Karin Matos 12.31.26 (2)----------------
BOARD AND COMMITTEE CHECKLIST
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OARD/COMMITTEE:A}Luy it LS
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FOR SCANNER
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DATE OF APPOINTMENT:1]l[225I
sling]Anointed by (am.Tan4a ya/-
TERM EN:)2[31])TERM tun+.0l3l3
l1els
FOR CLERK STAFF
Letter of Appointment
Letter of Reappointment
Copy of Letter of Appointment/Reappointment e-mailed to Committee Liaison on
Board and Committee Application (Completed on -_)
Resume/Curriculum Vitae
Diversity Statistics Reporting (Completed on
Oath
IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
RE r,EI VE D ✓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 (asJAN?7 Q075 amended through December 2010)
Amendments to the Code of Ethics Ordinance (September 2009 through July 2012)
CITY OF MIAMI BEACH •Highlights of the Miami-Dade County Ethics Code
C TY Cl.ERK ✓Sunshine Law and Public Records -Frequently Asked QuestionsOFFICEOFTHEllMemorandum-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
Board and Committees Liaison Responsibilities
O Diversity Statistics Reporting✓I acknowledge that pu,suant to Sec.2-22(9)of the Miami Beach Code of Q,dinances,I will be ,emoved
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 removal.
Scan O
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Received on I[ea5 son,X_[(_
~ate ~or Committee Member
/[2els"""·pyEmployee
Date City Clerk's Office Statt Initials
MIAMI BEACH
City of M iam i Beach,1700 Conv ention Conler Drive,Mia mi Bea ch,Florida 33139 yNyyy _miamnibgg chll_gay
OF FICE OF THE CITY CIERK,Rafae l E.Gran ado ,Ciy Clerk
Tel:305.673.7411,Fax 305.673.7254
Ema il:CiNyClerk @m iamibeachfl.go v
January 14,2025
M s.Karin M atos
1465 Cleveland Rd
M iami Beach,Fl 33141
SUB.JECT:Neighborhood Resiliency Projects Advisory Committee
Congratulations!You have been reappointed by Commissioner Tanya Bhatt 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 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.
Congratulations and good luck.
#l.%.
City Clerk
cc:Jose Gonzalez,Parking Director
Amy Knowles,City Liaison
ATTACHMENTS:
Letter of Appointment
Oath
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
Miam i-Dade County Code Section 2-11.1 -Conflict of Interest and Code of Ethics Ordinance
City W ide Permit Applica tion -(Parking Department Form)
Booklet -Guide to the Sunshine Amendment and Code of Ethics for Public Officers and Employees
Of+KE O TH CITY CI£RK Rafel F Granado,Cy Clod
Isl 30$673 741.,Ha 305 673 7254
F ml Cieriomiamiboohfl.go
Oath of Office
Oath of Civility
and
Acknowledgements
TO Ms Karin Matos
RE Neighborhood Resiliency Projects Advisory Committee
l 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,integnity 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 wth 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
4k.=
Swam to and '"bscnbed befo,e me th,s lit_day~;
----y Alice Lavado
Deputy Clerk
Please visit the City of Mam each website at www mambeachfl gov under City Clerk/board and
Gomttees tot additional mntormaton regarding the financial Disclosure Requirements
City of Miami Beach
OFFICE OF 'HE C'TY CLERK
Em ail BC@muamubeachf gov
elehone 305 673 7411
RECEIVED
JAN 2 1 2025
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
l am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4)
Ias(check (/)all that apply)
~am a resident of the City of Miami Beach for six months or longer.
Home Address !Au (vu@laud [d_ma.i fol.3itI§I have an ownership interest (for a minimum of six months)in a business established rn the
City of Miami Beach (for a minimum of six months)
Name f Business }dohlyntos,(/
usmess Address.L f3 K (cell.ht p .3,mi,,@d,(2_3lDIamafull-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)
[[3mn·f Py/PeSS..
[JS,/Des,(]feSS
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 mn it are true
~---------
14on L man
Date r I
Printed Name
City of Miami Beach
»!a totes [)rte
}Fray jh }a 3 ;
ea w:t 2hf go
OH HI E O F THE 'A +RK
trail:BC@mambeachf1 gov
Io teph o ne 3056 73./411
Last Name
BOARD &COMMITTEE ACKNOWLEDGEMENT STATEMENTS
'4 i
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
agency board,or committee
S ign al~t'.tn"L ./'J',()JuS Date I
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 CityClerk
Page 6 of6
L HS4LL BOARD AI L COMAL/THEES DA I#BASE Board and Committee Applicaton BOARD AND COMMII TEE APPLICATION JULY 22+do)date July 2 2024
ea
City of Miami Beach
k convention _onto,[iv
Mom Pooch Florid ?3130
OFFAL OF THE ITY CIERK
Ema E@muamubeachf/gov
oleohoro 30$673 7411
DI VERSITY STA TISTI CS REPORI
Last Name
K 4
First Name
L-
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:
ua edFemale0Other0Iprefer not to answer.
