Jose Hernandez 12.31.25M IA M I BEACH
BO A RD A N D CO M M ITTEE CHEC KLIST
- G ) rs4 A P P OI N TE E : Joe_ se [er.- !€ DA TE OF A PPOINTM ENT:
B O ARD /C O M MI TTE E: es_2 Qe «A 'o Ap p oint ed by: [_pry1slot rt 2
FOR SCANNER
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FOR CLERK STAFF
o Letter of Appointment
o Letter of Reappointment
o Copy of Letter of AppointmenUReappointment e-mailed to Committee Liaison on
o Board and Committee Application (Completed on - )
o R~sum~/Curriculum Vitae J [
o Diversity Statistics Reporting (Completed on l'Lo Q-}_y
o Oath
TR#A ND: 12/)/25 reRtn uumr: y/3]/3
i[th4
RECEIVED
JAN 12 2024
C IT Y O F M IA M I B E A C H
OFFICE OF THE CITY CLERK
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Sca n o
IM P O R TA N T IN FO R M A T IO N FO R B O A R D A N D C O M M ITT E E M EM B ER S B O O K
✓City Code Ordinance Section applicable to the agency, board or committee
t City Code Sections 2-21, 2-22, 2-2 3, 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 -- Gulde 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
l acknowledge that pursuant to Sec. 2-22(9) of the Miami Beach Code of Ordinances, I will be removed
from my board/committee upon fallure to atten d 33% of the regularly scheduled meetings.
Sec. 2-22(9) lf any mem ber of an agen cy, board or com mittee fails to attend 33 percent of the re gularly sch eduled
m eeting s pe r calendar year, such m emb er shall be autom atically re moved. To ca lculate the number of ab sences
under th e 33 percent fo rm ula, .4 or less ro unds down to the next whole num ber and .5 or more ro un ds up to the
next whole num ber.
Received on: 1/0/ 4 stonea o, ± Date
Processed on: /h t By Employee: ~
Date City Clerk's Office Staff Initials
Scanned on: 1/14 By Employee: 1-vv'\
Date City Clerk's Office Staff Initials
We ore committed to providing excellent public service and solely to oll who lve, work, and play in our vibrant, tropical, historic community.
MIAMI BEACH
City of Miami Beach, 1700 Convention Contort Drivo, Miami Boach, H lorida 33 1 39 wwww.mlamibca chll.gov
OFFICE OF THE CITY CIERK, Rolool E. Gran ado, CIy Clerk
Tel: 305.673.741, Fax 305.673.7254
Ema l: CiNylek @ml amibeach fl.gov
Oath of Office
Oath of Clvlllty
and
Acknowledgements
TO: Mr. Jose (Joseph) Hernandez
RE: Parks and Recreational Facilities Board
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, pledge fairness, integrity and civility, in all
actions taken and all communications made by me as a publlc servant.
I have been issued a copy of section 2-11.1 of the Miami-Dade County Code (Conflict of Interest and
Code of Ethi cs Ordinance), as well as Florida Commission on Ethics Gulde 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 boa rd 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 betoro me this _!"_ aay or JA , 202a} .t>
Deputy Clerk
*Please visit the City of Miami Beach website at www.mlamlbeachfl.gov under City Clerk/Board and
Committees for additional information regarding the Flnancial Disclosure Requirements.
MIAMI BEACH
City of Miami Beach, 1/00 Convention Canter Drive, Miami Boach, Florida 33 139 yyaw.miamibea ch[l_go
OFFICE OF THE CITY CLERK, Rafael E. Granado, City Clerk
Tl: 305.673.7411, Fax 305.673.7254
Email: CilyClerk@miamibeachfl.gov
December 28, 2023
Mr. Jose (Joseph) Hernandez
7832 Collins Ave #203
Miami Beach, Florida 33141
RE: Parks and Recreational Faciliti es Board
Dear Mr. Jose (Joseph) Hernandez:
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 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:
D e cem be r 31 o f th e year th e ap po inting C ity C o m m issio ne r le aves o ff ice or upo n th e
a p po intm e n t/ele ctio n o f the successo r C ity C o m m issio n m e m be r.
If yo u are u n a b le to acce p t this ap po in tm e nt, or h ave any qu e stio n s, ple a se ca ll the O ffi ce of the C ity
C le rk at 305.6 73.7 4 11 .
P le a se re a d th e e n c lo se d m a te ria ls ca re fu lly as th e y co n c e rn yo u r du tie s , re s p o n s ib ilitie s , a n d
requirem e n ts a s a board or com m itt ee m e m be r.
C o n g ratulatio n s aga in an d g o od luck.
