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Omar Jimenez 12.31.25MIAMI BEACH BOARD AND COMMITTEE CHECKLIST APPOINTEE.OMAR JIMENEZ DATE OF APPOINTMENT:_\O [30 [24 BOARD/COMMITTEE:NBCRA ADVISORY COMMITTf Appointed by:TANYA K.BHATT FOR SCANNER Scan o Scan o Scan o Scan o Scan o FOR CLERK STAFF o Letter of Appointment o Letter of Reappointment o Copy of Letter of Appointment/Reappointment e-maile to C o Board and Committee Application (Completed on 2.2 o Resume/Curriculum Vitae o Diversity statistics Reporting (Completed on LL[2[2Ly o Oath T T TERM END:12/31/2025 TERM LIMIT:12/31/2029 ul3[2t RECEIVED NOV 12 2024 CITY OF MIAMI BEACHOFFICEOFTHECITYCLERK 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 ✓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 [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 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 removat.~I ,r'\• 1 'V Received on:1111212024 Signed by X__~----~__()__~---·------- Date Processed on:__\,,_\,,_\_1-6_(~z._'{By Employee:--~-~·_L_._"aE City Clerk's Office Staff Initials We are committed to providing excellent public service and saley lo all who live,work,and play in our vibrant,tropical,historic community. MIAMI BEACH City of Miami Beach,I/OO Convonlion Cantor Drivo,Miami Boach,Florida 33 139 yyaw_miamibeachll.gov OFFICE OF IHE CITY CIERK,Rofaol E.Granado,City Clerk Tol:305.673.7411,Fox.305.673.7254Email:Ci#yClerk@miamiboachfl.gov November 07,2024 Mr.Omar Jimenez 7324 Gary Avenue Miami Beach,FL 33141 RE:North Beach CRA Advisory Committee Dear Mr.Omar Jimenez: 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. Regards, 2RafaelGranado City Clerk 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 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 MIAMI BEACH City of Miami Beach,1/OO Convention Contort Drivo,Miami Boch,Florida 33 139 yyw._miaInibeachll.gov OFFICE OF IHE CITYCLERK,Rafael E.Granado,Cy ClerkTel:305.673.7411,Fax.305.673.7254 Email:CiNyClerk@miamibeachll.gov Oath of Office Oath of Civility and Acknowledgements TO:Mr.Omar Jimenez RE:North Beach CRA Advisory 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.~i Mr.OmarJ~ Sworn to and subscribed before me this 11___,2024 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 l 700 Convention Center Drive Miami Beach,Florida 33139 OFFICE OF THE CITY CLERK Email:BC@miamibeachf_gov Telephone:305.673.7411 RECEIVED NOV 12 2024 CITY OF MIAMI BEAc#OFFICE O TE ·Irv e-·d,H NORTH BEACH CRA ADVISORY COMMITTEE AFFIDAVIT OF COMPLIANCE I am in compliance with the North Beach CRA Advisory Committee's Membership Composition requirements pursuant to Section 2-190.151 of the Miami Beach City Code as a: l Resident Member. a.Currently residing,for a minimum of five (5)years,within the North Beach area,generally considered as that portion of Miami Beach located north of 63"Street. Home Address:7324 GARY AVENUE.MIAMI BEACH,FL 33141 b.Currently residing,for a minimum of five (5)years within the geographic boundaries of the North Beach CRA or a 300-foot radius thereof. Home Address:YES -SAME AS ABOVE □Business Member with ownership interest for a minimum of five (5)years in a business established within the geographic boundaries of the North Beach CRA. [[a[f]9 f [[JS][eSS, [[[[[]es,S J(]]feSS, □Real Estate Industry Member residing generally within the City of Miami Beach. [fl J][PS,3, [_[em,P%[]][[e[, □Attorney Member with experience in land use,real estate,or other related practice area, residing generally within the City of Miami Beach or maintaining a full-time law practice and physical office located in North Beach. pff l(]]FPS,, [_q/H'fa[[e (]Hf@SS., [_[,Pe[,[][n[Pe], □Normandy Fountain Businesses Association Ex-Officio Member. I The five (5)year minimum residency requirement for the Resident Member Category (1)(a) has been waived by a 5/7ths vote of the City Commission. I have an interest in neighborhood leadership issues,including,without limitation, neighborhood business groups,homeowner or condominium associations and cooperatives, civic groups,and/or other similar qualifications. I The five 300-foot residency requirement for the Resident Member Category (1)(b)has been waived by a 5/7ths vote of the City Commission. I have an interest in neighborhood leadership issues,including,without limitation, neighborhood business groups,homeowner