Race/Ethnic Categories:
What is your race?
[African American/Black
Asian or Pacific Islander
[I Caucasian/whiteLINativeAmerican/American Indian
loher -Print RaceDIprefernottoanswer
Do you consider yourself to be Spanish,Hispanic,or Latino/a?
Jves
Rise0Iprefer not to answer
Do you consider yourself Physically Disabled?
e s
l No
[J1prefer not to answer this question
$I
Page 6 of 6
f +BOAR!#ND QIAMA!I!LE PP!IA HON!FINAL DRAA!TSBOARD)AND COMMA!IE APPICAHON REG +INA doc
=ELI
Clear From Print Form
SOURCE OF INCOME STATEMENT
Section 2.11 10f the {County Ethics ode requires that certain employees and public officials file a financial disclosure Statement on a yearly basis by .July 153t
try Var
Disclosure tor Tax Year Ending Last Name First Name Middle Name/initial
2024 ,DttU»
Mailing Address -Street Number,Street Name,or P.0.Box
it eutt@rd (
City,State,Zip
pva bad-,f3 3))
It your home address is your mailing address,and your home address is exempt from public records pursuant to Fla.Stat.$119.07,read
nstructions on the following page and check here.[]
·-----------------
Filing as an Employee (check one)-----------------------------------
0 County D Public Health Trust [Municipal:
Department
(Municipality)
Position or Title Employee ID Number
Work address Work telephone Employment began on/ended on
Filing as a Board Member (check one)
[county [uncial:
(Municipality)
Board where serving
(0,·
Work telephone
305-33.S7 3
Term began on/ended on
i i
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 tor services,income trom business,gains trom
property dealings,interest,rents,dividends,pensions,IRA distributions,and social security payments.Also,Include any source of income received by anottgr
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 ot the Principal Business Activity
far L m0at,.4.3 8 els he.34 /+44 .]min i ala .fl_,33)\.---i
I
I
j ---------.
II~--------------
I hereby swear (or affirm)that the information above is a true and correct statement
Sig~,..;Olscio,log •
[,L mo@tS
Ill4aleshed
RECEIVED BY ELECTIONS DEPARTMENT:RECEIVEDElectronicCopy
JAN 2 2 2025
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
BOARD &COMMITTEfS
PARKING APPLICATION
'fi Avon Sit,N Mi9riBc yh 33139/Ph (3054 3 795 u"y6,»'t ,'sy6/37 ont ,f
\\
CiNy of Miami Beach,PARKING DEPARTMENT aPARKING
As c Board/Committee member you are entitled to a Citywide Parking Permit,which includes City +«>7\ko ''-'>ll 1d
garage (G.y parkang access {Access Card),or a complimentary Citi Bike/Deco Bike Membershio,or
discounted MDC Monthly Transit Pass throughout your term.
Boord Member Information
vote o'Apicotior lie ]cs
Applicant Name;
{Mio mt#s
sssarcowieeane:,,e..',v4(hbs hod fsylithnyfr4uslA.st4 (cnidhg
Address.4a CteUfa pi a,,,
(ht fd,dr &,{?3it]
'E-Mail Address Kn=a tf sA·0n
work hone:2r-8t-¢9)
celPhone:35 -33SQ3
Home Phone:-
Preferred Contact Method'c fl
Please Choose One 1 0 tion:
~-Citvwide Parking Permit/G7 Access Card Citi Bike/Deco Bike Membership
Vehicle Information For Cit ide Parkin Permit/Access Card Onl
Tog:Color:ri
!__.___:,_c__;-+-----+---=-~~------------J
State:
Make:
I4.
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 Holl 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
n formation 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 S 10.00 replacement fee.
pp»cont signature•([i,_tao.3±i -
'eoe provide sign iJ,e Parking epartmerf located at 1755 Meridian Avenue.2v for.
toting hours are 8:30 10 5.00 p.m.or email to:ParkingReception@miamibeachfI,gov
e-mail subject:BOARD &COMMITTEE PARKING APPLICATION APPLICANT NAME