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Rafael Paz Form 9 QTR IF o rm 9 QUARTERLY GIFT DISCLOSURE (GIFTS OVER $100) LAST NAME -- FIRST NAME -- MIDDLE NAME: NAME OF AGENCY: Rafael A. Paz Citv of Miami Beach. Florida MAILING ADDRESS: OFFICE OR POSITION HELD: 1700 Convention Center Drive, 4th Floor City Attorney CITY: ZIP: COUNTY: FOR QUARTER ENDING (CHECK ONE): YEAR Miami Beach FL Miami-Dade □MARCH «JUN E □SEPTEMBER O DECEMBER 2023 PART A- STATEMENT OF GIFTS Please list below each gift, the value of which you believe to exceed $100, accepted by you during the calendar quarter for which this statement is being filed. You are required to describe the gift and state the monetary value of the gift, the name and address of the person making the gift, and the date(s) the gift was received. If any of these facts, other than the gift description, are unknown or not applicable, you should so state on the form. As explained more fully in the instructions on the reverse side of the form, you are not required to disclose gifts from relatives or certain other gifts. You are not required to fife this statement for any calendar quarter during which you did not receive a reportable gift. DATE DESCRIPTION MONETARY NAME OF PERSON ADDRESS OF PERSON RECEIVED OF GIFT VALUE MAKING THE GIFT MAKING THE GIFT 3/23/23 2 tickets, M iam i Open $300-500 per POI Healthcare, Inc. 400 Chestnut Ridge Rd, ticket Woodcliff Lake, NJ D CHECK HERE IF CONTINUED ON SEPARATE SHEET PART B - RECEIPT PROVIDED BY PERSON MAKING THE GIFT If any receipt for a gift listed above was provided to you by the person making the gift, you are required to attach a copy of that receipt to this form. You may attach an explanation of any differences between the information disclosed on this form and the information on the receipt. O CHECK HERE IF A RECEIPT IS ATTACHED TO THIS FORM PART C- OATH I, the person whose name appears al the beginning of this form, do depose on oath or affirmation and say that the information disclosed herein and on any attachments made by me constitutes a true accurate, and total listing of all gifts required to be reported by Section 112.3148, Florida Statutes. STATE OF FLORIDA ~ NTY OF MIGM I - CO cle S rn to (or affirmed) and subscribed before me by means of physical presence or O o line notarization, this 30 dayof +-ui ,2o 2> ,quit!Mu,, by myffpdFe"fl' hlhM ',,- e- Pt, ye. or stamp coy»@@Ge@fis oigigary Pei?z Personaiy Known o@ .ii@%,aeit~any g Type of Identification Produced; PART D- FILING INSTRUCTIONS This form, when duly signed and notarized, must be filed with the Commission on Ethics, P.O. Drawer 15709, Tallahassee, Florida 32317-5709; physi- cal address: 325 John Knox Road, Building E, Suite 200, Tallahassee, Florida 32303. The form must be filed no later than the last day of the calendar quarter that follows the calendar quarter for which this form is filed (For example, if a gift is received in March, it should be disclosed by June 30.) CE FORM 9 -EFF, 1/2016 (Refer to Rule 34-7.010(1)g), F.A.C.) (See reverse side for instructions) @' D'Agostin, Charles From: Sent: To: Subject: Attachments: Granado, Rafael Wednesday, May 31, 2023 11 :33 AM D'Agostin, Ch arles FW: Quarterly Gift Disclosure - Due June 30, 2023 Miami-Dade County Quarterly Gift_M arch 2023_EX ECUTE D.pd f; Form 9 Quarterly Gift Disclosure_M arch 2023_EXE C UTE D.pd f MIAMI EACH Rafael E. Granado, Esq., City Clerk OFFICE OF THE CITY CLERK 1700 Convention Center Drive, Miami Beach, FL 33139 Tel: 305.673.7411 rafaelgranado@miamibeachfl.gov We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community. From: Granado, Rafael Sent: Tuesday, May 30, 2023 5:24 PM To: Mena Caceres, Keila <KeilaMenaCaceres@miamibeachfl.gov>; D' Agostin, Charles <Ch arlesDA gostin@mia mibeachfl.gov> Subject: FW : Quarterly Gift Disclosure - Due June 30, 2023 Who is doing these? MIAMI H Rafael E. Granado, Esq., City Clerk OFFICE OF THE CITY CLERK 1700 Convention Center Drive, Miami Beach, FL 33139 Tel: 305.673.7411 rafaelgranado@miamibeachfl.gov We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community. From: Gonzalez, Amada <AmadaGonzalez@miamibeachfl.gov> Sent: Tuesday, May 30, 2023 4:42 PM To: Granado, Rafael <RafaelGranado@miamibeachfl.gov> Cc: Paz, Rafael <RafaelPaz@miamibeachfl.gov> Subject: RE: Quarterly Gift Disclosure - Due June 30, 2023 Hi Ralph, 1 A tt a c h e d a re R a fa e l's e x e cu te d Sta te (F or m 9 ) an d M ia m i-D a d e C o u n ty Q u a rte rl y G ift D isclo su re fo rm s. I w ill dro p off th e C o u n ty Fo rm to y o u a n d m a il th e Sta te (Form 9) to Commission on Ethics, P.O. Drawer 15709, Tallahassee, Florida 32317-5709. Thanks, Amada Gonzalez, Assistant to the City Attorney OFFICE OF THE CITY ATTORNEY Tel: 305-673-7470 Ext 26607 From: Granado, Rafael <RafaelGranado@miamibeachfl.gov> Sent: Tuesday, May 30, 2023 8:37 AM To: Mayor's Office Staff <MayorsOfficeStaff@miamibeachfl.gov>; Mayor Office Team <MayorsOfficeTeam@MiamiBeach.onmicrosoft.com>; Mayor's Office Aides <MayorsOfficeAides@miamibeachfl.gov>; Mayor and Commissioners Office <MayorandCommissionerOffice@miamibeachfl.goy>; Mayor's Office <MAYO Dept@miamibeachfl.gov> C c : City Clerk's Office <CityClerksOffice@miamibeachfl.gov>; City Attorney's Office <CityAttorneysOffice@miamibeachfl.gov>; City Manager's Office <CityManagersOffice@miamibeachfl.gov>; Office of the Inspector General <OfficeofthelnspectorGeneral@miamibeachfl.gov>; Department Directors <DepartmentDirectors@miam ibeachfl.gov>; Division Directors <DivisionDirectors@miamibeachfl.gov>; Assistant Department Directors <AssistantDepartmentDirectors@miamibeachfl.gov>; Assistant Division Directors <AssistantDivisionDirectors@miamibeachfl.gov>; Executive Staff <ExecutiveStaff@miamibeachfl.gov>; Management Team <ManagementTeam@miamibeachfl.gov>; Management Team Assistants <ManagementTeamAssistants@miamibeachfl.gov>; D' Agostin, Charles <CharlesDAgostin@miamibeachfl.gov>; Granado, Rafael <RafaelGranado@miamibeachfl.gov>; Mena Caceres, Keila <KeilaMenaCaceres@miamibeachfl.gov>; Camm, Patrick <PatrickCamm@miamibeachfl.gov>; Granado, Rafael <RafaelGranado@miamibeachfl.gov> Subject: Quarterly Gift Disclosure - Due June 30, 2023 Importance: High Good morning, Please be reminded that Quarterly Gift Disclosures forms are due on or before June 30, 2023, for the period of January, February, and March 2023. You must report any gift received from an individual or single entity during January, February, and/or March 2023 in excess of $100. Reporting is not required if no gilt was received. I have attached herewith a form entitled "2023 Financial Disclosure Filing Requirements" to assist you in determining whether you are required to file the State Quarterly Gift Disclosure (Form 9) or the Miami-Dade County Quarterly Gift Disclosure Form. (Note: Elected Officials are required to file Form 9.) Where to file? • Form 9 must be filed with the Commission on Ethics, P.O. Drawer 15709, Tallahassee, Florida 32317- 5709. • Miami-Dade County Quarterly Gift Disclosure must be filed with the City Clerk, 1°Floor City Hall. If you have any questions, please feel free to contact me. Regards, 2 Rafa el E. Granado, Esq., City Clerk OFFICE OF THE CITY CLERK 1700 Convention Center Drive, Miami Beach, FL 33139 Tel: 305.673. 7 411 rafaelgranado@miamibeachfl.gov We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community. 3