Beatriz Herrmann 12/31/22- MIAMI BEACH
FOR SCANNER
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FOR CLERK STAFF
o Letter of Appointment
o Letter of Reappointment
° 9,9f,/er of, Appointment/Reappointment_
. la weeneon com »wee4on > ' O
o Résumé/Curriculum Vitae
o Diversity Statistics Reporting (Completed on_!
º Oath
Liaison on
RECEIVED
MAY 19 2022
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 201 O)
✓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
✓
✓
CITY OF MIAMI BEACH ✓
OFFICE E "IE CITY CLERK
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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
Scan o o Acknowledgment of Financial Disclosure Requirement . ¿ O D¡_I ERSITY STATISTICS REPO~ING~eep COPY in file and ORIGl~for Annual Report.
Rece»vean._,_/7_,_2_l _snea»y }2 1-tt"a
] Date Boafd o)Committee Me ber
Processed on: SL //I/~ By Employee: --+--r-1',:,,'---~------------
1 Date I
scanned o: _,/) h-_a moo»yee: 1
r Date
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 public service and safety to all who live, work, and play in our vibrant, topical, historic community.
M IA M I BEACH
City of Miami Beach, 1/OO Convention Conlor Drive, Miam i Boach, Hlorida 33 139 wyy_miamiboa chl]goy
O FF ICE OF THE CITY CLERK, Rof aol E. Gr an ado, City Clerk
Tol: 305.673.7411, Fax. 305.673.7254
Email: CiNyClerk@miamibeachll.gov
M a y 17, 2022
M s. Beatriz H e rrm a nn
13 0 So uth S ho re D rive
M ia m i Bea ch, F l 33 14 1
R E: Com m ittee on the Hom eless
D ea r M s. Beatriz H e rrm ann:
C o ngratulatio ns! Y o u have been appointed by Com m issioner Kristen Rosen Gonzalezto the above-
referenced Boa rd or C om m itt ee, fo r a term ending: 12/31/2022.
Pursua nt to C ity of M iam i Beach C ode Section 2-22 (5)a:
N otw ithstand ing any other provision of the C ity C ode or of any R esolution, com m encing w ith
term s beg in ning on or aft er Jan uary 1, 2007, the term of every board m em ber w ho is directly
appointed by a m em ber of the C ity C om m ission shall autom atically expire upon the latter of:
D e cem be r 31 of the year the appointing C ity C om m issioner leaves office or upon the
appoi ntm ent/el ection of the successor C ity C om m ission m em ber.
If you are unable to accept this appointm ent, or have any questions, please call the Offi ce of the City
C le rk at 305 .67 3.7 4 11.
P le ase re a d th e enclose d m ateria ls ca refully as they co nce rn your duties, responsibilities, and
req uirem e nts as a board or com m ittee m em ber.
C ong ratulatio ns aga in and good luck.
R egards,
/
R afael G ranado
C ity C le rk
cc: M o nica Be ltran , Parking D irector
Jana y G uerrero, C ity Li aison
ENC LO SURES:
O ath of O ffi ce/O ath of C ivility/A cknow ledgem ents
C ity C o de/O rdina nce section applicable to agency, board or com m ittee
C ity C o de Se ction s 2-22, 2-23, 2-24, 2-25, 2-26, 2-458 an d 2-459
O rdina nce N o. 20 06-3543 - Amendment to C ity C ode Section 2-22
M ia m i-D ade C o unty C ode Section 2-11.1 - C on flict of Interest and C ode of Ethics
C ity Wi d e Perm it Ap pl ication - (Parking D epartm ent Form )
Book l et - G uid e to the Sunshine A m endm ent and C ode of Ethics fo r Public O fficers and Em ployees
M IAM I BEACH
City of Miami Beach, 1/OO Convention Canter Divo, Miami Boach, Horida 33 139 yyNwy_miamibcachl].go
OFFICE OF THE CITY CLERK, Rafael E. Gran ado, City Clerk
Tol: 305.673.7411, Fax. 305.673.7254
Email: CityClerk@miamibeachll.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Ms. Beatriz Herrmann
RE: Committee on the Homeless
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: 12/31/2022.
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
o f the cale nda r year on which I have served.
/„22
, Ms. Beatriz Herrmann
Sworn to and subscribed before me this < ,2022
pl e a se vi si t the C ity o f M ia m i B e a ch w e b site a t w w w .m ia m ib e a c hfl.g o v u nd e r C ity C le rk/B o a rd and
C o m m itt ee s fo r a dditio na l info rm atio n regarding the F ina ncia l D isclosure R equirem e n ts.
