Nancy Gaggino 12.31.25MI AMI BEA CH
BOARD AND COMMITTEE CHECKLIST
APPoree. _NAwf_6A6611JO Ar or APPoNTMENr: 2[22]!
soARrcowwrreee A{[{·a loo, Asoiea r._Ah, Cori&fi9)
pl31)2_ FOR SCANNER
Scan o
Scan o
Scan o
Scan o
Scan o
FOR CLERK STAFF
o Letter of Appointment TERM END:
o Letter of Reappointment }
o Copy of Letter of Appointment/Reappointment e-mailed to Committee Liaison on _2423[}
o Board and Committee Application (Completed on )
o R~sum~/Curriculum Vitae [.,I [
o Diversity Statistics Reporting (Completed on []
o Oath
TERM LIMIT: 12/31l2
RECEIVED
MAR 12 2024
CITY OF MIAMI BEACH
OFFICE OF THE 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
t County Code Section 2-11.1 -- Conflict of Interest and Code of Ethics Ordinance (as
amended through December 2010)
t Am endments to the Code of Ethics Ordinance (September 2009 through July 2012)
Highlights of the Miami-Dade County Ethics Code
t 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
l acknowledge that pursuant to Sec. 2-22(9) of the Miami Beach Code of Ordinances, I will be rem oved
from my boa rd/committee upon failure to attend 33% of the regularly scheduled meetings.
Sec. 2-22(9) lf 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 at(omatically removed. To calculate the number of absences
under the 33 percent formula, .4 or less rounds down the next whole number and .5 or more rounds up to the
next whole number.
NOTE: Members of the Land Use Bo ards will be remo d upon fallure to attend three of the regularly scheduled
meetings per calendar year, or upon abstaining fror voting due to a conflict of interest on four different
applications within a calendar year. A member who is shall not be reappointed to membership on the
board for at least one year from the date of removal.
Received on: _',............_{ l_l+--/ _2ft Signed by X. _
Date Board or Committee Member
Processed on: __ ~_{_l_l--{ __ 1- __ Lt __ By Employee:-------,~-·-~-~---------
ate Cy Ciei om samR initiais
WVe are committed to providing excellent public service and safety to all who live, work, and play in our vibrant, tropical. historic community
M IA M I BEACH
City of Miami Beach, 1ZOO Convention Contor Drive, Miam i Boach, Flor ida 33 139 yywy_miamiboachf]gov
OFF ICE OF THE CITY CLER K, Rafaol E. Granado, City Clerk
Tl: 305.673.7411, Fax€ 305.673.7254
Email: CiNyClerk@miamibeachfl.go
Fe b ruary 23, 20 24
M s. N ancy G a gg in o
82 5 5 A bbo tt A ve , apt 503
M ia m i Be a ch , Flo rida 33 14 1-5232
RE: A ff or d ab le Housing Advisory Committee
D e a r M s. N a ncy G a ggino:
C o ng ratulations! Y ou have been appointed by the City Commission to the agency, board or com m ittee
na m e d above fo r a term ending: 12 /31/2025.
If yo u are un a ble to accept this appo intm e nt, or ha ve any que stions, please call the O ffice of the City
C le rk at 30 5.67 3.74 11.
P le a se rea d th e e n cl o se d m ate ria ls ca refully as the y co ncern your duties, responsibilities, and
req uirem ents as a board or com m ittee m em ber.
C o ng ratulations ag ain and good luck.
R e ~
RafLranado
C ity C le rk
cc : M onica B eltra n , Parking D irector
M arce la R ubio , C ity Li aison
ENCLOSURES:
O a th of O ff ice/O ath of C ivility/A cknow ledgem ents
C ity C o de /O rdin ance sectio n applicable to agency, board or com m ittee
C ity C o de S ection 2-22 , 2-23, 2-24 , 2-25, 2-26, 2-458 an d 2-4 59
O rdinance N o . 20 0 6 -3543 - Am en dm ent to C ity C ode S ection 2-22
M ia m i-D a d e C o un ty C ode S ection 2-11.1 - C o nflict of Interest and C ode of Ethics
C ity W id e Perm it Ap plica tion - (Pa rking D epart m ent Form )
B o o kl e t - G uid e to the S unshine A m endm ent and C ode of Ethics fo r P ublic O ffi cers and Em ployees
M IAM I BEACH
City of Miami Beach, 1/00 Con ven tion Center Drive, Miami Beach, Florida 33 139 yayy_miamibcachll_gov
OFFICE OF THE CITY CLERK, Rafael E. Gran ado, Ciy Clerk
Tel: 305.673.7411, Fax. 305.673.7254
Ema l: CiNyClerk @miamibeachll.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Ms. Nancy Gaggino
RE: Affordable Housing 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: 12/31/2025.