or condominium associations and cooperatives, civic groups,and/or other similar qualifications and I live within a reasonable distance from the 300-foot radius of the North Beach CRA geographical boundary. "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 stated in it are true. %at OMAR JIMENEZ Printed Name 11/12/2024 Date MIAMI BEACH City of Miami Beach 1 700 Convention Center Drive Miami Beach,Florida 33139 OFFICE OF THE CITY CLERK Email:BC@miamibeachfl.gov Telephone:305.673.7411 RECEIVED NOV 12 2024 CITY OF MIAMI BEACH OFFICE OF HE CITY CLERK 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): I✓I I am a resident of the City of Miami Beach for six months or longer. Home Address:7324 GARY AVENUE,MIAMI BEACH,FL 33141 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). []are (f [3yg[/eSS, [[Jg[[es,S (](]resS, ]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:BELLA CUBA RESTAURANT Business Address:1659 WASHINGTON AVENUE,MIAMI BEACH,FL 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 ofJrjury,I declare that I have read the foregoing document and that the facts stated in/lOir:,..t!V•-~ y%%""1v2oz4 Signature Date OMAR JIMENEZ Printed Name MIAMI BEACH City of Miami Beach 1 700 Convention Center Drive Miami Beach,Florida 33139 www.miamibeachll.gov OFFICE OF THE CITY CLERK Email:BC@miamibeachfl.gov Telephone:305.673.7411 DIVERSITY STATISTICS REPORI JIMENEZ Last Name OMAR 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: [0 MaleLlFemaleloner0Iprefer not to answer. Race/Ethnic Categories: What is your race?DI African American/BlackDAsianorPacificIslanderLCaucasian/white0NativeAmerican/American Indian Lother --Print Race:-------------El I prefer not to answer. Do you consider yourself to be Spanish,Hispanic,or Latino/a? OvesLo0Iprefer not to answer. Do you consider yourself Physically Disabled? veso0Iprefer 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 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 JIMENEZ BOARD &COMMITTEE ACKNOWLEDGEMENT STATEMENTS OMAR 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 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"±.s Signature 11/12/2024 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 of6 F:ICLER\$ALLIBOARD AND COMMITTEES DATABASE\Board and Committee Application\BOARD AND COMMITTEE APPLICATION JULY 2024.d0cx Updated:July 2,2024 MIAMl·DADE-EM7 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 1stofeveryyear. Disclosure for Tax Year Ending I Last Name First Name Middle Name/Initial 2023 JIMENEZ OMAR Mailing Address -Street Number,Street Name,or P.O.Box 7324 GARY AVENUE City,State,Zip MIAMI BEACH,FL 33141 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.D 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 E]Municipal:MIAMI BEACH (Municipality) Board where serving NBCRA ADVISORY BOARD Alternate address (if home address is exempt)I Work telephone ! Term began on/ended on 11/12/2024 -12/31/2029 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 ofincomeindescendingorder,with the largest source first.Examples of sources of income 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 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 BELLA CUBA INC.1659 WASHINGTON AVE,HOSPITALITY MIAMI BEACH,FL 33139 I hereby swear (or affirm)that the information above is atrue and correct statement..us 11.12.2024 Date signed RECEIVED BY ELECTIONS DEPARTMENT: )Har@tcoRECEIVED□Electronic Copy NOV 12 2024 CITY OF MIAMI BEAOHOFFICEOFTHECITYCIEr OFFICE USE ONLY Accepted:Y /N Deficiency.-Processed Date/initials:Scanned Date/initials: 138SP-14 COE 2016 MIAMI BEACHCityofMiamiBeach,PARKING DEPARTMENT BOARD &COMMITTEES PARKING APPLICATION aPARKINGl755MeridianAvenue,Suite 200 Miami Beach,FL 33139/Ph:(305)673-7505 or (305)673-7000 ext.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 Date of Application: Applicant Name: Board/Committee Name: Address: E-Mail Address: Work Phone:Home Phone: Cell Phone: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 fee. Applicant Sianature:es Please provide signed form to the Parking Department located at 1755 Meridian Avenue,2d floor. Working hours are 8:30 to 5:00 p.m.or email to:ParkingReception@miamibeachfl.gov e-mail subject:BOARD &COMMITTEE PARKING APPLICATION -APPLICANT NAME f:\ping\$man\rar\forms\cw boards&committeesparkingform.doc form updated 1/18/2024