Gino Santorio 12.31.24MIAMI BEACH
BOARD AND COMMITTEE CHECKLIST
APPOINTEE: (in0 San_hrio
soARDcoMMrrre: ML.]ha AlnM
FOR SCANNER
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DATE OF APPOINTMENT: 2l1]23
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FOR CLERK STAFF
o Letter of Appointment
o Letter of Reappointment ° @,,9f.,Letter of Appointment/Reappointment e-mailed
2[a!23 1«-I
o Board and Committee Application (Completed on _flP/2
o R~sum~/Curriculum Vitae J
o Diversity Statistics Reporting (Completed on _2_[/J23
o Oath
Appointed by:
rRM eNo.-l3l h reRw uwr. 2/31/2
to Committee Liaison on
RECEIVED
FEB 9 2023
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
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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
o Source of Income Statement
o Acknowledgment of Financial Disclosure Requirement
Received on:
Scanned on:
o Board and Committees Liaison Responsibilities
O DIVERSITY STATISTICS REPORTING Kee p £QfX in file and ORIGINAL for Annual Report.
23-2± sr.»X .S.g
Orte Board or Committee Member
Processed on: _·.::;1.---1{,__01 __ 1✓-_3 By Employee: kA _
Date City Clerk's Office Staff Initials
la/° ors Keh
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:ICLERIBOARD AND COMMITTIES DATABASEICHECKLIST MASTERIB&C Checklist 2015 MASTER.docx
We are commuted to providing excellent pubhc service and sa'ey to all wh o live, work, and play in our vibrant, tropical, nvstoc community
City of Miami Beach, I/OO Convonlion Canter Drive, Miami Bsach, Florida 33139 yywy.IiaIibaachllgo
OFFICE OF THE CITY CLERK, Rafaal E. Granado, Cl y Clerk
Tel 305.673./411, Fx 305.673.7254
Email: CiNyClotk@miamiboochll.gov
February 03, 2023
Mr. Gino Santorio
1550 Salvatierra Drive
Coral Gables, Florida 33134
SUBJECT: Health Advisory Committee
Dear Mr. Gino Santorio:
Congratulations! You have been reappointed by the City Commission to the above referenced board or
committee, for a term ending: 12/31/2024.
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.
Resp~
Rafael Granado
City Clerk
cc: Monica Beltran, Parking Director
Marc Chevalier, 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
MIAMI BEACH
City of Miami Beach, I/OO Convonfion Contot Drivo, Miami Boach , Honda 33 139 yww_miamibachfl.gov
OFFICE OF THE CITY CIERK, Rafaol E. Granado, Cy Clord
Iol: 305.673.7411, Fax. 305.673.7254
Email:. CiyClerk@milamiboachll.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Mr. Gino Santorio
RE: Health 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: 12/31/2024.
T o my colleagues and to all of those I represent and serve, I pledge fairness, integrity and civility, in all
actions ta ken an d all com m u nica tion s m ade by m e a s a public serv a nt.
I have b een issued a co py of sect ion 2-1 1.1 of th e M iam i-D ade C oun ty C o de {C o n flict of Interest and
C ode o f E th ics Or di nan ce), as w ell as F lorida C om m ission o n E th ics G uide to th e S unshine A m endm en t
and C ode of E th ics fo r P ublic O ffi cers a nd u n derstand th at a s a m em ber of a C ity of M iam i B each B oard
and/o r C om m itt ee, I m u st co m ply w ith th e fin an ci al di scl osure" re qu irem ents of M iam i-D ade C oun ty o r th e
S ta te o f F lorida {d epen ding on th e board or com m itt e e o n w h ich I serv e) o n July 1st, fol lowi ng the cl osin g
of th e calen dar year o n w h ich I have serv ed.
M r. G ino S an torio
S w orn to an d sub scribe d be fore m e thi s h day or[eh..y 2023 24
Deputy Clerk
p le ase vi sit the C ity of M ia m i B each w ebsite at w w w .m iam i b ea ch fl .g ov u nd er C ity C lerk/B oard a nd
C om m itt e es fo r ad dition al in fo rm ation reg ardin g th e F in ancial D isclosure R e quire m en ts.
M IA M I BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl. gov
Telephone: 305.673.7411
RECEIVED
FEB 9 2023
CITY OF MIAMI BS oric or iii a 3 CH
- + 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):.
o I 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 _
Business Address _
ii 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_ _No.at a._ Mel!_ Cele
usmess Address._ /3o [Lh__ Ld_ _Ma. bed
"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 leclare that l have read the foregoing document and that the facts stated in it
are true. oh?l443 --"--'-------------- Signature
Chi na 1ale
Date
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of o physical presence or u online notarization,
o Ta atlhurj.o2 s (Qmo otovu
_ (Cii/of Miami Beach Board/Committee Member).
Produced ID
Form of Identification
Name of Notary. Typed, Printed, or Stamped
a«Rk4##a81%.
EXPIR ES: Jenuary 22, 2027
M IA M I BEACH
City of Miami Beach
l 700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfl.gov
OFFICE OF THE CITY CLERK
Email:. BC@miamibeachf. gov
Telephone: 305.673.7411
DIVERSITY STATISTICS REPORI
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:
[J Male
[ remate □Other
0 I prefer not to answer.
Race/Ethnic Categories:
What is your race?
[ Amican American/Black
Asta or Pacific Islander
[] Caucasian/white
0 Native American/American Indian
0 Other - Print Race: ------------ □I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
Ives
do
0 I prefer not to answer.
Do you consider yourself Physically Disabled?
voe
Ao
t prefer not to answer this question.
