Kristen Greene 12.31.24MI AM I BEACH
BOARD AND COMMITTEE CHECKLIST
APPOINTEE: Kristen Greene
BOARD/COMMITTEE. Disability Access Committee
DATE OF APPOINTMENT. February 14, 2023
Appointed by: Commissioner L. Dominguez
FOR SCANNER
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FOR CLERK STAFF
o Letter of Appointment
o Letter of Reappointment
o Copy of Letter of Appointment/Reappointment e-mailed to Committee Liaison on -----
0 Board and Committee Application (Completed on _,
o R6sum~/Curriculum Vitae
o Diversity Statistics Reporting (Completed on
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TERM ENo: _yy[/\{ TERM Lurr. _2/[/31
IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
✓City Code Ordinance Section applicable to the agency, board or committee
Y 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
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o Citywide Permit Application (Parking Department Fann)
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/] 1acknowledge 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) 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 automatically removed. To calculate the number of absences
under the 33 percent formula, .4 or Jess 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.
Received on: 2130 Signed by x._tip-4&.-.._a;,;;U,v--L'-------------
Date Board or Committee Member
Processed on: _ _,b__,},_..I C\__.....1-~------- By Employee:------~---------------- GE cw clens orco saniniiais
We are committed to providing excellent public service and salely to all who live, work, and play in our vibrant, tropical, historic community.
M IA M I BEACH
City of Miami Beach, 1/OO Convention Conlor Drive, Miami Boach, Horida 33 139 yy _miamibach ll.gov
OFFICE OF THE CITY CLERK, Rofool E. Granado, City Clerk
Tel: 305.673.7411, Fax. 305.673.7254
Emai l: CiNyClerk@miamibeachfl.gov
Fe b rua ry 13 , 20 24
M s. K riste n G ree ne
10 0 8 Je ff erso n A ve nu e , 10 1
M ia m i Be a ch , Flo rid a 33 13 9
RE: Disability Acces s Com m i tt ee
D e a r M s. K riste n G re e ne :
C o ng ratu la tio n s ! Y o u ha v e be e n ap p o in te d by Commissioner Laura Dominguez to th e a b o v e -
refere nced Bo a rd or C o m m itt ee , fo r a te rm end in g : 12/31/2024.
P ursua nt to C ity of M ia m i Be ach C o de Se ctio n 2-22 (5)a :
N o tw ithsta nd in g any othe r pro visio n of the C ity C ode or of any R eso lutio n, com m enci n g w ith
te rm s beg inn in g on or aft er Jan ua ry 1, 20 0 7, the te rm of every board m em ber w ho is directly
ap po inted by a m e m b e r of the C ity C o m m issio n sha ll autom atica lly expire up on the la tt er of:
D e ce m b e r 31 of the yea r the ap po intin g C ity C o m m issione r le aves offi ce o r up o n the
ap po in tm e nt/ele ctio n of the successo r C ity C o m m issio n m em ber.
If yo u are un a b le to acce p t th is ap p o in tm e n t, or ha ve any que stion s, please call th e O ffice of the C ity
C le rk at 30 5 .6 7 3 .7 4 11 .
P le a s e re a d th e e n c lo s e 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 , res po n s ib ilitie s, an d
requ irem e nts as a bo a rd or co m m itt ee m e m b e r.
C o ng ratula tio ns ag a in and go od luck.
