Lymari Veloz 12.31.23MIAMI BEACH
APPOINTEE:
BOARD/COMMITTEE: LC,~@LIA± _BA[visor) Appointed by..L avi Doi.s oz
FOR SCANNER FOR CLERK STAFF / J
Scan o o Letter of Appointm ent TERM END: l3]22
Scan o o Letter of Reappointment
o Copy I of Letter of Appointment/Reappointment e-mailed to Committee Liaison on
.kl#ace Norw«non corr»eeto.2 /hs
o R~sum~/Curriculum Vitae ],],2
o Diversity Statistics Reporting (Completed on 7 l2 _)
o Oath
TERM Luwrr. 12[31lo
Scan o
Scan o
)
Scan o
BO A R D A N D C O M M ITT EE C H ECKLIST
\(o2 DATE OF APPOINTMENr. /l2
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
C ITY O F M IA M I B EA C H ✓Memorandum - Solicitation by City Board and Committee Members
OFFICE C! .E CITY CLERK
RECEIVED
FEB 3 2023
Scan o
Scan o
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
o Acknowledgment of Financial Disclosure Requirement
Received on:
Processed on:
Scanned on:
o Board and Committees Liaison Responsibilities
O DIVERSITY STATISTICS REPORTING Keep COPY in file and ORIGINAL for Annual Report.
3//23 so»X '2k (--
Dale " ell@ or committee Member
2(3 [03 y moves: f/!
Date City Clerk's Office Staff Initials
a?l22 ro wers f
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\CHECl<UST 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.
MI MIB
City of Miami Beach, I/OO Con vention Can er Drivo, Miami Bach, Florida 33 139 yxwy._miamibaa chllgo
OFFICE OF THE CITY CLERK, Rafaal E. Granado, City Clerk
Tol: 305.673.7411, Fox: 305.673.7254
Email: Ci#Cl erk@miamibooch fl.gov
February 02, 2023
Ms. Lymari Veloz
8000 West Drive apt 621
North Bay Village, fl 33141
RE: LGBTQIA+ Advisory Committee
Dear Ms. Lymari Veloz:
Congratulations! You have been appointed by Commissioner Laura Dominguez 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. 7 411.
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.
R
Ra1Granado
City Clerk
cc: Monica Beltran, Parking Director
Brian Garces, 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
M IA M I BEACH
City of M iam i Beach, I/0O Convention Conlor Drive, Miami Boa ch, Florida 33 139 yyw.miaIibachll.gov
OFFICE OF THE CITY CLERK, Rafool E. Gr an ado, City Clerk
Tel: 305.673.7411, Fax. 305.673.7254
Emai l: CiyClerk @mi am i beach ll.gov
O ath of O ffice
Oath of Civility
and
Acknow ledgem ents
TO: Ms. Lym ari Veloz
RE: LGBTQIA+ 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. //. .i s. Lwna vioz
Sworn to and subscribed before me this (e o 4 -7 2023
*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.
M IAM I BEACH
C ity o f M ia m i Be a ch
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305 .673 .7411
RECEIVED
FEB 3 2023
CIT Y O F M IAMI 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):
□I am a resident of the City of Miami Beach for six months or longer.
bf7 Pe }Pe i
•V 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 or Business_ [ea_ (A_ \\A+ye S«lo
Business Address. Lo HA]yon ,,_ tL3137
a 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).
[[qmo tf Hy,]@S5
[1S]es,, (hf%S5
"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
s ,A- z/z/23
Signature T Date
{rai \V(oz
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of□physical presence or□online notarization,
s$_cay r Tebo £j,,2023 ». L-uoo VAAo2
_________ (City of Miami Beach Board/Committee Member).
/ Produced Rt Ove lLrA C
f Identification
Personall Kn - Signature of N tary Public
Name of Notary, Typed, Printed, or Stamped
M IA M I BEA C H
C ity o f M ia m i B e ach
17 0 0 C o nve ntio n C e nter D rive
M ia m i Bea ch, Flo rida 33 13 9
www.miamibeachfl.gov
OFFICE OF THE CITY CLERK
E m a il: B C @ m ia m ib e a chfl.gov
Telep ho ne: 30 5 .6 7 3 .7 4 11
PIVERSIJY STATISTICS REPORT
M
La st N a m e First N am e M iddle Initial
T h e fo llo wi n g info rm a tion is vo lu n ta ry and has no be aring on your consideration fo r appointm ent. It is being
a ske d to co m ply w ith C ity d ive rsity re po rt ing req uirem e nts.
G e n d e r:
Ll M at e
( rerae
Ll oner
0 I p re fe r no t to an sw e r.
R a c e /E th n ic C ate g o ries :
W h a t is y o u r ra c e ?
