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Gabriel Paez 12.31.24BO ARD A ND CO MM ITTEE CH ECKLIST APPonreE. ex&L @.'fa DATE OF APPOINTMENr. 2·23·2 3 sorotcowwtree. MMe};'t{es Ao«ea» Chord<s1so FOR SCANNER FOR CLERK STAFF .] } o Scan o o Letter of Appointment TERIM END : 12·\·2H{ TE RM LIMIT: I,l Scan o oLgtter of Reappointment <V CoEy lf .Letter of AppointmenUReappointment e-mailed to Committee Liaison on 2[j4]6 Er] Scan o ooaird ail Committee Application (Completed on L 2] L3 Scan o oR~sum~/curriculum Vitae J [ o Diversity Statistics Reporting (Completed on 3 2 Q3 ) Scan o o Oath RECEIVED 4AR 2 2023 CITY OF MIAMI BEACH OFFICE OE TE CITY CLERK Scan o Scan o IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK t 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 ✓Mem orandum - 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 o Board and Committees Liaison Responsibilities O DIVERSITY STATISTICS REPORLIN+ Received on: 2.24-23 Signed by X Date oard or C Processed on: s p/23 By Employee: KM Date City Clerk's Office Staff Initials Scanned on: 3//23 By Employee: City Cle,1;¥,-j:/e Staff Initials 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 At£. }i! 4.5 1 We ore committed to providing excelleil? public· s~ivce and sale»yto oll who live, work, and ploy in our vibrant, tropical, historic community. , ' : !y. i .: ·' City of Miami Beach, I/OO Convention Canter Drive, Miami Beach, Florida 33139 ywy._miamibachll.gov OFFICE OF THE CITY CLERK, Ral0al E. Gran ado, Cly Clerk Tel 305.673.741, Fax. 305.673.7254 Email: CityClerk@miamibooch li.go v February 23, 2023 Mr. Gabriel Paez 100 Lincoln Road #1638 Miami Beach, Florida 33139 RE: Art in Public Places Committee Dear Mr. Gabriel Paez: 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. # ..%.. City Clerk cc: Monica Beltran, Parking Director Brandi Reddick, 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 C ity o f M i a m i B e a ch , /00 Convonlion Conler Drivo, Miami Beach, Florida 33139 yyy.Iiamibcachll.gay OFFICE OF THE CITY CLERK, Rolaal E. Granado, Cly Clark Tel: 305.6 73.7 4 11, Fox. 305.6 73.7254 Emal: CiyClerk@miamibeachll.gov Oath of Office Oath of Civility and Acknowledgements TO: Mr. Gabriel Paez RE: Art in Public Places 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-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. Gabriel Paez Sworn to and subscribed before me this l::nd_ day of,,,,_;:.~'--" 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. MI/\1 BE A CH 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 RECE IVED MAR 2 2023 CITY OF MIAMI e s##"%gg, A F F ID A V IT O F A F FILI A T IO N W IT H TH E C IT Y O F M IA M I B E A C H S T A T E O F F L O R ID A C O U N T Y O F M IA M I-D A D E I am in co m p lian ce w ith the affi lia tion require m ent of M ia m i Be ach C ity C o d e Sections 2-22 (4), as (check (/0 3// th at apply): ✓I am a re sident of th e C ity of M ia m i B e ach fo r six m onths or long e r. one Atoe.._to Li no .u to ad (t,3e /co g 'teazd [ 33131 □I ha ve an ow ne rsh ip intere st (fo r a m in im um of six m onths) in a busin ess established in the C ity of M ia m i Be a ch (fo r a m in im u m of six m onths). []Q r 9 (of [[][P g S . [{IS[Pe,S, ([(]feS5 □I am a full-tim e e m plo ye e of a business (fo r a m inim um of six m onths) and I am based in an off ice or oth e r lo ca tion of th e bu sin ess tha t is physica lly located in M iam i Be ach (fo r a m inim um of six m onths). [J a m e ()[ [11S,/[@ } PAS,]Pg , J(]F S,S- "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. e ad th e foreg oin g do cumen t an d th at th e fact s stat e d in it / 22 8 ·2 [ l iy D ate Si gn at ure () (6«bit £. le± Prin te d N a m e NO T A R Y S w or n to (or affi rm e d ) an d su b scribe d befo re m e, by m e an s of u physic a l pre sen c e or u onlin e notariz ation , » 2 ca Ha«cl asz3 » _6alnel ls f~• - ________ (C ity of M ia m i B e ach Bo a rd/C o m m itte e M em ber). U ro a u ce a D F9\L_ F or m o f Identificatio n rsonally K no w n cs. s#%% gt, sen 'f 6335A) s8 dz Corri.. "? 34.».}is Expires: January 24, 2027 jiffs Noiay Public - State ot Florida "i j C ity o f M ia m i B e a ch 1700 Convention Center Drive Miami Beach, Florida 33139 www.miamibeachfl,gov OFFICE OF THE CITY CLERK Em ai l: BC@m iamibe achfl.gov Telephone: 305.673.7411 B O A RD & C O M MI T T E E FI N A N CI AL A C KN O WL E DGE M E N T S T A IEII EN T A c k n o w le dg e m e n t of fin e s/s u sp en sio n fo r B o ard/C o m m ittee M em b ers fo r failu re to co m p ly w ith M iam i- D a d e C o u n ty F in a n ci al D isclo su re C o de Pro visio n C o de Section 2-11.1 (i) (2) «. Last N am e First Name «al. «ao I und erst and th at no later th an July1of ea ch year all memb er s of Boards and Comm itte es of the City of Miami Beach, including those of a purely advisory nature, are required to com ply with Miam i-Dade County Financial Disclosure R equirem ents. O n e of the fo llow ing fo rm s m u st b e fil ed w ith the City Clerk of Miam i Beach, 1700 Convention Center Drive, Miam i Beach, Florida, no later than 