Sipiwe Anderson 12.31.26MIAMI BEACH
B O A R D A N D C O M M IT T E E C H EC K LIS T
APPOINTEE.Sipiwe Anderson DATE OF APPOINTMENT:1J9
BOARD/COMMITTEE:<Appointed by:[mm_Sag-r[t u onalz-
FOR SCANNER
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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 N D:_Ml3)lie TERM LuMI T:0[31[3o
1l4ls
REC EIV ED
JAN 16 7025
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
IMPORTANT INFORMATION FO R 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
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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 acknowl edge that pursuant to Sec.2-22(9)of the Miam i Beach Code of Ordinances,I wi ll be rem oved
from m y board/com m ittee upon failure to attend 33%of the regularly scheduled m eetings.
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 ro unds down to the next whole number and .5 or more ro unds 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 fro m 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 fro m the date of removal.
Received on:
Date card or Committee Member
Processed on:__t_.)._l_/1_/_i,,_r By Employee:)CN\__~----------
Date City Clerk's Office Staff Initials
We are committed to providing excellent public service and safety to all who live,work,and play in our vibrant,tropical,historic community.
MIAMIBEACH
City of M ia m i Bea ch,1/00 Convention Conlor Drive,Miami Boa ch,Florida 33 139 yywy_miaIib_achf]gov
OF FICE OF THE CITY CIER K ,Rafae l E.Granado ,City Clerk
Tel:305.673.7411,Fax:305 .673.7254
Email:CiyClerk@miamibeachfl.gov
January 09,2025
M s.Sipiw e Anderson.
8125 Crespi Blvd #1
M iami Beach,FL 33141
SU B JE C T :B lack A ff airs A dviso ry Com m ittee
Congratulations!You have been reappointed by C o m m issio ner Kristen Rosen G onzalez to the above
referenced,board or committee,for a term ending:12 /31/2026.
Pursuant to City of Miami Beach Code Section 2-22 (5)a,"Notwithstanding any other pro vision 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 Of fice of the City
Clerk at 305.673.7411.Please read the enclosed materials carefully.
Congratulations and good luck.
Regards,7%Rafael Granado
City Clerk
cc:Jose G onzalez,Parking Director
Li ssette Arrogante,City Liaison
A TT A C H M E N T S :
Letter of Appointment
O ath
City Code/O rdinance 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
O rdinance No.2006-3543 -Amendment to City Code Section 2-22
M iami-Dade County Code Section 2-11.1 -Conflict of Interest and Code of Ethics Ordinance
City W ide Permit Application -(Parking Department Form)
Booklet -G uide to the Sunshine Amendment and Code of Ethics for Public Officers and Employees
MIAMI BEACH
City of M ia m i Bea ch,17OO Convention Center Drive,Miami Beach,Florida 33139 yyNyy_miamiboachfl_gov
OFFICE OF THE CITY CLERK,Rafael E.Granado,Cy Clerk
Tl:305.673.7411,Fax.305.673.7254
Ema il:CiNyClerk @miamibeac hfl.gov
Oath of O ffice
O ath of Civility
and
Acknow ledgem ents
TO:Ms.Sipiwe Anderson.
RE:Black Affairs 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 /31/20 26.
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 t,following the closing
of the calendar year on which I have served.
Sworn to and subscribed before me this 15 day of _January,2025<n ice Lava@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.
MIAM I BEACH
REC E IVED
JAN 16 2025
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
City of Miami Beach
l 700 Convention Center Drive
M iam i Beach,Florida 33139
OFFICE OF THE CITY CLERK
Email:.BC@miamibeachfl_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):
[Z]I am a resident of the City of Miami Beach for six months or longer.
Home Address.8125 Crespi Blvd #1 Miami Beach,FI 33141
[Z]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).
Name of Business.US-Skin Consultant LLC
Business Address.8125 Crespi Blvd #1 Miami Beach FI 33141
D 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:-------------------------
Business Address:-------------------------
"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 de lare that I have read the foregoing document and that the facts
Si nature
Sipiwe Anderson
01-15-2025
Date
Printed Name
MIAMI BEACH
City of Miami Beach
l 700 Convention Center Drive
Miami Beach,Florida 33139
www.miamibeach[l.gov
OFFICE OF THE CITY CLERK
Email:BC@miamibeachfl.gov
Telephone:305.673.7411
DIVERSITY STATISTICS REP ORI
Anderson
Last Name
Sipiwe
First Name
s
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 MaelFemale0OtherDIprefer not to answer.
