Ariana Hernandez-Reguant 12/31/23/Al ty
BOARD AND COMMITTEE CHECKLIST
APPOINTEE: Ariana Hernandez-Reguant Jan 20, 2022 DATE OF APPOINTMENT: _
BOARD/COMMITTEE:_Human Rights Appointed by. City Commission
FOR SCANNER
Scan o
Scan o
Scan o
Scan o
Scan o
FOR CLERK STAFF 12/31 /23 12/31 /27
o Letter of Appointment TERM END:T ERI LIMIT: _
o Letter of Reappointment
o CP}9J, etter of Appointment/Reappointment e-mailed
o Board and Committee Application (Completed on 1/19/2022
o Résumé/Curriculum Vitae 2/3/2022
o Diversity Statistics Reporting (Completed on _
o Oath
to Committee Liaison on
IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
✓City Code Ordinance Section applicable to the agency, board or committee
Received February 3, 2022 ✓City Code Sections 2-21, 2-22, 2-23, 2-24, 2-25, 2-26, 2-458 and 2-459 ""@ ?{/' f eris ' county code see4on 2-11.1-cont ot terest and cote o tines ordnance as EV amended through December 2010)
Amendments to the Code of Ethics Ordinance (September 2009 through July 2012)
g Q0Zl Highlights of the Miami-Dade County Ethics Code [{b Sunshine Law and Public Records - Frequently Asked Questions
, Memorandum - Solicitation by City Board and Committee Members 4 },K in C\1';cto~ ír\t. C o Citywide Permit Application (Parking Department Form)
O'r o Booklet - Guide to Sunshine Amendment & Code of Ethics for Public Officers and Employees
Scan o o Source of Income Statement
Scan o o Acknowledgment of Financial Disclosure Requirement
•. 2/3 73$"3""""Ç" "prreesa«sa
/
Dat7 ;)_
Processed • 213 ¡)-;. By Employee: ---1'--;-,£-c---,,9---_.,e;""-----=----------
I ºªle se so 2_3 0 } a»ore»
)q[? o
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:ICLERIBOARD AND COMMITT IES DATABASE\CHECKLIST MASTER\B&C Checklist 2015 MASTER.docx
Ve are committed to providing excellent public service and safety to all who live, work, and play in our vibrant, tropicaí, historic community.
City of Miami Beach, 1/OO Convention Center Drive, Miami Boach, Florida 33 139 wyyw._miamibachf]go
OFFICE OF THE CITY CLERK, Rofool E. Gran ado, City Clerk
Tel: 305.673.7411, Fax. 305.673.7254
Email: City Clerk@miamibeachll.gov
January 20, 2022
Ms. Ariana Hernandez-Reguant
7921 Byron Ave
Miami Beach, FL 33141
RE: Human Rights Committee
Dear Ms. Ariana Hernandez-Reguant:
Congratulations! You have been appointed by the City Commission to the agency, board or committee
nam ed above for a term ending: 12/31/2023.
If you are unable to accept this appointm ent, or have any questions, please call the Office of the City
C lerk at 305.673. 7 411.
P lease read the encl osed m aterials carefully as they concern your duties, responsibilities, and
requirem ents as a board or com m ittee m em ber.
C ongratulations again and good luck.
R egards,
R afa el G ranado
C ity C lerk
cc: M onica Beltran, Parking D irector
Lana Hern andez, City Li aison
ENCLOSURES:
O ath of O ffi ce/O ath of C ivility/A cknow ledgem ents
C ity C ode/O rdinance section applicable to agency, board or com m ittee
C ity C ode S ection 2-22, 2-23, 2-24, 2-25, 2-26, 2-458 and 2-459
O rdinance No. 2006-3543 - Amendment to C ity C ode S ection 2-22
M iam i-Dade C ounty C ode S ection 2-11.1 - C onflict of Interest and C ode of Ethics
C ity Wi de P erm it Application - (Par kin g Departm ent Form )
Book let - G ui de to the S unshine A m endm ent and C ode of Ethics for P ublic O fficers and E m ployees
1B
City of Miami Beach, 1/OO Convention Coner Dive, Miami Boach, Florida 33 139 yyywwy._miamibaachfl_gov
OFFICE OF THE CITY CLERK, Rolaol E. Granado, City Clerk
Tel: 305.673.7411, fax. 305.673.7254
Email: City Clerk@miamibeachf l.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Ms. Arian a Hernan dez-Reguant
RE: Human Rights Committee
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
a ctions taken and all communications made by me as a public servant.