Page 6 of 6
F:ICLER1$ALLIREGIBOARO ANO COMMITTEE APPLICATIONS FINAL DRAFTS\BOARO ANO 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.mniamibeachfl.gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.741 l
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)
Last N a m e F irst N am e M id d le Initial
I u nd e rst a nd th at no later th a n Jul1,Of each year all m em b ers of B oard s an d C om m i tt e e s of th e Ci ty of Miami
B e a ch , In clud ing tho se of a pu re ly adv iso ry natu re , are requ ire d to co m p ly w ith M ia m i-D a d e C ou nty Financial
D isclo sure R e q u ire m e nts.
One o f the follo w in g fo rm s must be filed w ith the C ity C le rk of M ia m i Bea ch , 17 0 0 C onventio n C e nter D rive,
M ia m i B e a ch , F lo rid a , no la te r th an 12 :0 0 no on of July 1, of each year:
1. A "S o urce of In com e S tatem e nt;" or
2. A "S tate m e nt of F in a n cia l In te re sts (Fo rm 1)1" or
3. A C o p y of yo u r late st F e de ral In co m e T ax R e turn .
Failure to file one of the se form s, pu rsua nt to the M ia m i-D ad e C o u nty C o d e , m a y subject the person to a fine
of no m or e th an $50 0, 60 !s in jail, or both.
Cd.Z S .ts z/hos
Si gn a tu re D ate
1 M e m b e rs o f the P la n n ing B o a rd an d Bo a rd of A dju stm e nt w ill be no tified dire ctly by the S tate of Florida,
pursu a nt to F.S. $112.3 14 5 (1)(a ), to file a Statem e nt of F inan cia l Inte rests (Form 1) with the M ia m i-D a de C ounty
S u p e rv iso r o f E le ctio ns by 12:00 no on , Ju ly 1. P la n n ing B o a rd and Board of A dju stm e nt m e m bers w ho file their
F o rm 1 with the C o u nty S u p e rv iso r of E le ctio n s autom atica lly sa tisfy the C o unty 's finan cial disclosure
re q u ire m e nt as a M ia m i B e a ch C ity B o a rd/C o m m itt ee m e m be r an d nee d no t file an additional fo rm w ith the O ffi ce
o f the C ity C le rk. H o w e ve r, co m p lia n ce w ith the C o u nty disclosu re re q u irem e nt do e s not satisfy the S tate
re q u ire m e nt.
Page 5 of 6
F:IC LE R \$A LL\R E G IB O A R D A N D C O M M ITT E E A P P LI C A T IO N S FI N AL D R AF T S \B O AR D A N D CO M M ITT E E A P P LI C A T IO N R E G FI N AL .d oc x
Updated: June 2020
MIAMI-DADE:+ EI 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 I Last Name First Name Middle Name/Initial
2022 Son1lo Gr«o • Malling Address - Street Number, Street Name, or P.O. Box
I5o salhrerra Dr
as , Ca Ghte, .R 33134
If your home address Is your malling 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. 0
Filing as an Employee (check one)
[] county □Public Health Trust [] Municipal:
(Municipality)
Department
Position or Title Employee ID Number
Work address I Work telephone Employment began on/ended on
Filing as a Board Member (check one)
[] county [] Municipal: _.Hy o\ M« Ee.ck
(Municipality)
Board where serving
Hlea]\ l\as Cmn, H e /30 All 7a.2 an el
Alternate address (if home address is exempt) I 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
No So Me)val ekr 43e Al#, , llpll
I hereby swear (or affirm) that the information above is a true and correct statement.
@.d
Signature of Person Disclosing
h1lag
Date signed
ocavo or a FT%!N7NH9j
[ Hardcopy
J Electronic @pf 9 2023
CITY OF MIAMI BEACH
OFFICE OF TH E CITY CLERK
OFFICE USE ONLY Accepted: Y / N Deficiency. Processed Date/initials: Scanned Date/initials.
138_SP-14 COE 2016
M IA M I BEACH CITYWIDE (CW) BOARD & COMMITTEES a 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 et. 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.
B o a rd M e m b e r In fo rm a ti o n
Dote of Application: 3 //223
Applicant Name: e n«o Sole rio
Board/Committee Name: Hle Ill Mlvsry Ce 7Hk e
Address 4 A \L,-. » Ms. ed €L 33/0
E-Moil Address, l ee 10.Sn o S C, om
Work Phone: 3os -694-2223 Home Phone
Cell Phone: \ 451- (Al Preferred Contact Method ?el
V e h icl e In fo rm a ti o n
Tag: p1 4a Color: r ey
State: P Year: 26 o
Make: (nae l oo e.
Model: HS .
onto-.•(%,3/\
Please provide signed fotr to th Parki n} D ep ar tm en t located at 1755 Meridian Avenue, 2 " floor. Working
hours are 8:30 to 5:00 p.m. or email to: P a rk i n gR ece pt io n @m ia mi b e a ch fl ,go v
e -m a il su b jec t: B O A R D & C O M M ITT EE P A RK IN G A P P LIC AT IO N - A PP LIC A N T N A M E
Parkina Department Section
PERMIT SYSTEM GARAGE ACCESS
Expiration Dote: ID Card Serial #:
Issued By Print Name: Print Name:
Signature: 6 Signature: 6
Date lssued: Date Completed:
' '
mo Ea#+h t,to mn /OIUa Ht al alt