Race/Ethnic Categories:
What is your race?
[Amican American/Black0AsianorPacificIslander0Caucasian/WhiteLJNativeAmerican/American IndianDOther-Print Race:_
El prefer not to answer.
Do you consider yourself to be Spanish,Hispanic,or Latino/a?
Tvesho0Iprefer not to answer.
Do you consider yourself Physically Disabled?
aves0tprefer not to answer this question.
Page 6 of 6
F:\C LE R \$A LLIR E G IB 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 RA FT S \B O A R D A N D C O M M ITT EE A PPLI C A TIO N R EG FIN A L.docx
Updated:June 2020
MIAMI BEACH
City of Miami Beach
1700 Convention Center Drive
Miam i Beach,Florida 33139
w ww.m iam ibeachfl.gov
OFFICE OF THE CITY CLERK
Email:BC@ miamibeachfl.gov
Telephone:305.673.7411
Anderson
Last Name
BOARD &COMMITTEE ACKNOWLEDGEMENT STATEMENTS
Sipiwe
First Name
s
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 $500,60 days in jail,or both.
Acknowledgment to Comply with Miami Beach Code of Ordinances Sec.2-22 (23)
I understand that commencing with terms beginning on or after January 1,2024,and as a condition of applying
for appointment to a City agency,board,or committee,I voluntarily agree that in the event I file with the City
Clerk a Statement of Candidate formally announcing candidacy for City elective office,such filing with the City
Clerk shall be deemed a tender of resignation from the City agency,board,or committee.
Acknowledgment to Comply with Miami Beach Code of Ordinances Sec.2-22 (24)
I understand that if I am engaged to provide services,for compensation,to either (1)a candidate for City elected
office,or (2)a political committee or electioneering communications organization expending funds for or against
candidates for City elected office,such engagement shall be deemed a tender of resignation from the City
agency,boar~'·e~J/9e /de-o1-1s-2025
Signature Date
1 Members of the Planning Board and Board of Adjustment will be notified directly by the State of Florida,
pursuant to F.S.§112.3145(1 )(a),to electronically file a Statement of Financial Interests (Form 1)with the Florida
Commission on Ethics by 12:00 noon,July 1.Planning Board and Board of Adjustment members who file their
Form 1 with the Florida Commission on Ethics automatically satisfy the County's financial disclosure requirement
as a Miami Beach City Board/Committee member and need not file an additional form with the Office of the City
Clerk.
Page 6 of6
F:IC LE R 1$A LL\B O A R D A N D C O M M ITT E ES D A TA BA SE\B oard and C om m ittee Applica tion\BO A R D AN D CO M M ITT E E APPLI C ATIO N JU LY 2024.docx
Updated:July 2,2024
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
a
PARKING
A s a Board/Committee member you are entitled to a Cityw ide 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:0011-11662002255
Applicant Name'$jwe/Ndtensor
Board/Committee Name:BBC
Address:881t225 7es9pi td.#1.M sari Beath .HHI3381441
E-Mail Address:s$jiwg'sttmall om
Work Phone:Home Phone:
Cell Phone:301558221499433 Preferred Contact Method:Text and emall
se Choose One 1 0 tion:
itywide Parking Permit/G7 Access Card Citi Bike/Deco Bike Membership
Vehicle Inform ation (For Cityw ide Parking Permit/Access Card Only)
Tag:B8891884/Kf Color:Bk
State:IHI Year:20JIB
Make:lees Model:HK 33SD
A cityw ide (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
un n e c e ssa ry e nfo rc e ment 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.
Pleas e 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 ould my access card be lost,stolen or damage,I will be
responsible to pay a $10.00 ·placement fe
A,licant Si nature:es
Please provide signed form t the Parking Department located at 1755 Meridian Avenue,2nd 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\roar\forms\cw boards&committees parkingform.doc form updated 1/18/2024