Zaymar Vargas 12/31/23MIAMIBEACH
BOARD AND COMMITTEE CHECKLIST
APPOINTEE:2,4-�jm9'k VAR - DATE OF APPOINTMENT: oho/-)` o/-)`
BOARD/COMMITTEE: 14(C e S S Appointed by: S S► l"/C��/l'
FOR SCANNER FOR CLERK STAFF 69M1 ))
Scan o o Letter of Appointment TERM END:/ l3 I /
/d--3TERM LIMIT:P/3/ /30
Scan o o Lett r of Reappointment
o �of ��hof Appointment/Reappointment -mailed to Committee Liaison on
Scan o o Board and Committee Application (Completed on
Scan o o Resume/Curriculum Vitae
o Diversity Statistics Reporting (Completed on
Scan o o Oath
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
����V�� ✓ 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)
NOV 14 2022 ✓ Highlights of the Miami -Dade County Ethics Code
✓ Sunshine Law and Public Records – Frequently Asked Questions
CITY OF- MIAMI BEACH
✓ Memorandum - Solicitation by City Board and Committee Members
OFFICE OiTI-IF 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 Disclosure Requirement
O Board and Committees Liaison Responsibilities
O DIVERSITY STATISTICS REPORTING Keep COPS/ ' I ' KiGINAL for Annual Report.
�/
Received on: �� 0 z Z Signed by X
/ D to oa or Committeg-Majer
Processed on: ��By Employee:
Da ity r ' Office Staff Initials
Scanned on: l /� By Employee:
—2
Date Itv CIA's Office Vfiaff Initials
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
We are committed to providing excellent public service and safely to all who live, work, and play in our vibrant, tropical, historic community.
MIAMIBEACH
City of Miami Beach, 1700 Convonlion Conler Nivo, Miami Beach, Florida 33139 www.miamibeachfl.ci
OFFICE OF THE UY CLERIC, Rafael E. Granado, City Clerk
Te1: 305.671741 1, Fax: 305.673.7254
Email: CityClark0miomibeachfl.9ov
November 10, 2022
Ms. Zaymar Vargas
7735 Abbott Avenue apt #6F
Miami Beach, FL 33141
RE: Disability Access Committee
Dear Ms. Zaymar Vargas:
Congratulations! You have been appointed by Commissioner Steven Meiner to the above -referenced
Board or Committee, 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 as they concern your duties, responsibilities, and
requirements as a board or committee member.
Congratulations again and good luck.
Regards,
Rafael Gran - do
r
City Glerk
cc: Monica Beltran, Parking Director
Valeria Mejia, City Liaison
ENCLOSURES:
Oath of Office/Oath of Civility/Acknowledgements
City Code/Ordinance section applicable to agency, board or committee
City Code Sections 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
City Wide Permit Application - (Parking Department Form)
Booklet - Guide to the Sunshine Amendment and Code of Ethics for Public Officers and Employees
MIAMIBEACH
City of Miami Beach, I AX) Convention Conter Drive, Mmmi 13oach, Florida 33139 wvAv.miarnibejckLga<
OFFICE OF THE CITY CLERK, Rafael E. Gronado, City Clerk
Tel: 305.673.741 1, Fax: 345.6737254
Email: City0erk@m1am6ecn_hN.goY
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Ms. Zaymar Vargas
RE: Disability Access 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.
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 1 st, following the closing
of the calendar year on which I have served.
As. Zay ar Varga
Sworn to and subscribed before me this day ofrV OZ2022
D'Agostin
tv 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.
MIAMI BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BCCcDmiamibeachfl.gov
Telephone: 305.673.741 1
RECEIVED
NOV 14 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
(J) all that apply):
Va I am a resident of the City of Miami Beach for six months or longer.
Home Address -77
❑ 1 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 B
Business Address
❑ 1 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).
3:34 y j-
Name of Business a)ajolk?c� nit2 Qd I -P60 -s
Business Address Z8CA :5W 44,CtAt, h e Srt��-e -100W...MPf,_R
"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.
Under penalties of per' I �@ a that I have read the foregoing document and that the facts stated in it
are tris
Signature Date
2M' H -W
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means ofhysical presence ori❑ online notarization,
thisaRiay of P" -"1e—"- 20,! Eby `' `,b '41
(City of Miami Beach Board/Committee Member).
1jProduced ID 1 l S �;p'ry •., CHARLES J. DAGOSTIN
Form of Identification "' MY COMMISSION#HH 165705
EXPIRES: December 14, 2025
:.
