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Brigitte Andrade 12.31.25MIAMI BEACH BOARD AND COMMITTEE CHECKLIST APPOINTEE: Brigitte Andrade DATE OF APPOINTMENT: JIRA/f BOARD/COMMIT TEE. Black Affairs Advisory Comm''$ Appointed by: Alex Fernandez FOR SCANNER Scan o Scan o Scan o Scan o Scan o RECE IVED JAN 22 2024 FOR CLERK STAFF / I o Letter of Appointment TERM END: 12/31/2025. TERM LIMIT. fl3// o Letter of Reappointment [ o Copy of Letter of Appointment/Reappointment e-mailed to Committee Liaison on I I ::J- [vf o Board and Committee Application (Completed on' o Resume/Curriculum Vitae [ [ o Diversity Statistics Reporting (Completed on 0] @7 )f3 o Oath 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 CITY OF MIAM I BEACH OFFICE OF THE CITY CLERK 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. Received on: Scanned on: an 1%".?0?¢ soneas, XBrite Andrade Date Board or Committee Member roses.sea on: Ilwlzl remotores ) Date City Clerk's Office Staff Initials __ l_/_i_i_/_i._t.f- __ By Employee: (_A/) _ Date City Clerk's Office Staff Initials We are committed to providing excellent public service and saley to all who live, work, and play in our vibran t, tropical, historic community. MIAMI BEACH City of Miami Beach, 1/00 Convention Cantor Drive, Miami Boa ch, Horida 33139 yayyy._Iiamnibgachll,go OFFICE OF THE CITY CIERK, Rafol E. Granado, Cy Clerk Tel: 305.673.7411, Fax. 305.673.7254 Email: CiNyClerk@miamibeachfl.gov January 16, 2024 Ms. Brigitte "Bibi" Andrade 7133 Bay Drive Miami Beach, FL 33141 SUBJECT: Black Affairs Advisory Com mitte e Congratulations! You have been reappointed by Commissioner Alex Fernandez to the above referenced, board or committee named above, 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. Congratulations and good luck. ,I ..%. City Clerk cc: Monica Beltran, Parking Director Lissette Arrogante, City Liaison ATT ACHMENTS: Letter of Appointment Oath 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 - Am endm ent to City Code Section 2-22 Miami-Dade County Code Section 2-11.1 - Conflict of Interest and Code of Ethics Ordinance City W ide Permit Application - (Parking Department Form) Booklet - Guide to the Sunshine Amendment and Code of Ethics for Public Officers and Employees M IA M I BEACH City of M iam i Beach, I/OO Convention Contort Drive, Miami Boa ch, Flor id a 33139 yyywy._miaIiboa chll_go OFFICE OF THE CITY CLERK, Raf0ol E. Gran ado, City Clerk Tel: 305.673.7411, Fax. 305.673.7254 Ema l: CiyClerk@miamibeachll.gov Oath of Office Oath of Civility and Acknowledgements T O : M s. Brigitt e "B ibi" A ndrade R E : Black A ff airs A dvisory C om m itt ee I do so le m n ly sw ea r or affi rm to bear true faith, loyalty and allegiance to the Govern m ent of the U nited States, the State of Florida, and the C ity of M iam i Beach, and to perform all the duties of a m em ber of the above -m entioned board 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: 12/31/2025. T o m y co llea g ue s and to all of those I represent and serve, I pledge fairn ess, integrity and civility, in all actions taken and all com m unications m ade by m e as a public serv ant. I ha ve be e n issued a copy of section 2-11.1 of the M iam i-D ade C ounty C ode (C onflict of Interest and C ode of Ethics O rdinance), as w ell as Florida C om m ission on Ethics Guide to the Sunshine Am endm ent and C o de of Ethics for Public O ffi cers and understand that as a m em ber of a C ity of M iam i Beach Board and/or C o m m itt ee , I m ust com ply w ith the financial disclosure requirem en ts of M iam i-Dade C ounty or the State of Flo rida (de pending on the board or com m ittee on w hich I serve) on July 1st, fo llow ing the closing of the cale ndar yea r on w hich I have serv ed. M s. Brigitte "B ibi" Andrade Sw orn to an d subscribe d befor e m e thi s 'l _day of 44,4, 2024 pl e a se vi sit the C ity of M ia m i Beach w ebsite at w w w .m iam ibeachfl.gov under City Clerk/Board and C o m m itt ees fo r additional inform ation regarding the Financi al Di scl osure Requirem ents. MIAM I BEACH City of Miami Beach 1 700 Convention Center Drive Miami Beach, Florida 33139 RECEIVED JAN 22204 p,MI BEACH cm or Mp2Cini OFFICE OF THE OFFICE OF THE CITY CLERK Email: BC@miamibeachfl.gov 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): /{1am a resident of the City of Miami Beach for six months or longer. Home Address: 7133 Bay Drive Miami Beach, FL 33141 /[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: Bibi Art Media Inc. Business Address: 7133 Bay Drive Miami Beach, FL 33141 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}. 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 stated in it are true. snioitte Andrade "..a.a Signature Brigitte Andrade January 18th, 2024 Date Printed Name M IA M I BEA CH 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 REP ORI Andrade Brigitte V 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 M ae [l remate D Other D I prefer not to answer. Race/Ethnic Categories: What is your race? [] African American/Black D Asian or Pacific Islander 0 Caucasian/White J ave American/American Indian D Other- Print Race: _ D I prefer not to answer. Do you consider yourself to be Spanish, Hispanic, or Latino/a? Tves Ho D I prefer not to answer. Do you consider yourself Physically Disabled? aves zl o D I prefer not to answer this question. Page 6 of 6 F:ICLER\$ALL\REG \BO ARD AND CO M M ITT EE APPLICATIO NS FINAL DRAFTS\BOARD AND COMMITT EE APPLICATION REG FINAL.docx Updated: June 2020 M IA M I BEACH City of Miami Beach 1700 Convention Center Drive Miami Beach, Florida 33139 www.miamibeach[l.gov OFFICE OF THE CITY CLERK Email: BC@miamibeachfl.gov Telephone: 305.673.7 411 Andrade BOARD & COMMITTEE ACKNOWLEDGEMENT STATEMENTS Brigitte V 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 January 18, 2024 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 6 of6 F:\CLER\$ALL\BOARD AND COMMITTEES DATABASE\Board and Committee Application\BOARD AND COMMITTEE APPLICATION OCT 2023.docx Updated: January 9, 2023 M IA M l·DAD E ♦EII 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 2023 Andrade Brigitte V Mailing Address - Street Number, Street Name, or P.O. Box 7133 Bay Drive 706 City, State, Zip Miami Beach 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 □Public Health Trust [] Municipal: (Municipality) Department Position or Title Employee ID Number Work address I Work telephone Employment began on/ended on Filing as a Board Member (check one) [] county E] Municipal: Miami Beach (Municipality) Board where serving Black Affairs Advisory Committee Alternate address (if home address is exempt) I Work telephone I Term began on/ended on 305.532.1929 1/1/2024 - 12/31/2025. 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 Bibi Art Media Inc. 7133 Bay Drive 706 Miami Publishing/Art Beach, FL 33141 I hereby swear (or affirm) that the information above is a true and correct statement. Signature of Person Disclosing January 18, 2024 Date signed RECEIVED BY ELECTIONS DEPARTMENT: Jorey, qECEIVED [] Electronic Copy JAN 222024 CITY OF MIAMI BEACH OFFICE USE ONLY Accepted: Y I N Deficiency. Processed Date/initials: Scanned Date/initials: 138 _SP-14 COE 2016 2 ±\9£4.2 1" 2±2 %.± I? 1755 Meridian Avenue, Suite 200/Miami Beach, FL 33139/Ph: (305) 673-7505 or (305) 673-7000 ex4. 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 "pa rking 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: January 1, 2024 Applicant Name: Brigitte Andrade Board/Committee Name: Black Affairs Advisory Committee Address: 7133 Bay Drive 706 E-Mail Address: aostavallemiami@gmail.com W or k Phon e: 305. 305.532.1929 Home Phone 305.532.1929 Cell Phone: 786.222.7834 Preferred Contact Method: Email Vehicle Information Ta g: KZCH18 Color: Grey Silver State: FL Year: 2007 Make: Hyndai Model: Accent Alan saran. ? 'bu,ala. 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, ·ti D ar' mna epartment ection PERMIT SYSTEM GARAGE ACCESS Expiration Date: ID Card Serial #: Issued By Print Name: Print Name: Signature: e Signa ture: Date Issued: Date Completed: s . mng man 'or torm s cw ar is comm ittees par' mngtorm,toc orm up tare