R eg a rds,
cc: M o nica Be ltra n , Pa rking D ire cto r
V a le ria M e jia , C ity Li a iso n
ENCLOSURES:
O a th of O ff ice/O a th of C ivility/A ckno w le dg e m e nts
C ity C o d e /O rdina nce se ctio n ap p licab le to ag e ncy, board or co m m itt ee
C ity C o d e S e ctio ns 2-2 2 , 2-23 , 2-24 , 2-2 5 , 2-26 , 2-4 58 and 2-4 5 9
O rdina n ce N o . 20 06 -3 54 3 - Am en dm en t to C ity C o de S e ction 2-22
M ia m i-D a d e C o unty C o d e S e ct ion 2-11.1 - C o nflict of Inte rest and C o de of Ethics
C ity W id e Pe rm it Ap pl icatio n - (Parking D e pa rt m e nt Form )
B o ok l et - G ui d e to the S un shine A m e nd m e nt and C o d e of Ethics fo r Pub lic O ffi ce rs and Em plo yees
MI AMIBEACH
City of Miami Beach, 170O Convention Center DriNvo, Miami Beach, Florido 33 139 www.miamibeachl.got
OFF OF TH CITY CLERK, Rall E. Granado, Coy Clerk
Tel: 305.673.711, Fax 305.673.7254
Email: Ci»yler lc@lamtbeachll .go
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Ms. Kristen Greene
RE: Disability Access 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.
Ms. Kristen Greene
Sworn to and subscribed before me this _[d_ day 9f , ,2024
Kei
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.
M IA M I BEACH
City of Miami Bea ch
1 700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF TH E CITY CLERK
Email: BC@miamibeach~l.got
Telephone: 305.673.7411
AFFIOA VIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
I am in compliance with the affiliation requirement of Miami Beach City Cod e Sections 2-22 (4),
as ( check ( ✓) all that apply):
v]1am a resident of the City of Miami Beach for six months or longer.
Hom e Address : 10 0 8 Je ffe rs o n A ve n u e , N o . 10 1, M ia m i B e a ch , FL 33 139
D I have an owners hip interest (for a m inim um of six m onths) in a business established in th e
C ity of M iam i B ea ch (for a m inim um of six m onth s).
[ar e f p1gs]nesS.,
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D I am a fu ll-tim e em ployee of a business (for a m inim um of six m onths) and I am based in an
office or oth er loca tion of the business that is physica lly loca ted in M iam i B each (for a
m inim um of six m onth s).
famn e f 1J S][esS.
H3JS1fess (](Sf@SS,
"Ownership Interest" means the ownership of ten percent (10%) or m ore (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.
U nder penalties of perjury , I declare that I have read the fo regoing docum ent and that the facts
stated in it are tru e.
#!er 2 -14 -2 0 2 4
D ate
K risten G re e n e
P rinted N am e
MIAMI BEACH
City of M ia m i Bea ch
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachf.gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
DIVE RSI TY STATI STI CS REPORT
Greene Kristen J.
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 a e
El remale
loner
0 I prefer not to answer.
Race/Ethnic Categories:
What is your race?
0 African American/Black
D Asian or Pacific Islander
El Caucasian/white
D Native American/American Indian loner- Print Race: _
D I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latinola?
LJ ves
o
D I prefer not to answer.
Do you consider yourself Physically Disabled?
v s go
D I prefer not to answer this question.
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F:ACLER$ALL RE GBO ARD AND COMMITTE E AP PLICA TIONS FINAL DRA FTS\B OARD AND COMMI TTEE AP PLICATION REG FINAL.docx
Updated: Jun e 2020
MIAMI BEACH
Ci ty of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
wow w,miami beachf l.gov
OF FICE OF THE CITY CLERK
Email: BC@miamibeachf\.gov
Telephone: 305.673.7411
Greene
BOARD & COMMITTEE ACKNOWLEDGEMENT STATEMENTS
Kristen J.
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 flied 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)';" 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 $500, 60 days in jail, or both.
