Haley Ross 12.31.25BEACH
RECEIVED
MAY 24 2024
CITY OF MIAMI BEACH
OFFICE OE "u CITY CLERK
BOARD AND COMMITTEE CHECKLIST
APoreEe: Ha\e 4, Vo>
soARcowwreEeQ994,d9co±on w M{a _«.
FOR SCANNER FOR CLERK STAFF
scan ·Letter of Appointment TERM END: \0.3\.96
Scan o o Letter of Reappointment
o Copy of Letter of Appointment/Reappointment e-mailed to Committee Liaison on
o Board and Committee Application (Completed on 3.13.2} _)
o R~sum~/Curriculum Vitae
o Diversity statistics Reporting (Completed on S.Q.a-])
o Oath
DATE OF APPOINTMENT: 5.A.94
Appointed by. (iH (oomni$6io
Scan o
Scan o
Scan o
rERM Luu- \3.3\.31
6.10.2+
IMPORTANT INFORMATION FOR BOARD ANO 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
✓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
[2f 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. 2-229) 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.
Received on:~AJ-4 10 I 202.q Signed by X__,_-1-----,1-"'----A--- _/_~--------
[Date
Processed on: 5 I :>H
0
·\e~ By Employee:--'--+--~--------------- J' City'clerks Office Staff initials
MIAMIBEACH
City of Miami Beach, I/OO Convonfion Center Drive, Miami Boach, Horida 33 139 yaw_miaIibachf]go
OFFICE OF THE CITY CLERK, Rafool E. Granado, City Clerk
Tel: 305.673.7411, Fax. 305.673.7254
Emall: CiNyClerk @miamibeachll.gov
May 15, 2024
Ms. Hayley Ross
5757 Collins Avenue
Miami Beach, FL 33140
RE: Committee for Quality Education in Miami Beach
Dear Ms. Hayley Ross:
Congratulations! You have been appointed by Commissioner David Suarez to the above-referenced
Board or Committee, for a term ending: 12/31/2025.
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
appointmenUelection 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.
R~
Raz~ranado
City Clerk
cc: Monica Beltran, Parking Director
Dr. Leslie Rosenfeld, 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
t
City of Miami Beach, x attn.o4 D«,Mam+Ian, Ia±a 4l._niu__i..g!i
OFFKCF OF TH CITY CIFRK., Ralool I Granado, City Clerk
Iol. 305 673 7al1, fax 305 673.7254
I ml it.Clerk+mamtbccc hf! gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Ms. Hayley Ross
RE: Committee for Quality Education in Miami Beach
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 secved. ~ ~
s. H ley Ross
Swor to and subscribed before me tua uW o'Ho4\20%
·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.
MIAMI BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@mamibeachfl_gov
Telephone: 305 .673 7411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH AND THE COMMITTEE
FOR QUALITY EDUCATION IN MIAMI BEACH
As a voting member of the Committee for Quality Education in Miami Beach, I am in
compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4) and
2-190.137 as:
D I am a City of Miami Beach resident for six months or longer.
Home Address: _
D I am the parent/guardian of a student attending a Miami Beach school for the school
year.
School: _
Under penalties of perjury, I declare that I have read the foregoing document and that the facts
stated in it are true.
Signature Date
Printed Name
RECEIVED
MIAMIBEACH
City of Miami Beach
1 700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfl.gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
DIVERSITY STATISTICS REPORI
Ross
Last Name
A 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:
L]Mate
El remale
D Other
D I prefer not to answer.
Race/Ethnic Categories:
What is your race?
D African American/Black
[J Asa or Pacific Islander
El Caucasian/white
0 Native American/American Indian
D Other - Print Race: ------------- □I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
[l voe
Jo
0 I prefer not to answer.
Do you consider yourself Physically Disabled?
a.
21+
D I prefer not to answer this question.
Page 6 of 6
F:ICLER\$ALLIREGIBOARD ANO COMMITTEE APPLICATIONS FINAL DRAFTSIBOARD ANO COMMITTEE APPLICATION REG FINAL.docx
Updated: 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: 305.673.7 411
Ross
Last Name
BOARD & COMMITTEE ACKNOWLEDGEMENT STATEMENTS
k!Ale.v A
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 shall be deemed a tender of resignation from the City agency, board, or committee .±sh9d 14 20,202¥
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\$ALLIBOARD AND COMMITTEES DATABASE\Board and Committee Application\BOARD AND COMMITTEE APPLICATION FEB 2024.docx
Updated: February 22, 2024
MIAMI-OADE- EI 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
2023
Mailing Address - Street Number, Street Name, or P.O. Box
5 Av
Middle Name/Initial
A
0
City, State, Zip e 33140
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.El
Filing as an Employee (check one)
[] 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 D Municipal:
(Municipality)
Board where serving
Alternate address (if home 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 or 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
G= ATTACH ED
I hereby swear (or affirm) that the information above is a true and correct statement.
Signature of Person Disclosing
Date signed
RECEIVED BY ELECTIONS DEPARTMENT:
/war«co» RECEIVED
[] Electronic Copy
MAY 24 2024
CIT» ' MIAMI BEACH
OFFICE USE ONLY Accepted: Y / N Deficiency. Processed Date/Initials: Scanned Date/initials.-
138_SP-14 COE 2016
2023 Form 6 - Full and Public Disclosure of Financial interests
Income
Identify each separate source and amount of income which exceeded $1,000 during the year, including secondary sources of
Income. Or attach a complete copy of your 2023 federal income tax return, induding all W2s, schedules, and attachments.
Please redact any social security or account numbers before attaching your returns, as the law requires these documents be
posted to the Commission's website.
[l1elect to file a copy of my 2023 federal income tax return and alt W2s, schedules, and attachments.
PRIMARY SOURCES OF INCOME:
Name of Source of income Exceeding $1,000 Address of Source of income Amount
Rental Home Income 1111 Shirley Pressley Road, Glenville, NC $ 25,465.00
Florida Retirement System Division of Retirement Systems, PO Box 9000, $ 9,564.00 Tallahassee, FL
Ross Financial Advisors, LLC 5757 Collins Ave, Miami Beach, FL 33140 $ 24,948.00
Social Security Administration, Office of Public Inquiries,
Social Security 1100 West High Rise, 6401 Security Blvd., Baltimore, MD $15,180.00
21235.
SECONDARY SOURCES OF INCOME (Major customers, clients, etc. of businesses owned by reporting person):
Name of Business Entity Name of Major Sources of Address of Source Principal Business
Business' income Activity of Source
Ross Financial Advisors, LLC Consulting 5757 Collins Ave, Apt 707, Consulting Miami Beach, FL 33140
Interests in Specified Businesses
Business Entity # 1
N/A
Printed from the Florida EFDMS System Page 4 of 5
MIAMI 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
ta
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
Cells 0
E-Mail Address: I .cos
Work Phone:
cell Phone: 305- H+98-07/o Preferred Contact Method:
Please Choose One 1 0 tion:
Citywide Parking Permit/G7 Access Cord O Cili Bike/Deco Bike Membership
Vehicle Information
Tag:
State:
Permit/ Access Card Only
FL
color. Gre
Year: 20
Make: Model: Scu
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 r lacement fee.
A, licant Si nature:. es
Please provide signed form t ]king Department located at 1755 Meridian Avenue, 2d floor.
Working hours ore 8:30 to 5:00 p.m. or email to: ParkingReception@miamibeachfl.gov
e-mail subiect: BOARD & COMMITTEE PARKING APPLICATION - APPLICANT NAME
t; \u\ran or\loruns\cw toaras&committees :arkgfcmm.doc tvm u:dated '/8[202