Lourdes Oroza 12/31/23M IAMI BEACH
BO A R D A N D COM M ITTEE C H EC K LIST
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FOR CLERK STAFF
o Letter of Appointment
o Letter of Reappointment · "85; %9$38%yr7corers
o Bo rd and Co mittee Application (Completed O lI
o Résumé/Curriculum Vitae r')/ 7z "')_,,r)
o Diversity Statistics Reporting (Completed on_-Cr )7/>
º Oath
REC EIV ED
FEB -7 2027
C ITY O F M IA M I B E A C H
O FF IC E O F T H E C ITY C LER K
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
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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 Requirement
Scanned on:
I. O Di::RSITY STATISTICS REPORTING
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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 p ublic service and safet y to all who live, work, and play in our vibrant, tropical, historic community.
MIAMI BEACH
City of Miami Beach, 7O0 Convention Conter Drive, Miami Bach, Tlorida 33139 wy _miamibachll.goy
OFFICE OF IHE CITY CLERK, Raf0ol E. Granado, City Clerk
Tel: 305.673.7411, Fax. 305.673.7254
Email: CiNyClerk@miamibeachfl.gov
January 25, 2022
Dr. Lourdes Oroza
5825 Collins Avenue, #10F
Miami Beach, Florida 33140
SUBJ ECT; Marine and Water front Protecti on Authority
Congratulations! You have been reappointed by Commissioner Steven Meiner 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: December 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. 7 411. Please read the enclosed materials carefully.
Congratulations and good luck.
Regards,
Rafael Granado
City Clerk
cc: Monica Beltran, Parking Director
Kenneth Varela, City Liaison
ATTACHMENTS:
Letter of Appointment
Oath
City Code/Ordinance section applicable to agency, board or committee
City C ode S ection 2-22, 2-23, 2-24, 2-25, 2-26, 2-4 58 and 2-459
O rdinance N o. 2006-3543 - Am en dm en t to C ity C ode S ection 2-22
M iam i-Dade C ounty C ode S ection 2-11.1 - C onfl ict of Interest and C ode of Ethics O rdinance
C ity W ide P erm it Appl ication - (Par king D epartm ent Form )
Book let - G uide to the S unshine A m endm ent and C ode of Ethics fo r P ublic O fficers and E m ployees
MIAMI BEACH
City of Miami Beach, 1/OO Convention Conlet Drivo, Miami Beach, Florida 33 139 yaw_miaInibca chf].gov
OFFICE OF THE CITY CIERK, Ralaol E. Granado, City Clerk
Tol: 305.673.7411, Fox. 305.673.7254
Email: CiyCl etk@mi amibeoch fl.gov
Oath o Offioo
Oath of Civility
and
Acknowledgements
TO: Dr. Lourdes Oroza
RE: Marine and Waterfront Protection Authority
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
of the calendar year on which I have served. es
Sworn to and subscribed before me this
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.
MIA}I BE
City of Miami Beach
1 700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
RECEIVED
FEB -7 2022
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411 C ITY O F MIAMI BEAO
OFFICE OF THE CITy ¢
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH "ERK
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):
✓I am a resident of the City of Miami Beach for six months or longer.
or e aaare.._ _589C>//ins/he ho 7 yo
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).
[Jar (f [IS,][es,5-
H1IS,][,, J (]fes-
o 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).
[qr (f 1],/[es5
[1y,[[e,, l (]fes,-
"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 association.
are that I have read the foregoing document and !?the facts stated in it
2e - o/7/022
Signature Date 7
looroles Croza-
Printed Name
NOTARY
swam to ( or affirmed) apd subscribed before me, ¡ means oÌ~~ysi':"I presence or o online notarization ,
o.Za.b ucp 2. _ardes @roza
/(~l" of Mtf j(B~~ ~asrd/Com¿;e ::~:: ~ ri-9.,.,!! ... ~ ... -!!!!!!CHARlE!'!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!~ >< Produced ID /.J" VV"° ~ ,r '-"-" i~¿'·~-;. SJ.OAGOSTIN 5si i¿ MY COMMISSION # HH 165705
Form of Identification "}; ¿$? EXPIRES: Docamber 14, 2025
"%ii?" Bonded Thru Notary Pubic Undenwtors
(NOTARY SEAL)
Signat
/\/\IAM IBEA H
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
DIVERSITY STATI STICS REPORT
O 0 Z A lo o roes • 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.
G end er:
Lale
I remale
loner
O I prefer not to answer.
R ace/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.
D o yo u co nsid er yo urself to be Sp anish, H isp anic, or Latino/a?
áv,
l o
O I prefer not to answer.
D o yo u co nsid er yourself Physically Disabled?
ves 0A o
O I prefer not to answer this question.
Page 6 of6
F:\CLER\$ALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
MAM«BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfl.goy
OFFICE OF THE CITY CLERK
Email: B C @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)
l.oordes • Last Name First Name Middle Initial
I understand that no later than July1,of each year all member s of Boards an d Committees of the City of Miami
Beach, including those of a purely advisory nature, are required to comply with Miami-Dade County Financial
D is c lo su re R e q u ire m e n ts .
One of th e fo llo w in g fo rm s 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 "S ta te ment of Financial Interests (Form 1)1" or
3. A Copy of your latest Federal Income Tax Return.
Failure to file o n e of th e se for m s , p ur s u an t to the M ia m i-D ade County Code, may subject the person to a fine
of no mo $500, 60 da · · · or both.
oa/az/o2
Date '
1 Member s 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 of6
F:\CLER\$ALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
MIAMIª EE SOURCE OF INCOME STATEMENT
Section 2-11.1 (i) of the County Ethics Code requires that certain employees and public officiais 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/Initiai
2021 0A0ZA l.oordes M.
Malling Address - Street Number, Street Name, or P.O. Box
6825 Collins Ave at. /oE
ciy, state, zw ·, ¢
ami eac FL 33//0
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 E] Municipal:
(Municipality)
Department
Position or Title Employee ID Number
Work address I Work telephone Employment began on/ended on
Filing as a B oard M emb er (check on e)
[] county [] Municipal: Ci/yo tao; 0each
(Municipality)
B oard w here serving
Mariné and tlaero / 7%
A lte rn ate address {If hom e address Is exem pt) Work te lephone Te began on/ended on
7G n. oa2
List below every source of incom e you received, along w ith the address and the principal activity of each source. Include your public salary. Place the sources of
incom e in descending order, w ith the largest source first. Exam ples of sources of incom e include: com pensation for services, incom e fro m business, gains fro m
pro pert y dealings, interest, rents, dividends, pensions, IRA distributions, and social security paym ents. A lso, include any source of incom e received by an other
person for your benefit. How ever, the incom e of your spouse or any business part ner need not be disclosed. If contin ued on a separate sheet, ch eck here.L_]
N am e of S ource of Incom e A ddress Descripti on of the P rincipal Business A ctivity
Flrial, Re hireent Tallahassee, FL acerr e ?j e ' 5rs/em To n d minis, Yo hr
5-ea/ 6eorily
Pe n s io n
affirm) that the information above is a true and correct statement.
Si gnatu re of Pers on D~clos lng ~
oa/o7/ca2
D ate signed
RECEIV ED BY ELECTIO NS DEPARTM ENT:
O Hardcopy
) pectromie ci, CEIVED
FEB -7 2022
CITY OF MIAMI BEACH
REMEMBER TO PRINT, SIGN, AND SUBMIT TO THE OFFICE OF THE CITY CLERK VIA EMAIL OR HARDCOPY.
//\áA//\/BE, (CI cwE (Cw OARD & COMMITTEES
City of Miami Beach, PARKING DEPARTMENT PARKING APPLICATION
1755 Meridian Avenue, Suite 200/Miami Beach, FL 33139/Ph: (305) 673-7505 or (305) 673-7000 ext. 6200
A ci tyw id e (C W ) p a rkin g p e rm it is ho n o re d a t m e te re d p a rkin g 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
in fo rm a tio n m a y le ad to th e issu a n ce o f p a rkin g ci ta tio n (s) a n d /o r the to w in g o f you r ve h icl e .
Ple a se no te th a t th is ne w a cce ss ca rd CANNOT be hole-punched or perforated in any manner. To use
th e ne w car d p le ase ho ld th e ca rd a t cl o se p rox im ity to th e re ad e r un til the g a te ope n s. Y o u m a y ne e d
to try the o th er sid e o f th e car d . Ple ase e n su re you ho ld the e n tire su rfa ce o f th e ca rd a g ainst 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.
B o a rd M em b e r In fo rm a tio n
Date of Application: Erary 7 , 2022
Applicant Name: o orat es Oro2o-
Board/committee Name: Marine ano l er bony Fok5fyn 90yri'},
Address: 6826 Collins Poe 9ph or //ami' ach a3/o
E-Mail Address: 0Roz.@O belsooY. ne7
Work Phone: /A Home Phone -
Cell Phone: 78 6 - 674-767 Preferred Contact Method: emoil
V eh icl e In fo rm a tio n
to 37J 23 Color:
State: Flor ida. Year: 20 /3
Make: Lincoln Model: MKZ t obriot
Applicant Si«nature: 5
Please provide signed form to the Parking Department lo fed at 1755 Meridian Avenue, 2" floor. Working
hours are 8:30 to 5:00 p.m. or email to: P a rk in g R ece p tio n @ m ia m ib e a ch fl.g o v
e -m a il su bi ect: B O AR D & C O M M ITTE E P A R KI N G A P P LI C A TIO N - A PP L I C A N T N A M E
P k' D rt ar' mna ea men ec'ion
PERMIT SYSTEM GARAGE ACCESS
Expiration Date: ID Card Serial #:
Issued By Print Name: Print Name:
Signature: f Signature: f
Date Issued: Date Completed:
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