Karin L. Matos 12.31.24 MIAMI BEACH
BOARD AND COMMITTEE CHECKLIST
APPOINTEE: Karin L. Matos 3/1/2024
DATE OF APPOINTMENT:
BOARD/COMMITTEE: Neighborhoods Resiliency Proj. Appointed by: Comm Tanya Bhatt
FOR SCANNER FOR CLERK STAFF
Scan o o Letter of Appointment TERM END: I a131 12)a' TERM LIMIT: ‘2(3 i 13 i
Scan o o Letter of Reappointment
o Copy of Letter of Appointment/Reappointment e-mailed to Committee Liaison on ?74-14
.74
Scan 0 a Board and Committee Application (Completed on
Scan , 0 Resume/Curriculum Vitae I ��
o Diversity Statistics Reporting (Completed on 5 �'t )
Scan 0 o Oath
IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
✓ City Code Ordinance Section applicable to the agency, board or committee
RECEIVED ✓ 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)
MAR 05 2024 ✓ 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
CITY OF l'AIAMI BEACH ✓ Memorandum-Solicitation by City Board and Committee Members
OFFICE OF THE CITY CLERK
o Citywide Permit Application (Parking Department Form)
o Booklet—Guide to Sunshine Amendment&Code of Ethics for Public Officers and Employees
Scan 0 o Source of Income Statement
Scan 0 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.
NOTE: Members of the Land Use Boards will be removed upon failure to attend three of the regularly scheduled
meetings per calendar year; or upon abstaining from voting due to a conflict of interest on four different
applications within a calendar year. A member who is removed shall not be reappointed to membership on the
board for at least one year from the date of removal.
3/3/2024 vKarin L. Matos � I i
Received on: Signed by/X
Date Board or Co mi e Member
Processed on: By Employee
Date City Clerk's Office Staff Initials
, •v +rd ro providing oxceltent p,i;hc :cry,e 06c2 safety to oU who h is,work,and play in our vibrant, tropicol historic community
MIAMI BEACH
City of Miami Beach, 170O Comedian Came,Drive,Miami Beach, Florida 33139 www.miamibeachfl.gov
OFFICE OF THE CITY CLERK,Rafael E.Granada,CT/Clock
Tel:305.673.741 1,Fax:305.673.7254
Email:CityCorkOmiamibeachfl.gov
February 29, 2024
Ms. Karin Matos
1465 Cleveland Rd
Miami Beach, Fl 33141
RE: Neighborhood Resiliency Projects Advisory Committee
Dear Ms. Karin Matos:
Congratulations!You have been appointed by Commissioner Tanya Bhatt to the above-referenced
Board or Committee, for a term ending: 12/31/2024.
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:
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,
Rafa I Granado
City Clerk
cc: Monica Beltran, Parking Director
Amy Knowles, 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 -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
MIAMI BEACH
City of Miami Brach, 1700 Canrtnrion Cantor Drive,Miami Beath,Florida 33139 geouptimlinzaacti
OFFKE OF TFIF CITY CtFOK,bind E Grtnrab,Coy OtA
TA 305.6737411,Fax 305.673.7254
imod:C1pUr►florrorobodi gor
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Ms. Karin Matos
RE: Neighborhood Resiliency Projects Advisory 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 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
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 I serve)on July 1st,following the closing
of the calendar year on which I have served.
(t)z.
Ms. Karin Matos
Sworn to and subscribed before me this 1 day of 12024
Keila e a Caceres
Deputy Clerk
*Please visit the City of Miami Beach website at www.miamibeachfl.gov under City Clerk/Board and
Committees for additional information regarding the Financial Disclosure Requirements.
1- I
MIAMI BEACH
RECEIVED
City of Miami Beach
1700 Convention Center Drive MAR 05 2024
Miami Beoch, Florida 33139
OFFICE OF THE CITY CLERK CITY OF MIAMI BEACHOFFICE OF THE CITY CLERK
Email:BCemiamibeachfl.gov
Telephone: 305.673.741 1
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):
V I am a resident of the City of Miami Beach for six months or longer
Home Address.1465 Cleveland Rd, 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).
Karin L. Matos, PA
Name of Business:
6538 Collins Ave. #345, Miami Beach, FL 33141
Business Address
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.
Karin L. Matos 3/3/2024
Signature Date
Date
Karin L. Matos
Printed Name
MIAMI BEACH
Cite of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miomibeochfl.gov
OFFICE OF THE CITY CLERK
Email: BCamlamibeachfl aov
Telephone: 305.673.741 1
PIVERSITY STATISTICS REPORT
Matos Karin L
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:
El Male
ID Female
CD Other
El I prefer not to answer.
Race/Ethnic Categories:
What is your race?
a African American/Black
a Asian or Pacific Islander
Caucasian/White
Native American/American Indian
El Other— Print Race:
a I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
El Yes
ID No
CI I prefer not to answer.
Do you consider yourself Physically Disabled?
Yes
No
I prefer not to answer this question.
Page 6 of 6
c CI(R.$ALL,REG BOARD AND COMMIT FEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL docx
Urhate0 June 2020
MIAMI BEACH
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
BOARD & COMMITTEE ACKNOWLEDGEMENT STATEMENTS
Matos Karin L
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 Copy of your latest Federal Income Tax Return
Members of the Planning Board and the Board of Adjustment must electronically file a "Statement of Financial
Interests (Form 1)1" directly with the Florida Commission on Ethics
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
3/3/2024
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 electronically file a Statement of Financial Interests(Form 1)with the Florida
Commission on Ethics by 12:00 noon, July 1. Planning Board and Board of Adjustment members who file their
Form 1 with the Florida Commission on Ethics 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.
Page 6 of 6
F 1CLER4ALL\BOARD AND COMMITTEES DATABASE\Board and Committee APPhcation\BOARD AND COMMITTEE APPLICATION FEB 2024 docx
Updated February 22,2024
Clear From Print Form
MIAMFQADE SOURCE OF INCOME STATEMENT
COUNTY
Section 2-11.1(i)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 Last Name First Name Middle Name/Initial
2023 Matos Karin L
Mailing Address—Street Number,Street Name,or P.O.Box
1465 Cleveland Rd
City,State,Zip
Miami Beach, FL 33141
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.❑
Filing as an Employee(check one)
❑ County ❑ Public Health Trust ❑ Municipal:
(Municipality)
Department
Position or Title Employee ID Number
Work address Work telephone Employment began on/ended on
Filing as a Board Member(check one)
Mary Beach
❑ County ❑ Municipal: Boabs-
(Municipality)
Board where serving
Neighborhood Resiliency Projects Advisory Committee
Alternate address(if home address is exempt) J Work telephone Term began on/ended on
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
Karin L. Matos, PA 6538 Collins Ave. #345, Attorney
Miami Beach, FL 33141
I hereby swear(or affirm)that the information above is a true and correct statement. RECEIVED BY EIECTIo • ENT:
Hardcopy
Karin L. Matos3/3/2024 ElectronlkiiiibpyOb 2024
Signature of Person Disclosing
CITY OF BEACH
OFFICE OF THE CITY CLERK
3/3/2024
Date signed
.._...REMEMBER TO PRINT, SIGN,AND SUBMIT TO THE OFFICE OF THE CITY CLERK VIA EMAIL OR HARDCOPY.
MI AM I BEACH BOARD & 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
PARKING
As a Board/Committee member you are entitled to a Citywide Parking Permit, which includes City Hall
garage (G7) parking access (Access Card), or a complimentary Citi Bike/Deco Bike Membership, or a
discounted MDC Monthly Transit Pass throughout your term.
Board Member Information
Date of Application: 3/3/2024
Applicant Name: Karin L. Maots
Board/Committee Name: Neighborhood Resiliency Projects Advisory Comm
Address: 1465 Cleveland Rd, Miami Beach, FL 33141
E-Mail Address: klmatos@usa.com
Work Phone: 305-861-6976 Home Phone:
Cell Phone: 305-336-5763 Preferred Contact Method: Cell phone
Please Choose One (1) Option: _
Citywide Parking Permit/G7 Access Card 0 Citi Bike/Deco Bike Membership O MDC Monthly Transit Pass
L_L Credit
Vehicle Information(For Citywide Parking Permit/Access Card Only)
Tag: QCQ A89 Color: White
State: FL Year: 2023
•
Make: Lincoln Model: Corsair
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". 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.
Karin L. Matos
Applicant Signature:,es
Please provide signed form to the Par ing Department located at 1755 Meridian Avenue, 2nd floor.
Working hours are 8:30 to 5:00 p.m. or email to: ParkinaReception@miamibeachfl.gov
e-mail subject: BOARD & COMMITTEE PARKING APPLICATION - APPLICANT NAME
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