Kate Mosley 12.31.25ittrvrL)
MIAMIBEACH MAY 28 2024
BOARD AND COMMITTEE CHECKLIST
Poree.. _a_e_ /Hosle
BOARD/COMMITTEE: G.2oct_ Oeos[glt_ Appointed y. Cly_ oyeigsyoy coo»nee FOR SCANNER FOR CLERK STAFF
Scan o oLetter of Appointment TERM END: TERM LIMIT:.
Scan o o Letter of Reappointment l ~
o copy of Letter ot AnointmenuReappointment e-ma«{g?gee Liaison a, 5\\202\
Scan o oBoard and Committee Application (Completed on _i[[_)-{ _)
Scan o o Resume/curriculum Vitae ],'
o Diversity statistics Reporting (completed on ]29\2y\_ y
o Oath E +\
DATE OF APPOINTMENT:
yr+r MAM! BEACH syay22±9vi
Scan o
Scan o
Scan O
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
t Sunshine Law and Public Records - Frequently Asked Questions
✓Memorandum - Solicitation by City Board and Committee Members
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 absencos
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.
Received on
Processed on:
@9/3Y/20_ .son«as, X =-. kale (os/ey.
Date Board or Committee Member7
\32\0?koenwore h-,,.....
Date City Clerk's Office Slaff Initials
WVe are committed o providing excellent public servce and solely to all who live, work, ond play out vibrant, topical, histic community
12.31.25 12.31.29
MIAMI BEACH
City of Miami Beach, 1/OO Convention Conler Drive, Miami Boach, Florida 33 139 yyyy._miamibgachll.gov
OFFICE OF THE CITY CIERK, Rafaol E. Granado, Ciiy Clerk
Tol: 305.673.7411, Fax. 305.673.7254
Email: CiyClerk@miamibeachll.gov
May 15, 2024
Ms. Kate Mosley
836 Lenox Ave, apt 316
Miami Beach, FL 33139
RE: General Obligation (G,O,) Bond Oversight Committee
Dear Ms. Kate Mosley:
Congratulations! You have been appointed by the City Commission to the agency, board or committee
named above for a term ending: 12/31/2025.
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.
7R
Ra~ Granado
City Clerk
cc: Jose Gonzalez, Parking Director
Maria Hernandez, City Liaison
ENCLOSURES:
Oath of Office/Oath of Civility/Acknowledgements
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 - 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
City of Miami Beach, 1/OO Corvontion Contos Drwvo, Mami [ooch, Hlodo 33 139 www.miamQ.hll, g
OHKCE O TH CITY CIERK. Rolaol E Granado, City Clord
1l 305673.711, fax 305 673.7254
F ml. CNyCdork @mlamiboochll gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Ms. Kate Mosley
RE: General Obligation (G.0.) Bond Oversight 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.
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. Kate Mosley
Sworn to and subscribed before me this fl day of~ 2024
Alice Lavado
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.
RECEIVED
MAY 28 2024
MIAIBEACH
City of Miami each
1700 Convention Center Drive
Miami Beach, Florida 33139
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
OFFICE OF THE CITY CLERK
Emal. BC@miambeachf\. gov
Telephone: 305.673.7 411
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):
0 am a resident of the City of Miami Beach for six months or longer.
Home Address: 835 Lenox Ave, apt. 316, Miami Beach, Florida, 33139
D 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).
[[3mm of Py[eSS,-
Py,1[@S,S, J(][es,S,
[Z] 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: Kate Mosley Design LLC
Business Address: 835 Lenox Ave, apt. 316, Miami Beach, Florida, 33139
"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 tile facts
stated in it are true. g_=
Signature
Kate Mosley
Date
Printed Name
MIAMI BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florido 33139
www.miamubeachfl.gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
DIVERSITY STATISTICS REPORT
see "e5lg 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 Mate
pd remale
loner
D I prefer not to answer.
Race/Ethnic Categories:
What is your race?
D African American/Black
0 Asian or Pacific Islander
D] Caucasian/white
CJ Native American/American Indian CJ Other- Print Race: _
D I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
Jves it o D I prefer not to answer.
Do you consider yourself Physically Disabled?
lves
»0 Ro t prefer not to answer this question.
