Sara Velasquez 12.31.24M IAM I B E ACH
BO A R D A N D CO M M ITT EE C H EC K LIST
APPOINTEE:. {r /\Ute 2 DATE OF APPOINTMENr. 3/»/23
soArco»MurreEe:. _4cpn 'tu w fa r poitea by._Ah} 0r41640h
rRM No. [[3l/24 FOR SCANNER
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FOR CLERK STAFF
o Letter of Appointment
o Letter of Reappointment
o Copy of Letter of Appointment/Reappointment e-mailed
3/2 l4 2 sh ] o Board aid Committee Application (Completed on 3]'}428
o Resume/curriculum Vitae /} ·]
o Diversity Statistics Reporting (Completed on 4])/b
o Oath
rRM Lu»rr: (2[31 )26
to Committee Liaison on
IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
✓City Code Ordinance Section applicable to the agency, board or committee
R EC EIV ED ✓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
R 042023 amended through December 2010)
AP ✓Amendments to the Code of Ethics Ordinance (September 2009 through July 2012)
✓Highlights of the Miami-Dade County Ethics Code
C ITY O F M IA M I B E A C H ✓Sunshine Law and Public Records - Frequently Asked Questions
OFFICE. OF THE CITY CLERK ✓Memorandum - 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
Scan o o Source of Income Statement
Scan o o Acknowledgment of Financial Disclosure Requirement
o Board and Committees Liaison Responsibilities
O DIVERSITY STATISTICS REPORTI G Keep COPY in file and ORIGINAL for Annual Report
Received on: 0\.CH4_.20 signed oy % pr I! I// Mt
Scanned on:
Date Board or Committee Member
Processed on: _y~-+J_l/+---+}_l.-_3 By Employee: KN\ _
Date City Clerk's Office Staff Initials
_4~)_L/_.__) _2-_~ By Employee: }<N) _
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 MASTERIB&C Checklist 2015 MASTER.docx
WVe are committed to providing excellent public service and safety to all who live, work, and play in our vibrant, tropical, historic community.
1B
City of Miami Beach, 1/00 Convention Cantor Drive, Miami Boach, Florida 33139 yyy_miamnibgachill.gov
OFFICE OF THE CITY CLERK, Rafael E. Granado, City Clerk
Tel 305.673.7411, Fax: 305.673.7254
Email: CityCl erk@miamibcach fl.gov
March 28, 2023
Ms. Sara Velasquez
1776 Normandy Drive
Miami Beach, Florida 33141
RE: Design Review Board
Dear Ms. Sara Velasquez:
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.
Regards,
Rafael Granado
City Clerk
cc: Monica Beltran, Parking Director
Michael Belush, 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
M IA M I BEACH
City of Miami Beach, 1/0O Con ven tion Canter Dive, Miami Boach, Florida 33 139 yNyw y_Ii am nibea ch f]g ov
OFFICE OF IHE CITY CIERK, Rafaol E. Granado, City Clerk
Tel 305.673.7411, Fax. 305.673.7254
Email: CilyClerk @mi am i booch fl.g ov
O ath of O ffice
O ath of C ivility
an d
A ckno w ledg em e nts
TO: Ms. Sara Velasquez
RE: Design Review 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.
Sworn to and subscribed before me +# h jay o'
K eila M ena Caceres
D eputy Clerk
*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 IA M I B EACH
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
PR 04 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):
rJ I am a resident of the City of Miami Beach for six months or longer.
Home Address
□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 business association.
Under penalties of perjury, I declare that I have read the foregoing document and that the facts stated in it
are true. M'(\{\ ~·
Signature
$a Vela9ez_
Date
Printed Name
NOTARY
________ (City of Miami Beach Board/Committee Member).
Sworn to (or affirmed) and subscribed before me, by means of□physical presence or online notarization,
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Produced ID t Ou4
Form of Identification
Signature of Not
Name of Notary, Typed, Printed, or Stamped
M IA M I BEACH
City of Miami Beach
l 70 0 C o nventio n C enter Drive
M ia m i Beach, Flo rid a 33 13 9
www.m iam i b each fl .g ov
O FFIC E O F TH E CI TY C LERK
Email: BC@miamibeachfl.gov
Telep ho ne: 30 5 .6 7 3 .7 4 11
DIVERSITY STATISTICS REPORT
5AA
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 at e
L3 rem ale
L)one
0 I prefer not to answer.
Race/Ethnic Categories:
What is your race?
DI African American/Black
Asian or Pacific Islander
Caucasian/White
Native American/American Indian l • L1..-i
Lq oner-Pint Race: Hl62l1CH/iI
0 I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
~va.
Lo
0 I prefer not to answer.
Do you consider yourself Physically Disabled?
v e,
~ ~;refer not to answer this question.
Page 6 of 6
F:\CLER\$ALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
M IAM I BEACH
City of M iam i Beach
1700 Convention Center D rive
M iam i Beach, Florida 33 139
ww w .mi am ibeach],g ov
O FFIC E O F TH E CITY CLERK
Em ail: BC@ m iam ibeachfl.gov
Telephone: 305.673.7 411
BO A R D & CO M M ITTE E FINA NC IAL A CK NO W LEDG E M ENT STA TEM ENT
A ckno w ledg em ent of fines/suspension fo r Board/Com m ittee M em bers fo r failure to com ply w ith M iam i-
Dade C ounty Financial Disclosure Code Provision Code Section 2-11.1(i) (2)
VELA6u2.
Last Name
4de -
First Name Middle Initial
l understand that no later than July 1, 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.
O n e of the following forms m ust be fil ed 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.
Failu re 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 wool Date
ALL 1.3022
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 COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
M I A M l ·DAD E.
EI S O U R C E O F IN C O M E S TAT E M E N T
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 Last Name
2022
First Name
$KA
Middle Name/Initial -
Mailing Address - Street Number, Street Name, or P.O. Box
4 Or a l
City, State, Zip
Ml
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)
D County [] Public Health Trust [ Municipal:
(Municipality)
Department
Position or Title Employee ID Number
Work address Work telephone Employment began on/ended on
Filing as a Board Member (check one)
D County [ Municipal: Pu 41l 6c
(Municipality)
Board where serving
DE EN4 0AI
Alternate address (if home address is exempt) Work telephone 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
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I hereby swear (or affirm) that the information above is a true and correct statement.
MOL_1 02
Dae signed'
RECEIVED BY ELECTIONS DEPARTMENT:
[] Hardcopy,, ,
ti eeii@E~EIVED
APR 04 2023
CITY O F M IAM I BEACH
OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/Initials: Scanned Date/Initials: _
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