HomeMy WebLinkAboutSubmittal-Alisa B. Cepeda-Form 4A-w
FORM 4A DISCLOSURE OF BUSINESS TRANSACTION, RELATIONSHIP OR INTEREST
T NAME . FIRST NAME • MIDDLE INITIAL OFF t 1 Z N L
fpWa. Al** R.
k.ING ADDRESS AGENCY OR AOViSORY BOARD
T w Foyer Warm 21 Ad Hoe Task Fan
Streit
iY ZIP COUNTY ADDRESS OF AGENCY
.NM 33130 M,nn,•OaOf
HOW TO COMPLETE AND FILE THIS FORM:
ii A and B of this form serve two diffarent purposes. Isar A 1s for advisory board members who wish to use an exemption in IN
s taws that is applicable only to advisory board members Part B is for public officers and employees who wish to use a Saps -
exemption that a applicable when the business entity involved is the sole source of supply within the political subdivision. In
r to complete and fife this form:
Fill out Part A or Part B. as applicable.
Sign and date the form on the reverse side
Fite Part A with the appointing body or person that will be waiving the restrictions of 112.313(3) or (7), Fla. Stat.,
prior to the waiver.
File Part B with the governing body of the political subdivision in which the reporting person is serving, prier to the
transaction.
PART A - DISCLOSURE OF TRANSACTION OR RELATIONSHIP CONCERNING ADVISORY BOARD MEMBER
Sections 112.313(3) and 112.313(7), Florida Statutes, prohibit certain business relatioriships on the part of public officers
and employees, including persons serving on advisory boards. See Part III, Chapter 112, Florida Statutes, and/or the
brochure entitled •A Guide to the Sunshine Amendment and Code of Ethics for Public Officers and Employees' for more
details an these prohibitions. However. Section 112.313(12), Florida Statutes, permits the appointing official or body to
waive these requirements in a particular instance provided: (a) waiver by the appointing body must be upon a two-thirds
affirmative vote of that body: or (b) waiver by the appointing person must be effected after a puW hearing; and (c) in either
case the advisory board member must fully disclose the transaction or retationship which would otherwise be prohibited by
Subsections (3) of (7) of Section 112.313, Florida Statutes. This Pail of Form 4A has been prescribed by the Commission
on Ethics for such disciasure. if and when app6caM to an advisory board member.
COMPLETE THE FOLLOWING:
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The partnership, directorship, proprietorship, ownership of a material interest, position of officer, employment, or*�
relationship whin would otherwise violate Subsection (3) or (7) of Section 112.313, Florda Statutes, s held
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check applicable spare(s)):
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(A The reporting person;
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The spouse of the reporting person, whose name is
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( ) A child of the reporting person, whose name is
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The particular transacion or relationship for which this waivers sought involves [check applicable space):
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04 Supplying the following realty, goods, andlor services: Structural Enaineerino Services. Volunteer.
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( ) Regulation of the business entity by the governmental agency served by the advisory board member
3. The following business entity is daft business with or regulated by the governmental agency: I am a co-owner of RH
EjjDeepOg Group Inc which arovides, stndural emmre0m servic4s to Oroi M in the City of Miami but does not represent ttrern in front
of the City of Miami. The MiMO Biscayne Association it, The Porn Grove Neighborhood Assoc_ as Presiderd.
4. The relationship of the undersigned advisory board member, or spouse or Child of the advisory board member, to the bust-
ness entity trarisacting this business is (Check applicable spacesr.
C1d Offer: (4 Partner, ( ) Associate; ( ) Sole proprietor: ( ) Stockholder; ( ) Director, ( ) Owner of in excess of 6% of
the assets of capital stock in such business entity: ( ) Employee; ( ) Contractual relationship with the business entity;
( ) Other, please describe-
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PART 9 - DISCLOSURE OF INTEREST IN SOLE SOURCE OF SUPPLY
MUST COMPLETE THIS PART'
Sections 112.313(3) and 112.313(7). Florida Statutes, prohibit certain employment and businese relationships on the Dart of pub-
lic officers and employees. See Past 10. Chapter 112, Fkxids Statutes, andfor the tuaocchure enWad 'A Guide to the Sunahwie
Amendment and Code of Eftcs for Public Of oafs and Employees' for more details on these prohbbons. However, Sermon
112.313(12)(e), Florida Statutes, provides on exemption from the above-rnentored restrictions in me event that tine business
entity involved is the only souroo of supply witnit, the political subdivision of the officer or emcee to such cases fhe dtticxrs
or employee's interest in the business entity must be ittity used to Ise governing body of fhe political subdivision. This Part
of Form 4A has been presusbed by the Commission on Ethics for such disclosure, If and when appftat+ils.
COMPLETE THE FOLLOWfNG--
1 The partnership, directorship, proprietorship. ownership of a material interest. position of officer, employment or c mtrach*
relationship which would otherwise violate Subsection (3) or (7) of Section 112.313, Florida Statues. is held by (please
check applicable spece(s)I.
C ) The Ong person;
() The spouse of the reporting Parson, whose name is or
( ) A child of the reporting person, whose name is
2. The Bowing are the goods, realty, or services being supplied by a business entity with which tine PuWoc offer or employee,
or spouse or child of such officer or employee. is involved is:
3 The business entity which is the only source of supply of the goods. realty, or services within the political subdivision is:
(NAM OF ENTITY) (ADDRESS OF ENTITY)
4. The rat000nship of the undersigned public officer or employee, or spouse or child of such officer or employ, to the busi-
ness entity named in Item 3 above is (check applicable spades):
( ) Olfcar, ( ) Partner: ( ) Associate; ( ) Sole proprietor ( ) SWdittder, ( ) Dire W, ( ) Owner of in excess of
5% of
OW arsseta or capital Stock in such )wo n9W entity; ( i EmptOyet (? Cantracttrer MillftonsAip with the business t";
( ) Otiner, please describe.
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P(�a OF FLORIOA 3TATUTE3 w 11231 ,A FAILURE SO YAXE ANY ItEOWRED OISCLOSUtt d:flNST1tWV3 GRWNDS FOR AND
;:Y ONE tUt YORE OF THE FOLLOWW-, WEACYMENT, REMOVAL OR SUSPENSION FROM OFFICE OR EMPLOYMENT, OEWTION.
OUCTION IN SALARY VAPOUMAW OR A CIVIL PV4ALYY NOT TO EXCEEO 610=.
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Submitted into the public
record for item(s) RE.1%
on 07-23-2020, City Clerk
Ewan, Nicole
From: Hannon, Todd
Sent: Thursday, July 23, 2020 12:10 PM
To: Ewan, Nicole
Subject: Fwd: Miami 21 Task Force Ethics Issue Update - Important Time -Sensitive Reminder
Attachments: ACepeda form 4A.pdf
FYI
Get Outlook for iOS
From: Alisa Cepeda <acepeda@rhengineeringgroup.com>
Sent: Thursday, July 23, 202012:07 PM
To: Ketterer, Amber L.; Hannon, Todd
Cc: Min, Barnaby; Wysong, George
Subject: RE: Miami 21 Task Force Ethics Issue Update - Important Time -Sensitive Reminder
CAUTION: This'is"an email from an external source. Do not click links or open attachments unless ytr rectnize the .
sender and know the content is "safe. v.
Good Afternoon,
I am reattaching my completed form.
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Sincerely,
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Alisa Cepeda
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From: Ketterer, Amber L. <AKetterer@miamigov.com>�
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Sent: Thursday, July 23, 202011:48 AM
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To: Alisa Cepeda <acepeda@rhengineeringgroup.com>; Hannon, Todd <thannon@miamigov.com
ry
Cc: Min, Barnaby <bmin@miamigov.com>; Wysong, George <GWysong@miami-police.org>
Subject: RE: Miami 21 Task Force Ethics Issue Update - Important Time -Sensitive Reminder
Thank you, Alisa. You did not check off a box in #2.
Amber L. Ketterer, Assistant City Attorney
General Government Division
City of Miami
Office of the City Attomey
Telephone: 305-416-1859
Facsimile: 305-416-1801
akettererAmiatniizov.com
Assistant: Stephanie Fernandez: (305) 416-1833
Disclaimer: This e-mail is intended only for the individual(s) or entity(s) named within the message. This e-mail might contain legally privileged and
confidential information. If you properly received this e-mail as a client or retained expert, please hold it in confidence to protect the attorney -client
or work product privileges. Should the intended recipient forward or disclose this message to another person or party, that action could constitute a
waiver of the attomey-client privilege. If the reader of this message is not the intended recipient, or the agent responsible to deliver it to the intended
recipient, you are hereby notified that any review, dissemination, distribution or copying of this communication is prohibited by the sender and to do
so might constitute a violation of the Electronic Communications Privacy Act, 18 U.S.C. section 2510-2521. If this communication was received in
error we apologize for the intrusion. Please notify us by reply e-mail and delete the original message. Nothing in this e-mail message shall, in and of
itself, create an attorney -client relationship with the sender. Under Florida law, e-mail addresses are public records. If you do not want your e-
mail address released in response to a public records request, do not send electronic mail to this entity. Instead, contact this office by phone
or in writing.
4a�
Please consider the environment before printing this e-mail.
From: Alisa Cepeda<acepeda@rhengineeringgroup.com>
Sent: Thursday, July 23, 202011:19 AM
To: Ketterer, Amber L. <AKetterer@miamigov.com>; Hannon, Todd <thannon@miamigov.com>
Subject: RE: Miami 21 Task Force Ethics Issue Update - Important Time -Sensitive Reminder
CAUTION: This is an email from an external source. Do not click links or open attachments unless you recognize the
sender and know the content is safe.
Good Morning,
Attached please find my completed form 4A.
U Y
Sincerely, a,
Alisa Cepeda 3a CC
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From: Ketterer, Amber L. <AKetterer@miamigov.com> o E N
Sent: Wednesday, July 22, 2020 3:30 PM LJ o
L N
Cc: Eisenberg, Joseph <JEisenberg@miamipov.com>; Keirn, Jacob <JKeirn@miamigov.com>; Garcia, Anastassia a w cri
<ANGARCIA@miamigov.com> c
Subject: RE: Miami 21 Task Force Ethics Issue Update - Important Time -Sensitive Reminder o
N O
Dear Miami 21 Task Force Members:
As a reminder, the City Commission will be considering tomorrow a Resolution to waive any conflicts of interest of the
task force members upon proof of a member's full disclosure of his or her conflicting transactions or relationships
provided on the attached Form 4A.
Any Task Force member who has a conflict pursuant to the draft opinion and my below email sent last week, namely
those that represent third -party clients before various boards and committees of the City, must complete the attached
Form 4A before the City Commission votes on the item. Please complete the form and email it to me and the City Clerk
at thannon@miamigov.com by the end of today.
Please advise if you have any questions. Thank you.
Amber L. Ketterer, Assistant City Attorney
General Government Division
City of Miami
Office of the City Attorney
Telephone: 305-416-18 5 9
' Facsimile: 305-416-1801
aketterer(i ,miami ov.com
Assistant: Stephanie Fernandez: (305) 416-1833
Disclaimer: This e-mail is intended only for the individual(s) or entity(s) named within the message. This e-mail might contain legally privileged and
confidential information. If you properly received this e-mail as a client or retained expert, please hold it in confidence to protect the attorney -client
or work product privileges. Should the intended recipient forward or disclose this message to another person or party, that action could constitute a
waiver of the attorney -client privilege. If the reader of this message is not the intended recipient, or the agent responsible to deliver it to the intended
recipient, you are hereby notified that any review, dissemination, distribution or copying of this communication is prohibited by the sender and to do
so might constitute a violation of the Electronic Communications Privacy Act, 18 U.S.C. section 2510-2521. If this communication was received in
error we apologize for the intrusion. Please notify us by reply e-mail and delete the original message. Nothing in this e-mail message shall, in and of
itself, create an attorney -client relationship with the sender. Under Florida law, e-mail addresses are public records. If you do not want your e-
mail address released in response to a public records request, do not send electronic mail to this entity. Instead, contact this office by phone
or in writing.
Please consider the environment before printing this e-mail.
From: Ketterer, Amber L.
Sent: Friday, July 17, 2020 10:05 AM
Cc: Eisenberg, Joseph <JEisenberg@miamigov.com>; Keirn, Jacob <JKeirn@miamigov.com>; Garcia, Anastassia
<ANGARCIA@miamigov.com>
Subject: Miami 21 Task Force Ethics Issue Update
Dear Miami 21 Task Force Members:
I hope this email finds you all well. As you know, our office has been working to resolve an ethics issue regarding this
task force and its members. Please review the attached draft opinion that is posted on the Florida Commission on Ethics
website. Here is the link to the opinion on the website as
well: http://ethics.state.fl.us/Documents/Ethics/MeetingAgendas/Jul20%20Materials/2763.pdf. Please note that this is
only a draft and has not yet been officially adopted. It is set to be heard by the Florida Commission on Ethics on July 24,
2020.
As we expect the adoption of the attached opinion on July 24, 2020, we anticipate a Resolution will be heard by the City
Commission at the July 23, 2020 City Commission meeting to waive any conflict of interest upon proof of a
member's full disclosure of his or her conflicting transactions or relationships on the attached State of Florida
Commission on Ethics Form 4A pursuant to Section 112.313, Florida Statutes, in accordance with the anticipated opinion
from the Florida Commission on Ethics. Please note that this opinion could affect several members of this task force,
namely those that represent third -party clients before various boards and committees of the City, including the City
Commission. If the City Commission approves the waiver of the conflict of interest, those members will have to
complete the attached Form 4A.
Thank you.
U Y
a LLi i J
Amber L. Ketterer, Assistant City Attorney a_
General Government Division u
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City of Miami c a' o
Office of the City Attorney a) ,o cn
Telephone: 305-416-1859 t -0
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Facsimile: 305-416-1801 a ° o
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aketterer(amiamigov.com cn L o
Assistant: Stephanie Fernandez: (305) 416-1833
Disclaimer: This e-mail is intended only for the individual(s) or entitv(s) named within the message. This e-mail might contain legally privileged and
confidential information. If you properly received this e-mail as a client or retained expert, please hold it in confidence to protect the attorney -client
or work product privileges. Should the intended recipient forward or disclose this message to another person or parry, that action could constitute a
waiver of the attorney -client privilege. If the reader of this message is not the intended recipient, or the agent responsible to deliver it to the intended
recipient, you are hereby notified that any review, dissemination, distribution or copying of this communication is prohibited by the sender and to do
so might constitute a violation of the Electronic Communications Privacy Act, 18 U.S.C. section 2510-2521. If this communication was received in
error we apologize for the intrusion. Please notify us by reply e-mail and delete the original message. Nothing in this e-mail message shall, in and of
itself, create an attorney -client relationship with the sender. Under Florida law, e-mail addresses are public records. If you do not want your e-
mail address released in response to a public records request, do not send electronic mail to this entity. Instead, contact this office by phone
or in writing.
Please consider the environment before printing this e-mail.
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