Page 6 of 6
F CLER'SALL REG BOARO AND COMMITTEE APPLICATIONS FINAL DRAFT SBOARD AND COMMIT IEE APPLICATION REG FINAL docx
Updated. June 2020
MIAMI BEACH
Clly of Mlaml Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamleach!l,gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
Last Name
BOARD & COMMITTEE ACKNOWLEDGEMENT STATEMENTS
/es/e
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)
l 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 shall be deemed a tender of resignation from the City agency, board, or committee
Signature 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 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 CLER\SALL\BOARDO AND COMMIT TEES DATABASE Board and Committee ApplicationB3OARD AND COMMIT IEE APPLICATION FEB 2024 docx
Updated: February 22, 2024
MIAMHlAOE- EM 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 ot every year.
Disclosure for Tax Year Ending I last Nomo First Name Middle Mame/initial
2023 /osrey Kake
Mailing Address - Street Number, Street Name, or P. Box
r3 Levok ve , apt. 31
I».sue"Z, - I
/pt B3ea c //oeido, 33139 t
lf your home address is your mailing address, and your home address is exempt from public records pursuant to Fla. Stat. $119.07, read
instructions on the following page and check here. D
Filing as an Employee (check one)
L] county [] Public Health Trust [] Municipal:
(Municipality)
Department
Position or Title Employee ID Number
Work address I Work telephone Employment began on/ended on
Filing as a Board Member (check one)
[] county [I Municipal:
(Municipality)
Board where serving
to~ Coevutiou GNutee DRive 1tiaai
Alternate address (if home address is exempt) Work telephone
List below every source of income you received, along with the address and the principal activity of each source. Include your public salary. Place the sources of
income in descending order, with the largest source first. Examples of sources of income include: compensation tor services, income from business, gains trom
property dealings, interest, rents, dividends, pensions, IRA distributions, and social security payments. Also, include any source of income received by another
person for your benefit. However, the income of your spouse or any business partner need not be disclosed. If continued on a separate sheet, check here.[]
Name of Source of Income Address Description of the Principal Business Activity
I hereby swear (or affirm) that the information above is a true and correct statement.
-
Signature of Person Disclosing
0/a1/olt
Date signed
wtcovo wv @n4$ PE9py
[ I Hardcopy
Iaeetromni,f/%! 28 2024
CITY OF MIAMI BEACH
OFFICE E 1AF CITY CLERK
OFFICE USE ONLY Accepted Y / N Deficiency. Processed Date/initials:. Scanned Date/Initials:-
138 5P-14 COE 2016
\//AI BEACH soARD e Cc0Motets
cm»v ot Merv oesen. ANG trAmr PARKING APPL[CA[ION
1755 Merdian Avenue._Suite 200 Mori each, ft_33139/Ph: (305) 673-7505 0r (305) 673 7000 0t. 6200
Ll PARKING
As a Board/Committee member you are entitled to a Citywide Parking Permil, which includes City Hall
garage (G7) parking access (Access Card), or a complimentary Cili Bike/Deco Bike Membership, or a
discounted MDC Monthly Transit Pass throughout your term.
Boord Member Information
Date of Application:
Applicant Name:
Address P235
E-Mail Address: jj,
Work Phone:
Cell Phone: .5P3 3836 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)
Tog: }0+6 NS 4 0616 Color: White
Stole: Fort Year: O 4.
Make: l€ks Model: Se 430
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 lo you for City Holl Garage {G7) access.
IMPORTANT NOTE: Your vehicle license plate serves as your "parking permit". To ovoid any
unnecessary enforcement actions, ii 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 lowing of your vehicle.
Please note that this new access cord CANNOT be hole-punched or perforated in any manner. To use
the new card please hold the card al close proximity to the reader until the gale opens. You may
need lo try lhe olher side of the card. Please ensure you hold lhe entire surface of lhe card against
the reader unlil the gale opens.
ACKNOWLEDGEMENT: I acknowledge that should my access cord be lost, stolen or damage, I will be
responsible to pay a $10.00 replacement fee.
oocant sionotore:. .st5DD»- _
Please provide signed form to the Parking Department located at 1755 Meridian Avenue, 2' floor.
Working hours are 8:30 to 5:00 p.m. or email to: ParkingReceptlon@miamibeachfl.gov
e-mail subject: BOARD & COMMITTEE PARKING APPLICATION - APPLICANT NAME
\{manor\toms\cw toads.c omuttees tom.doc tomn toted 1/18/202