Margarita Kruyff 12.31.24I
1
DATE OF APPOINTMENr. \21[23
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BOARD AND COMMITTEE CHECKLIST
APPowTEE: 6! j0 1la tvyf
BOARD/COMMITTEE: Su±iQQbllIt- Appointed by. _Bopoy (ae lo&wt
FOR SCANNER FOR CLERK STAFF [eyl£ [31[)2
scan oteter or Appointment TERM EN: IO )2 rERM Lu rr: ''I "
Scan o o Letter of Reappointment "ij}, [3'4"" ot AonointmenuReappointment e-mailed to commtee tuason on
o oar@ an@ committee Application (completed on. _1}00)2
o R~sum~/Curriculum Vitae , I .., J
o Diversity Statistics Reporting (Completed on _, [[d
o Oath
RECEIVED
APR 12 2023
IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOKK
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 CIT Y O F M IA M I BEA CH
OFFI CE OF THE CITY CLERK o Citywide Permit Application (Parking Department Form)
Scanned on:
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 Keep COPY in file an d ORIGINAL for Ann ual Report.
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Processed on. t if1_hi By Employee. h/
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Date City Clerk's Office Staff Initials
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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 ore committed to providing excellent public service and safety to oli who live, work, and ploy in cur vibrant, tropical, historic community
City of Miami Beach, I/OO Convonlion Canter Drive, Miami Bach, Florida 33139 yyw_Iiamibaachl]_gov
OFFICE OF THE CITY CIERK, Rall E. Granado, Cy Clerk
Tol 305.673.7411, Fax¢ 305.673.7254
Email: Ci#yClerk@miamibooch fl.gov
February 21, 2023
Ms. Margarita Kruyff
900 West Avenue #1133
Miami Beach, FL 33139
SUBJECT: Sustainability Committee
Congratulations! You have been reappointed by Mayor Dan Gelberto the above referenced, board or
committee named above, for a term ending: 12 /31/20 24 .
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.
Rega1
Rafa~~ranado s:
cc: Monica Beltran, Parking Director
Juanita Ballesteros, 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, !7OO Conv enlion Coner Drive, Miami B ach, Florida 33139 yyy ._miamiba chll.gov
OFFICE OF THE CITY CLERK, Raf0ol E. Granado, City Clork
Tel: 305.673.7411, Fax 305.673.7254
Email: Ci/Clerk@miamibcachfl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Ms. Margarita Kruyff
RE: Sustainability 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.
swom to and subscribed before me this ] day or lg, 2023
KeilaM~
Deputy 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.
1ALA IBE
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachf.gov
Telephone: 305 .673 .7411
RECEIVED
APR 12 2023
CITY OF MIAMI BEACH
OFFICE OF TH E CITY CLERK
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
STATE OF FLORIDA
COUNTY OF MIAMI-DADE
l am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4), as (check
(/) all that apply):
/ am a resident of the City of Miami Beach for six months or longer.
Home A«tar.. /(00 ye } A/eye #1(3%, Liaw 3e@$7 F 33137
□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}.
[[arm9 (f [[,/PeS;
[1[S[mes,S, J\][res3
□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).
pp9re f P[]g1Po$5
31[1p9,S, [\(]]rs
"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
ape.. 4,· / d1 [ [j[foil \\y _il1(0
soi6 W (J[{ sis
eyqyda troy-
Printed
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of f physical presence or n online notarization,
ms _ 'faay or _Peg_ ,2023 oy j'aeon 1o yEE
________ (City of Miami Beach Board/Committee Member).
Produced ID
" Form of Identification
- own
1 .
- ii tblic
'nui F»oz_ VE»net
Name of Notary, Typed, Printed, or Stamped
ML AMIE
City of Mi ami 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
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 Na First N 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.
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 than $5 0 0 , 60 days in jail, or both.
lNluq uit @ signature T ·
114/023
Date
' 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 :0 0 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
FACL ERI $AL L\R EG\B OA RD A ND C O M MI TTE E AP P LI C ATI O NS FI NAL D RAF TS\BO A RD AND C OM MI T TE E AP PLI C A TION REG FINAL .doc x
Updated: June 2020
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
!44t
Last Nan le First Nanhe 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:
L Mae
Ll remale □Other
0 I prefer not to answer.
Race/Ethnic Categories:
What is your race?
D African American/Black
El Asian or Pacific Islander
DK Caucasian/white
LI Native American/American Indian 0 Other- Print Race: _
0 I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
~
.lo
Ll1 prefer not to answer.
Do you consider yourself Physically Disabled?
es
ho
D I prefer not to answer this question.
Page 6 of 6
F:ICLER\$ALLIREG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
SOURCE OF INCOM E STATE M ENT
Section 2-11.1(i) of the County Ethics Code requires that certain employees and public officials file a finan cial disclosure Statement on a yearly basis by July 1st
of every year.
Disclosure for Tax Year Ending Last Name
2022 \o f(
First Name
Mo41la
Middle Name/Initial
Mailing Address - Street Number, Street N e, or P.O. Box
900 1es# et0e H((3
City, State, Zip
Mi au'+ ed
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. []
Filing as an Employee (check one)
TI 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 runic»at. Cl cf tugs, Beggy
(Municipality)
Board where serving
u s#a4 n«boi l h Co t#le e
Alternate address (if hom e address is exempt) EE.a.r 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.L_]
Name of Source of Income Address Description of the Principal Business Activity
Rgdov $Sy80,c. to NW 6 5\eel voawo!al (gs ti0wu, F 33\1¥
I hereby swear (or affirm) that the information above is a true and correct statement.
Date signed
across are7E' [] Hardcopy it?
D Electronic Copy
APR 12 2023
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
OFFICE USE ONLY Accepted: Y / N Deficiency. Processed Date/initials: Scann ed Date/initials:
138_SP-14 COE 2016
01\ .. ! A;, ;,\l.· } { f } j M///\u
City of Miami Beach, PARKING DEPARTMENT
1755 Meridian Avenue, Suite 200/Miami Beach, FL 33139/Ph: (305) 673-7505 or (305) 6737000 ex4. 6200
CITYW IDE (CW) BOARD & COMMITTEES
PARKING APPLICATION PARKING
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 fo r C ity Hall G ara ge (G 7) access.
IMPORTANT NOTE: Y our veh icl e licens e pl ate serves as your "parking permit". In order to avoid
any unnecessary en lorcem ent actions, it is impor tant that our records reflect the most current and
accurate infor ma tion regarding your veh icl e license plate. Inaccurate and/or outd ated vehicle
infor m ation may lead to th e issuanc e of parking citation(s) and/or th e towi ng of your vehicle.
Please note th at th is new access card CANNOT be hole-pun ch ed or perforated in an y m anner . To use
the new card please hold the card at close proxim ity to the reader until the gate opens. You m ay need
to try th e oth er side of the card. Please en sure you hol d th e entire surface of th e card against the reader
until the gate op ens.
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 lnformation
D ate of Appl ic at ion ' +[ q,202~ I
Applicant N am e' ([(y 1Ju41r I
B oar d /C om m i tte e N am e:<4 squ a ll l i ya(#eo,
Address: [o est /Aue (27 Mu@st Beal F 3,33\
E-Mail Address: (w@ dd00 .@¥\
Work Phone: H om e Phone
cell Ph on e 30-Q0l- 5 Preferred C onta ct M eth od l l 3Mo,
Vehicle Information
Tag: NP?132 Color:
State: r Year: 2or1
Make: Model: 440i
Ap pl ican t Si «natur e : es
Plea se pr o vi de sig ned for to th e Pc ;ki n g D ep ar tm dn t located at 17 55 Meridian Avenue, 2" floor. Working
hours are 8:30 to 5:00 p.m. or email to: ParkingReception@migmilbeachf.gov
e-mail subject: BOARD & COMMITTEE PARKING APPLICATION - APPLICANT NAME
P ti D S ar' Ina eparment ection
PERMIT SYSTEM GARAGE ACCESS
Expiration Date: ID Card Serial #:
lssued By Print Name: Print Name:
Signature: es Sign ature: #5
Date lssued: Date Completed: