Lissette Collazo 12.31.25BOARD AND COMMITTEE CHECKLIST
APPOINTEE: Lissette Collazo DAT or APP oNn Nr : L2/h°
BOARD/COMMITTEE: H!Spano fairs Appointed by: David Suaroz
FOR SCANNER
Scan o
Scan o
Scan o
Scan o
Scan o
FOR CLERK STAFF
o Letter of Appointment
o Letter of Reappointment
o Copy of Letter of Appointment/Reappointment e-mailjd to {ommittee Liaison on
o Board and Committee Application (Completed on )] _)
o R~sum~/Curriculum Vitae
o Diversity Statistics Reporting (Completed on t/1Jf
o Oath
TERM END:.L2/3/h2 rerM Lum.[2/31_J3l
[a]24
RECEIVED
JAN 09 2024
CI TY OF MIAMI BEA CH
OFFICE Or a. CITY CLERK
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
Scan o
Scan o
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 Statement
o Board and Committees Liaison Responsibilities
o Diversity Statistics Reporting
I acknowledge that pursuant to Sec. 2-22(9) of the Miami Beach Code of Ordinances, I will be removed
from my board/committee upon failure to attend 33% of the regularly scheduled meetings.
Sec. 2-22(9) If any member of an agency, board or committee fails to attend 33 percent of the regularly scheduled
meetings per calendar year, such member shall be automatically removed. To calculate the number of absences
under the 33 percent formula, .4 or less rounds down to the next whole number and .5 or more rounds up to the
next whole number.
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01/09/24 Signed by X -.. Received on:
Date Board or Committee Member
Processed on: LL[4 By Employee: ·(Iv)
1 Date City Clerk's Office Staff Initials
Scanned on: /uh4 By Employee:
KN)
Date City Clerk's Office Staff Initials
to oli who live, work, and ploy in our vibrant, topical, historic com m u nity
1B
City of Miami Beach, /OO Convontion Can ter Drive, Miami Boa ch, Florida 33139 yywymiamibaachllgo
OFFICE OF THE CITY CLERK, Ralaal E. Granado, City Clerk
Tel: 305.673.7411, Fox: 305.673.7254
Emai l: Ci#Cl erk@mi amibooch fl.gov
January 08, 2024
Ms. Lissette Collazo
1700 Meridian Avenue, Apt 101
Miami Beach, Florida 33139
RE: Hispanic Affairs Committee
Dear Ms. Lissette Collazo:
Congratulations! You have been appointed by Commissioner David Suarez to the above-referenced
Board or Committee, for a term ending: 12/31/2025.
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 Jan uary 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 as they concern your duties, responsibilities, and
requirements as a board or committee member.
Congratulations again and good luck.
Regards,
cc: Monica Beltran, Parking Director
Leonor Hernandez, City Liaison
ENCLOSURES:
Oath of Office/Oath of Civility/Acknowledgements
City Code/Ordinance section applicable to agency, board or committee
City Code Section s 2-22, 2-23, 2-24, 2-25, 2-26, 2-458 an d 2-459
Ordinance No. 2006-3543 - Am en dment to City Code Section 2-22
Miami-Dade County Code Section 2-11.1 - Conflict of Interest and Code of Ethics
City Wide Permit App lication - (Par king Department Form)
Booklet - Guide to the Sunshine Amendment and Code of Ethics for Public Officers and Employees
City of Miami Beach, 1/0O Convention Center Drive, Miami Bach, Florida 33 139 yaw_IiaIibgachf]_go
OFFICE OF THE CITY CLERK, Rofaal E. Granado, Ciiy Clerk
Tel: 305.673.7411, Fax. 305.673.7254
Email: Ci/Clerk@mioamibeachfl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Ms. Lissette Collazo
RE: Hispanic Affairs 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: 12/31/2025.
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
a nd/or Committee, I must comply with the financial disclosure* requirements of Miami-Dade County or the
S tate o f F lo rid a (de pending on the boa rd or com m ittee o n w hich I serve) o n July 1s t, fo llow ing the cl osing
of the cale nda r ye ar o n w h ich I h ave served .
M s. Lissett e C o lla zo
S w orn to and subscrib ed b efo re m e this 09 -I,2 024
*P le a se visit the C ity o f M ia m i B e a c h w e b site a t w w w .m ia m ib e a chfl.g o v u n d e r C ity C le rk/B o a rd an d
C o m m itt ees fo r a dditio nal info rm atio n rega rding the F ina nci a l D iscl osure R equirem e n ts.
MIA\Ml
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
RECEIVED
MN 092,
CITY Or M
OFic± 6,-1, EAc
U/TY C.ER
OFFICE OF THE CITY CLERK
Email: B C @m i am i b e ach fl.g ov
Telephone: 305.673.7411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as ( check ( ✓) all that apply):
}/Elam a resident of the City of Miami Beach for six months or longer.
Home Address: 1700 Meridian Avenue, Apt 101, Miami Beach, FL 33139
D 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).
[[qr (f [I[[eSS,
[[JS[[es,S (]]feSS,
D 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).
[[Qre f [[IS[[eSS,
[JS[PeSS [\(](]reSS,
"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.