T o 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
C ode o f E thics O rdina nce), as w e ll as Florida Commission on Ethics Guide to the Sunshine Amendment
and C o de of E thics for P ub lic Officers and understand that as a member o a City of Miami Beach Board
and/o r C o m m itt ee , I m ust com p ly w ith the financial disclosure* requirements f Miami-Da 'ounty or the
S tate of F lo rida (depending on the board or committee on which I serve) on ly 1st, foll the closing
o f the cale nd ar yea r on w hich I h a ve se rv ed.
S w orn to and subscribed b efo re m e this 12
pl e a se visit the C ity o f M ia m i B e a c h w e b site a t www .m ia m ib e a chfl.g o v u nd e r C ity C le rk/B o a rd an d
C om m itt ee s fo r a dditional info rm a tio n rega rding th e F ina ncia l D iscl o sure R equirem e n ts.
MIAMI
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
M4AR 12 2024
CITY OF MIAM I BEA CH
OFFICE OF THE CITY CLERK
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):
~ I am a resident of the City of Miami Beach for six months or longer.
or - A«es. &25 RN,b olt v # So3
D I ha v e a n ow ne rsh ip inte re st (for a minimum of six months) in a business established in the
C ity of M ia m i B e a ch (for a m in im u m of six m o nths ).
N a m e of B usine ss : --------------------------
B u s ine ss A dd re ss: -------------------------- □I am a full-tim e e m p lo ye e of a busin e ss (fo r a m in im u m of six m o nths ) an d I am based in an
offi ce o r othe r lo ca tio n o f the bus in e ss tha t is p hysic a lly lo ca te d in M ia m i B e a ch (for a
m in im u m of six m o n ths).
N a m e of B usin e ss : --------------------------
[(I s /m e ss (d d fesS ,
"O wn e rsh ip Interest" m e a n s th e o wn e rsh ip of ten p e rce n t (10 %) or m o re (in cluding th e
o wn e rsh ip of 10 % or m ore o f th e o u tstan ding cap ital stock) in a b usine s s.
'B u sin e ss " m e a n s an y so le p rop rieto rsh ip , sp o nso rsh ip , co rp o ra tion, lim ite d liab ility com p a ny,
r o th e r e n tity or b u sin e ss asso ciation .
s of pe rju ry , I d e cla re th a t I ha ve re a d the fo re g o in g do c um e n t and th a t the fa cts
p d/i/)it al tr ue .
D a te l
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
A61O UA -----+. --------'---
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
D isclosure R equirements.
One of the following forms must be filed with the City Clerk of Miami Beach, 1700 Convention Center Drive,
M iam i Beach, Florida, no later th an 12:00 noon of July 1, of each year:
1. A "S ource of Incom e S tatem ent;" or
2. A C opy of your latest Federal Incom e Tax R eturn .
M em bers of the P lanning Board and the B oard of A djustm ent m ust electronically file a "Statem ent of Fin ancial
Interests (Form 1)"" dire ctly w ith the Florida Com m ission on E thics.
ilure to file one of these form s, pursuant to the M iam i-Dade C ounty C ode, m ay subject the pers on to a fine
of n m ore than $500, 60 days in jail, or both.
cknowledgment to Comply with Miami Beach Code of Ordinances Division 1 Sec. 2-22 (23)
I under tand that commencing with terms beginning on or after January 1, 2024, and as a condition of applying
fo r app intm e tt to a City agency, board, or committee, I voluntarily agree that in the event I file with the City
C lerk a tate of C andidate fo rm ally announcing candidacy fo r C ity elective office, such filing w ith the C ity
C lerks I be ed a tender of resignation fr om the City agency, board, or com m ittee
D ate
1 M em bers of the Planning B oard and B oard of A djustm ent w ill be notified directly by the State of Florida,
pursuant to F.S . $112.3145(1)a ), to electro nically file a S tatem ent of Financial Interests (F orm 1) with the Florida
C om m ission on. Ethics by 12:00 noon, July 1. P lanning B oard and B oard of Adjustm ent m em bers w ho file their
Form 1 with the Florida C om m ission on Ethics autom atically satisfy the C ounty's financial disclosure requirem ent
as a M iam i B each City Board/Com m ittee m em ber and need not file an additional fo rm w ith the O ffice of the C ity
C lerk.
Page 6 of 6
F:\CLER\$ALL\BOARD AND COMMITTEES DATABASE\Board and Committee ApplicationlBOARD AND COMMITTEE APPLICATION FEB 2024.d0cx
Updated: February 22, 2024
MI AMI BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florido 33139
www .miamibeachfl,goy
OFFICE OF THE CITY C LERK
Em ail: BC @ m iam ibeachfl.gov
Telephone: 305.673.7411
DIVERSITY STATISTICS REPORT
Last Name
Apo ef
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 ale
4 Female
(3 oner
0 I prefer not to answer.
Race/Ethnic Categories:
What is your race?
D African American/Black
0 Asian or Pacific Islander
El Caucasian/white
D Native American/American Indian oner- Print Race: _
D I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
ves
J o
El i prefer not to answer.
Do you consider yourself Physically Disabled?
ves so
D I prefer not to answer this question.
Page 6 of 6
F:\CLER\$ALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
...MA99
ii@ii iiii SOURCE OF INCOME STATEMENT
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 I Last Name y Middle Name/Initial
2023 b6A66l1)0 MA
Mailing Address - Street Number, Street Name, or P.0. Box
825S po ol Av o ; 331 ¥]
If your home address is your malling 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. []
Fil ing as an Empl oyee (check one)
□County □Public Health Trust [] M unici pal:
(M unicip ality )
Department
Position or Title Employee ID Number
Work address I Work telephone Employment began on/ended on
Fil ing as a Boar d M em ber (check one)
□County J Muniei at . Ht', l-cl-2
(M un ici pality )
Board where serving
D
Alternate address (if o e address is exempt) 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
alloy
I hereby swe r ( r at 'irm ) that the information above is a true and correct statement.
Date signed
RECEIVED BY ELECTIONS DEPARTMENT:
J war4co» RECEIVED
D Electronic Copy
MAR 12 2024
CITY OF MIA MI BEACH
OFFICE OF TE r n
O FFIC E USE O N LY Accepted: Y / N Deficiency. Processed Date/initials: Scanned Date/initials:
138_SP-14 COE 2016
MIAMI BEACH
City of Miami Beach, PARKING DEPARTMENT
1755 Meridian Avenue, Suite 200 Miami Beach, FL 33139/Ph: (305) 673-7505 or (305) 673-7000 ext. 6200
BO AR D & CO M MI TTEES
PARKING APPLICATIO N ?
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: ,, LL 202)
Applicant Name: M c 6A 661Mo
Address. $2S Nvl}Jo
Work Phone:
cell Phone:43 23 %45 Preferred Contact Method: [8-j,
Please Choose One 1 0 tlon:
Citywide Parking Permit/G7 Access Card Citi Bike/Deco Bike Membership
Vehicle lnfor
Tag:
State:
Ide Parkin Permit/ Access Card Onl
FL
Color: ?
Year: 2o
Make: M) X2 Moder: x?
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 pleas Id the card at close proximity to the reader until the gate opens. You may
need to try the other sid of the card. Please ensure you hold the entire surface of the card against
the reader until the gate
ACKNOWLEDGEMENT: I knowledge that should my access card be lost, stolen or damage, I will be
responsible to pay a $10. O re ement fee.
A, licant Simnature: es
Please provide signed forr to the Parking Department located at 1755 Meridian Avenue, 2d floor.
Working hours are 8:30 to 5: p.m. or email to: ParkingReception@miamibeachfl.gov
e-mail sub ect: BOARD & COMMITTEE PARKING APPLICATION - APPLICANT NAME
f;' in '\$m an \v a r\for m s\cw bo ar a s&co m mi tte e s arkin 1torr .d o c form upd a te d 1/18 /2024