,.w., ;QP Bonded Thru Notary Pubrrs Underwriters
Signah-re of ary Public
Name of Notary, Typed, Printed, or Stamped
MIAMI BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfl.gov
OFFICE OF THE CITY CLERK
Email: 13C(cDmiamibeachfI.cjov
Telephone: 305.673.741 1
DIVERSITY STATISTICS REPORT
�I 5 �Z-Ay
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.
Gender:
0 Male
Ell Female
U Other
Il I prefer not to answer.
Race/Ethnic Categories:
What is your race?
L.3 African American/Black
l Asian or Pacific Islander
Caucasian/White
Native American/American Indian
h Other — Print Race:
l 1 prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
Yes
l
No
1 I prefer not to answer.
Do you consider yourself Physically Disabled?
U Yes
No
I prefer not to answer this question.
Page 6 of 6
F:\CLER\$ALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
MIAMI BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www,miamibeachfl.gov
OFFICE OF THE CITY CLERK
Email: BC(amiamibeachfl.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(1) (2)
VAQ6;AS ZA yap A2 C .
Last Name First 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 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 f, rms, pursuant to the Miami -Dade County Code, may subject the person to a fine
of no more than 50 -6 in-' il, or both.
9y 202Z
Signature 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 of 6
F:\CLER\$ALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
MII®°"'DE SOURCE OF INCOME STATEMENT
Section 2-11.1(1) 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 Last Name First Name Middle Name/Initial
2021 Y6A'z�,'
Mailing Address — Street Number, Street Name, or P.O. Box _
773S- Abboff Av-�vt,&
City, State, Zip
144'M-11� Iseho -1 L 33 4 L -I I
IT your nome aaaress IS your malhng aaaress, ana your nome aaaress IS exempt from puDIIC recoras pursuant to I -la. Stat. $i iumt, reaa
instructions on the following page and check here. ❑
Filing as an Employee (check one)
County blic Health Trust r! Municipal: �-
1111unicipal ity)
Department
Position or Title
Employee ID Number
Work address
Work telephone
Employment began on/ended an
Filing as a Board Member (check one)
0 County
(Municipalit
Board where serving
S'10 Iknz
Alternate address (if home address is exempt) Work telephone Term began on/ended on
130S---qS02V36 1112-022
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
pp
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2801 lcw -14-H-(" kl-k
w.a 4-L -3 -392
LQ, -e n titre �s
I hereby swear (or affirm) that the i
Signature ofy'erson Disclosing
// ry 2D22
Date igne
I above is a true and correct statement.
RECEIVED BY ELECTIONS DEPARTMENT:
❑ Hardcopy RECEIVED
❑ Electronic Copy
N O V 14 2022
CITY OP MIAMI BEACH
OFFI(;r= nr- -ri.aG r,,,, --
OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/Initials: Scanned Date/Initials:
138 SP -14 COE 2016
MIAMI BEACH CITYWIDE (CW) BOARD & 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 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 (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: 1 acknowledge that should my access card be lost, stolen or
damage, I will be responsible to pay a $10.00 replacement fee.
Rnnrel Mem6cr InfnrmnNnn
Date of Application: -11/m 2dc?L2
GARAGE ACCESS
Applicant Name: I
ZAY"Arz
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Board/Committee Name:
Print Name:
Address:
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E -Mail Address:
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Work Phone: g05 -_,`5-02,V 3
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Home Phone
Cell Phone: :305,- zl�D 2 `i 34;�,
Please provide signed form to the Parking Department located at 1755 Meridian Avenue, 2°' floor. Working
hours are 8:30 to 5:00 p.m. or email to: ParkingReception@miamibeachfl.aov
e-mail subject: BOARD & COMMITTEE PARKING APPLICATION - APPLICANT NAME
Preferred Contact Method: /
Vsah;rla Infnrrtin4inn
Tag: G XA�2-7L
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GARAGE ACCESS
Color:
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State: .
Print Name:
Year:
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Make:}'lC
Date Completed:
Model:
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Applicant signature:
Please provide signed form to the Parking Department located at 1755 Meridian Avenue, 2°' floor. Working
hours are 8:30 to 5:00 p.m. or email to: ParkingReception@miamibeachfl.aov
e-mail subject: BOARD & COMMITTEE PARKING APPLICATION - APPLICANT NAME
D"AAm" nom~4rr "f Cv�4i�n
PERMIT SYSTEM
GARAGE ACCESS
Expiration Date:
ID Card Serial #:
Issued By Print Name:
Print Name:
Signature: xs
Signature: ,5
Date Issued:
Date Completed:
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