R eg~
Rafa~ranado
C ity C le rk
cc: M o nica B e ltran, P a rking Di recto r
Vi an c a P ero n-S el lan , Ci ty Li a iso n
ENCLOSURES:
O ath o f O ff ice/O ath of C ivility/A cknow ledge m e n ts
C ity C o de/O rd ina nce sectio n ap plicab le to a ge ncy, boa rd or co m m itt ee
C ity C o de S e ct io ns 2 -22 , 2-23 , 2 -24 , 2 -2 5, 2 -26, 2 -4 58 and 2-4 59
O rdina nce N o . 2006-3543 - Am en dm en t to C ity C ode S e ct io n 2 -22
M ia m i-D ade C o unty C o de S ection 2 -11.1 - C on fl ict o f Interest and C o de of E thics
C ity W ide P e rm it Ap plic ation - (Par ki ng D e pa rt m e n t F o rm )
B ook l e t - G uid e to th e S unshine A m e n d m e n t a nd C ode o f E thics for P ub lic O ff icers and E m ployees
MIAMI 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
JAN 12 2024
CITY O F M IA M I BEA CH
OFFICE OF THE CITY CLERK
AFFIDAVI T O F A FFILIATION WI TH THE CITY O F MIAMI BEA CH
I am in co mpliance with the affiliation requirement of Miami Beach City Cod e Section s 2-22 (4),
as (ch eck (/) all that apply):
c;;;ri am a resident of the City of Miami Beach for six months or longer.
Hom e Addre ss: 6305 f.A. C eel Z }}
/1 nave an own ership intere st (for a minimum of six month s) in a business establish ed in the
City of M iami Beach (for a minimum of six months).
Nam e of Business:_ s t )_1coo4en-.1 o0ye,_LL_
Busi ness Addre ss:_630 d eel 4}
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 locat ion of the business that is ph ysical ly loca ted in Miam i Beach (for a
m inimum of six m onths).
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 entity or business association.
Under penalties of perjury, I declare that I have read the foregoing document and that the facts
sta te~d in i are 1e.
/y/202y
Sign~ure Date
... Ha... a_
Printed Name
M IA M I BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florido 33139
www.miamibeachfl.gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
DIVERSITY STATI STICS REPOR I -- )os 1
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:
ts»
[l remale
(l oner
D I prefer not to answer.
Race/Ethnic Categories:
What is your race?
[l Amican American/Black
El Asian or Pacific Islander
ET Caucasian/whi te
D Native American/American Indian D Other-Print Race: _
D I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a? s.
Jo
0; I prefer not to answer.
Do you conslder yourself Physically Disabled?
EJoe.
LI No
D I prefer not to answer this question.
Page 6 of6 EG FINAL.docx
F:CLER$ALLREGBOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION R
Updated: June 2020
M IA M I B E A C H
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
wow w.miamibeachfl.gov
O FFIC E O F THE CITY CLERK
Email: BC@miamibeachf,gov
Telephone: 305.673.7411
BOARD & COMMITTEE ACKNOWLEDGEMENT STATEMENTS
llecad€ Sos
Last N a m e Firs t N am e M iddle Initial
Acknowledgment of fines/suspenslon for Board/Committee Members for failure to comply with Miami-
Dade County Financial Dlsclosure Code Provision Code Section 2-11.1 (I) (2)
l u nd er s tan d th a t n o la ter th a n July 1, of each year al l m em b ers of B o ard s an d C o m mi tt ees of th e C ity of Mi am i
B e a ch, includ ing tho se of a p urely ad viso ry n ature, are required to co m p ly w ith M iam i-D ad e C o unty F ina ncial
D iscl o sure R equirem e nts.
One of th e follo w ing fonn s must be flied w ith th e C ity C le rk o f M iam i B each, 17 0 0 C o nventio n C e nter D rive ,
M iam i B e a ch, F lo rida , n o la te r tha n 12 :0 0 n o o n of July 1, of each year:
1. A "S o urc e of Incom e St atem e nt;" or
2. A "S tatem e nt of F ina ncia l In terests (F o rm 1)';" or
3. A C o py of yo ur la test F ed eral In co m e T ax R eturn .
Failure to flle one of the se fo rm s, p u rs uant to the M iam i-D ad e C o unty C ode , m a y subje ct the pers o n to a fin e
of n o m o re tha n $5 0 0 , 6 0 da ys in ja il, o r bo th.
