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Carol Motley 12.31.26MIAMI BEACH BOARD AND COMMITTEE CHECKLIST APPOINTEE:Carol Motley DATE OF APPOINTMENT.1•10.2025----------------- soARcowmrrEe.M"CGCC"Arote4y.<8ovk? 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-mailed to Committee Liaison on o Board and Committee Application (Completed on -- o Resume/Curriculum Vitae o Diversity Statistics Reporting (Completed on o Oath TERM END:L2]3th-g reRMurr: IMPO RTANT INFORMATION FOR BOARD AND COMMIT TEE 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 MembersCI[{OF MIAMI BEACHkcorTHECICLERK 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 [Z]I acknowledge that pursuant to Sec.2-22(9)of the Miam i Beach Code of Ordinances,I will be removed from m y board/com m ittee upon failure to attend 33%of the regularly scheduled meetings. Sec.2-22(9)If any m em ber of an agency,board or com m ittee fails to attend 33 percent of the regularly scheduled m eetings per calendar year,such m em ber shall be autom atically rem oved.To calculate the num ber of absences und er the 33 percent form ula,.4 or less ro unds dow n to the next w hole num ber and .5 or more ro unds up to the next w hole num ber. NOTE:M em bers of the Land Use Boards w ill be rem oved upon failure to attend three of the regularly scheduled m eetings per calendar year;or upon abstaining fro m voting due to a conflict of interest on fo ur different applications w ithin a calend ar year.A m em ber who is rem oved shall not be reappointed to mem bership on the board for at least one year fro m the date of rem oval. 1102075sons»}Cao€vet Date Board or comniGi e ber Pro cessed on:__,......,_\_4_,l'--i_o By Employee:__,_~-------------- Date City Clerk's Office Staff Initials Received on: We ore co mmitted to providing excellent public service and salety to all who live,work,and play in our vibrant,tropical,historic community. MIAMI BEACH City of M iam i Beach,1/OO Convention Center Drive,Mia mi Boach,Florida 33 139 yywy _miamniba chll_go OFFICE OF THE CITY CLERK,Rafael E.Granado ,City Clerk Tel:305 .673.7411,Fax.305 .673.72 54 Ema il:CiNyClerk @m iamibeachll .gov Oath of Office Oath of Civility and Acknowledgem ents TO:Ms.Carol Motley RE:Convention Center Advisory Board 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:12/31/2026. 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.Carol Motley Sworn to and subscribed before me this 1 Oth day of Jan ,2025 /~n,2@cs r+@o 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. MIAMI BEACH City of Miami Beach l 700 Convention Center Drive Miami Beach,Florida 33139 OFFICE OF THE CITY CLERK Email:BC@miamibeachfl.gov Telephone:305 .673 .7 41 l RECEIVE-t JAN 14+ CiTY OF MIAMI BEACH OFFICE OF THE 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): D I am a resident of the City of Miami Beach for six months or longer. Hom e Address:--------------------------□I have an ownership interest (for a minim um of six months)in a business established in the City of Miam i Beach (fo r a minim um of six months). Nam e of Business:_ Business Address:_ []am a full-tim e em ployee of a business (for a m inim um of six months)and I am based in an office or other location of the business that is physically located in Miam i Beach (for a minim um of six months). Nam e of Business:G M C VB------------------------- Business Address:1901 Convention Center Drive,M iam i Beach,FL 33139 "O wnership Interest"m eans the ownership of ten percent (10%)or m ore (including the ownership of 10%or m ore of the outstanding capital stock)in a business. "Business"m eans any sole pro prietorship,sponsorship,corporation,limited liability com pany, or other entity or business association. Under penalties of perjury ,I declare that I have read the fo regoing document and that the facts stated in it are true. •Carol M otley Printed Nam e 1.10.2 025 Date 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 DIVERSITY STATISTICS REP ORI Motley Last Nam e Carol First Nam e L Middle Initial The following information is voluntary and has no bearing on your consideration fo r appointment.It is being asked to com ply with City diversity reporting requirem ents. Gender: LJ MaelFemaleoner0Iprefer not to answer. Race/Ethnic Categories: What is your race? [African American/BlackLJAstaorPacificIslanderDCaucasian/wh ite0NativeAmerican/America n Indian0Other-Print Race:-------------□I prefer not to answer. Do you consider yourself to be Spanish,Hispanic,or Latino/a? ves o0Iprefer not to answer. Do you consider yourself Physically Disabled? vesz0oDIprefer not to answer this question. Page 6 of 6 F:\C LE R \$A LL\R E G \B O A R D A N D C O M M ITT E E A P P LI C A T IO N S FIN A L D R A FT S \B O A R D A N D C O M M ITT E E A P P LI C A T IO N R E G FIN A L.d ocx U p da te d:Ju ne 20 2 0 MIAMI BEACH C ity of M ia m i Be a c h 1700 Convention Center Drive Miam i Beach,Florida 33139 w w w.m iam ibeachfl.gov O FFICE OF THE CITY CLERK Email:BC@ miamibeachfl.gov Telephone:305.673.7 411 Motley Last Name BOARD &COMMITTEE ACKNOWLEDGEMENT STATEMENTS Carol First Name L 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 agency,board,or committee. 1.10.2025 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:IC LE R \$A L LIB O A R D A N D C O M M ITT E E S D A TA B A S E \B oard and C om m itt ee A pplica tion\B O A R D A N D C O M M ITT E E APP LI C AT IO N JU LY 2024.docx Updated:July 2,2024 MIAMl·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 Statement on a yearly basis by July 1st of every year. Disclosure for Tax Year Ending I Last Name First Name Middle Name/Initial 2023 Motley Carol L Mailing Address -Street Number,Street Name,or P.O.Box 201 S.Biscayne Blvd,Suite 2200 City,State,Zip Miami,FL 33131 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.[l Filing as an Employee (check one) []county 0 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 [Municipal: (Municipality) Board where serving Miami Beach Alternate address (if home address is exempt) ! Work telephone I Term began on/ended on (301)539-3020 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 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 GMCVB 201 S.Biscayne Blvd,suite 2200 Convention and Visitors Bureau Miami,FL 33131 I hereby swear (or affirm)that the information above is a true and correct statement.~;::~:::r.z:, 1.10.2025 _ Date signed RECEIVED BY ELECTIONS DEPARTMENT: Jard-yCEIVEL[]Electronic Copy JAN 14?0 CITY OF MIAMI BEACH OFFICE USE ONLY Accepted:Y /N Deficiency.Processed Date/initials:Scanned Date/initials: 138SP-14 COE 2016 MIAMI BEA C H City of Miami Beach,PARKING DEPARTMENT BOARD &COMMITTEES PARKING APPLICATION La PA RK IN G1755MeridianAvenue,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:1.10.2025 Applicant Name:Carol Motley Board/Committee Name:CCAB Address:201 S.Biscayne Blvd,Suite 2200 Miami,FL 33131 E-Mail Address:Cmotley@gmcvb.com Work Phone:301-539-3020 Home Phone: Cell Phone:301-237-7807 Preferred Contact Method:cell Please Choose One 1 O tion: •Citywide Parking Permit/G7 Access Card Citi Bike/Deco Bike Membership Vehicle Information (For Cityw ide Parking Permit/Access Card Only) Tag:RGAS34 Color:Red State:Florida Year:2017 Make:GLC 300 Model:Mercedes 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. I•t s·t ~t~A,lican i mna ure: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 subiect:BOARD &COMMITTEE PARKING APPLICATION -APPLICANT NAME f:\ping\$man\rar\forms\cw boards&committees parkingform.doc form updated 1/18/2024