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Karen Fryd 12/31/23APPOINTEE: OLT -e A DATE OF APPOINTMENT: BOARD/COMMITTEE:Appointed by: a�y,),r FOR SCANNER FOR CLERK STAFF Scan oLetter ofAppointment TERM END TERM LIMIT: /°~ Scan oLetter ofReappointment ^ ,of Appointment/Reappointment e-mailed to Committee Liaison on �� ~_ 8nano n8obrdand Committee Application (Completed on ) Goan o oRAaum6/Curricu|umVitae " Diversity Statistics Reporting (Completed on ^r— — Sconu oOmth Received on Processed on Scanned on oDIVERSITY STATISTICS REPORTING IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK DaeEe / City Code Ordinance Section applicable to the agency, board or committee ��c��D / C��oS��n�1.��.��.��.��.��.����� rl�w~' / County Code Section 2-111—Conflict of Interest and Code ofEthics Ordinance (as � 70YY amended �mu0kDecember 20�) NOV � / Ordinance (Se�ember2O08thmughJuly 2O12) ' / Highlights ofthe Miami -Dade County Ethics Code H � Sunshine Law and Public Rnoo�o—Froqueot�Asked Ouoo�onoro {}vK8\/\KA\FV Q .ity Board ��� Committee 0FF\CEOFTHET,C^^.'Solicitation_by oCitywide Permit Application (Parking Department Form) 0 Booklet — Guide to Sunshine Amendment & Code of Ethics for Public Officers and Employees Scan » o Source ofIncome Statement Scan o o Acknowledgment o/Financial Disclosure Requirement « Board and Committees Liaison Responsibilities Received on Processed on Scanned on oDIVERSITY STATISTICS REPORTING Keep file and ORIGINAL for Annual Report. Term Expired Letter Date Processed DaeEe B( By Employee: j Date // / Initials Scan 0 Removal Letter due to absences By Employee: ' Date C1 Keep file and ORIGINAL for Annual Report. Term Expired Letter Date Processed Initials Scan 0 --- �esignatio_n Letter Date Processed Initials Scan 0 Removal Letter due to absences Date processed Initials Scan 0 pmu;�\130An ANoCo mnTIsa mASrmB&oChecklist mmmASrERwcx ' � ond/d"Iyu0'.)"�������� MIAMBEACH City of Miatni Beach, 1700 Convenlion Conler Drivo, Miami B Bach, Florida 33139 wvAv.miamibeachllaov OFFICE OF THE CITY CLERK, Rafoel E. Granada, City Clerk Tel: 305.673.7411, Fax: 305.673.7254 Email CityCierk@miomibeochfl.gov November 10, 2022 Ms. Karen Fryd 1708 W 25th St. Miami Beach, Florida 33140 RE: Committee on the Homeless Dear Ms. Karen Fryd: Congratulations! You have been appointed by Mayor Dan Gelberto 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 Granado City Clerk cc: Monica Beltran, Parking Director Janay Guerrero, 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 C i' City of Miami Beach, 1700 f onvrynV0n Conler [>ivo, A%ml lk�ach, itc,rida 33139 y"Ay.miamibeachfl. aw OFFICE OF THE CITY CLERK, Wad E. Gr€Fnado, City Clerk TeE, 305,671741 t, Fax: 305.673.7254 Email: CiWaTk miamibGachfi.9v/ Oath of Office Oath of Civility and Acknowledgements TO: Ms. Karen Fryd 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: 12/31/2023. 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. ) W , Ms. Karen Fryd Sworn to and subscribed before me this day oi' 2022 yam.... har D'Agostin Deputy 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. nniAnni BEACH City of Miami beach RECEIVE® 1700 Convention Center Drive Miami Beach, Florida 33139 NOV 14 2022 OFFICE OF THE CITY CLERK Email: BC@miamibeachfl.gov CITY OF MIAMI BEACH Telephone: 305.673.7411 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): t I am a resident of the City of Miami Beach for six months or longer. Home Address ITO t aye J -- 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 0701V I& 4t Business Address 412, P`"'4,14 0 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). Name of Business Business Address "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 perjury, I declare that I have read the foregoing document and that the facts stated in it are tru y " s Signature Date t>rA Printed Name NOTARY Sworn to (or affirmed) and subscribed before me, by means of o physical presence or c::i online notarization, this i day of A)04 , 20 22,. by e (City of Miami Beach Board/Committee Member). Produced ID ,/ Form of Identification VPersonally Known 14:, Signature of N at) u.J.l S Name of Notary, Typed. Printed, or Stamped tr�xYoJ,g':' JONN2� RYD �''�.�y c�1Qdt PYib of Florioa Commission N GG 952878 `ov r My Comm. Expires Jan 29, 2024 Bonded through National Notary Assn. £IAM! City of Miami Beach 1700 Convention Center Drive Miami Beach, Florida 33139 W_Ny mi9mibtLq_ph cc v OFFICE OF THE CITY CLERK Email: BC(o) miamibeachfl.gov Telephone: 305.673.741 1 :0 - - � : •� 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) 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. Q,g 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 $500, 60 days in jail, or both. Signature Date Members of the Planning Board and Board of Adjustment will be notified directly by the State of Florida, pursuant to F.S. §112.3145(1)(a), to file a Statement of Financial Interests (Form 1) with the Miami -Dade County Supervisor of Elections by 12:00 noon, July 1. Planning Board and Board of Adjustment members who file their Form 1 with the County Supervisor of Elections automatically satisfy the County's financial disclosure requirement as a Miami Beach City Board/Committee member and need not file an additional form with the Office of the City Clerk. However, compliance with the County disclosure requirement does not satisfy the State requirement. Page 5 of 6 F:\CLER\$A1_L\REG\t3OARD AND COMMITTEE APPLICATIONS FINAL DRAFTSWARD AND COMMITTEE APPLICATION REG I-INAL.docx Updated: June 2020 �}t i R k�3y I �F" c ; � � a �i 1L C City of Miami Beach 1700 Convention Center Drive Miami Beach, Florida 33139 v ,mjamibeachfl aov OFFICE OF THE CITY CLERK Email: BC miamibpag!2fl.rtov Telephone: 305.673.741 1 Last Name j4A 0";573 First Name Middle Initial The following information is voluntary and has no bearing on your consideration for appointment. It is being asked to comply with City diversity reporting requirements. Gender: Male Female Other I prefer not to answer. Race/Ethnic Categories: What is your race? 0l African American/Black i Asian or Pacific Islander I' Caucasian/White ID Native American/American Indian Qther — Forint Race: 1 prefer not to answer. Do you consider yourself to be Spanish, Hispanic, or Latino/a? yes No I prefer not to answer. Do you consider yourself Physically Disabled? ED,Y-bs No I prefer not to answer this question. Page 6 of 6 F:\CLER1$ALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx Updated: June 2020 MIAMI -DARE SOURCE OF INCOME STATEMENT EM 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 Last Name First Name Middle Name/Initial 2021 ', ar) Mailing Address — Street Number, Street Name, or P,D, Box AC-) City, State, Zip 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. ❑ Filing as an Employee (check one) 0 County n Public Health Trust Q Municipal: (Municipality) Department Position or Title Employee 10 Number Work address Work telephone Employment began on/ended on Filing as a ward Member (check one) _._ _._ _. _ ..... .....__.....__ .......... _—.._..... _ _. E] County Municipal: &A�A JU (Municipality) Board where serving Alternate address (if home address is exempt) Work telephone Term began on/onded on 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 vour benefit. However, the income of your spouse or anv 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 _�.._...._...—_......... __...................... .__..__.............._.._._.. I hereby swear (or affirm) that the information above is a true and correct statement. Signature of person Disclosing I t 1> Date signe RECEIVED BY ELECT i}NS1tfnA D El Hardcopy C:1 Electronic Copy! 0 V 14 2022 OFFICE USE ONLY Accepted: Y / N Deficiency: _ Processed Date/Initials: Scanned Date/Initials: 138 SP -14 COE 20716 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: I acknowledge that should my access card be lost, stolen or damage, I will be responsible to pay a $ 10.00 replacement fee. Date of Application: � Applicant Nome: -A Board/Committee Name: t,Q t4 Address: E -Mail Address' A Work Phone: 4 Home Phone Cell Phone: Preferred Contact Method: Unilt e, Tog: F, C L Color eA�� State: Print Name: Year: Signature: Make: 3 4 Model: 0\1`0 Qj195 Applicant Signawre; As Please provide signed form to the Parking Department located at 1755 Meridian Avenue, 2-a floor. Working hours are 8:30 to 5:00 p.m. or email to: EqtkkLnq& ptLqn . oy e-mail subject; BOARD & COMM17TEE PARKING APPLICATION — APPLICANT NAME Parking Department Section PERMIT SYSTEM GARAGE ACCESS Expiration Date: ID Card Serial #: Issued By Print Nome: Print Name: Signature: A Signature: Date Issued: Date Completed: