Raquel Pacheco 12.31.24MI MI/BE
BOARD AND COMMITTEE CHECKLIST
APPOINTEE. Raquel Pacheco
BOARD/COMMITTEE: Personnel Board
DATE OF APPOINTMENT. 02/07/2023
Aoiotea y. Tso
FOR SCANNER
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Scan o
FOR CLERK STAFF
o Letter of Appointment
o Letter of Reappoihtment
° "$),&"" Aromo enurReenosonw ent emo te
o Board and Committee Application (Completed on _Al21_]2)
o R~sum~/Curriculum Vitae y]
o Diversity Statistics Reporting (Completed on //)23
o Oath
reRM eno. l31)4 TE RM LIMIT:
Scan o
Scan o
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to Committee Liaison on
RECEIVED
FEB 9 7023
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
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 an d 2-459
County Code Section 2-11.1 - Conflict of Interest and Code of Ethics Ordinan ce (as
amended through December 2010)
Am endments to the Code of Ethics Ordinance (Septem ber 2009 through July 2012)
Highlights of the Miami-Dade County Ethics Code
Sunshine Law and Public Records -- Frequently Asked Questions
Mem orandum - Solicitation by City Board and Com mittee Mem bers
O Citywide Permit ·Application (Parking Department Form)
o Booklet - Guide to Sunshine Amendment & Code of Ethics for Public Officers and Employees
O Source of-Incom e Statement
o Acknowledgment of Financial Disclosure Requirement
o Board and Committees Liaison Responsibilities
_ _.. segg 2g gag _ . ., Mae ,
O DIVERSITY STATISTICS REPORTING Keep ~QPy in file and ORIGINAL for Annual Report.
Received on: 02- 8 •2023 . . . Signed by -
Date Br r Committee Member
Processeao. 021.2023 BY mrovee:[L
Date City Clerk's Office Staff Initials
Scanned • 02.1.2023 y Employee: ------'~L----=--------------
Date City Clerk's Office Staff Initials
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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 COMMIT TIES DATABASE CHECKLIST MASTER\&C Checklist 2015 MASTER.docx
C ity of Miami Beach, 1ZOO Convention Cantor Drive, Miami [oach, Florida 33 139 ggyyy y_miamibachll.go
OFFICE OF THE CITY CIERK, Rafael E. Granado, City Clerk
Tel: 305.673.741I, Fax. 305.673.7254
Email: Cit/Clerk.@miamibeachll.gov
February 06, 2023
Ms. Raquel Pacheco
732 Lenox Avenue
Miami Beach, Florida 33139
SUBJECT: Personnel Board
Dear Ms. Raquel Pacheco:
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.
Ra ado
City Clerk
cc: Monica Beltran, Parking Director
Marla Alpizar, 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
MIA MI BE
City of Miami Beach, /) Convonlion Canter Drive, Miami Beach, Torda 33 139 wwyy.mlamibgachfl.gov
OFHKCE OF THE CITY CLERK, Ralcol E. Granado, Cy Clerk
tel: 305.6/3./411, Fax. 305.673.7254
Email: CityClerk@miamibeachfl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Ms. Raquel Pacheco
RE: Personnel Board
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 1st, following the closing
of the calendar year on which I have served.
• .2. ~s. Raquel Pacheco
swor to and subscribed before me u 1h_day of._,lZ, 2023
K
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
700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Emait: BC@mniamiteachft.gov
Telephone: 305.673.7411
RECEIVED
FEB 9 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):
p lam a resident of the City of Miami Beach for six months or longer.
Home Address (2 Lenox Ave, Unit B1, Miami Beach, FL 33139
□I have an ownership interest (for a minimum of six months) in a business established in the City of
Miami Beach (for a minim um of six month s).
[[4ff of J]Pg3.
[[S 1m e s, (]][Pe S -
I lam a full-time employee of a business (for a minim um of six months) and l am based in an office or
other location of the business that is physically located in Miami Beach (fo r a minim um of six month s).
[}qr7}% rT Py[[@S3.
[B S [f e S, (Hf@Sbi-
"O w n e rsh ip In tere st" m e a n s th e o w n e rsh ip o f te n p e rce n t (10 %) o r m o re (in clu d ing th e o w n e rsh ip o f
10 % o r m o re o f th e o u tstan d in g cap it a l sto ck) in a b u sin e ss.
"B u sin e ss" m e a n s an y so le p ropr ie to rsh ip, sp o n sor s h ip, co rp o ra tio n, lim ite d lia b ility com p a n y, o r ot h e r
e n tity o r b u sin e ss a sso cia tio n .
Under penalties of perjury , I declare that I have read the foregoing docum ent and that the facts stated in it " --> ms si@rare ae
Raquel Pacheco
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of o ph ysical presence or o online notarization,
• %a fey_s3 q,el YaLo
(City of Miam i Beach Board/Com mittee Member ).
[ e s Lee
s %., ' ·.° GARY Z}» TA ZELAYA
+ Cory 1fssion # HH 231811
pires June 28, 202
(NOTARY SEAL)
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.migmibegchfl.gov
O FFI CE OF THE CITY CLERK
Email: BC@miamibeachfL._gov
Telephone: 305.673.7411
DIVERSITY STATISTICS REPORT
Pacheco R aquel A
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 a e
Female
Ll oth er
D I prefer not to answer.
Race/Ethnic Categories:
What Is your race?
D African American/Black
D Asian or Pacific Islander
El Caucasian/white
0 Native American/American Indian D Other- Print Race: _
El prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
J ves
J o
El prefer not to answer.
Do you consider yourself Physically Disabled?
l ee 2R D I prefer not to answer this question.
Page 6 of 6
FACLERI$ALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL docx
Updated: June 2020
1I4M/BE
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
wwow.miamibeachfl,gov
OFFICE OF THE CITY CLERK
Email: BC@mlamibeachfl.gov
Telephone: 305.673,7411
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)
Pacheco Raquel A
Last Name First Name Middle Initial
I understand that no later than Jul_1, of each 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 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.
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. a= 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:ICLER\$ALLIREG\SOARD AND COMMITTEE APPLICATIONS FINAL DRAFTSIBOARD AND COMMITTEE APPLICATION REG FINAL. docx
Updated: June 2020
MIAMl•DA DE. 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 En di ng (ast Name First Name Middle Name/Initial
2022 Pacheco Raquel A
Mailing Address - Street Number, Street Name, or P.O. Box
732 Lenox Avenue, Apt. B1
City, State, Zip
Miami Beach, FL 33139
If your home addre ss is your m ailing addre ss, 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 @mica. #$556&. h
(Municipality)
Department
Position or Title Employee ID Number
Work address [ W or k telephone Employment began on/ended on
I '
Filing as a Board Member (check one)
[] county E] Municipal: Miami Beach
(Municipality)
Board where serving
Miami Beach
Alternate address (if hom e address is exem pt) I W ork telephone I Term began on/end ed on
List bel ow every source of income you received, along w ith the address and the principal activity of each source. Include your public sal ary. Pla ce th e sources of
income in descending order, with the largest source first. Examples of sources of income include: com p en sation for services, income from busin ess, 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
RDP Agency LLC PO Box 340188 Hartford, CT Translation/interpretation
06134 company
RDP Agency LLC PO Box 398332 Miami Beach, FL Translation/interpretation
33239 company
I hereby swear (or affirm) that the information above is a true and correct statement.
<>
RECEIVED sY EiEoS EPA~itir:
[] Hardcopy
I] Electronic op" 9 30Z3
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
OFFICE USE ONLY Accepted: Y / N Deficiency. Processed Date/initials: Scanned Date/initials:
138 SP-14 COE 2016
CITYWIDE {CW) BOARD & COMMITTEES
cmy ct Menor ease±, PARING DP ARrMNT PARKING APP[[CAT[ON
1755 Meridian Aven ue, Suite 200/Miami Beoch, FL 33139/Ph: (305) 673-7505 or (305) 673-7000 04. 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 ol 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.
ACKNOW LEDGEMENT: I acknow ledge that should my access card be lost, stolen or
damage, I will be responsible to pay a $10.00 repl acem ent fee.
Board Member Information
Date of Application: 92. .2023
Applicant Name: Raquel Pacheco
Board/Committee Name: personnel Board
Address: 732 Lenox Avenue, Apt .B1, Miami Beach, FL 33139
E-Mail Address: rpacheco@rdptranslation.com
Work Phone: Home Phone 305-450-5357
Cell Phone' 305-450-5357 Preferred Contact Method: 6ell
Vehicle Information
Tag: 012s t Color: White
State: Florida Year: 2014
Make: Audi Model: Q5
Applicant Sianature: e
Please provide signed form to the Parking Department localed at 1755 Meridian Avenue, 2d floor. Working
hours are 8:30 to 5.00 p.m. or email to: ParkingReception@miamibeachf.gov
e-mail subject: BOARD 8 COMM ITTEE PARK ING APPLICATIO N -- APPLI CANT NAME
P ·kd D ar mna epartment ection
PERMIT SYSTEM G A RAGE A C CE S S
Expiration Date: ID Cord Serial #:
lssued B y Print Name: Pr int N am e:.
Si gnat ure : Signature:
D ate Issued: Dote C om pl eted:
s