMMISSION#HH165705
ix; ?"; EyPIRES; Decem ber 14, 2025 :% S: t,,Aar]lgrg 32,$ ponded Tru Notary Pub lic Udef ·g££%°
ry, Typed, Printed, or Stamped
MIAMl·DAD E-
EI7 SOURCE OF INCOME STATEMENT
Section 2-11.1(@) 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
2021
Mailing Address - Street Number
i5 -
City, State, Zi
Middle Name/Initial e
33023
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. O
Filing as an Employee (check one) ·,,,
[] County I] Public Health Trust [] Municipal:
Department
Position or Title
Work telephone
Employee ID Number
Filing as a Board Member (check one}
[] county
Board wherg servin9 , c- Alternate address (if home address is exempt)
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
Sig a e of Person Disclosing
glee
Date signed
RECEIVED BY ELECTIONS DEPARTMENT:
t) oreo RECEIVED
[] Electronic Copy
FEB 3 2022
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
M IA M I BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachll.goy
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7 411
Last Name
DIVERSITY STATISTICS REPORI
.e's e
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:
Maté Jemale
O Other
O I prefer not to answer.
Race/Ethnic Categories:
what'ís your race?
Í tea Am erican/lack
O Asian or Pacific Islander
O Caucasian/White
O Native American/American Indian
O Other - Print Race: ------------- □I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
Tves
Tio
O I prefer not to answer.
Do you consider yourself Physically Disabled?
ís.
No
O I prefer not to answer this question.
Page 6 of 6
F:ICLER\$ALL\REG\BOARD AND COMMITT EE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITT EE APPLICATION REG FINAL.dccx
Updated: June 2020
M IA M I BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfl.gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachf.gov
Telephone: 305.673.7 411
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)
Firs@ Name Middle Initial
I und er st and that no later than July1, 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 t $500, 60 days in j · ~ =--_d_--1\1--3-~;;)_· _d- _
L --S 19n ure tj 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:\C LER \$ALL\REG \BO ARD AND CO M M ITT EE APPLICATIO NS FINAL DRAFTS\BOARD AND COMMITT EE APPLICATION REG FINAL.dccx
U p da te d : Ju ne 20 2 0
±£%2A4 .4 4 7 r 12 1%. I
1755 Meridian Avenue, Suite 200/Miami Beach, FL 33139 /Ph: (305) 673-7505 or (305) 673-7000 ext. 6200 PARKING
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:
Board/Committ
Address:
E-Mail Ad
Work Phone:
Cell Phone:
Vehicle lnformaf
Tag:
State:
Make:
Preferred Contact Method:
Color:
Year :
Model:
Applicant St«nature: e
Please provide signed form to the Parking Department located at 1755 Meridian Avenue, 2 floor. Working
hours are 8:30 to 5:00 p.m. or email to: ParkingReception@miamibeachfl.gov
e-mail subject: BOARD & COMMITTEE PARKING APPLICATION -- APPLICANT NAME
p, ·kd D ar mna epartment ection
PERMIT SYSTEM GARAGE ACCESS
Expiration Date: ID Card Serial #:
Issued By Print Name: Print Name:
Signature: e Signature: e
Date Issued: Date Completed:
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Operation of a motor vehicle constitutes onset to ry sobriety test requirt by iew