Ana Cecilia Velasco 02.01.24MIA M I BEACH
B O ARD AN D C OM MI TTEE CH E CKLIST
APPOINTEE: Ana Cecilia Velasco DATE OF APPOINTMENT. 03/28/2023
BOARD/COMMITTEE: 2023 Hall of Fame Selection Co Appointed by: Comm. Alex Fernandez
FOR SCANNER
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FOR CLERK STAFF
o Letter of Appointment
o Letter of Reappointment " 3)',"/9, Aoononveoonoent, e-moo
o Board and Committee Application (Completed on 2' }'µ, J 2,e,
o Resume/curriculum vitae _{[ _[
o Diversity statistics Reporting (completed on [) ]y
o Oath
TERM END. 2/1/2024 TERM LIMIT: 1 year ------
to Committee Liaison on
RECEIVED
APR 1 3 2023
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
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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
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
Received on:
o Board and Committees Liaison Resp
O DIVERSITY STATISTICS REPO NG
413/202° stone4
nd ORIGINAL for Annual Report.
Date
Processed on:. "100° By Employee: I'I
Date
Scanned on:
Initials
4/10/20° By Employee:
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:\C LER\BO ARD AND CO M M ITT IES DATABASE\CHECKLI ST MASTER\B&C Checklist 2015 MASTER.docx
We are com mi tted to providing excellent public service and safety to all wh o live, work, and plo y in our vibrant, tropical, historic community.
C ity o f Mi a m i B e a ch, I7OO Convanlion Canter Drive, Miami Boach, Florida 33 139 yews.IiaInihaachll.gov
OFFICE OF THE CITY CLERK, Rafael E. Granado, City Clerk
Tel: 305.673.7411, Fax. 305.673.7254
Email: Cit/Clerk@miamibeoch fl.gov
March 28, 2023
Ms. Ana Cecilia Velasco
2455 Flamingo Drive, #404
Miami Beach, FL 33140
RE: 2023 Hall of Fame Selection Committee
Dear Ms. Ana Cecilia Velasco:
Congratulations! You have been appointed by the City Commission to the agency, board or committee
named above for a term ending: 02/01/2024.
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.
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
MIAMI B E A CH
City of Miami Beach, I/OO Convention Center Drive, Miami Bea ch, Florida 33 139 yNyyw.mi a IIibea chll.gov
OFFICE OF THE CITY CLERK, Rafael E. Granado, Cy Clerk
Tol: 305.673.7411, Fax:. 305.673.7254
Email: CilyClerk@miamibeachll.gov
Oath of Office
Oath of Civility
and
Acknowledgements
T O : M s. A na C ecilia V elasco
R E : 2023 H all of Fam e Selection C om m ittee
I do so lem n ly sw e a r or aff irm to bear true faith, loyalty and allegiance to the Govern m ent of the United
S tates, the S tate of Florida, and the C ity of M iam i Beach, and to perform all the duties of a m em ber of the
ab ove-m entione d bo ard or com m ittee of the C ity of M iam i Beach to w hich I have been appointed fo r a
term ending : 02/01/2024.
T o m y colleag u es and to all of those I represent and serv e, I pledge fairn ess, integrity and civility, in all
actio ns taken and all com m unications m ade by m e as a public serv ant.
I ha ve be en issue d a copy of section 2-11.1 of the M iam i-D ade C ounty C ode (C onflict of Interest and
C o de of Ethics O rdinance), as w ell as Florida C om m ission on Ethics G uide to the Sunshine Am endm ent
and C od e of Ethics for Public O ffi cers and understand that as a m em ber of a City of M iam i Beach Board
and/or C om m itt ee , I m ust com ply w ith the financial disclosure requirem en ts of M iam i-Dade County or the
State of Fl or id a (depe ndi n g on th e board or comm itte e on w hich I serv e) on July 1 st, followi ng th e closing
of th e cal en d ar year on wh ich I have serv ed. f
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Sw orn to an d subs cribe d before m e this jhh
Keil
p le ase vi si t th e C ity of M iam i B each w ebsite at w w w .m iam ibeachfl.gov under C ity Clerk/Board and
C o m m itt ees fo r add itional info rm ation regarding the Financial D isclosure R equirem ents.
M IA M I BEACH
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
APR 13 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.
Home AddresZ?455 Flamingo Drive, #404, Miami Beach, FL 33140
□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
ey y or b iness association.
declare that I have read the foregoing document a that the facts stated in it
2,42 Z n (di'fa
Date
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of o physical presence or o online notarization,
os 2hoy ow. Anl _o?». Ao Clio- / @AoO
________ (City of Miami Beach Board/Committee Member).
flQnvols Lion4€ Produced ID
Form of Identification
Personally Known
Name of Notary, Typed, Printed, or Stamped-
M IA M I BEACH
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 STATISTICS RE POR T
Velasco Ana Cecilia
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 Mate
El rem ale
D Other
0 I prefer not to answer.
Race/Ethnic Categories:
What is your race?
D African American/Black
LJAstan or Pacific Islander
El Caucasian/white
D Native American/American Indian 0 Other- Print Race: _
D I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
[lves
L o
El1 prefer not to answer.
Do you consider yourself Physically Disabled?
v s no
0 I prefer not to answer this question.
Page 6 of 6
F:\C LER\$ALL\REG \BO ARD AND CO M M ITT EE APPLI CATIO NS FINAL DRAFT S\BO ARD AND COMMITT EE APPLICATION REG FINAL.docx
U p da ted : Ju n e 202 0
M IA M I BEACH
City of Miami Beach
1 700 Convention Center Drive
Miami Beach, Florida 33139
www.mi am ibeachfl.gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305. 673 7411
BOA RD & COMM ITTEE FINANCIAL ACKNOWLEDGEM ENT STA TEMENT
Acknow ledgem ent of fines/suspension fo r Board/Com m ittee Mem bers for failure to com ply with Miami-
Dade County Financial Disclosure Code Provision Code Section 2-11.1(i) (2)
Velasco Ana Cecilia
Last Name First Name Middle Initial
I 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. Vor our latest Federal Income Tax Return.
e of e o s, pursuant to the Miami-Dade County Code, may subject the person to a fine
$5, '60) ay9/in jail, or both. / y 1//8/?a
Date
1 Members of the Planning Board and Board of Adjustment will be notified directly by the State of Florida,
pursuantto 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.
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F:IC L E R \$A LLIR E G IB O A R D A N O C O M M ITT E E A P P LI C A T IO N S FIN A L D R A FT S IB O A R D A N D C O M M ITT EE A PPLI C ATIO N RE G FIN A L.docx
Updated: June 2020
M IA M I-DAD E- EI SOURCE OF INCOME STATEMENT
Section 2-11.1(@) 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 Velasco Ana Cecilia
Mailing Address - Street Number, Street Name, or P.O. Box
2455 Flamingo Drive, #404
City, State, Zip
Miami Beach, FL 33140
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 D Public Health Trust E] Municipal:
(M uni cipality)
Department
Position or Title Employee ID Number
Work address I Work telephone Employment began on/ended on
Fillng as a Board Member (check one)
□County D Municipal: Miami Beach
(Municipality)
Board where serving
2022 Hall of Fame Selection Committee
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
O cean D rive A ssoci ation 760 O cean D rive, S uite 9 Non-pro fit business association
M iam i Beach, FL 3314 0
RECEIVED BY ELECTIONS DEPARTMENT:
[] Hardcopy.
ti ens&lE~EIVED
APR 1 3 2023
CITY OF MIAMI BEACH
OFFICE USE ONLY Accepted: Y / N Deficiency. Processed Date/Initials:Scanned Date/initials:-
138_SP-14 COE 2016
MIAMI BEACH CITYWIDE (CW) BOARD & COMMITTEES r■ll
City of Miami Beach, PARKING DEPARTMENT PARKING APPLICATION II.Ill
1755 Meridian Avenue, Suite 200/Miami Beach, FL 33139/Ph: (305) 673-7505 or (305) 673-7000 e4. 6200 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 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
D a te of A p p licatio n: 443)2a
A p p lica nt N a m e : / lo V\J
Bo ar d /C om m i ttee N am e: 2023 Lt.ll «fm elk (own Be
A d d ress: 2 45 5 F lam in g o D rive, #4 0 4, M iam i Bea ch , FL 3314 0
E-M a il A d d ress: exe cd ire cto r@ oce a n d rive m b.co m
W o rk Pho ne : Hom e Phone
C e ll Phone : 30 5 -5 28 -8 12 5 Pre ferre d C on tact M eth od: ¢el l
Vehicle Information
Tag: 0 5 A E M D C ol or: B lack
State: F L Yea r: 2021
M ake: Lexu s M odel: IS 300
A p p lica nt Si na ture:
Ple ase pro vi de sig ned form to tfe Parking Departm ent locate d at 1755 M eridia n Aven ue, 2d floor . W orking
ho urs are 8:3 0 to 5:00 p.m . or em a il to : ParkingReception@miamibeachfl.gov
e-mail subiect: BO AR D & CO M M ITTE E PARKING A PP LICATI ON -- AP P LICANT NAM E
P ·d D a r' In a e p a rt m e n t ectio n
PERMIT SYSTEM GARAGE ACCESS
Expiration Date: ID Card Serial #:
Issued By Print Name: Print Name:
Signature: e5 Signature: 6
Dote Issued: Dote Completed:
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