Acknowledgment to Comply with Miami Beach Code of Ordinances Division 1 Sec. 2-22 (23)
I u nd e rs tand tha t co m m e ncing w ith term s b eginning on or aft er Janu a ry 1, 2024 , an d a s a co nd ition of ap p lying
fo r ap p o intm e nt to a C ity ag e ncy, b o a rd , or com m itt ee, I voluntarily ag ree tha t in the e vent I file w ith the C ity
C le rk a S tate m e nt o f C andid a te form ally ann o un cin g ca nd idacy for C ity ele ctive offi ce , such tiling w ith the C ity
C le rk sha ll be dee m e d a te nd e r of resign ati o n fro m the C ity ag e ncy, bo ard, or co m m itt ee
S ign a t
)/1/zo4
D ate
' M e m b e rs of the P la nn ing B o a rd and B o a rd of A djustm e nt w ill be no tified directly by the S tate o f F lo rida ,
pu rsu a nt to F .S . §1 1 2 .3 14 5(1 )(a ), to file a S tatem e nt of F ina nci al Inte rests (F o rm 1) w ith the M iam i-D ad e C o unty
S u p e rv iso r of E le ctio ns b y 12 :0 0 n o o n, Jul y 1. Pl a nn in g B o a rd and B o ard of A djustm e nt m e m be rs w ho tile the ir
F o rm 1 w ith the C o un ty S up erv iso r of E le ctio ns au tom a tically satisfy the C o unty's fin a ncia l d isclo su re
requ irem e nt a s a M iam i B each C ity B o ard /C om m itt ee m e m b e r a nd n e ed no t tile an a d d itio na l form w ith the O ffi ce
of the C ity C le rk . H ow ever, co m p liance w ith the C o unty discl o sure requirem e nt do es no t satisfy the S tate
requ irem e nt.
Page 6 of6
F:CLERISALL BOARD AND COMMITTEES DATABASE Board and Committoo Application\BOARD AND COMMITTEE APPLICATION OCT 2023.d0cx
Up d ated: Jan uary 9, 2023
MIAMI-DADE - EEI SOURCE OF INCOME STATEMENT
Section 2-11.1(@) of the County Ethics Code requires that certain employees and public officlals file a financial disclosure Statement on a yearly basis by July 1st
of every year.
Dlsclosure tor Tax Year Ending /Last Name
2023 rwesd%2-
First Name -- os
Mlddle Name/inttlal
Malling Address - Street Number, Street Name, or P.0. Box
0 Sa: cc
City, State, ZIp
l-
If your home address Is your malling address, and your home address Is exempt from public records pursuant to Fla. Stat. $119.07, read
instru ctions on the following page and check here.El
FIlng as an Employee (check ono)
D County D Public Health Trust D Munlclpal:
(Munlclpallty)
Department
Position or Title Employee ID Number
Work address 'Work telephone Employment began on/ended on
FIlng as a Board Member (cbeck one)
D County [/unicipat: /\a-l a - (Munlclpallty)
Board where serving
M' ea, ,cs c, 2.}s
Altemate address (it home address is exempt) I Work telephone renn began on/ended on
os ?1 749
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 soclal security payments. Also, include any source ot Income received by another
person tor your benefit. Howev er, the Income of your spouse or any business partner need not be dlsclosed. It continued on a separate sheet, check here.Ll
Name of Source of Income Address Description of the Principal Business Activity
- 7os 7.d Ceev Or +5 (@>43 rte1)
Jsk Jr [+.k Mi« cc.,fL
la,o ''
Jo\so a- Lon 3399 Si 34 ¢ ih t?on ssh. K
rv1 ,fL
I hereby swear (or affirm) that the Information above Is a true and correct statement.
• (/I1/4
Date signed
RECEIVED BY ELE CT1NS DEPARTMENT;
Hardcopy 'it:E:I VEL
□Electr onic Copy
JAN 12 2024
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLE RK
OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/initials: Scanned Date/lnltlals:
138_SP.14 COE 2016
MIAMI BEACH CITYWIDE (CW) BOARD & COMMITTEES Ir.II
car ·i iii -sis. vi@a oiwino PARKING APPLICATION [M.{SI]
1755 Meridian Avenue, Soi 2 00/Miami Beach, FL 33139/Ph. (305) 673.7505 or (305) 673-7000 a. 6200 PARKING
A cilywi de (CW) parking permit is honored al 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, ii 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 lo 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: 1//1/2oz·]
Applicant Name: - Hern-le z J»
Board/Committee Name: s cod 2zcelo Go.rd
Address: 305 5.4 ct #+
E-Mail Address: SO4o')·co
Work Phone: 303 87°? 76v4} Home Phone o 87 749
Cell Phone: 305 7g 74% Preferred Contact Method:
Vehicle Information
Tag: NH3 Color: &l-
State: £ Year: 202 3
Make: 1 Model: 33oE Mw/
Applicant Sianature: 4// Tr
Please provide signed form lo the Parking Department located at 1755 Meridian Avenue, 2" 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
Parkina Department Section
PERMIT SYSTEM GARAGE ACCESS
Expiration Dote: ID Card Serial #:
Issued By Print Nome: Print Nome:
Signature: 6 Signature: 6
Dote Issued: Dote Completed: