Marcella Novela 12/31/23M IA M I BEACH
BOARD AND COMMITTEE CHECKLIST
era«e tlacgyI A'bel swovo"-9%22%,
oARorcowurrees_[\,l i Rlc \laceo»otea y. (41j o7.Syo/
2" "22... soso»./2///3ron./2/3/23
Scan o o Letter of Reappointment
o ,C~ o/ L~O~ointment/Reappointment ~~ailed to Committee Liaison on
Scan o o dar and öbmmittee Application (Completed on ~ )
Scan o o Résumé/Curriculum Vitae 0 7 ~ / · rJ ')
o Diversity Statistics Reporting (Completed on2/ /±)Oz>
Scan o o Oath , 7
IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
✓City Code Ordinance Section applicable to the agency, board or committee
RECEIVED " ci ty 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) FEB -9 2022 Amendments to the Code of Ethics Ordinance (September 2009 through July 2012)
t Highlights of the Miami-Dade County Ethics Code
✓Sunshine Law and Public Records - Frequently Asked Questions
CITY O F M IA M I BE A C H ✓Memorandum- Solicitation by City Board and Committee Members
OFFICE OF THE CITY CLERK
O Citywide Permit Application (Parking Department Form)
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 Disclosur
O DIVERSITY STATISTICS REPORTI N
Rece»ea o_Q\2)22 _sones. ,=?u Day am
roes.a./_/_l _re w oree Á. k....
Scanned on: J-../ CJ ¡e J-9-. By Employee:
Date 35a5 3 $gn,pg.
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.dccx
We ore committed to providing excellent bl so d f »llh I put hc service anc salety to ol ho live, wo rk, and ploy in our vibrant, tropical, historic community
MIAMI B EA C H
City of Miami Beach, I/OO C onv ention Co nt er Divo, Mi ami Boach, Eonida 33 139 wyw._miamiboachllgo
OFFICE OF THE CIIY CIERK, Rafaol E. Granado, Cy Clerk
Tel: 305.673.74H1, fax 305.673.7254
Emal: CityClerk@mlamtbeachfl.gov
O a th o f O ffi c e
O a th o f C iv ili ty
and
A c kn o wl e dgem en ts
TO: Ms. Marcella Novela
RE: Art in Public Places 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
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 Jul 1st, following the closing
of the calendar year on which I have served.
Ms. Marcella Novela
Sworn to and subscribed before me this..,...., __ day 0~2022
"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.
MIAMI 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 -9 2022
CITY OF MIAMI BEACH
OFFIOF OE F 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):
{ lam a resident of the City of Miami Beach for six months or longer. ors A«es q \2 Haon qo Que
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).
[arfe tf H,1fes-
1y,1mes,, l(]fes5
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).
[ame (f [31y,1fes,j-
y,1fes,S, J(]([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.
e lare that I have read the foregoing document and that the facts stated in it
Signature
ljae ella Movel«
Date
ntG
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of o physical p~es7nce or □inline notarization,
22a«Yr1022. el]9 \Jovel
sêj#., Ris n.sosrw
? ¿,¿ MY COMMISSION # HH 165705
%%3;; gé EXPIRES: Docomber 14, 2025 V' s" pa,a ·,
kt"" Bon ded Thru Notary Public Underwrleng
Produced ID
i Beach Board/Committee Member ). ¡u rose
Sig (NOTARY SEAL)
M IA M I BEACH
C ity of M ia m i B e a ch
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfl.gov
OFFICE OF THE CITY CLERK
Em ail: BC @ m iam ibeachfl.gov
Telephone: 305.673.7411
DIVERSITY STATISTICS REPORT
Last Name
i acella e
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 e n d e r:
ate
LA rem ale
O Other
O I prefer not to answer.
R ac e /E th n ic C a te g o rie s :
W ha t is yo u r rac e?
O African American/Black
O Asian or Pacific Islander
ES Caucasian/white
O Native American/American Indian
O Other - Print Race: _
O I prefer not to answer.
