Dana Wolpert Martorella 12.31.24BO ARD A ND C O M MITTEE CHE C KLIS T
APPOI N TE E: Do • w a iec..d M:w-hlA-lv.- DATE OF APPOINTMENT: 6 }1.:=t- /z3.
8OAR D/COMM ITTE E: GO -.a orj±±_o.-_.u.e_ Ap poi nte d by thy 0M91fK00)
rev eo. Pl3Lh24 1eon2/31/2 FOR SCANNER
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RECEIVED
M AY 24 2023
FOR CLERK STAFF
o Letter of Appointment
Letter of Reappointment jB26] $"$' " Ao«osmcorona «-otea e
ar@ ad committee Application (completed an]23)23
e som ercoe ov oae sL ]
Diversity statistics Reporting (competed on_. ? )~ )
o Oath
IMPORTANT IN FO R MA TION FOR BO A RD AND COMMITTEE MEMBERS BOOK
City C ode Or dina nc e Section applicable to th e agenc y, board or cormittee
City Code Sections 2-21,2-22. 2-23, 2-24. 2-25, 2-26, 2-458 and 2-459
County Code S ect ion 2-11.1 -- Conflict of Interest and Code ot Ethics Ordinance (as
am en ded thro ugh December 2010)
A m endm ent s to the Code of Et h ics Ordinance (September 2009 through July 2012)
Highlights of the Miami-Dade County Ethics Code
v Sunshine Law and Public R ecord s - Fr equen tly Asked Questions
v M emor an d um - S olici tation by City Board and Committee M emb ers C ITY O F M IA M I B E A C H
O FFIC E O F TH E C ITY C LER K
o C itywi d e P ermi t A pp lic ation (P arki ng Departme nt Form )
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Re ce ived on
Pr ocessed on .
0 B ookl et -- G uid e to Sunshine A m endm e nt & Code of Ethic s for Public Officers and Employees
G S ource of Inc om e St atem en t
O Ack nowledg m ent of Fin anci al Discl osure Requiremen t
0 B oar d and Committees Li aison Respon sib iliti es
O DI VE RSITY STA TIS TI C S RE P O R TI N G; Keep COPY in file and OR IGI NAL for An n ual Report.
s]2uh2» .soneay _,,_,At
Date B6ard or Committee Member
)4/3 eyeooree.. K) oooooooowoo«oooooooooowoo«oooo~ Date Ci ty Clerk's Office Statt initials
Scanned on. Sh24/73 »rwores. 10
Date City Clerk's Office Staff Initials
CONCLUDED ,------
T err Expired Letter
C ommi ttee Luats on o0
RESIGNATION LETT'RS
Date Processed Initials Scan o
Date Pr oce ssed Initials Scan o
R em oval Lette r due to ab sence s Date processed Initials Scan a
F CLEREOARD AND CCOMMIT HIE S DI ABA SE CHECKLIST MASTER\BC Chech»st 2015 MASTER dcx
MI
City of Miami Beach, 1700 Convention Conlon Drivo, Miami Boach, Florida 33139 yw_miamihoachll.gay
OFFICE OF THE CITY CLERK, Ralaol E. Granado, City Clerk
Tel: 305.673.7411, Fax. 305.673.7254
Email: Cit/Clerk@miamiboachfl.gov
April 20, 2023
Ms. Dana Martorella
RE: General Obligation (G.O.) Bond Oversight Committee
Dear Ms. Dana Martorella:
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.
#
Rafael Granado
City Clerk
cc: Monica Beltran, Parking Director
Maria Hernandez, 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
MI
City of Miami peach, ta, 'Uonwondon Canter Orv, Mam « Bah, Honda 33139 yyg_mjgmfgh} ggy
OE OR I CITY CI£RX., Rall £. Granado, Cay Clod Fol 305.6737a11,far: 305 673.7254
Ema! Ca/Cl+l,@ton«le.hft go
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Ms. Dana Martorella
RE: General Obligation (G.0.) Bond Oversight 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 m y colleagues and to all of those l 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 l serve) on July 1st, following the closing
of the calendar year on which l have served.
Ms. Dana Martorella
Sworn to and subscribed before me this a''a y
• Please visit the City of Miami Beach website at www.miamibeachtl.gov under City Clerk/Board and
Committees for additional information regarding the Financial Disclosure Requirements.
City of Miami beach
1700 Coventon Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Emal EC@mem beach.go¥
Telephone. 305 673 7411
RECEIVED
MAY 24 207
CITY OF MIAMI BEACH
OFFICE F L,« Cr CLER K
AFFIDAVIT OF AFFILIATION ITH THE CIT 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 Address_L,$0ht_fr_Pr__M« >»+,W. st9
[] 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).
[yQfT ti P1,1f,
Py,][PS,, l(ff?S,bi
lam a full-time emp loyee 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 mon ths)
[}pQf {f P1pf,][},b3.
Pp3,1},, ]f@,y-
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 peplies of perjury, I declare that have read the foregoing document and that the facts stated in it
are trye/ p
••.y_ s/2/2s
Signature [.nu
D o- A. vol«t Ma tor4ta.
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of o physical presence or zu online notarization,
us?:'day o1.0019.202_y _a.AA_okc_ UcLpnL
Ci ty of Miaru Beach Board/Committee Member)
• Produced t !AOL _DNA,ty» tu>AS
Form of Identification
Personally Kown
·"'-'"':1/ .. ,, ..... - ...
saire ooGy ii€
)ti+ fj191y2!!
Name of Notary, Typed Printed, or Stamnped
C ity of Miami Beach
1700 Convention Center Dive
Miami Florida 33139
ww.miamibeg.hfl.gay
OF FICE OF THE CITY CLER&K
Emal. BC@miambeach1 go
Telephone 305.6737411
8
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 com ply with City diversity repor ting requirements.
Gender:
L Jae
(EN Renae
Doner
El refer not to answer
Race/Ethnic Categories:
What is your race?
[]African America/lack
[ Asian or Pacifc Island er
EH Caucasian/mi te
Native American/American Indian
Dl other -- Pint Race o Llt prefer not to answer
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
lee
ch
Lloreter not to answer
Do you consider yourself Physically Disabled?
[. 3ii
Lloreter not to answer this question
r en o ·o«- Page 6 0f6
F CLER$AAA REG BARO AN} CCNM!TTEE APPLICATIONS FINAL DRAFTS BOARD ANDO COMMIT TEE APPLACA TCON REG FINAL d0.8
Udated Jane 202)
City of Miami Beach
1700 Coventon Center Drive
Miami Beach, Hor«da 33139
www.miam.beach!l.go¥
OFFICE OH HE CITY CLERK
Emal
Telephone. 305.673 7411
BOARD & COMMITTEE FINAN CIAL ACKNOWLED GEME NT STA TEMIENI
Ackn owledgem ent of fines/suspen sion for Board/Comm ittee Members for failure to com ply with Miami-
Dade County Financi al Disclosure Code Provision Code Section 2-11.1(i) (2)
Last Name First Name Middle Initial
I understand that no later than Jul1. 9f 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 Financial Interests (Form 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
1 of no more than S500, 60 days in jail or bot
£ LL.y
Signature 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 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 ot6
F CL ER SALA REGBCGARO AND CCOMMIT TEE APUCA IONS FINAL DRAFTS BOARD AND COMMITTEE AP?PICA PON RE G F HAL doc
updated June 2020
SOURCE OF INCOME STATEMEN T
Section 2-11 1@) 0f 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 yeat
Disclosure for Tax Vear 8tding !Lam Name . '''"''
2022 woleok M-I«{u.
First Name
Ona.
Mitdle Mars/initial
Mailing Address - Streot Number, Street Mame, or P,0, Box
S s+ , Pt
City, State, Zip
Mi ch, f 319
lf your home address is your mailing address, and your home address is exempt from public records pursuant to Fla. Stat. $119.07 read
instructions on the following page and check here.[]
[] county Public Health Trust [] Municipal:
(Municipality)
Department
Position or Title Employee ID Number
Work address I Work telephone Employment began on/ended on
[] county [ uniial: Mi a.e
(4tunicipality)
Board where serving nl } oymy \le, M b0±-, + G0 0S Y q
Altmaie address {if homo address is exempt) I Work telephone [Term began on/ended on
I
i
List below every source of income you received, along with the address and the principal activity of each source. Include your public salary Place the sources of
income in descending order, with the largest source first Examples ol sources of income include: compensation for sorvices, income from business, gains from
property dealings, interest, rents, dividends, pensions, IRA distributions, and social security payments Also, include any source ot income received by anothgy
person to your benefit. However, the income of your spouse or any business partner need no! be disclosed. ii continued on a separate sheet, check here.l]
Name of Source of Income Address Description of the Principal Business Activity
I hereby swear or affirm) that the informatuon above is a true and correct statement.
//
Date igd
RECEIVED Y ELECTIONS DEPARTMENT
0on«so RECEIVED
]Electronic Copy
MAY 24 2023
CITY OF MIAMI BEACH
OFF
OFFICE USE ONLY cpd t ' t bet.an.y
+8 £4°t$ of s
1 MI 1 }
City of Mluri Beat, PARKING DEPARTMENT
CITY WI DE (CW} BOARD & COMMITTEES
PARKING APPLICATION
1755 Meridio Aveve, S006 200/Miami Beach, ft 33139/Ph {305) 73.7505 or (305) 6737000 et 6200
A citywide [CW} parking permit is honored at metered parking spaces and restricted residential zones
parking spaces. A CW parking permit IS NO T honored in prohibited are as. An Access Card will be
provided lo you for City Hall Garage (G7) access
IMPORTANT NOTE: Your vehicle license pl a te 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
infor m a tion m a y lead to the issuance ol parking citation [s) and /or the towing ol your vehicle.
Please note that this new access card CAN N O T be hole- punched or perforated in any manner. Io use
the new card please hold the cord at close proximity to the reader until the gate ope ns. You may need
lo try the other side ol the card. Please ensure you hol d the entire surface ol the card against the reader
until the ga te opens.
ACKN O WLE DGE ME NT: I acknowledge that should my access card be lost, stolen or
damage, I will be responsible to pay a $10.00 replacement fee.
hoard Perler lnforig?tom%
Dote of Application: , Me4 23, 2o2.3
E-Mail Address: «--..wok o3 \. a
Work Ph one:
Cell Phone: +9-$2-8822 Preferred Contact Method: ct/lift3-2$Lz
Color:
State. Year:
Make: Model.
Applicant S7nature. es
Please provide signed form to the Parkin g Department located at 1755 Meridian Avenue, 2 floor Working
hours ore 8/30 1o 5/0 0 p.m. or email to:
e-mail subject: BOARD 8 COMMITTEE PARKING APPLICATION - APPLICANT NAME
ID Card Serio! #
Issued ly Print tome Pri nt N a me
Sgnature.
ate ls0ed Date Completed