0 A frica n A m e rica n/B la ck □A sia n o r P a c ific Isla n d er
[Z] C a u c a si an wi te □N a tive A m e rica n/A m erica n In d ia n
0 Other - Print R ace : ------------ □I p re fe r no t to a n sw e r.
D o y o u c o n s id e r yo u rs elf to be S p an ish , H is panic, or Latin o/a?
A ves
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D I p re fe r no t to a n sw e r.
D o y o u c o n sid er yo u rs e lf P hys ica lly D is a b le d ?
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D I p re fe r n o t to a n sw e r th is qu estion .
Page 6 of6
F:\CLER\$ALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
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: 305.673.7 411
B O A R D & C O M M ITT E E FINA N C IA L AC K NOW LED G EM ENT S TATEM EN T
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
M
First Name Middle Initial
I understand that no later than Jul y 1_of ea ch vear 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 m ust be fil e d 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.
2± l ·{a //:>
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 (For m 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:\CLER\$ALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
...HAg99 &jii ii» S O U R C E O F IN C O M E STAT EM E N T
Section 2-11.1(i) of the Co unty Et hics Code req uires that certa in em ployees and public offi cials file a financial disclosu re Statem ent on a year ly basis by July 1st
of eve ry year.
Disclosu re for Tax Year Endi ng Last Name First Name Middl e Name/lnltlal
2022 Veloz LV( M
Malling Address -- Street Number, Stre et Name, or P.O. Box
6000 v+ Dr ¥621 WU, F 33//
City, Sta te, Zip
W99 ,PL- 331(I
If your home address is you r mailing ad dress, and yo ur home address is exempt fro m public records pursuant to Fla. Stat. $119.07, read
instru ct ions on the fol lowing page and check here.[l
Filing as an Employee (check one)
EI county □Public Health Trust I] Municipal:
(M un icipality)
Departm ent
Position or 11tl e Em ployee ID Number
Work address [ on eletone Employment beg an on/ended on
Fling as a Board ember (check one)
E] county E wet /ti, fl.
(Municipali ty)
Board where serving
Le3¢ WA+ [i
Alte rnate address (if hom e address is exempt)
0lo }ln o
Work telephone 'Term began on/ended on
12635516€
List belo w ev ery so urc e of in com e you re ceived, along wi th th e addre ss an d th e principal activity of each source. Incl ude yo ur public salary. Pl ace th e sources of
incom e In descending ord er, w ith the larg est so urce firs t. Ex am ples of sourc es of incom e include: com pensation for serv ices, incom e fro m business , gains fro m
property deal in gs, interest, ren ts, divi dends, pensi ons, IR A distribution s, an d soci al security paym ents. Also, include any sourc e of incom e received by an other
pers on for your ben efit. How ever, th e inc om e of your sp ouse or any busi ness partn er nee d not be disclose d. If continued on a separate sheet, check here.]_l
Name of Source of Income Address Description of the Principa l Busi ness Activity
e h H Ae Sa lo [036 #+cn 2D Ree$io v+
I hereby swear (or affirm ) th at the inform ation ab ove is a true and correct statement.
signature oriel-an cocci@si n
Date signed
RECEIVED BY ELECTIONS DEPARTMENT.
D Hardcopy BECEIVED □Electron ic Copy
FEB 3 2023
CITY O F MIAMI BEACH
OFFICE OF THE CITY CLERK
REMEMBER TO PRINT, SIGN, AND SUBMIT TO THE OFFICE OF THE CITY CLERK VIA EMAIL OR HARDCOP.
.±.9£A.l" 2 2% La
1755 Meridian Avenue, Suite 200/Miami Beach, FL 33139/Ph: (305) 673-7505 or (305) 673-7000 ex4. 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.
B o a rd M em b er Info rm a ti o n
Date of Application: 2-//23
Ap plic a nt Name: (w«vi I Velo2-
Board/Committee Name: (GT&1#+ /\ vi5r v\
Address: V
334/ G000 /@S+ Oeiv& z N%y
E-Mail Address: i«w e b« ,r l.o
Work Phone: ) g 6 ~
Home Phone 355 $468 3as 467/57
Cell Phone: 3$ 447 157 Preferred Contact Method: 3, 35 @87(7
V e h icl e In fo rm a ti o n
Tag: LNDV@ Color: loe
State: l Year: 2ot
Make: po di 6 3 Model: 1\ 0 D1 3
Applicant Sianature: as -a4 + 4 o
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: Pa rk in g R ecep tio n@ m iam ib eachfl.g ov
e-mail su bj e ct: B O A R D & C O M MI TTE E P AR K IN G A P P LICATI O N - A PP LI CA NT N A M E
P ki D rt ar ana epa men ec'ion
PERMIT SYSTEM GARAGE ACCESS
Expi ration Date: ID Cord Serial #:
Issued By Print Name: Print Name:
Si gnatur e: Signature: 5
Date Issued: Date Completed:
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