D o yo u co n s id er yo u rs e lf to be S p a n ish , H isp anic, or Latino /a?
p v.
I No
O I prefer not to answer.
D o yo u co n s id er yo u rse lf P hy s ically D isab led ?
vas
•• to answer this question.
F ICLER l$ALLIREG18 Page 6 of 6
U. d t d OARD AND COM M ITT EE APPLICATIONS FINAL DRA FT SIB OARD AND COM MITT EE APPLI CATIO N REG FINAL doc x p a e : Ju n e 2020 ·
M IA M I BEACH
City of Miami Beach
l 700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfl,gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl gov
Telephone: 305.673.7411
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) Liu rnG - Last 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 file d 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)';" or
3. A Copy of your latest Federal Income Tax Return.
ne of these forms, pursuant to the Miami-Dade County Code, may subject the person to a fine
, 60 days in jail, or both.
Date
' 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 0f6
F ACLERALL RE GBOARD AND COMMIT TEE APPLICATIONS FINAL DRAF TSBOARD AND COMMITTEE APPLICATION REG FINAL docx
Updated: June 2020
M IA M l·llÄDE • EEIII
Clear From Print Form
SOURCE OF INCOME STATEMENT
Section 2-11.1(l) 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.
Dlsclosure for Tax Year Ending Last me \ Arst Name Mlddle Name/Initiai
2o21 OU2I O L
Malling Address - Street Number, Street ame, or P.O. Box
p] ve
If your home address Is your malling 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 Empl oyee (check one)
[] coun ty O Public Health Trust [] M uni cipal :
(Municipality)
Departm ent
Po sition or Ti tle Em ployee ID Num ber
W ork addres s I Work telephone Em ploym ent began on/ended on
Fling as a Board Member (check one)
D County w no»te luan (ea]
(Municipality)
Al te rn ate addres s (if home addre ss Is exempt) Work telephone T n
2-
List below every source of income you received, along with the address and the principal activity ot 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
prop erty dealings, Interest, rents, dividends, pensions, IRA distributions, and soclal security paym ents. Also, Include any source of income received by another
person for your benefit. However, the income of your spouse or any business partn er need not be dlsclosed. If continued on a separate sheet, check here.L_]
Name of Source of Income Addre ss Description of the Prfnclpal Business Activity
(ollari 004a. a( O. [\H
ear (or al ¡rm) that the Information above ls a true and correct statement.
Date si gne d
c v sv TFPf)E /E
O Hardcopy
() lectromie copy3 -9 20922
CITY OF M IAM I BEACH
OFFICE OF THE CITY CIERK
REMEMBER TO PRINT. SIGN. AND SUBMIT TO THE OFFICE OF THE CITY CLERK VIA EMAIL OR HARDCOPY
±4g4.±£.g.E; Il
1755 Meridian Avenue, Suite 200/Miami Beach, FL 33139/Ph. (305) 673-7505 or (305) 673-7000 ext. 6200
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 oreas. 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: Ü I -
Applicant Name: )/\A
Boord/Committee Name:
Address:
E-M a il Address:
Work Phone:
Cell Phone: 7
Vehicle Information
Tag:
State:
Make:
Preferred Contact Method:
o Color:
Year:
Model:
Applicant St+nature:
Please provide signed form to the Parking Department located at 1755 Meridian Avenue, 2d floor. Working
hours ore 8:30 to 5.00 p.m. or email to: ParkingReception@miamibeachfl.gov
e-mail subiect: BO A RD & CO M M ITTE E PAR KING A PPLICATI O N - APPLICANT NAME
P, ·i D ar' mna epartment ection
PERMIT SYSTEM GARAGE ACCESS
Expiration Date: ID Card Serial #:
Issued By Print Name: Print Nome:
Si gn at u re: 6 Signature: 6
Dote Issued: Date Completed:
s
Pol icy Number:. 5400-019725
f?
ternate
H ea th P la 1-8 14 00-00
M em bertD : _Gr o ur lumber. ·00 8868
TUMRx'
IN., 819279
C N:. 9999
P: UGRI