Patricia Henao-van Beek 12.31.24B O A RD AND COMMITTEE CHECKLIST
APronreEe. _Fatica Henao var (5re or ArPomwNr. 2/22/23
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rERw No. _p2/1]24 reno tum. _y2]1/2, FOR SCANNER
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to Committee Liaison on
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FOR CLERK STAFF
o Letter of Appointment
o Letter of Reappointment 5]$y43° Aonoenvreaomwent e-rates
o Board and Committee Application (Completed , /2]2/
• Resurrcorcutom vae .]/
o Diversity Statistics Reporting (Completed on <_B
o Oath
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
RECEIVED ✓County Code Section 2-11.1 -- Conflict of Interest and Code of Ethics Ordinance (as
amended through December 2010)
MAR 2 2023 ' 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
CITY OF MIAMI BEACH ✓Memorandum - Solicitation by City Board and Committee Members
OFF ICE 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
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o Source of Income Statement
o Acknowledgment of Financial Disclosure Requirement
Scanned on:
o Board and Committees Liaison Responsibilities
o DivERsrr srAriscs REPORTING .,e feyer
2bh> .soaX Jut
Date mmittee Member
Processed 3ll3 Employee: t(/V\ _
D,te City Clerk's Office Staff Initials
_3_~} _i, __ }3 By Employee: ---~l(M _
Received on:
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:\CLER\BOARD AND COMMITTIES DATABASE\CHECKLIST MASTER\B&C Checklist 2015 MASTER.docx
We are committed to providing excellent public service and safety to all who live, work, and ploy in our vibrant, topical, historic community.
C ity of Miami Beach, MOO Convention Cantor Drive, Miami Beach, Florida 33139 yywy._miamihaachllaov
OFFICE OF THE CITY CLERK, Rafoal E. Granado, Cy Clerk
Tl: 305.673.74I1, Fax: 305.673.7254
Email:. Ci#yClerk@miamiboochfl.gov
February 23, 2023
Ms. Patricia Henao-van Beek
1145 Bay Drive
Miami Beach, FL 33141
SUBJECT: Transportation, Parking and Bicycle-Pedestrian Facilities Committee
Dear Ms. Patricia Henao-van Beek:
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°:f/1
Rafael lranado
City Clerk
cc: Monica Beltran, Parking Director
Monica Beltran, 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,
H¥ Ht !PY IRK fatal I ranode fwy le«k
lei 3056/311 +ax 305/37234
frail ikimiatibhf? yow
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Ms. Patricia Henao-van Beek
RE: Transportation, Parking and Bicycle-Pedestrian Facilities 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.
swor to and subscribed before me a Ld_ aay o/vr4
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
170 Convention Center Drive
Miami Florid0 33139
OFFICE OE THE CITY CLERK
Email: 8C@gm.amtbeach#l.soy
Telephone: 305.673 7A'1
RECEIVED
MAR 2 2023
CITY OF MIAMI BEA CH
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):
lam a resident of the City of Miami Beach for six months or longer.
Home Adoress_[IL6 Eay Dive Miam i £each FL 314]
□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 _
□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 _
Business Address _
"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 busiess association.
rjury, I declare that I have read the foregoing document and that the facts stated in it
March 1 2023
Signature
Patrica Hleno- yaneel
Date
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of u physical presence or online notarization,
es2adaay or. Moh zoo, [h i 1enoo-vu _lee
¥
________ (City of Miami Beach Board/Committee Member).
f Or y2r Lune Produced ID
For of I ntification
e-
Signature of Notary Public
Name of Notary, Typed, Printed, or Stamped
OFFICE OF THE CIY CLERK
BOARD & COMMIIIEE 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)
lenqo -van Peek Parido
Last Name First Name Middle Initial
I understand that no later than July_1,of each ear 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 Finan cial Interests (For m 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 $500, 60 days in jail, or both.
a»2 Signaifre
arch t/73
pi /
' Members of the Pl an ni ng Board and Board of Adjustment will be notified directly by the State of Florida,
pursuant toF.S. S112.3145(1)(a): to file a Statement of Financial Interests (Fo rm 1) with the Miami-Dade County
Supervisor of Elections by 12:00 noon, July 1. Planning Board and Board of Adjustment members who file their
Form 1 with the County Supervisor of Elections automatically satisfy the County's financial disclosure
requirement as a Miami Beach City Board/Committee member and need not file an additional form with the Office
of the City Clerk. However, compliance with the County disclosure requirement does not satisfy the State
requirement.
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F:\CLERi$ALL\REGIBOARD AND COMMITTEE APPLICATIONS FINAL DRAF T S \BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated June 2020
C ity of M ia mi B e a ch
1700 Convention Center Duve
139
OFFICE OF THE CITY CLERK
Email:. SC@marib e achfL.go
Telephone. 305.673.7411
DIVERSITY STATISTICS REPOR T
Henao- van eek Patricia
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:
[lyae
[iremale
D Other
El t prefer not to answer.
Race/Ethnic Categories:
What is your race?
[] African American/Black
[] Asian or Pacific Islander
[T Caucasian/white
[]Native American/American Indian
[] other -- Print Race:
totttttotttottottit
El prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latinola?
Er ,
[Jo
[l1prefer not to answer.
Do you consider yourself Physically Disabled?
ye.
t
El~refer not to answer this question.
Page 6 of6
F:\CL ER\SALL\REG'BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTE E APPLICATION REG FINAL.doc»
Up dated: June 2020
Clear From Print Form
MIAMI-
Em7 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 Vear Ending I Last Name First Name Middle Name/Initial
2022 Henao-van Beek Po tric1a
Miting Address - Street Numher, Street Name, or P.0. Bx
I45 0q Die Miami Beo@h
City, State, zip
Peach 33p4.l Mia rot FL
lf 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.[]
Filing as an Employee (chock ons)
[] county I] Public Health Trust [] Municipal:
(Municipality)
Department
Posi tion or Title Employee ID Number
Work address I Work telephone Employment began on/ended on
Fitiny as a Board Henaber (check one)
[] county J wonteae It4 _," Miami 3each
(Municipality)
Board where serving
Transor anon Eakin and test~an fachhe Income
telephone
62029102
Term began on/ended on
3/18 2021
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 tor your benefit. However, the income of your spouse or any business partner need not be disclosed. If continued on a separate sheet, check here.l]
Name of Source of Income Address Description of the Principal Business Acthvity
Spa.se, 145 04 Drive Reared Miami @ah FL 33/4/ 4 +,
# t
$
I hereby swear (or affirm) that the information above is a true and correct statement.
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siGaile err6k ~«iosia
3/1/2013 ale cica
RECEIVED BY ELECTIONS DEPARTMENT:
[ ] Hardcopy
t1ectone {3ECEIVED
MAR 2 2023
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F:o'
con stitutes
roquired by law.
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