Rosary Plana Falero 12.31.24M IA M I BEACH
BO A R D A N D COM M ITTEE C H EC K LIST
Rosary Plana Fal er o 2/1/23
APPOINTEE: DATE OF APPOINTMENT:
Hispanic Affairs Committee Mayor Dan Gelber
BOARD/COMMITTEE: Appointed by: _
FOR SCANNER
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Scan o
Scan o
Scan o
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FOR CLERK STAFF
o Letter of Appointment
o Letter of Reappointment
o Copy I of Letter of Appointment/Reappointment e-mailed
/fl3 .
o Board and Committee Application (Completed on _all.h )
o R~sum~/Curriculum Vitae J
o Diversity Statistics Reporting (Completed on /,'23
o Oath
TERM END: nl3 1h4 TER M LI Mr r: l 3yl
to Committee Liaison on
)
RECEIVED
FEB
✓
✓CITY OF MIAMI BEACH
OF FI C E OF TH E CITY CL ERK
8 2023
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
Scan o
Scan o
Received on:
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
o Board and Committees Liaison Res
O DIVERSITY STATISTICS REPORT
211123 X
Signed by .l_7yr TI
Scanned on:
Bo rd or Committee Member
2/1/23 y
Processed on.By Employee.r
City Clerk's Office Staff Initials
21/23 2MA
Ey Employee.d"-
City Clerk's Office Staff Initials
Date
Date
Date
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
WVe are committed to providing excellent public service and safe ty to all who live, work, and pla y in our vibrant, tropical, historic community.
City of Miami Beach, 1/OO Convonlion Canter Drive, Miami Bach, Florida 33 139 yyyy_mianihaachllgo
OFFICE OF THE CITY CLERK, Rafaal E. Granado, Cy Clerk
Tel 305.673.7AIL, Fox 305.673.7254
Email: CityClerk@miamibeochfl.gov
January 31, 2023
Ms. Rosary Falero
4550 Pine Tree Drive
Miami Beach, Fl 33140
SUBJECT: Hispanic Affairs Committee
Congratulations! You have been reappointed by Mayor Dan Gelber to 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.
cc: Monica Beltran, Parking Director
Leonor Hernandez, 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
C ity of Miami Beach, I/OO Convention Coner Drive, Miami Boch, Florida 33 139 yyywy_miarib_achll.go
OFFICE OF THE CITY CLERK, Rof0al E. Granado, Ciy Clerk
Tel: 305.673.7411, Fax. 305.673.7254
Email: Cit/Clerk@miamibeachfl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Ms. Rosary Falero
RE: Hispanic Affairs 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- ade County or the
State of Florida (depending on the board or committee on which I serve - July 1 , f llowi the closing
of the calendar year on which I have Served.
Sworn to and subscribed before me ..., ~-1'-"t"'1
Keila Mena Caceres
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.
M IAM I BEACH
City of Miami Beach
1 700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Ema il: BC@miamibeachfl. gov
Telephone: 305.673.7411
RECEIVED
FEB 8 2023
CITY OF MIAMI BEACH
OFFICE OF THE ClTY 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):
121 I am a resident of the City of Miami Beach for six months or longer.
4550 Pine Tree Drive, Miami Beach, Fl. 33140 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 -----------------------
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 associati .
re that I have read the foregoing document and that the facts stated in it
2/1/23
Signatur
Rosary Plana Falero
Date
Printed Name
N O T A RY
Sworn to (or affirmed) and subscribed before me, by means of□physical presence or u online notarization,
as "7na ay or _to n g ,zoa ». Koga-no l o
________ (City of Miami Beach Board/Committee Member).
PL_ r yy L n £ Produced ID
Form of Identification
_ Perso~------
sionatare or Notary Die
Name of Notary, Typed, Printed, or Stamped
M IA M I BEACH
City of Miami Beach
17 0 0 C o nventio n C e nter D rive
M ia m i Bea ch, Florida 33 13 9
www.miamibeachfl.gov
OFFICE OF THE CITY CLERK
E m a il: B C @ m ia m ib e a chfl.g o v
Telephone: 30 5 .6 7 3.7 4 11
DIVERSI TY STA TI S TICS REPORT
Falero Rosary Plana
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:
Luae
I Female
L oner
0 I prefer not to answer.
Race/Ethnic Categories:
What is your race?
0 African American/Black
D Asia or Pacific Islander
Native American/American Indian
[] Other - Print Race.
D I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
tr.
No
D I prefer not to answer.
Do you consider yourself Physically Disabled?
c
l o
D I prefer not to answer this question.
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F:\CLER\$ALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
M IAM 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 7411
BOARD & COMMITTEE FINAN CI AL 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)
Falero Rosary Plana
Last Name First Name Middle Initial
I un derstand that no later than Jul1,of each vear all mem bers of Boards and Com mittees 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.
Fail
Of n
rms, pursuant to the Miami-Dade County Code, may subject the person to a fine
s in jail, or both.
2/1/23
Date
1 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
a..Hg9 &jiii» Clear From Print Form
SOURCE OF INCOME STATEMENT
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
2022 1Falero Rosary Plana
Mailing Address - Street Number, Street Name, or P.O. Box
4550 Pine Tree Drive
City, state, Zip
Miami Beach, Fl. 33140
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.Dl
Filing as an Employee (check one)
EI] 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 E] Municipal: City of Miami Beach
(Municipality)
Board where serving
Hispanic Affairs Committee
Alternate address (if home address is exempt) Work telephone Tenn began on/ended on
786-414-6455 2/1/23
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 an other
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.Ll
Name of Source of Income Address Description of the Principal Business Activity
Wells Fargo 333 SE 2nd Avenue, 23rd Floor, Banking
Miami, FI. 33131
Date signed
ormation above is a true and correct statement. ova .g9q%/ " Jara}EG
tie-mop,%g" 4 23
CITY OF MIAMI BEACH
OF FI CE OF THE CIT Y CL ERK
REMEMBER TO PRINT, SIGN, AND SUBMIT TO THE OFFICE OF THE CITY CLERK VIA EMAIL OR HARDCOPY.
.2.9£.4..247#2.2%%% L
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 par king 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 car d 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 e m b e r In fo rm a tio n
Date of Application: 2/1/23
Applicant Name: Rosary Plana Falero
Board/Committee Name: Hispanic Affairs Committee
Address: 4550 Pine Tree Drive, Miami Beach, Fl. 33140
E-Mail Address: rosaryfalero@yahoo.com
Work Phone: Home Phone
Cell Phone: 786-4 14 -64 5 5 Preferred Contact Method: Cell Phone
V e h icl e In fo rm a tio n
Tag: 54DAYW Color: Blue/Green
State: Fl Year : 2022
Make: Ford
=-------- / n Model: Bronco - L> [ I )
Applicant sianolore: a [j k[ L/
Please provide signed fbrm t p the Parking Department located at 1755 Meridian Avenue, 2 floor. Working
hours are 8:30 to 5:00 p.m. or email to: Pa rkin g R e ce p tio n@ m iam ib eachfl.g ov
e-m a il subject: B O AR D & C O M M ITT EE PA R K IN G A P PLI CATIO N - A P P LI CA N T N A M E
P ·ti D ar mna epartment ection
PERM IT SYSTEM G AR A GE ACCESS
Expi ration Date: ID Cord Serial #:
Issued By Print N am e: Print N ame:
Si gna ture : e5 Signature: f
D ate Issued: D ate Completed:
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