Evie Fernandez 6.30.24MI AMIBEAC
DA T E O F A P PO IN TM EN T :
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BOARD AND COMMITTEE CHECKLIST
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Scan o o Letter of Appointment TE RM END: &( bO f +ERM LIr: _A[_
Scan o o Letter of Reappointment " '8"]{p4' of AppointmenvReappointment e-mailed to committee tuaison on
o Board and Committee Application (Completed on_r
o R~sum~/Curriculum Vitae ,l
o Diversity statistics Repor ting (competed on _d] / /3_)
o Oath 7
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IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
✓City Code Ordinance Section applicable to the agency, board or committee
Ci ty 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
o Board and Committees Liaison Responsibilities
o DIVERSITY STATISTICS REPORT
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Date City Clerk's Office Staff Initials
CONCLUDED & RESIGNATION LETTERS
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Resignation Letter Date Processed Initials Scan o
Removal Letter due to absences Date processed Initials Scan o
F:\CLER\BOAR D AND CO M M ITT IES DATABA SE\CH EC KLI ST M ASTER \B&C Ch e cklist 2015 MA STER.d ox
We are committed to providing excellent public service and salety to all who live, work, and play in our vibrant, tropical, historic community.
MIAMI BEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139 www .miamibeachfl.gov
OFFICE OF THE CITY CLERK, Rafael E. Granado, City Clerk
Tel: 305.673.741 l, Fax: 305.673.7254
Email: CityClerk@miamibeachfl.gov
August 22, 2023
Evie Fernandez
2355 N Bay Road
Miami Beach, FL 33140
RE: Committee for Quality Education in Miami Beach
Dear Ms. Fernandez,
Congratulations! You have been appointed to the above-referenced Board or Committee as a
representative for the Nautilus Middle School PTA, for a term ending on 06/30/2024.
If you are unable to accept this appointment or have any questions, please call the Office of the
City Clerk at 305.673. 7 411.
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,
7J{-
Rafael Granado
City Clerk
cc: Monica Beltran, Parking Director
Dr. Leslie Rosenfeld, City Liaison
ENCLOSURES:
Oath of Office/Oath of Civility/Acknowledgements
City Code/Ordinance section applicable to agency, board or committee
City Code Sections 2-22, 2-23, 2-24, 2-25, 2-26, 2-458 and 2-459
Ordinance No. 2006-3543 - Am en dmen t 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
We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community.
O ath of Of1ice
Oath of Cilty
and
Acknowledgements
{erg"e yer r op ho1 try f+# ,, , - -i··J rc: din Dear e lam, loyalty and allegiance to the Cav em m ent of the United
·-, e gs'gt ;9A, +4, (¢of M ·'Be i -<.-,r-a ·riCa,a:d Te ·Y Miami each, and to perform a!l the duties of a member cf the
ere"-. Ea :dcr , of th C t fM4i ·[ <>'iv-c: comm.dee n 1e ·y Ol Miami leach to vhich I have been appointed fcr a
1a=.edr~.c/20/2024.
Try.a gues ard to a'l of those I represent and ser ve, I p'ledge fairn ess, integrity an d civ.:ty, in a'l
as t2en ara,courcatos mad e by me as a pub ic servant.
l:av teen issue a coy of section 2-111 of the Miami-Dade County Code (Conflict of Interest and
s E::.c Cr:Crance), as we'l as Florida Commission cn Ethics Guide to the Suns hine Am end m ent
an:C' ! ":s for Pub..c Officers and understand that as a member of a City of Miami Beach Board
and'r Con:."te,I must corp'y with the financial disclosure" require ments of Miami-D ade County or the
2ts Fra (derdrg on the board or co m mi tte e on which l serve) on July 1st, fol'awing the cosing
:ear'ar yea r n which I have serv ed .
snom to and subscnb e d betore me us ]hf cay ot_[0 , 202 3
.Lt
Deputy Clerk
·ib« ·hfl. 1ov under City Clerk/B oard and "Plea¢e Viz~t the City of Miam~ Beach website at vww.miamibeach 1.9., 9ts
Com m:tees for additional informa tion reg arding th e Fi nancial Di sclosure Requireme i-
f I I
/V \IA M I B E A C H
City of Miami Beach
l 700 Convention Center Drive
Miami Beach, Florido 33139
OFFICE OF THE CITY CLERK
Em ail: BC@ mi a mube achf goy
Telephone: 305.673.741 l
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH AND THE COMMITTEE
FOR QUALITY EDUCATION IN MIAMI BEACH
A s a vo tin g m e m b e r of the C o m m ittee fo r Q uality Educatio n in M iam i Beach, I am in
co m p lia n ce w ith the aff iliatio n req uirem e nt of M ia m i Beach C ity C ode Section s 2-22 (4) and
2-190 137 as:
... City of Miami Beach resident for six months or longer.
so». 323So IN Ba, kl M am , Pach, 3//o
u; am th e paren t/g uar di an of a stude nt attend ing a M iam i Beach school fo r the ;). 3 /c2 /s chool
ye a r.
sos iEtla ulLluc_lii ul do k , {u ni Br td ou o g
U n d e r pe n a ltie s of pe rju ry , I de cl a re that I have read the forego ing docum e nt and that the fa cts
sta t in it are true
M IAM I BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miomi beachtl,gov
OFFICE OF THE CITY CLERK
Email: C@miamibeachfl._gov
Telephone: 305.673.7411
DIVERSITY STATISTICS REPORT
vie
Last N am e First Nam e M iddle Initial
The fo llow ing inform ation is voluntary and has no bearing on your consideration for appointm ent. It is being
asked to com p ly wi th Ci ty diversity reporting requirem ents.
Gender:
L ale
Lkr emale
D O ther
0 I prefer not to answ er.
Race/Ethnic Categories:
What is your race?
[l Amica A m erican/B lack
[lAsian or P acific Islan d er
[d C aucasian /whi te
0 N ative A m erican/A m erican Indian 0 O ther- P rint R ace: _
D I prefer not to answ er.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
L ve»
Lk~o
0 I prefer not to answ er.
Do you consider yourself Physically Disabled?
L a
i s
0 I prefer not to answ er this question.
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U. d IB A R D A N D C O M M ITT E E A P P LI C A T IO N S FI N AL D RA FT S\B O A R D A N D C O M M ITT E E A P P LI C A T IO N R E G FIN A L docx p ated: June 2020 "
M IA M I BEACH
C ity of Miami Be a ch
1700 Convention Center Drive
Miami Beach, Flor ido 33139
www,miamibeachfl,goy
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl_gov
Telephone: 305.673.7411
BOAR D & COM MI TTEE FINAN CI AL ACK N OWLED GE MEN T STA TEMEN T
Acknow ledgem ent of fines/suspension fo r Board/Com m ittee M em bers for fa ilure to com ply w ith M iam i-
Dade County Financial Disclosure Code Provision Code Section 2-11.1(i) (2)
Last Name First Nan Middle Initial
I understand that no later than Jul y 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 m ust be fi led wi th 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 fil e one of these forms, pursuant to the Miami-Dade County Code, may subject the person to a fine
of no ore than $5,00, 60 days in jail, or both.
' 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.
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F:ICLER\SALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020