Acknowledgment to Comply with Miami Beach Code of Ordinances Division 1 Sec. 2-22 (23)
I understand that commencing with terms beginning on or after January 1, 2024, and as a condition of applying
for appointment to a City agency, board, or committee, I voluntarily agree that in the event l file with the City
Clerk a Statement of Candidate formally announcing candidacy for City elective office, such filing with the City
Clerk shall be deemed a tender of resignation from the City agency, board, or committee
siGriiore Date
1 Members of the Planning Board and Board of Adjustment will be notified directly by the State of Florida,
pursuant to F.S. §112.3145(1 )(a), to file a Statement of Financial Interests (Form 1) with the Miami-Dade County
Supervisor of Elections by 12:00 noon, July 1. Planning Board and Board of Adjustment members who file their
Form 1 with the County Supervisor of Elections automatically satisfy the County's financial disclosure
requirement as a Miami Beach City Board/Committee member and need not file an additional form with the Office
of the City Clerk. However, compliance with the County disclosure requirement does not satisfy the State
requirement.
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F:CLERI$ALL BOARD AND COMMITTEES DATABAS E\Board and Committee Application\BOARD AND COMMITTEE AP PLICA TION OC T 2023.d0cx
Updated: January 9, 2023
MIAM . Em SOU RC E O F INC OM E STATEM ENT
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 ev ery year.
Disclosure fo r Tu Year Ending !Las t Name
2023 \Greene
First Name
Kristen
Mi dd le Name/initial
J
M ailin g Address - Str ee t Number, Stre et Name, or P.0. Box
1008 Jefferson Avenue, No. 101
City, State, Zi p
Miami Beach, FL 33139
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 her e.El
[ Co unty [] Public Health Trust [] Municipal:
(M un icipal ity)
Department
Position or Title Em ployee ID Num ber
Work address I W ork te lephone Employment began on/ended on
Fling as a Board Member (check one)
[] co unt y [] Municipal: Miami"each
(Municipality)
Board where serving
Disability Access Committee
Alternate address (if home address is exempt) I W ork te leph one Term beg an on/en ded on
Li st below every source of income you received, along wi th 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. H co ntinued on a separate shee t, check here.□
Name of Source of income Address Description of the Principal Business Activity
Mickey Burk es 1265 W ashington Avenue, Restaura nt, Bar & Grill (My
Miami Beach FL 33139 employer)
I hereby swear (or affirm) that the information above is a true and correct statement.
a±kt..-.
Date signed
RECEIVE D BY ELECTI ONS DEPARTMENT:
[ Hardcopy
0aero "%? s 204
CI TY O» M Mi
OFC
OFFICE USE ONLY Accepted: Y / N Deficiency Processed Date/initials: Scanned Date/initials:
138_SP-14 COE 2016
M IAM I BEACH
City ot Miami Bea ch, PARKING DEPARTMENT
BOARD & COMMITTEES
PARKING APPLICATION
1755 Meridian Avenue, Suite 200 Miami Beach, FL 33139/Ph: (305) 673-7505 0r (305) 673-7000 ext. 6200
a
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. gr a
discounted MDC Monthly Transit Pass throughout your term.
Board Member Information
Date of Application: 2-14-2024
Applicant Name: Kristen Greene
Board/Committee Name: Disability Access Committee
Address: 1008 Jefferson Avenue, No. 101, Miami Beach, FL 33139
E-Mail Address: kristenjgreene@hotmail.com
Work Phone: 305-636-9291 Home Phone: 305-636-9291
Cell Phone: 305-636-9291 Preferred Contact Method: 305-636-9291
Please Choose One 1 O Hon:
Citywide Parking Permit/G7 Access Card • Citi Bike/Deco Bike Membership MDC Monthly Transit Pass
Vehicle Information (For Citywide Parking Permit/Access Card Only)
Tag: Color:
State: Year:
Make: Model:
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 S$10.00 replacement fee.
A licant Si mnature: es
Please provide signed f rm to the Parking Department located at 1755 Meridian Avenue, 2nd floor.
Working hours are 8:30 to 5:00 p.m. or email to: ParklngReceptlon@mfamfbeachfl.gov
e-mail subject: BOARD & COMMITTEE PARKING APPLICATION - APPLICANT NAME
f:\pin~\$man var\forms\cw boards&committees " jform.doc tom ur fated 1/18/2024