12:00 noon of Ju ly 1, of each year: 1. A "Source of Incom e Statem ent;" or 2. A "Statem ent of Financial Interests (Form 1)1;" or 3. A Copy of your latest Federal Incom e Tax Return . Fa ilu re t of no m$re1ha1 s, pursuant to the M iam i-Dade County Code, may subject the person to a fine jail, or both. Date ' M emb er s of the Planning Board and Board of Adjustm ent will be notified directly by the State of Florida, pursuant to F.S. $112.3145(1)(a) to file a Statem ent of Financial Interests (Form 1) with the Miam i-Dade County Supervisor of Elections by 12:00 noon , July 1. Plannin g Board and Board of Adjustment m em bers who file their Form 1 wi th the County Superv isor of Elections autom atically satisfy the County's financial disclosure requirem ent as a M iam i Beach City Board/C om m ittee mem ber and need not file an additional fo rm with the Office of the C ity Clerk. H owever, com pliance with the County disclosure requirement does not satisfy the State requirem ent. Page 5 of 6 F:ICLER\$ALL\REGIBOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx Updated: June 2020 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 DIVERSITY ST A TIS TICS REPORT r. 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. G ender: tie Ll remate Ll oner Ll 1 pref er not to answer. R ace/E thnic C atego ries: W hat is yo ur race? DI African American/Black [] Asian or Pacific Islander 0 Caucasian/White L_l Native American/American Indi an [k other --Print Race: _b2tu" 0 I prefer not to answer. D o yo u consider you rself to be S panish, H ispanic, or Latino/a? tK. Io D I prefer not to answer. D o yo u co nsider yo urself P hysically D isab led? EE " No D I prefer not to answer this question. Page 6 of 6 F:ACLERISALLREG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTSIBOARD AND COMMITTEE APPLICATION REG FINAL.docx Updated: June 2020 MIAMl·DADE. &I 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 La~e First Name Middle Name/Initial 2022 A2- 4iL T Mailing Address - Street Number, Strep-~ or P.O. Box loo inL A ll,3 ow».so»g, , Po l 3314 M{wt HA , oi ( 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. D 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) D County ~unicipal: Cry ore (t a»i 'Be #E -- (Municipality) 1"pc x ft 'us l LES Alternate address (if home address is exempt) I Work telephone I Term began on/ended on 3065-315-1)435 22323 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 M;Aw )DE c4 I ' IT SheeT eve ET' MIN«i , 3312 I · ) that the information above is a true and correct statement. Date signed RECEIVED BY ELECTIONS DEPARTMENT: tar«co RECEIVED [] Electronic Copy MAR 2 2023 CITY OF MIAM I BEA CH OFFICE OF THE CITY CLERK OFFICE USE ONLY Accepted: Y / N Deficiency. Processed Date/initials: Scanned Date/initials: 136._SP-14 COE 2016 +//,4 1 ./.. CI T Y WI DE (CW) BOARD & COMMITTEES g ..g or.ii s.... «cone oco«coo» PARKING APPLICATION EL.Elf# 1755 Meridian Avenue, Suite 200/Miami Beach, FL 33139/Ph: (305) 673-7505 or (305) 673-7000 ea. 6200 PARKING A city w ide (CW ) parking permit is honored at m etered parking spaces and restrict ed residential zones par king spaces. A CW parking perm it IS NOT honored in prohibited ar eas. An Access Card will be provided to you fo r City Hall G ar age (G 7) access, IMPORTANT NOTE: Your vehicl e lic en se plate serves as your "parking perm it". In order to avoi d any unnecessar y enfo rcement act ions, it is important that our records reflect the most current and accura te info rm ation regar ding your vehicle license plate. Inaccurate and/or outdated vehicle info rm ation m ay lead to the issuance of park ing citation (s) and /or the towing of your vehicle. Please note that this new access car d CANNOT be hole-punched or perfora ted in any manner. To use the new car d please hold the car d at cl ose pro xim ity to the reader until the gate opens. You may need to try the other side of the card. Please ensure you hold the entire surfa ce of the car d against the reader until the gate opens. ACKNOWLEDGEMENT: I acknow ledge that should m y access card be lost, stolen or dam age, I will be responsible to pay a $10.00 repl acem ent fee. Board M em ber Info rmation Date of Application: 22323 Applicant Name: C Ail. T Yez - Board/Committee Name: er Kol '4es Address: 1oo Lnon d (3e H A«i'b o at f oei d 33139 E-Mail Address: J P012.250 9 no.om work Ph on e' 36-31- 935° . Home Phone 78-2.-o{7 Cell Phone: 78-'/3 -4 7 33 Preferred Contact Method· (de// Vehicle Info rmation Tag: N802q Color: BA State: Lida Year: 0 Make: Lkweli Model: G 35 I Applicant Sianature: e5 Please provide signed form to the Parking Department located at 1755 Meridian Avenue, 2" floor. Working hours are 8:30 to 5:00 p.m. or email to: ParkingReception@m iamibeachfl,gov e-mail subject: BOARD & COMMITT EE PARKING APPLICATION - APPLICANT NAME P k' D rt ar mna epa men ec'Ion PERMIT SYSTEM GARAGE ACCESS Expiration Date: ID Card Serial #: Issued By Print Name: Print Name: Signature: Signature: e6 Date Issued: Date Completed: t S :ti : pug man ror torms cw aris committees patmgtotm.doc