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Sara de los Reyes 12.31.24BOARD AND COMMITTEE CHECKLIST APPOINTEE: DATE OF APPOINTMENT:- o 'y I Z 3 BOARD/COMMITTEE: I -ClY1 I kkti4 h il"r- ' ppointed by: C o[m), I �S 1 tl -P-y1Y�L►�1�tL FOR SCANNER FOR CLERK STAFF Scan o o Letter of Appointment : E.1-11 i I :ta�t�u I L I Ili rrFZ M, L- MI T Scan o o Letter of Reappointment o ICgpS of Letter of Appointment/Reappointment e-mailed to Committee Liaison on Scan o o Board and Committee Application (Completed on i L 1 1 L ) Scan o o Resume/Curriculum Vitae f L 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 ✓ 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 Scan o o Source of Income Statement Scan O o Acknowledgment of Financial Disclosure Requirement O Board and Committees Liaison Responsibilities o /DIVERSITY STATISTICS RE�/PORTIN�j Keep COPY in file and ORIGINAL for Annual Report. Received on: 1 G I '� _3 Signed by x ,a�/ ` Date Board or Committee Memb r Processed on: t(6 43 By Employee: _ Date City Clerk's Office Staff Initials Scanned on: ! 4' 1)- By Employee: )",n Date City Clerk's Office Staff 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 ore committed to providing excellent public service and safely to all who live, work, and play in our vibrant, tropical, historic community. City of Miami Reach, £7wl Conv niion Con1w lliv,:4„ Mkimi I1,: Q h, i lougl'a i? 131 �rw^rwF.mi�rr�E�� �eh.(l.aer FF F. OF TW. CITY CLERK, Ral l F, Granado, Cily C brk TA 305.673-7A T i , Fax: 305.673.725,4 FTrmil: C *yCJ&Tk@rniamibGw-hf .gay January 05, 2023 Ms. Sara de los Reyes 1800 Sunset Harbour Drive #901 Miami Beach, Florida 33139 SUBJECT: Animal Welfare Committee Congratulations! You have been reappointed by Commissioner Laura Dominguezto the above referenced, board or committee named above, for a term ending: 12/31/2024. 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 Julio Rodriguez, 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 - (Parking Department Form) Booklet - Guide to the Sunshine Amendment and Code of Ethics for Public Officers and Employees V,. , ' I _ A SI City of Hied Beach, 1700 Conve niion C onlar Dfivo,. ✓ &nmi I:leach, f loader 33139 www. miornibg_xjcEl.qcsv OFFICE OF THE CITY CLERIC, Rakwl. E. Granad'o, City Ckffk Tal: 306.673.7411, Fax: 305.673.7254 E-mail: CilydeA@miamib@whfl.gov Oath of Office Oath of Civility and Acknowledgements TO: Ms. Sara de los Reyes RE: Animal Welfare 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: 12/31/2024. 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 1 st, following the closing of the calendar year on which I have served. ,f Ms. Sara de los Reye Sworn to and subscribed before me this to day of t..54r-rr 2023 rles 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. �'ANA I BEA( City of Miami Beach 1700 Convention Center Drive Miami Beach, Florida 33139 OFFICE OF THE CITY CLERK Email: BCArniamibeachfi.gov Telephone: 305.673.741 1 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 Sections2-22 (4), as (check (J) II that apply): I am a resident of the City of Miami Beach for six months or longer. Home Address f go 0 � DA� _tjw 6e'-� '� 3-3 / 3; ❑ 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 Business Business Address 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). 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 deglar.� that I have read the foregoing document and that the facts stated in it are true. Signature Date )fa 41A 6 Printed Name NOTARY Sworn to (or affirmed) and subscribed before me, by means of hysical presence or ❑ online notarization, this day o � , 20,9--Sby (City of Miami Beach Board/Committee Member). �, ��� �C ��pYP(, I CHARLES J. MY COMMISSIONN # HH HH 165 165705 Produced ID er 14,2025 Form of Identification ;F oPo= FIRES:000embkUndewdt •.,};f F �,, Bonded Ttuu Notary Public Undenvrilers 7711 Known (NOTARY SEAL) Sig n4r�^061:5-ublic Name of Notary, Typed, Printed, or Stamped FA 7 A/M C B City of Miami Beach 1700 Convention Center Drive Miami Beach, Florida 33139 www.miamibeachfl.gov OFFICE OF THE CITY CLERK Email: BC aArniamibeachfl.gov Telephone: 305.673.741 1 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) r d . 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: 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 inAil, or both. ature Dates 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 City of Miami Beach 1700 Convention Center Drive Miami Beach, Florida 33139 NKw .miamibeachfl.egov OFFICE OF THE CITY CLERK Email: BCgmiamibeachfl.gav Telephone: 305.673.741 1 Last Name DIVERSITY STATISTICS REPORT 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 prefer not to answer. Race/Ethnic Categories: What is your race? �i African American/Black Yscan or Pacific Islander 1 ACaucasian/White —1 Native American/American Indian Other — Print Race: prefer not to answer. Dou consider yourself to be Spanish, Hispanic, or Latino/a? l Yes No I prefer not to answer. Do you consider yourself Physically Disabled? L—Ivves No Ca 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 Clear From Print Form MIAMI 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 Alm Mailing Address — Street Number, Street Name, or P.O. Box ( _ City, State, Zip 1� % �czc/iJ �'C�/uc3/`% 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) County ❑ Public Health Trust Q Municipal: (Municipality) Department Position or Title Employee ID Number Work address Work telephone Employment began on/ended on Filing as a Board Member (check one) County Board where serving Alternate address (if home address is exempt) Municipal: (Municipality) Work telephone I Term began on/ended 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 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 I hereby swear (or affirm) that the information above is a true and correct statement. Signature of Person Disclosing 6 J2 -.3 - Date signed RECEIVED BY ELECTIONS DEPARTMENT: ❑ Hardcopy ❑ Electronic Copy, l i K41 fit" Erg ..i..C) PRINT, ICT, AND SUBMIT WI_ .f..11 , OFFICE OF THE CITY t31LlmmRK VIA EMAIL OR HARDCOPY. 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 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 (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: / 4 4Z _-3 - Applicant Name: 5 RA e- v s P_ Is Board/Committee Name: , (,at,, Address: I i ` 1 �tD So. _A -00 C_ ocl��' DP- J4, --- % qc�! �i%�ryu l eel do � idE'�c �j1�� E -Mail Address: 11 .SV4 C-7 Date Issued: Work Phone: t©:' -:764D Make: Home Phone 31)6--'.5 -31? -g K; 6 - hone: 3v5- 5Al1) Preferred Contact Method: Vehicle Infnrmatinn Tag: Color: ID Card Serial #: Issued By Print Name: Stater®�1 Signature: A-1 Year: Date Issued: r4 61 1� Make: W Model: IZ�_ w I) Applicant signature: - Please provide signed form to the Parking Department (oca d at 1755 Meridian Avenue, 211 floor. Working hours are 8:30 to 5:00 p.m. or email to: r i c tin i i e I. w,-- e-mail subject: BOARD & COMMITTEE PARKING APPLICATION - APPLICANT NAME Pnrlrinn mannrfineant Crartinn PERMIT SYSTEM GARAGE ACCESS Expiration Date: ID Card Serial #: Issued By Print Name: Print Name: Signature: A-1 Signature: e Date Issued: Date Completed: