Grace Calvani 12/31/23MIAM/B
BOARD AND COMMITTEE CHECKLIST
weoree hyace, (glvani
soARorcow rr eEe }pc [ff~us
12/22/2021
DATE OF APPOINTMENT: _
#lle y Retarle>
FOR SCANNER
Scan o
Scan o
Appointed by: (J1l/tn -
TERM END. 12/31/23 FOR CLERK ST AFF
o Letter of Appointment
o Letter of Reappointment
° Y%%%59/3///R o' Appointment/Reappointment e-mailed
s Boar@ an Committee Aplication (completed on_" I
o Résumé/Curriculum Vitae 2/3/2022
o Diversity Statistics Reporting (Completed on I
o Oath
TERA LIMIT:
12/31/25
to Committee Liaison on
Scan
Scan o
Scan o
IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
t 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
Received February 3, 2022/ county Code Section 2-11.1 -- Conflict of Interest and Code of Ethics Ordinance (as
Office of the City Clerk amended through December 2010)
✓Amendmenls to the Code of Ethics Ordinance (September 2009 through July 2012)
Highlights of the Miami-Dade County Ethics Code
t Sunshine Law and Public Records -- Frequently Asked Questions
✓Memorandum - Solicitation by City Board and Committee Members
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 DIVERSITY STATISTICS REPO ep COPY
2/3/2022 X
Received on. Signed by ",4dfé{tu'.
Date {oard or Cor {mittee Member
2/3/2022 O,,J,, 732A
Processed on: B y Employed;/0d, Y P0duh>
ae o,Ci geiris offe,sei injai
2/7/2022 Chaoa l?'goan
b y Employee. (/
Date City Clerk's Office Staff Initials
Scan o
Scan o
Scanned on:
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 COMMIT TIES DATABASE\CHECKLIST MASTER\B&C Checklist 2015 MASTER doc
C ity of Miami Beach, !OO Convention Canter Driva, Miami Booch, Horida 33 139 yNxwy_miamibachfl_go
OFFICE OF THE CITY CLERK, R0fol E. Granado, City Clerk
Tel: 305.673.7411, Fox. 305.673.7254
Email: Ci#yClerk@miamibeachfl.gov
December 21, 2021
Ms. Grace Calvani
4337 Sheridan Avenue
Miami Beach, Florida 33140
SUBJECT: Hispanic Affairs 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
C ity C ode or o f a ny resolutio n, com m e nci ng w ith term s be gin ning o n or a fter Jan uary 1, 20 07 , th e term of
e very boa rd m e m b e r w ho is d irectly a p po inted by a member of the City Commission shall automatically
e xpire u p o n th e latt er of: D e cem b e r 31 o f the yea r the a p p o in tin g C ity C o m m issio ne r le a ves o ffi ce o r
upon the a ppointm e n t/electio n o f th e successo r C ity C om m issio n m e m b er."
If yo u are u n a b le to a ccept this ap p o intm e nt, or h a ve a ny que stio ns , p le ase ca ll the O ffi ce o f the C ity
C lerk at 30 5.6 7 3. 74 1 1. P lea se rea d the encl osed m ateria ls care fu lly.
C ongra tulatio ns a nd good luck.
"7e
RlG,anado
C ity C le rk
cc: M o nica B e ltran, P a rkin g D irector
L eo no r H e rn a ndez, C ity Li a iso n
ATTACHMENTS:
Lett er of A ppointm e n t
O ath
C ity C ode/O rdina nce section applicable to age ncy, b oa rd or co m m itt ee
C ity C o de S e ct io n 2 -22 , 2-2 3 , 2 -24, 2-25, 2 -26, 2-45 8 an d 2 -4 5 9
O rdina nce N o . 2 0 06-354 3 - Am en dm e nt to C ity C ode S ect io n 2 -22
M ia m i-D a de C o unty C o de S e ction 2-1 1.1 - C on flict of Interest and C ode of E thics O rdina nce
C ity Wi d e P erm it Application - (Pa rkin g D e part m e n t F orm )
B ookl et - G uid e to the S unshine A m e nd m e nt a nd C ode of E thics fo r P ub lic O ff icers a nd E m p loyees
City of Miami Beach, /0O Corvoln ontr Dro, Mami Boa.h, Hlrd 33139 gr2¿y_aigu_il_gLl] g
OHICE OF HE CIIY CIERK, Ralaol L Granado, Ciy Clod.
Il: 305.67/3.7411, fox. 305 673./254
(mal. CiiyClorkhlomibeoc hfl qov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Ms. Grace Calvani
RE: Hispanic Affairs Committee
l 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
of the calendar year on which I have served.
Swor to and subscribed before me @ 3rd aayq Feb ,go22022
Ciac 'geti-
Charles D'Agostin
Deputy Clerk
Please visit the City of Miami Beach website at www.miamibeachfl.gov under City Clerk/Board and
Committees for additional information regarding the Financial Disclosure Requirements.