~
MIAM I 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
MAY 19 2022
CITY OF MIAMI BEACH
OFFICE OF THE 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):
l I am a resident of the City of Miami Beach for six months or longer.
or-. A«as (0 5 o ru uce [o .
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).
Name of Business _
Business Address _
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 loca tion of the business that is physically located in Miami Beach (for a minimum of six months).
Name of Business _
Business Address _
"Own ership 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.
Under penalties of perjury, I declare that I have read the foregoing document and that the facts stated in it
y-puant2 a), ] (2'fl a [922223
Signala,n ' ,"11
Bekr2 //LAU
Printed Name
NOTARY
Sworn to (or affirr~tscribed before me, by means of óhysical presence or□online notarization,
o»./tra. (t22. [ali haAu!
(Cit of Miami Beach Board/Committee Member ).
+[cs. ·Cea sg Produced ID
Form of Identification
/jiri«~~-, CHARI.ES J. DAGOSTIN ¿i ¿? MY COMMISSION # HH 165705
i%3$, egg EXPIRES: December 14, 2025 "fig' Bonded Tu Notary Public Underwriters
(NOTARY SEAL)
Sign
Name of Notary, Typed, Printed, or Stamped
MIAMl·DADE.
EEI 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
2021
Last Name
H EK RM»UM
First Name
/AT1z
Middle Name/Initial
6
Mailing Address - Street Number, Street Name, or P.0. Box__ i.O oorl No»e •
City, State, Zip
M4 EACH EL
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)
O 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)
D County Kí Municipal:
(Municipality)
Board where serving
ouire£ 0 ru [houées
Alternate address (if home address is exempt) Work telephone Term began on/ended on
00a2
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
9$2,l
R.tba J
I hereby swear {or affirm) that the information above is a true and correct statement.
fie-
Signature of Person Disclosing
5 l18/224
Date ignea l
RECEIVED BY ELECTIONS DEPARTMENT:
□Hardcopy RECEIVED
O Electronic Copy
MAY 19 2022
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/initials: Scanned Date/Initials:
138_SP-14 COE 2016
M IA M I BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfl.gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
DIVERSITY STATISTICS REPORT
/3 err2 • L'ast Name First Name Middle Initial
The following information is voluntary and has no bearing on your consideration for appointment. It is being
asked to comply with City diversity reporting requirements.
Gender:
Ll Mae
[Zl remale
Ll oner
O I prefer not to answer.
Race/Ethnic Categories:
What is your race?
O African American/Black
O Asian or Pacific Islander
O Caucasian/W hite
O Native American/American Indian
loner--Pnnt Race: 2BLT _fULGt
O I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
23ves
Lo
O I prefer not to answer.
Do you consider yourself Physically Disabled?
aves 8io
D I prefer not to answer this question.
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F:\CLER1$ALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
MIAM I BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachf.gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachf.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)
ß
Last Name First Name Middle Initial
I understand that no later than Jul1, Of each Vear all members of Boards and Com mittees 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 than $500, 60 days in jail, or both.
/:J .
Signature Date I I
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 of6
F:ICLER\$ALL\REGIBOARD AND COMMITTEE APPLICATIONS FINAL DRAFTSIBOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
M IA M I BEACH CITYWIDE (CW ) BOARD & COMMITTEES a 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 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 Hall Garage (GZ) 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 replacemen t fee.
Board Member Information
Date of Application: /re/202%
Applicant Name: 4 H fR MIO I RAT1z
Board/Committee Name:
Address: 130 Soorn++o@e b. p7. 64, PL. 33I /
ale
E.Moil Address pl&eu 1,6 heat, el
Work Phone: e Home Phone
Cell Phone: 7-I23-// Preferred Contact Method: Tl
Vehicle Information
Tag: 4tr5 q Color: >KR /
State: E. Year: 200
Make: 10y0TA $0AA Model: >O-AR
Applicant sianaiur. , ($ 3j @„Ln»?
I e
Please provide signed form to the Parking Department located at 1755 Meridian Avenue, 2d floor. Working
hours are 8:30 to 5:00 p.m. or email to: ParkingReception@miamibeachfl.gov
e-mail subject: BOARD 8& COMMITTEE PARKING APPLICATION - APPLICANT NAME
Parkina Department Section
PERMIT SYSTEM GARAGE ACCESS
Expiration Date: ID Card Serial #:
Issued By Print Name: Print Name:
Signature: 6 Signature: 6
Date Issued: Date Completed:
, lp] lll l +? LlhHJu rorro ar