Jessica Perez Waleck 12.31.24BO A R D A N D C O M M ITT E E C H E C K LIS T
APPOINTEE: Jessica Perez Waleck
BOARD/COMMITTEE:. Senior Affairs Committe
FOR SCANNER
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RECEIVED
FEB 27 2023
DATE OF APPOINTMENT. 2-7-2023
Appointed by: City Commission
FOR CLERK STAFF
o Letter of Appointment
o Letter of Reappointment
° P! f,,/etter of Appointment/Reappointment e-mailed to
2[3/23 [ /
o Board and Committee Application (Completed on [O J> D2
:$.$%3.2-co-.o 2bal3
o Oath
rerR eNo: pl1)¥ reRM wrr. (2/31/
Committee 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 MIAMI BEA CH
OFFICE OF TE CITY CLERK
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Received on:
Scanned 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 Responsibilities
o DIVERSITY STATISTICS REPORTING {ep coy 1n nle and ORIGINAL tor Annuat Report.
2-7-2023
Date
Processed on: _2P __ -2_0_2_3 By Employee: ----'"'"~P>~-1--------------
Date City Clerk's office Staff Initials
_2_1J_-_2_0_2_3 By Employee: _._pt/l_-'-----'-----·---------
City Clerk's Office Staff Initials Date
CONCLUDED & RESI GNATION LET TERS
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\B&C Checklist 2015 MASTER.docx
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City of Miami Beach, 1700 Convention Conlor Drivo, Miami Boach, Florida 33139 wyews_miaIIibgachll.gov
OFFICE OF THE CITY CLERK, Ralaol E. Granado, City Clerk
Tel: 305.673.741I, Fax. 305.673.7254
Email: Cit/Clerk@miamiboachll.gov
February 06, 2023
Ms. Jessica Perez Waleck
12000 Biscayne Blvd
Miami, FL 33181
RE: Senior Affairs Committee
Dear Ms. Jessica Perez Waleck:
Congratulations! You have been appointed by the City Commission to the agency, board or committee
named above 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 as they concern your duties, responsibilities, and
requirements as a board or committee member.
Congratulations again and good luck.
Regar{/&
Rafael Granado
City Clerk
cc: Monica Beltran, Parking Director
Luis Callejas, City Liaison
ENCLOSURES:
Oath of Office/Oath of Civility/Acknowledgements
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
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, 1700 Convlon Canter Drive, Miami Boach, Ford0 33 139 ggyyyIILam_iLcE.Hg
OFFICE OF IHE CITY CIERK, Raf0al E. Granado, Ciiy Clerk
Tel. 305 673 7311, Fa. 305 673 7254
Emoil. City/Clonk@miamibeochfl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Ms. Jessica Perez Waleck
RE: Senior 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 Miam i 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 0f 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,
Sworn to and subscribed before me this Q2_day ofgz"-
Keil
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.
13 D
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 27 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):
I am a resident of the City of Miami Beach for six months or longer.
[tm7% lk(]f,bi»
□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).
[3[e ()f 1J S][S i.+
1IS,]PS,S, J(]([[Sb3.-
lam a full-time employee of a business (for a minimum of six months)
are or Business. Jhrh tnmrunit(@rcci o! fuhh +Iol, In•
Business Adares '29@0 By c" o., .FL 33)81 +qated rps@ni@ o T mmuifq (eina
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.
declare that I have read the foregoing document and that the facts stated in it
2.22.20 23
Date
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of□physical presence or□online notarization, . )
his23 day ot fr0, _2023 y. _)rs,o ere t,laked_
- (City of Miami Beach Board/Committee Member).
Produced ID "
Eorm of Identification
_l Personally Knowr
. -~-- 2±g$,,S. E,:
Signature of Notary Public ,2'- Doon4, .S+SJ
Name of Notary, Typed, Printed, or Stamped
A
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
ww w .mi ari heachfl.go v
O FFIC E O F TH E C ITY C LERK
Emoil: BC@miamibeachfl 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)
Perez Waleck Jessica L
Last Name First Name Middle Initial
I underst and that no later than July.1, of each year all member s of Boards and Committees of the City of Mi am i
Beach, including those of a purely advisory nature, are required to comply with Miami-Dade County Financial
Disclosure Requirements.
One of the following form s must be filed wi th the City Cl erk of Mi ami 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 Statem en t;" 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~:::;days in jail, or both.
sa ne0 ( ~
2-22-2023
Date
1 Members of the Planning Board and Board of Adjustment will be notified directly by the State of Florida,
pursuant to F.S. $112.3145(1)a), to file a Statement of Financial Interests (Form 1) with the Miami-Dade County
Supervisor of Elections by 12:00 noon , July 1. Planning Board and Board of Adjustment members who file their
Form 1 with the County Supervisor of Elections automatically satisfy the County's financial disclosure
requirement as a Miami Beach City Board/Committee member and need not file an additional form with the Office
of the City Clerk. However, compliance with the County disclosure requirement does not satisfy the State
requirement.
Page 5 of6
F:ICLER1$ALLIREGIBOARD AND COMMITTEE APPLICATIONS FINAL DRAFTSIBOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
EAC
City of Miami Beach
1 700 Convention Center Drive
Miami Beach, Florida 33139
wwwmiamibeachhl. gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
DIVERSITY STATISTIC S REP ORT
Perez Waleck Jessica L
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:
LJ Mae
[l remale
0 Other
El prefer not to answer.
Race/Ethnic Categories:
What is your race?
[African American/Black
0 Asian or Pacific Islander
[l Caucasian/wh ite
0 Native American/American Indian 0 Other- Print Race: _
[l I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
lves
Io
0 I prefer not to answer,
Do you consider yourself Physically Disabled?
ti I Yes z» ' No
LJ1 prefer not to answer this question.
Page 6 of6
F:ICLER1$ALLIREGIBOARD AND COMMITTEE APPLICATIONS FINAL DRAFTSIBOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
MIAMI
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 Perez Waleck Jessica L
Mailing Address -- Street Number, Street Name, or P.O. Box
12000 Biscayne Blvd, Suite 303
City, State, Zip
Miami, FL 33312
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)
[] county 0 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 Wember (check one)
D County [] Municipal: Miami Beach
(Municipality)
Board where serving ARP r s omw He Miami Beach 9r
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
Jewish Community Services of 12000 Biscayne Blvd., Suite 303, The mission of Jewish Community Services is to improve the
quality of life and self-sufficiency of the Jewish and broader
South Florida, Inc. Miami, FL 33181 communities throughout South Florida in accordance with
Jewish values.
I hereby swear (or affirm) that the information above is a true and correct statement.
4a.
2-22-2023
Date signed
RECEIVED BY ELECTIONS DEPARTMENT:
an eo RECEIVED
[] Electronic Copy
FEB 27 2023
CITY OF MIAIVII BEACH
OFFICE OF THE CITY CLERK
OFFICE USE ONLY Accepted: Y / N Deficiency:- Processed Date/initials: Scanned Date/initials:.---
138_SP-14 COE 2016
/{//\/\{ A{4CITYWIDE (CW) BOARD & COM MITTEES
coy + inti sos±, Arie ore#in~nor PARKING APPLICATION
1755 Meridian Avenue, Suite 200/Miami Beoch, FL 33139/Ph: (305) 6737505 or (305) 673-7000 ex4. 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.
Board Member Information
Date of Application: 2-7-2023
Applicant Name: Jessica Perez Waleck
Board/Committee Name: Senior Affairs Committe
Address: 12000 Biscayne Blvd, Suite 303, Miami, FL 33181
E-Mail Address: jperez@jcsfl.org
Work Phone: 305-899-8301 Home Phone
Cell Phone: Preferred Contact Method:
...
Vehicle Information
Tag: LFGR80 Color: Blue
State: Florida Year: 2017
Make: Kia Model: Niro
Applicant siaao,, >/1 , » =
Please provide signed#rt to the Pk g Department locoted at 1755 Meridian Avenue, 2% floor. Working
hours are 8:30 to 5:00 p.m. or email to: PgrkingReception@migmibeachfl.gov
e-mail subject: BOARD & COMMITTEE PARKING APPLICATION - APPLICANT NAME
Parking Department Section
PERMIT SYSTEM GARAGE ACCESS
Expiration Date: ID Card Serial #.
Issued By Print Nome: Print Name:
Signature: Signature: 6
Date Issued Dale Completed: