Allison Buttacavoli 12.31.25IAMAIBEA C
BOARD AND COMMITTEE CHECKLIST
arrowree (}iso Et\acavot
oARrcowwrrrEEe:_joke Cities
DATE OF APPOINTMENT:8.]2{
Aooitea by.txre eine
FOR SCANNERScano
Scan o
Scan o
Scan o
Scan o
RECEIVED
AUG 1 6 2024
CITY OF MIAMI BEACH
OFFICE O THE CITY CLERK
Scan O
Scan O
FOR CLERK STAFF
•teter of Appointment TRMEND:\?_·3\.Z TERMLurr.(2.$1.3\
o Letter of Reappointment
o Copy of Letter of Appointment/Reappointment e-mailed tg @ogp/lee Liaison an ·)2d
o Board and Committee Application (Completed on •22.Z )
o Resume/Curriculum Vitae
o Diversity statistics Reporting (Completed on _]yo [zk
o Oath
IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
t 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)
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
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
M i8z4-«
.\1.2}By Employee rt
-,cam#,,Date City Clerk's Office Staff Initials
We are committedio providing excollont public service andsafety to all wholive,wok,andplayin our vibrant,#opcol,htstac corununiy.
'Processed on:
Received on.
MIAMI BEACH
City of Miami Beach,I/0O Convontion Canter Drive,Miami Boach,Florida 33 139 yywy_miamibeachll.gov
OFFICE OF THE CITYCLERK,Ralol E.Granado,Cy Clerk
Tel:305.673.7411,Fox:.305.673.7254
Email:CilyClerk@miamibeochfl.gov
August 08,2024
Ms.Allison Buttacavoli
5451 Alton Road
Miami Beach,FL 33140
RE:Sister Cities Program
Dear Ms.Allison Buttacavoli:
Congratulations!You have been appointed by Mayor Steven Meinerto 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
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.
cc:Jose Gonzalez,Parking Director
Rickelle Williams,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
MIAMIBEACH
City of Miami Beach,700 Convention Center DNe,Mam»Boach,Florida 331 39 www.mlamtbeachfl.gat
OEHKCE OFTHE CITY CLERK,Rolol E.Gronodo,Cay Clerktel:305.673.7411,Fax.305.673.7254
Emal:CH/Clerk lamtbsohflgov
Oath of Office
Oath of Civility
and
Acknowledgements
TO:Ms.Allison Buttacavoli
RE:Sister Cities Program
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 l 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.
sworn to and sutscrited tetore me us_\['lay or ho9p o24
~vado
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.
MIAMIBEA H
City of Miami Beach
1700 Convention Center Drive
Miami Beach,Florida 33139
OFFICE OF THE CITY CLERK
Email:BC@miamibeachfl.goy
Telephone:305.673.7411
RECEIVED
AUG 1 6 2024
CITY OF MIAMI BEACHOFFICEOFTHECITYCLERK
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):
15(}1 am a resident of the City of Miami Beach for six months or longer.
ors so..G/61 PoPd,Mias ea,f.3\0
[]1have an ownership interest ((or a minimum of six months)in a business established in the
City of Miami Beach (for a minimum of six months).
Name of Business:------------------------
Business Address:------------------------
[[1am 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 aminimumofsixmonths).
[[Qfn (of Py1nP@es,S,
P{[[,S,f\(]fS,S,
"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.
,I declare that I have read the foregoing document and that the facts
S a r#4up Mata.coo%nGame
MIAMIBEA H
City of Miami Beach
1700 Convention Center Drive
Miomi Beach,Florido 33139
www.miamibeachfl,goy
OFFICE OF THE CITY CLERK
Email:BC@miamibeachf]_gov
Telephone:305.673.7411
DIVERSITY STATISTICS REPORT
itName 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:
J MaeElFemaleJonerDIprefernot to answer.
Race/Ethnic Categories:
What is your race?[l African American/BlackEIAsianorPacificIslanderNdcaucasian/'wbite
T@Native American/American Indian
[}Other -Print Race.EH prefer not to answer.
Do you consider yourself to be Spanish,Hispanic,or Latinola?
Ives/zHtoElprefer not to answer.
Do you consider yourself Physically Disabled?
gvee
125 No
ll1prefer not to answer this question.
Page 6 of6FACLERSALL'REG\BOARD AND COMMITTEEAPPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINALdox
Updated:.June 2020
MIAMIBEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach,Florida 33139
www.miamibeachfl.aov
OFFICE OF THE CII'Y CLERK
Email:BC@mniamibeachfl_govTelephone:305.673.7411
BOARD &COMMITTEE ACKNOWLEDGEMENT STATEMENTS(±la ca«iLastName DMiddle 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 gach 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 FinancialDisclosureRequirements.
ne 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 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.
Acknowledgment to Comply with Miami Beach Code of Ordinances Sec.2-22 (24)
I understand that if I am engaged to provide services,for compensation,to either (1)a candidate for City elected
office,or (2)a political committee or electioneering communications organization expending funds for or against
candidates for City elected office,such engagement shall be deemed a tender of resignation from the City
agency,board,or committee.
'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 1200 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
FACLERISALLBOARDND COMMITTEES DATABASEBoard and Committee Aphcatun\BOARD AND COMMITTEE APPLICATION JULY 2024 docx
Updated:July 2,2024
MIAMI-DADE'Em 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 Statementon a yearly basis byJuly 1tofeveryyear.
Disclosure for Tax Year Ending
2023
Middle Name/Initial
Mailing Address -Street N
rrvi(ca,P 33/{'
lt 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.[]
Filing as an Employee (check one)
[7 Couty I]Public Health Trust []Municipal:I
(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)
E]county
is exempt)Worktelephone
List below every source of incomeyou received,along with the address and the principal activity of each source.Include your publicsalary.Place the sources ofincomeindescendingorder,with the largest source first.Examples ofsources ofincome include:compensation for services,income from business,gains frompropertydealings,interest,rents,dividends,pensions,IRA distributions,and social security payments.Also,include any source of income received by anotherpersonforyourbenefit.However,the income ofyour spouse orany business partner need not be disclosed.Ifcontinued on a separate sheet,check here.[_]
tameofSource of Income Address Description ofthe Principal Business Activity
closing%l#Dat sign
RECEIVED SY ELECTIONSDEPARTMENT:tor«co»FE:CEIVED
Electronic Copy
AUG 1 6 2024
CITY OF MIAMI BEACHOFFICEOFTHEIT,-
OFFICE USEONLY cepted.Y /N Deficiency...Processed Date/lndials
138,SP-14 COE2016
MIAMIBEACCHyo!Miami Beach,PARKING DEPARTMENT
1755 Meridian Avenue,Suite 200 Miami Beach,FL 33139/Ph:(305)673-7505 or (305)673-7000ext.6200
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
BOARD &COMMITTEES
PARKING APPLICATION
Date of Application:
Applicant Name:
Address 4,t
E-Mail Address:
Work Phone:
cel Phone OS-,01.Preferred Contact Method:
Please Choose One 1 Ortion:
Citywide Parking Permit/G7 Access Card
Vehicle Info
Tag:
State:
Make:
Ciii Bike/Deco Bike Membership
Permit/Access Card Onl
color:Mk
Year:
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 fee.
A,licant Si mnature:es
Please provide signed fk ent located at 1755 Meridian Avenue,2d floor.
Working hours are 8:30 to 5:00 p.m.or email to:ParkdngReception@miamibeachfl.gov
e-mail sub)ect:BOARD &COMMITTEE PARKING APPLICATION --APPLICANT NAME
f:\ping\Jrarartoms\cwboards&commlltees pouting!orm.dac for wrdoted 8/2024