I ha ve b e e n issue d a co py o f se ction 2-1 1 .1 of the M ia m i-D a de C o un ty Code (Conflict of Interest and
C o de o f E thics O rdina nce), a s w ell a s F lo rid a C o m mission on Ethics Guide to the Sunshine Amendment
a nd C o de of E thics fo r P ub lic O fficers a nd u nd e rstand 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
S tate o f Flo rida (de pe nd ing on the b oard o r com m itt ee o n w hich I serve) o n Ju ly 1s t, fo llow ing th e cl o sing
o f the cale nda r yea r on w hich I have se rv e d.
M s. A ria na H e rn a ndez-R egu an t
S w orn to a nd subscribe d before m e this
*P le a se visit the C ity of M ia m i B e a ch w e b site a t w w w .m ia m ib e a chfl.g o v u n d e r C ity C le rk/B o a rd an d
C om m itt ee s fo r a dd itio na l inform atio n rega rding the Fina ncia l D iscl osure R equirem e n ts.
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
O FFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
RECEIVED
FEB 3 2022
CITY OF MIAMI BEACH
OFFI CE OF THE CITY CLERK
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
STATE OF FLORIDA
COUNTY OF MIAMI-DADE
l am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4), as (check
(/) all that apply):
X lam a resident of the City of Miami Beach for six months or longer.
ome Aaaress "1Poe"+1Nam"em
I have an ownership interest (for a minimum of six months) in a business established in the City of
Miami Beach (for a mínimum of six months).
Name of Business -----------------------
Business Address -----------------------
n 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 o
Business Address _
"Own ership Interest" means the own ership 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. /f. tP~. __ F_e_b_3_, _20_2_2 _
si@naure "j- öae
Ariana Hernandez-Requant
Printed Name
NOTARY
Sworn d (or affirmed) and subscribed before me, by means of e physical presence or e online notarization,
«.3 f@ a2Zs» Bria tenun dcz - Ke4us
(City of Miami Beach Board/Committee Member).
Produced ID
- Form of Identification
5__Persone o,)2__ 11, 7l # P. pl út (NOTARY SEAL)
Name of Notary, Typed, Printed, or Stamped
MIAMI-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 First Name Middle Name/Initial
2021 Hernandez-Reguant Ariana
Mailing Address - Street Number, Street Name, or P.O. Box
7921 Byron Avenue
City, State, Zip
Miami Beach, FL 33141
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.Ll
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 Z] Municipal: Miami Beach, FL
(Municipality)
Board where serving
Human Rights
Alternate address (if home address is exempt) I Work telephone I Term began on/ended on
305.209.0722 1.21.2022-
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
Unemployment Compensation 7921 Byron Ave, Miami Beach, research services and art
Fl practice halted by pandemic
I hereby swear (or affirm) that the information above is a true and correct statement. 82
Signature of Person Disclosing
Feb 3, 2022
Date signed
RECEIVED BY ELECTIONS DEPARTMENT:
[] Hardcopy 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
MIAMIBE
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfl.goy
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfL.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)
Hernandez-Reguant Ariana
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 thHrf.;9,ªY= jail, or ""
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 DRAFTSIBOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
M IAM I
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeach[l,gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfL.gov
Telephone: 305.673.7411
DIVERSITY STATISTICS REPORT
Hernandez-Reguant Ariana
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:
JMate
[l 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
Ll 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?
Ll ves
N o
O I prefer not to answer.
Do you consider yourself Physically Disabled?
ves
l o
Lt prefer not to answer this question.
Page 6 of 6
F:\C LER \$A LL\R E G \BO A RD A ND C O M M ITT E E A P P LI CA TIO NS FINA L D R A FTS\B OA RD A N D COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020