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Luidgi Mary 12.31.24M IA M I BEACH B O A R D A N D C O M M IT T EE C H EC K LIST APPOINTEE: k-sidgi /arr BOARDCOMMITTEE: h.AA.C. Appointed by: e u4zi t. TERM No: _12/3l /zf reRMwuwn. t/3//al 3] 2u h4 DATE OF APPOINTMENT: _3/3/102f FOR SCANNER Scan o Scan o Scan o Scan o Scan o RE5EIVED ..... L- . MAR 27 2024 FOR CLERK STAFF o Letter of Appointment o Letter of Reappointment o Copy of Letter of Appointment/Reappointment e-mailed to Committee Liaison on o Board and Committee Application (Completed on I o R~sum~/Curriculum Vitae o Diversity statistics Reporting (Completed on 2/02h2 4 ) o Oath IMPORTANT INFORMATION FOR BOARD AND COMMITT EE 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 CI T Y OF M IAMI BEA CH OFFICE OF AE ITV CLERK3 ct ide P it Ar li ti (P rki r D 1rtr 1tF 1) · - 'Itywile 'ermit pplication 'aring 'epar .ment orm o Booklet - Guide to Sunshine Amendment & Code of Ethics for Public Officers and Employees Scan o Scan o o Source of Income Statement o Acknowledgment Statement o Board and Committees Liaison Responsibilities o Diversity Statistics Reporting [Z] 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 wh ole 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~/~___._.'.1/4"-"-~-~--Signed by X_~ _/- !'}µ_. _ •]5.p4 alps,a- Processed on ' _l_ yEmployee: Bl Date Received on: City Clerk's Office Staff Initials WVe are com mitted to providing excellent public service and salety to all who live, work, and pl a y in our vibrant, tropical, historic community. MIA M IBE A CH City of Miami Beach, ZOO Convention Conler Drive, Miami Bea ch, Florida 33139 yyyyy_miamiboachf_gov OFFICE OF THE CITY CLERK, Rafael E. Gran ado, City Clerk Tel 305.673.7411, Fax€ 305.673.7254 Email: CiNyClerk@miomibeachfl.gov March 19, 2024 Mr. Luidgi Mary 1632 Meridian Avenue APT#303 Miami Beach, Florida 33139 RE: Black Affairs Advisory Committee Dear Mr. Luidgi Mary: Congratulations! You have been appointed by Commissioner Joseph Magazine 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: Notw ithstanding 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 as they concern your duties, responsibilities, and requirements as a board or committee member. Congratulations again and good luck. Reg~ Rafael Granado City Clerk cc: Monica Beltran, Parking Director Lissette Arrogante, 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 M I A MI BEACH City o f M ia m i B e a ch , 17 00 C on v ention Center Drive, Miami Boach, Florid a 33 139 yyw_miamibcachll_gov OFFICE OF THE CITY CLERK, Rafael E. Gran ado, City Clerk Tel:. 305.673.7 411, Fax€ 305.673.7254 Email: CiNyClerk@mi amibeach lfl.gov Oath of Office Oath of Civility and Acknowledgements T O : M r. Luidgi M a ry R E : Black A ff airs A dvisory C om m itt ee I do so lem n ly sw ea r or affirm 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 perf orm all the duties of a m em ber of the ab o ve-m e ntio n e d 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 end ing: 12/31/2024. T o m y co lle a gues and to all of those I represent and serv e, 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 bee 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 o d e of Ethics O rdinance), as w ell as Florida C om m ission on Ethics Guide to the Sunshine Am endm ent and C ode of Ethics for Public O ff icers and understand that as a m em ber of a C ity of M iam i Beach Board and/or C o m m ittee , I m ust com ply w ith the financial discl osure* requirem ents of M iam i-Dade County or the State of F lo rid a (de pending on the board or com m ittee on w hich I serv e) on July 1st, fo llow ing the closing of the calenda r yea r on w hich I have serv ed. Sw orn to an d subs cribe d befo re m e t+jg l day of/rp,1 *P le ase visit the C ity of M iam i Beach w ebsite at w w w .m ia m ibeachfl.gov under City Clerk/Board and C o m m itt ee s fo r additional info rm ation regarding the Financial D iscl osure Requirem ents. M IA M I 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 .7 41 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): [Z] I am a resident of the City of Miami Beach for six months or longer. Home Address:.16Ml Merila Aue Ar_" 303 bi %a} ,Fl 3313% @ 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 ot osmess. Q6Editorial !ICC Business Aadress._B) Mo 38855t la bah,, \ 3323 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 ""pp)99%9 4/1 3/z/024 s6tore Die koiljj, Mler Printel Name MIAM I BEACH City of Miami Beach 1 700 Convention Center Drive Miami Beach, Florida 33139 www.miamibeach[l_gov OFFICE OF THE CITY CLERK Email: BC@miamibeachfl_gov Telephone: 305. 673 7411 DIVERSITY STATISTICS REPORI rs 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 ale D Female DJo her El t refer not to answer. Race/Ethnic Categories: What is your race? D African American/Black D Asian or Pacific Islander D Caucasian/white 0 Native American/American Indian [[Other - Print Race. [l 1 prefer not to answer. Do you consider yourself to be Spanish, Hispanic, or Latino/a? v es ~~refer not to answer. Do you consider yourself Physically Disabled? vs ~Nirefer 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 M IA M I B E A C H City of Miami Beach 1700 Convention Center Drive Miami Beach, Florida 33139 www.m iamibeachfl.gov OFFICE OF THE CITY CLERK Email: BC@ miamibeachfl.gov Telephone: 305.673.7411 Last Name BOARD & COMMITTEE ACKNOWLEDGEMENT STATEMENTS loidgi 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)" 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 sh;3~e de/d a tender of resignation from the City agency, board, or committee ~ -~~a......___1/4'---/)"-'-"'J.4 _ 4al£ so 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 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 of6 F:IC L E R \$A LL\B O A R D A N D C O M M ITT E E S D A T A B A S E IB o ard and C o m m ittee A p plicatio n\B O A R D A N D C O M M ITT E E A P P LI C A TIO N FE B 2024.docx Updated: February 22, 2024 MIAMl·DAD E- EI 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. Di sclosure for Tax Year Ending Last Nam e 2023 First Nam e L»id' Middle Nam e/Initial %% City, State, Zip lat 33134 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.Dl Filing as an Employee (check one} [] county D Public Health Trust [] Municipal: (Municipality) Departm ent Position or Title Em ployee ID Num ber W ork address I W ork telephone Em ployment began on/ended on Filing as a Board Member (check one} D County Pf~wonteioat: (Municipality ) Board w here serving t Altern ate address (if hom e address is exem pt) W ork telephone List below every source of incom e 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 pro perty dealings, interest, rents, dividends, pensions, IRA distributions, and social security payments. Also, include any source of income received by another person fo r your benefit. However, the income of your spouse or any business partner need not be disclosed. If continued on a separate sheet, ch eck here.[] Nam e of Source of Incom e Address Description of the Principal Business Activity ecorit4 7531 we+ . 4 3302 I hereby swear (or affirm) that the information above is a true and correct statement. ~,.;,, Date signed RECEIVED BY ELECTI ONS DEPARTMENT: wardco» FCEIVED D Electro nic Copy MAR 27 2024 CITY OF MIAM I Be OFEE Wl BE ACH O F F IC E U S E O N LY Accepted: Y I N Deficiency: Processed Date/Initials: Scanned Date/Initials: _ 138 SP-14 COE 2016 M IA M I BEACH City of Miami Beach, PARKING DEPARTMENT BOARD & COMMITTEES PARKING APPLICATION 1755 Meridian Avenue, Suite 200 Miami Beach, FL 33139/Ph: (305) 673-7505 or (305) 673-7000 ext. 6200 a PARKING A_s a Board/Committee member you are entitled to a Cityw ide 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: 3/2 Applicant Name: kui Board/Committee Name: Address: E-Mail Address: Work Phone: Home Phone: Cell Phone: 101.} 867- 104 Preferred Contact Method: Please Choose One 1 O tion: Citywide Parking Permit/G7 Access Card Citi Bike/Deco Bike Membership 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 $10.00 replacement fe A Please provide signe rm to the Parking Departmen t located at 1755 Meridian Avenue, 2nd floor. Working hours are 8:30 to 5:00 p.m. or email to: ParkingReception@miamibeachfl.gov e-mail subiect: BOARD & COMMITTEE PARKING APPLICATION - APPLICANT NAME f:\ping\$man\rar\forms\cw boards&committees parkingform.doc form updated 1/18/2024