Sandra Martin 12/31/23MIAMIBEA CH
APPOINTEE:
BOARD AND COMMITTEE CHECKLIST
S AN D R A_M AR TI N_ _Ar or Arron»er. /_61022-
1
S c an o
BOARD/COMMITTEE: FOR WOMEN Appointed by:Commisioner David Richardson
ge "%2... .lb3,o.l2/3/07
S can o o Letter of Reappointment "g"/$/1 9Py3/eromeos»rennet ·m e« e crsrote» as s
o Board and Committee Application (Completed on, )
• esumercumcuor veé 2/ j/
o Di v ersi ty Statistics Reporting (Completed on_CC/ u yU a;
o Oath· 7
S can o
S c an o
RECEIVED
FEB 11 2022
CI T Y OF MIAMI B E A C}
O FFI C E OF THE CITY CL ER
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
o Citywide Permit Application (Parking Department Form)
o Booklet - Guide to Sunshine Amendment & Code of Ethics for Public Officers and Employees
S can o
S c an o
CONCLUDED & RESIGNATION LETTERS
Term Expired Letter Date Processed Initials S c an o
Resignation Letter Date Processed Initials S c an o
Removal Letter due to absences Date processed Initials S c an o
F:CLER\BOARD AND COMMITTIES DATABASE\CHECKLIST MASTER\B&C Checklist 2015 MASTER.docx
We ave committed to oroviding excellent pubic service ad safety to all wno iive, wosk and play in our vibrant tropical, historic community.
MIAMI BEA CH
City of Miami Beach, 1/OO Corvonlion Conter Dio, Miami ßoach, Florida 33 139 www.miam!bgachll.goy
OFFICE OF THE CITY CIERK, Rolaol E. Grando, City Clark
Tol: 305.673.74I1, Fox: 305.673.7254
Email: CilyClork@miamiboachll.gov
February 08, 2022
Ms. Sandra Martin
5701 Collins Avenue, Apt 41 O
Miami Beach, Florida 33140
SUBJECT; Miam i Beach Commission For Women
Congratulations! You have been reappointed by Commissioner David Richardson 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 305.673.7411. Please read the enclosed materials carefully.
Congratulations and good luck.
Regards,
Rafael Granado
City Clerk
cc: Monica Beltran, Parking Director
Monica Matteo-Salinas, City Liaison
ATTACHMENTS:
Letter of Appointment
Oath
City Code/Ordinance section applicable to agency, board or committee
City Code Section 2-22, 2-23, 2-24, 2-25, 2-26, 2-458 and 2-459
Ordinance No. 2006-3543 - Amendment to City Code Section 2-22
Miami-Dade County Code Section 2-11.1 - Conflict of Interest and Code of Ethics Ordinance
City Wide Permit Application - (Packing Department Form)
Booklet - Guide to the Sunshine Amendment and Code of Ethics for Public Officers and Employees
MIA M\I BE A C H
City of Miami Beach, 1ZOO Convention Canter Drive, Miami [oach, Florida 33 139 yyw_miaribcachll.go
OFFICE OF THE CITY CIFRK, Rafael E. Granado, Cy Clark
Tal: 305.673.7411, Foxe 305.673.7254
Emal: CiyClerk@miamtbeachfl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Ms. Sandra Martin
RE: Miami Beach Commission For Women
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 en din g: 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) or Jul 1st, following the closing
of the calendar year on which I have served.
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.
MI A MI BE A CH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florido 33 1 39
OFFICE OF THE CllY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
RECEIVED
FEB 11 2022
CITY OF MIAMI BEACH
OFFICE OF TH E CITY CLERK
A F FIDAVIT 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):
t lam a resident of the City of Miami Beach for six months or longer.
Home Address 5701 COLLINS AVE APT 410 MIAMI BEACH FL 33140
"' 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 ESTRELLA INSURANCE
Business Address 1321 ALTON RD MIAMI BEACH El 33139
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 P1[S,[@Si
[[[[mes,g (]Hf@Si
"Ownership Interest" means the ownership of ten perçent (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.
eclare thatl,have read the foregoing document and that the facts stated in it 2-- 02/11/2022
Signature
Sandra Martin
Date
Printed Name
NOTARY
Sworn to (or affirme ) and subscribed before me, by means of~ysical presen~line notarization,
» /la»si _2a Sul4 nt4e hi/
> Produced ID
(City of Mi ami Beach Board/Committee Member).
Z u?s L1se
Form of Identification
onally Known
(NOT ARY SEAL)
Sig gèif¿, CHARLES J. DAGOSTN
$$'4"; McouMussIoN NH 1os7os
%¿,gda.lg ExPREs: Decambor 14, 2025
"·GR2$' Bonded Thru Nolarv Public Underwriters i¡i v a
M IAM I BEACH
City of Miami Beach
l 700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfl.gov
OFFICE OF THE CITY CLERK
Email: BC@miamìbeachfl.gov
Telephone: 305.673.7411
DIVERSITY STATISTICS REPORT
MARTIN
-------------,~-- Last Name
SANDRA N
First Name Middle Initial
The following information is voluntary and has no bearing on your consideration for appointment. It is being
asked to comply with City diversity reporting requirements.