/I
City of Miami Beach
1700 Convontion Conter Divo
Miami Beach, Horida 33139
OF FICE OF TH E CIIY CLERK
Emat BC@mamboachi ao
Telephono. 305 6 73.7411
Received February 3, 2022
Office 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 tho affiliation requirement of Miami Beach City Code Sections 2-22 (4), as (chock
(/) all that apply).
@e l am a resident of the City of Miami Beach for six months or longer.
voe «a.. 1337Cheda Arc, at let oar0
I
a Ihave 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)
[jam79 t)[ Pp1Pg5b}on«on«noon«no««
P91p9SS (Hf,,or«or»
) lam a full-time employee of a business (for a minimum of six months) and l am based in an office or
other location of the business that is physically located in Miami Beach (for a minimum of six months).
[[qr9 )[ P{11mgSj.
P1151eSS, (]Hf9si
"Ownership Interest" moans tho ownership of ton porcent (10%) or more (including tho ownorship of
10% or more of the outstanding capital stock) in a business.
Business" moans any solo prop riotorship, sponsorship, corporation, limitod liability company, or other
entity or businoss association.
Under pt " ·re that l have read the foregoing documet mnd that the facts stated in it
are rue • I 12.) 0021-
ooooolona Signatut Date I lee Ninea ñame
NOTARY
Sworn to (or affirmed) and subscribed before mo, by means of physical presence orX online notarization,
.1?2a January .a22s»_@ea@a"a"
(City of Miami Beach Board/Committee Member).
gee"tee
_,;_F.;;;;,L;,..,. D:;_;_;,ri.,;_ve,;;.;r-''s..,.=L..cic..c.e"'"'n,;:;,.,se,;:,.,..,,. _,., .-~A·:·::~.. CHARLES J. DAGOSTIN
Form of Identification [; ,¿ MY COMMISSION # HH 165705
zjj, ¿gg EXPIRES: December 14, 2025 09p9999y, $0%93)4„te, I%%4%$ 8$% /20d, Y 7d-rt ",jjj8" Bonded Tru Notary Public Underwrit ers
(NO TRY SEAL)
Signature of Notary Public
Charles J D'Agostin
X Produced ID
Name of Notary, Typed, Printed, or Stamped
M IA M l·DAD ♦EI
clear From Print Fommt
SOURCE OF INCOME STATEMENT
Section 2-111() of the County Ethics Code requires that certain employees and putc oluails file a lnancal disclosure Statement on a yealy tass by July 1st
of every year
First Name Middle Name/initial
u ant
Mailing Address - Street Number, Street Name, or P,0. 0 x
1331 hend Ay Ica. sac." k 'ea@l-
It your home address is your mailing address, and your home address is exempt from public records pursuant to Fla Sta! $11907, read
instructions on the following page and check Hele.
Filing as an Employee (check one)
[) couy [] Public Health Trust O M un icipal:
(Municipality)
Department
Position or Title Employee ID Number
Work address I Work telephone Employm en t began on/ended on
Filing as a Board Memb er (check one )
O County Jíoniciat:
(Municipality)
«
Work telephone Term began on/ended on
List below every source of incom e you received, alon g with the address and the prncpal activity of each source Incl ude yout public salary Place the sources of
incom e in descen ding order, with the largest source first Exam pl es o! so urce s of income include compensation for services, incom e from business, gains from
proper ty dealing s, interest, ren ts, dividend s, pen si ons, IRA distribution s, and soaa! secunty paymen ts Also, incl ude an y so urce of incom e received by another
person lot your ben efit However, the incom e of your spo use or any business partner need not be disclosed If continued on a separate sheet, check here. []
Name of Source of Income Address Description ot the Princlpal Business Activity
pg,, h[VS Scad coll f@eat_Go'
V i al '€ 1 rdm1hi'sla +O
'reo.gogna, f", I lb nlt dt biv aeh ne
I hereby swear (or affirm) that the informa tion above is a true and correct statement
Date'signed
RECEIVED BY ELECTIONS DEPARTMENT:
(_}Hardcopy
Electronic Coy
Received February 3, 202
Office of the City Clerk
REM E MB ER TO PR INT, SI G N, AN D SUBMIT TO TH E OFF ICE OF THE CITY CL ERK V A EM AI L OR HAR D C O PY
MI AMI BEA CH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florido 33139
wow.miamibeachll.gov
OFFICE OF THE CITY CLERK
Emoi l: BC@m iami beachfl_gov
Telephone. 305.673.7411
BOAR D & COM M I TTE E FIN AN CIAL ACKNO WLEDGEMENT STATE MENT
A cknow ledgem ent of fines/suspension fo r Board/Com m ittee M em bers for fa ilure to com ply with Miam i-
Dade County Financial Discl osure Code Provision Code Section 2-11.1(i) (2)
Last N al e @oe
First Name Mi ddle Initi al
I un d e rs tand that no later than July_1,o f ea ch year al l m em bers of Board s and C om m i ttees of th e Ci ty of M iam i
Beach , in cl uding th ose of a purel y advis ory nature , are require d to comp l y wi th Mi am i -D ade C oun ty Finan ci al
Di s cl o sure R equi rem en t s.
n g of th e fol lowi ng form s must be filgd wi th th e City Cl er k of Mi am i Beach , 1700 C on ven tion C enter Drive,
M iam i Beach , Florida, no later th an 12.00 noon of July 1, of each year:
1. A "Source of Incom e Statem ent;" or
2. A "Statement of Fi nan ci al Inter e st s (Form 1)!" or
3. A C opy of your latest Fed eral Incom e T ax R eturn .
Failu re to fil e one of these form s, pursuant to the M iam i-D ade County Code, m ay subject the person to a fine
of no m o~r t; $500, 60 ~ int il. or both. , -oo, (u 1/ya/2o 22
Sig nat u re 7 Dale T 7
'M emb er s of th e Pl an nin g Board and Board of Adjustm en t wi ll be notified dire ctly by the St ate of Flor ida,
p u rs uant to F .S. $112.3 145(1)(a ), to fil e a St atem en t of Fin an ci al Int ere sts (Form 1) with the Mi am i -D a de C oun ty
S up erv isor of Elections by 12.00 noon , July 1. Pl an ning Board and Board of Adjustm ent m em bers w ho fil e their
Form 1 wi th th e C ounty Sup ervi sor of Ele ction s aut om atically satisfy the C oun t y's fin an ci al di scl osure
req ui rem ent as a Miami Beach C ity Board/C om m i tt ee m em b er and need not fil e an addition al form wi th th e Of fi ce
of the City C lerk. H ow ever , com pl ian ce wi th th e C oun ty dis cl osure requi rem en t does not satisfy th e Stat e
req uire m ent.
Page 5 of6
F CLERSAL L REG BOARD AND COMMITTEE APPLICATIONS FINAL DRAF TSBOARD AN D COMMITTEE APPLICATION REG FINAL doz,
Updated June 2020
MIAMA' EACH
City o f M ia mi Be ach
1700 Convention Center Dr ive
Miami Beach , Flor ida 33139
ww miam ibeachf].go v
OFFICE OF THE CITY CLERK
Em ail. ç@miamibeachfl_gov
Teleph one: 305.673.7411
DIVERSITY STATISTICS REPORT
{gluai
Last First Nam e Middle Initial
The followi ng inform ation is vol untary and has no bearing on your consideration for appointm ent. It is being
asked to com ply with City diversity reporting requirem ents
G e n der:
y áe
LL{ Female
Cl oner
O I prefer not to answ er.
R ace/Eth nic C ategor i es:
W hat is your race?
O African American/Black
[_l Asian or Paci fic Island er
LK Caucasian/white
O Native Am erican/Am erican Indian O O ther -- Print Race: _
O I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a? e.
N o
O I prefer not to answer.
Do you consider yourself Physically Disabled?
Dc
Ao
O I prefer not to answer this question.
Page 6 of 6
FACLERSALLREGIOARD AND COMMITTEE APPLICATIONS FINAL DRA FTSBOARD AND COMMIT TEE APPLICATION REG FINAL docx
Updated. Jun e 2020
MIA\N/\/B} CwIE (cw) oAD & co»mtees .lg
air siisri ers«s ni««i ve orearc»won PARKING APPLICATION Ik.ES###
\755 Meridian Avenue, Suite 200/Mi0mi eoch, Ft 33139/P (305) 673-7505 01 (305) 6737000 ea 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 Holl Garage (G7) access.
IMPORTANT NOTE: Your vehicle licen se plale serves as your "parking permit". In order to avoid
any unnecessary entorcement actions, it is important that our records rellect the most current and
accurate information regarding your vehicle license plate. Inaccurate and/or outdated vehicle
information may lead to the issuance ot parking citation{s) and/or the towing of your vehicle.
Please note that this new access cord CAN NOT 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 en sure 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 replacem ent fee.
Board Member Information
Date of Ap plication:
A ppl icant Name:
Address:
E-Mail Address:
Work Phone:
Cell Phone: Preferred Contact M ethod: = _
20 Color:
Stole:
Make:
Year:
Model:
Applicant Sianature: 6
Please provide signed form (o 1e Parkin Department located ol 1755 Meridian Aven ue, 2" floor. Working
hours are 8:30 to 5:00 p.m. or émail to: ParkingReeption@migmibeachf[.gov
e-mai l subject: BO AR D & CO M MI TTEE PARKI N G APPLICATIO N - APPLICAN T NAME
Pa rk in D ep a rt m ent Section
PER MI T SYSTE M GARAGE ACCESS
Expiration Dole: ID Cord Seriol #
Issued By Print Name:. Print Name:
Signature:. 6 Signature: 6
Dote Issued: Dale Completed:
415-293-53 '77-.0
1 7/4
10/17/2027
MONE