Eddie Sierra 12.31.23BOARD AND COMMITTEE CHECKLIST
APPorEE. _LE_cl[__ @err_ DATE or APPonrEeNr: _)2_l21))2
BOARD/COMMITTEE: _[)/ Appointed y. (0y104 o_eg
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TERM EN. 10[31/23 reRLurr: L2/s1)23 FOR SCANNER
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RECE IVED
FEB 14 2023
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FOR CLERK STAFF
o Letter of Appointment
o Letter of Reappointment
°.g?OP), 9, leer of Appointment/Reappointment e-mailed to Committee
24,22
0 Board and Committee Application (Completed on- _
o R~sum/Curriculum Vitae Jg]
o Diversity Statistics Reporting (Completed on II-4 2
o Oath
Liaison on
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
CITY OF MIAM I BEA CH
OFFICE OF THE CITY CLERK
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 Responsibilities
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O DIVERSITY STATISTICS REPORTING ;py min file and ORIGINAL
2\+4l 2 Signed By
Report.
Received on:
Scanned on:
Date Board or Committee Member
Processed lh> Employee: -K/111 __ ~------------
: "7 " h//E,_3 syEmo»veer
Date City Clerk's Office Staff Initials
CONCLUDED & RESIGNATION LETTERS
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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 ore cormiited o providing excellent public service and safety to al who live, work, and ploy in our vibrant, tropical, historic community.
City of Miami Beach, )ZOO Convonlion Can ter Drive, Miami Bea ch, Hlorid1 33139 yyy_miamnibaa chll.go
OFFICE OF THE CITY CLERK, Ra~al E. Granado, Cy Clerk
Tel 305.673.7411, Fax. 305.673.7254
Email: Cit/Clerk@miamiboochf.gov
December 29, 2022
Mr. Eddie Sierra
2954 SW 25th Terr
Miami, Florida 33133
SUBJECT: Disability Access Committee
Congratulations! You have been reappointed by Commissioner Laura Dominguez to the above
referenced, board or committee named above, 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 305.673.7411. Please read the enclosed materials carefully.
Congratulations and good luck.
Regards,
cc: Monica Beltran, Parking Director
Valeria Mejia, 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
City of Miami Beach, 1/OO Convention Coner Drive, Miami Boo.h, Florida 33 139 yyyw._IiamIibachfl_go
OFFICE OF THE CITY CLERK, Rofal E. Granado, City Clerk
Tel : 305.6 73.7411, Fax. 305.673.7254
Emai l: CityClerk@mi amibeachfl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Mr. Eddie Sierra
RE: Disability Access 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. ~
Mr. Eddie Sierra
Sworn to and subscribed before me this I t.f tn. d = 2023
{lo6
Mt'
*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 \MI E H
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 14 2023
CITY OF MIAMI BEACH
OFFICE OE TAE 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.
p)fr l\]]re,
ls! 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_ s ol f-lord6 s___pc-_l
susmess Address. 3 vS Loco • 53
□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).
[Jar [ [[y1res8S
[[IS[[eS JS]feSS
"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.
s of perjury, I declare that I have read the foregoing document and that the facts stated in it
2\4\23
Signature -
C_delta 'Soc
Date
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of□physical presence or online notarization,
LJA ,_ ;y,y, 2, 4 .45 y.»,,- t, this_l"'1_11tiay of +<,.1v1vvvq-, 20_1,.:,_by_~.t;;""c.A __ V_l_v __ 'b_._v_,_ r ...... _'-- _
_________ (City of Miami Beach Board/Committee Member).
produced ID
E
Pers lly Kn
Signature of ary Public
Name of Notary, Typed, Printed, or Stamped
M IA M I
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www .miamibeach!l,gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
DIVERSITY STATISTICS REPORT
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:
th nae
irenae
0 Other
0 I prefer not to answer.
Race/Ethnic Categories:
What is your race?
DI African American/Black
LJ Asta or Pacific Islander
0 Caucasian/White
LI Native American/American Indian
[L] oher-Print Race: t y po
DI I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
fns.
)»
0 I prefer not to answer.
Do you consider yourself Physically Disabled?
hi % i» t prefer not to answer this question.
Page 6 of 6
F:\C LER \$A LL\RE G\BO A R D A ND C O M M ITT E E A P P LI C A TIO NS FIN A L DR A FT S\BO A RD A ND C O M M ITT E E A P P LI C A TIO N R E G FINA L.docx
Updated: June 2020
1LA I B
City of Miami Beach
1 700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfl,goy
OFFICE OF THE CITY CLERK
Email: BC@rniarnibeachfl.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)
Last Name First Name Middle Initial
I understand that no later than July1. 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.
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 th , 60 days in jail or both.
Signature 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\$ALL\REG\BOARD AND COMMITT EE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITT EE APPLICATION REG FINAL.docx
Updated: June 2020
MIAMl·DADE- EII SOURCE OF INCOME STATEMENT
Section 2-11.1(@) 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 I Last Name Nae, Middle Name/Initial
2022 <oe CJ i
Mailing Address - Street Number, Street Name, or P.O. Box
262 09 2 Tog
City, State, Zip
338 (p ~l..._,
If your hom e addre ss 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. D
Filing as an Em ployee (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: ( a
(Municipality)
Board where serving
DO
Alternate address (if home address is exempt) I Work telephone I Term began on/ended on
3,1 21 240
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
a4+oo+ls ors 2 \:,\rd 0\ I- C's<sly
i > , 3$31655
I hereby swe~9-~e information above is a true and correct statement
Signature of Person Disclosing
Date signed
RECEIVED BY ELECTIONS DEPARTMENT:
□Hardcopy RECEIVED
[] Electronic Copy
FEB 14 2023
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
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