Gender:
Male
[l remale
other
O I prefer not to answer.
Race/Eth nic Categories:
What is your race?
O African American/Black
O Asian or Pacific Islander
L.} Caucasian/white
O Native American/American Indian O Other- Print Race: _
O I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
l ves
No
O I prefer not to answer.
Do you consider yourself Physically Disabled?
ves go
O I prefer not to answer this question.
Page 6 of 6
F:\CLERl$ALLIREG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL docx
Updated: June 2020
M IA M I BEACH
City of Miami Beach
17 0 0 C onve ntio n C enter D rive
Miami Beach, Florida 33 13 9
www.miamibeachfl.goy
OFFICE OF THE CITY CLERK
Em ail: BC @ m iam ibeachfl.gov
Te lepho ne: 3 0 5.6 7 3.7 4 11
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)
MARTIN SANDRA N
Last Name First Name Middle Initial
I understand that no later than Jul 1 of each Vear 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.
fthese forms, pursuant to the Miami-Dade County Code, may subject the person to a fine
O, 6 ys in jail, or both.
02/11/2022
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:\CLER\$ALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTSIBOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
MIAM I-LE. EIII 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 I Last Name First Name Middle Name/initial
2021 MARTIN SANDRA N
Mailing Address - Street Number, Street Name, or P.O. Box
5701 COLLINS AVE APT 410
City, State, Zip
MIAMI BEACH FL 33140
-
If your home address is your mailing address, and your home address is exempt from public records pursuant to Fla. Stat. $119.07, read
instructions on the following page and check here. O
Filing a
E] county [] Municipal:
Department
Position or Title
Work address
Employee ID Numb er
Work telephone
Filing as a Board llember (ch e ck one)
D County .. () R í@ar
[] Municipal:- ' y ' y.fr' y t 1 (Municipality)
Board where serving Coi$S )oov o
Alternate address (if home address is exempt) Work telephone Term began
2
/ended on
2 0 2 2
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 .
FRANCHISE OWNER ESTRELLA 1321 ALTON RD MIAMI BEACH FL 33139 INSURANCE AGENCY INSURANCE
,. ····--
-·-
I hern by sw ea (m lli att he.i~fo cma tirn 1 ab'!'' is a true and correct statemen t.
Signa
Date sign ed
c ive sY 4.EgT9N$ KPRNr-
J aracoE ElVED
[] Electronic Cop y
FEB 11 2022
CITY O F M IAM I BEACH
OFFICE OF TH E CITY CL E RK
OFFICE USE ONLY Accepted: Y I N Deficiency:- Processed Date/initials: Scanned Date/Initials:
138 SP-14 COE 2016
/\I/AMI BEACH CIwe (CW) OARD & COMMITTEES Iii cwy of Meri sea+, PAR«no ArrNr PAR KI N G PP[[CATION
1755 Meridian Avenue, Suite 200/Miami Beach, FL 33139/Ph: (305) 673.7505 or (305) 673.7000 et. 6200
A citywide (CW) parking permit is honored at metered parking spaces and restricted residential zones
parking spaces. A CW parking permit 15 NOT honored in prohibited areas. An Access Card will be
provided to you for City Hall Garage (G) access.
IMPORTANT NOTE: Your vehicle license plate serves as your "parking permit", In order lo avoid
any unnecessary enforcement actions, íl 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 citalion(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 gale opens.
ACKNOWLEDGEMENT: l acknowledge that should my access card be lost, stolen or
damage, I w ill be responsible to pay a $10.00 replacement fee.
Bo a rd M em ber Inform ation
Date of Application: 02/11/2022
Applicant Name: Sandra Martin
Boord/Committee Name: FOR WOMEN
Address: 5701 COLLINS AVE APT 410 MIAMI BEACH FL 33140
E-Mail Address: sandra.martin@estrellainsurance.com
Work Phone: 305 534 9434 Home Phone
Cell Phone: 786 514 7175 Preferred Contact Method: cell
V ehicl e Info rm ation
Tag: GBJW49 Color: SILVER
State: FLORIDA Year: 2021 -
Make: HONDA ( .j - Model: HRV
Applicant Sianature: e -1
Please provide signed form to the'Párking Department located at 1755 Meridian Avenue, 2d floor. Working
hours are 8:30 to 5:00 p.m. or email to: ParkingReception@ m iam ibeachfl.gov
e-m ail subj ect: BO A RD & CO M MI TTE E PARKI NG A PPLICATIO N - AP PLICA N T NAME
Pa rk in a D e p a rt m e n t Se cti o n
PERMIT SYSTEM GARAGE ACCESS .
ID Card Serial #: Expiration Date:
Issued By Print Name: Print Name:
Signature: 6 Signature:
Date ls ued: Date Completed:
.
MO4 \?man or rors to ads&commtrees part9tort.do form UO+ta t/ Of Utt