Bibi Andrade 12.31.23MIAMMEAC
BOARD AND COMMITTEE CHECKLIST
APPOINTEE: TCi= Ana.QAcNrr DATE OF APPOINTMENT:
444
BOARD/COMMITTEE: 1��eAQ04-t,j2-_S /Zl Appointed by: �� -1
FOR SCANNER FOR CLERK STAFF C0/4V1 '
Scan o o Letter of Appointment 'TERMF�ND:/,�-// /&S "I['ERiVI
Scan o o Letter of Reappointment
o M,2f� of Appointment/Reappointment e-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
✓ County Code Section 2-11.1 — Conflict of Interest and Code of Ethics Ordinance (as
amended through December 2010)
RECEIVED ✓ Amendments to the Code of Ethics Ordinance (September 2009 through July 2012)
✓ Highlights of the Miami -Dade County Ethics Code
.JAN 27 2023 ✓ Sunshine Law and Public Records — Frequently Asked Questions
✓ Memorandum - Solicitation by City Board and Committee Members
t,ITY OF MIAMI BEACd-
,�=FICE OF THE CITY CLE Citywide Permit Application (Parking Department Form)
C 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 REPPOR ING Keep COPY in file and ORIGINAL for Annual Report.
Received on: Signed by X
Date B rd r QQmmittee Member
Processed on: By Employee: _
Date / � Ci s Staf ' 'als
Scanned on: By Employee:
Date CitfClerklgWice 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 are committed to providing excellent public service and safety to all who live, work, and play in our vibrant, tropical, historic community.
" A MI BEACH
City of Miami Reach, N 7co conveani n Canter ivw,, lv't,urni I ch, florida florid33 I "tri u��ryrr.rrsi rr� l� s� hfl.�cr
OFFICI Cf THE CITYC[FRK, RafaelF. Grano&,. City Ckvk
Tel:. 305A73-74,11 1, Fax: 305.63.e25d
Emil: CjfyCIrrk0miamkbowhfl.goy
January 13, 2023
Ms. Brigitte "Bibi" Andrade
7133 Bay Drive
Miami Beach, FL 33141
RE: Black Affairs Advisory Committee
Dear Ms. Brigitte "Bibi" Andrade:
Congratulations! You have been appointed by Commissioner Alex Fernandez to the above -referenced
Board or Committee, for a term ending: 12131/2023.
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
Lissette Arrogante, 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
MIA1,AMEACH
City of Miatni Beach, 1700 Convention Conley Drivo, Miami Broach, Florida 33130 ti.^r, r.miarrribcacfr}Lgcr�
OFFICE OF THE CITY CLERK, Rafael E. Gronado, City Clark
Tot: 30.5.6737411, Fax: 30.')_673.7254
Email: CityClork(�miami[)eochfl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Ms. Brigitte "Bibi" Andrade
RE: Black Affairs Advisory 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.
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. 14
Ms. Brigitte "Bibi" Andrade
Sworn to and subscribed before me this )-,+ day of �-�, 2023
6
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.
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@rniarnibeachfl.gov
Telephone: 305.673.741 1
RECEIVED
JAN 27 2023
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):
AI am a resident of the City of Miami Beach for six months or longer.
Home Address
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—&,
k) hs D. T 1 ' ►r,�� ��, (% .
Business
3SAI
❑ 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 declare that I have read the foregoing d ent and that the facts stated in it
are tru�
Signature Date
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of physical presence or o online notarization,
th69'
&ay o
Lk �W ,120 �)y d__4d1e,_
Produced ID
(City of Miam=eachBoard/Commiftee Member).
4
Form of Identification
P sonally Known
Sign ure o y Public
Name of Notary, Typed, Printed, or Stamped
gh, CHARLES J.
DAGOSTIN
MY COMMISSION # HH 165705
EXPIRES: December 14, 2025
FeF v ;�.•' Bonded Tluu Notary Public Underwriters
(NOTARY SEAL)
10 1 A/V� I b ic
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.rniamibeachA.gov
OFFICE OF THE CITY CLERK
Email: BC@.miamibeachfl.gov
Telephone: 305.673.741 1
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)
CZ 1
Last Name First Name I 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= 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 Count�i C11e, may subject the person to a fine
of nq more than $500, 60 days in jail, or both.
L4
re
' 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
MI®°i�'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 LasA Name First Name Middle N me/Initial
2021 °
Mailing Address — Strember, Street Name, or P.O. Box
e u
City, State, ip
&--
It 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 ® 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 ❑ Municipal:
(Municipality)
BoaN where serving
Alternate a dress (if home address is exempt) Work telephone 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
3
u1p��ltx1. ,1�•�.�
vL
I hereW-Gear (or affirm) that the information above is a true and correct statement.
of Pers n Disclosing
N_ D-4 ') -02-3
RECEIVED BY ELECTIONS DEPARTMENT:
❑ Hardcopy RECEIVED
❑ Electronic Copy
JAN 27 2023
CITY OF WAAAi L r--Ar,,►j
OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/Initials: Scanned Date/Initials:
138 SP -14 COE 2016
MIAMI BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfl.gov
OFFICE OF THE CITY CLERK
Email: 13C(9miamibeachfI.gov
Telephone: 305.673.741 1
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:
❑ Male
I Female
Other
I prefer not to answer.
Race/Ethnic Categories:
What is your race?
African American/Black
Asian or Pacific Islander
❑1 Caucasian/White
❑ Native American/American Indian
❑ Other — Print Race:
prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
❑" Yes
iNo
prefer not to answer.
Do you consider yourself Physically Disabled?
❑1 Yes
rZI No
ElI 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
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.
RnnrA Mamhar Infnrmntinn
Date of Application:
Applicant Name:
Board/Committee N• -
ID Card Serial #:
Addres
-Cell
Print Name:
Work P.
Phone
Phone'.
Preferred Contact Method:
Vahicla Infnrmnf;nn
Tag:
GARAGE ACCESS
Color:
ID Card Serial #:
State:
Print Name:
Year:
ZnO 97
Make:
Date Completed:
Model:
Applicant Signature: ,es
Please provide signed form to the Parking Department located at 1755 Meridian Avenue, 2"d floor. Working
hours are 8:30 to 5:00 p.m. or email to:.ParkingReception@miamibeachfi.gov
e-mail subject: BOARD & COMMITTEE PARKING APPLICATION — APPLICANT NAME
Pnrlrinn na%nnrtm Ani Sae}inn
PERMIT SYSTEM
GARAGE ACCESS
Expiration Date:
ID Card Serial #:
Issued By Print Name:
Print Name:
Signature: ,f
Signature: ,5
Date Issued:
Date Completed:
Lo or
Q lwr,- .0.
cle) 0 w z
Lo Lu >- w
<r<(a
amt -:F
0-400
LA.