01/09/24
Signature
Lissette Collazo
Date
Printed Name
M IA M IB E H
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www._miamibeachhl, gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
DIVERSITY STATISTICS REPORT
Collazo Lissette
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 ate
[l remale
D Other
0 I prefer not to answer.
Race/Ethnic Categories:
What is your race?
DI African American/Black
LJ Asta or Pacific Islander
El Caucasian/white
0 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?
Elves
J o
0 I prefer not to answer.
Do you consider yourself Physically Disabled?
lves
z0o
D I prefer not to answer this question.
Page 6 of 6
F:IC LER \$ALLIREG \BO ARD AND CO M M ITT EE APPLI CATIO NS FINAL DRAFTS\BO ARD AND CO MM ITT EE APPLI CATIO N REG FINAL.docx
U p da ted : Ju ne 20 20
Ml 1BE
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfl,gov
OFFICE OF THE CITY CLERK
Em ai l: BC@miamibeachfl_gov
Telephone: 305.673.741 l
Collazo
BOARD & COMMITTEE ACKNOWLEDGEMENT STATEMENTS
Lissette
Last Name First Name Middle Initial
Acknowledgment 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)
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. 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 $500, 60 days in jail, or both.
Acknowledgment to Comply with Miami Beach Code of Ordinances Division 1 Sec. 2-22 (23)
I understand that commencing with terms beginning on or after January 1, 2024, and as a condition of applying
for appointment to a City agency, board, or committee, I voluntarily agree that in the event I file with the City
Clerk a Statement of Candidate formally announcing candidacy for City elective office, such filing with the City
Clerk shall be deemed a tender of resignation from the City agency, board, or committee
5>
01/09/24
Signature Date
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 6 of 6
F:ICLER\$ALL\BOARD AND COMMITTEES DATABASE\Board and Committee Application\BOARD AND COMMITTEE APPLICATION OCT 2023.docx
Updated: Janu ary 9, 2023
MIAMI-DADE.
Eml SOURCE OF INCOME STATEMENT
Section 2-11.1(i) of the County Ethics Code re quires that certain em ployees and public offi cials fil e a financial disclosure Statement on a yearly basis by July 1st
of every year.
Disclosure for Tax Y ear End ing I Last Nam e First Nam e M idd le Nam e/Initi al
2023 C ollazo Li ssette
M ailing Address - S tr eet Num ber, Street Nam e, or P.O . Box
1700 M eridian A venue, Ap t 101
City, S tate, Zip
M iam i B each, FL 33139
If your hom e address is your m ailing addre ss, and your hom e addre ss is exem pt fro m public records pursuant to Fla . Stat. $119.0 7, read
instru ctions on the follow ing page and check here . D
Filing as an Em ployee (ch eck one)
[] county □Public Health Trust [] Municipal :
(M unicipality)
Departm ent
Positi on or Title Em ployee ID Num ber
W ork addre ss I W ork telephone Em ploym ent began on/ended on
Filing as a Board Mem ber (ch eck on e)
[] count y [] Municipal : M iam i B each
(M unicipality)
Board w here serving
Hispanic Affairs Committee
Altern ate address (if hom e addre ss is exem pt) I W ork telephone I Term began on/ended on
(786) 519-6200
Li st below every source of incom e you received, along w ith 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
Bruce Gendelman Company 2404 Florida Avenue Insurance
West Palm Beach, FL 33401
I hereby swear (or affirm) that the information above is a true and correct statement.
_5=
Signature of Person Disclosing
01/09/24
Date signed
RECEIVED BY ELECTIONS DEPARTMENT:
t1ad].,CEIVED
[ Electronic Copy
JAN 09 2024
CITY OF MIAMI BEA CH
rs·rz po (>
OFFICE USE ONLY A ccepted: Y / N Deficiency: Processed Date/Initials: Scanned Date/initials:
138_SP-14 COE 2016
[/\/\/\/ CI wI DE (CW) BO ARD & COMMITTEES
City of Miami Beach, PARKING DEPARTMENT PARKING APPLICATION
1755 Meridian Avenue, Suite 200/Miami Beach, FL 33139 /Ph: (305) 673-7505 or (305) 673-7000 ext. 6200
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
Date of Application: 01 /09/24
Applicant Name: Lissette Collazo
Board/Committee Name: Hispanic Affairs Committee
Address: 1700 Meridian Avenue, Apt 101, Miami Beach, FL 33139
E-Mail Address: lissycollazo@gmail.com
Work Phone: Home Phone
Cell Phone: 786-519-6200 Preferred Contact Method:
Vehicle Information
Tag: QUXX0? Color: Black
State: Florida Year: 2021
Make: BMW Model: X4 M40i - ______., ~
Applicant Sia nature: f c ~
Please provide signed form to the Parking Department located at 1755 Meridian Avenue, 2d floor. Working
hours are 8:30 to 5:00 p.m. or email to: ParkingReception@miamibeachfl.gov
e-mail subject: BOARD & COMMITTEE PARKING APPLICATION - APPLICANT NAME
p, ·d D ar' una epartment ection
PERMIT SYSTEM GARAGE ACCESS
Expiration Dote: ID Card Serial #:
Issued By Print Name: Print Name:
Signature: e5 Signature:
Date Issued: Date Completed:
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