HomeMy WebLinkAboutSubmittal-Alisa B. Cepeda-Form 4A-w
FORM 4A DISCLOSURE OF BUSINESS TRANSACTION, RELATIONSHIP OR INTEREST
LAST NAME - FIRST NAME • MIDDLE INITIAL
Daiwa. Alan a.
OFFICE t POSITION NEW
MAIUNG AGGRESS
es? W Fuller
Street
AGENCY OR ADVISORY BOARD
Warm 21 Ad Hoe Task Fora
ran
N,am
ZIP
33130
COUNTY
Weem•Daee
ADDRESS OF AGENCY
HOW TO COMPLETE AND FILE THIS FORM:
'arts A and B of this form serve two d,t%rent purposes. Part A is for advisory board members who wish to use an exemption in the
ethics taws that is applicable only to advisory board members Pert B is for public officers and employees who wish to use a sepa-
rate exemption that is applicable when the business entity involved is the sole source of supply within the political subdivision. In
order to complete and file this form:
• Fill out Part A or Part B. as applicable.
e Sign and date the form on the reverse side
e File Part A with the appointing body or person that will be waiving the restrictions of 112.313(3) a' (7), Fla. Stat.,
prior to the waiver.
e File Part B with the governing body of the political subdivision In which the reporting person is serving, prior to the
transaction.
PART A - DISCLOSURE OF TRANSACTION OR RELATIONSHIP CONCERNING ADVISORY BOARD MEMBER
'WHO MOST COMPLETE THIS PART:
Sections 112.313(3) end 112.313(7), Florida Statutes, prohibit certain business relationships 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), FiorWa Statutes, permits the appointing official or body to
waive these requirements in a parfiCularinstance 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 public hearing; and (c) in either
case the advisory board member must fulty disclose the transaction or relationship which would otherwise be prohibited by
Subsections (3) of (7) of Section 112.313, Florida Statutes. This Part 0f Form 4A has been prescribed by the Commission
On Ethics for such disclosure. 1 and vette» appicabis to an advisory board member.
PLEASE COMPLETE THE FOLLOWING: es;
1 The partnership, directorship, proprietorship. ownership of a material interest, position of officer. employment, orAntraell
relationship which would otherwise violate Subsection (3) or (7) of Section 112.313, Florida Statutes, is held by I se
check applicable space(s)): Ff
be) The reporting Person: c)..,- N
GO
( ) The spouse of the reporting person, whose name is cri ' of
( ) A child of the reporting person, whose name is �-=i 3,
2. The particular transaction or relationship for which this waiver is sought involves [check applicable space]:
()4 Supplying the fallowing realty, goods, and/or services; Structural Engineering Services. Volunteer.
( ) Regulation of the business entity by the governmental agency served by the advisory board member.
3. The following business entity is doing business with or regulated by the governmental agency: ) am a co-owner of RH
Fnomeernno Group. Inc which provides siructurat erio neerina services 10 Droiects in the ON of Miami but does not represent then in front
RI the City Of Miami. The MiMo Biscayne Association a The Palm Grove Neighborhood Assoc_ as President.
4. The relationship of the undersigned advisory board member. or spouse or child of the advisory board member, to the busi-
ness entity transacting this business is (check applicable spaces]:
Oc) Ofr er; (>Q Partner, ( ) Associate; ( ) Sole Proprietor; ( ) Stockholder; ( ) Director, ( ) Owner of in excess of 5% of
the assets of capital stock in such business entity; ( ) Employee; ( ) Contractual relationship with the business entity;
( )Other. please describe-
CE FORM N - REV. 141
fCONTtNUEO ON REVERSE stpEl
74f-I 4ksa B. Cipeda- Fiwrr-j4A
PART B - DISCLOSURE OF INTEREST IN SOLE SOURCE OF SUPPLY
Y HO MUST COMPLETE THIS PART -
Sections 112.313(3) and 112.313(7), Florida Statutes, prohibit certain employment and business relationships on the Dart of pub-
lic officers and employees. See Pert ID, Chapter 112, Florida Statutes, andtor the brochure entitled 'A Guide to the Sunshine
Amendment and Code of Ethics for Public Officers and Employees' for more details on these prohibitions. However, Sermon
112.313(12Xe), Florida Statutes, provides an exemption from the above -mentioned restrictions in the event that the business
entity involved is the only source of supply within the political subdivision of the officer or emcee. to such cases the officers
or employee's interest in the business entity must be dilly k%losed to the governing body of the political subdivision. This Part
of Form 4A has been prescribed by the Commission on Ethics for such disclosure, 1 and when labile.
PLEASE COMPLETE THE FOLLOWING.
1. The partnership, directorship, proprietorship. ownership of a material interest positon of officer, employment or contractual
relationship which would otherwise violate Subsection (3) or (7) of Section 112.313, Florida Statutes, is held by (please
check applicable spece(s)):
( ) The Ong person;
( ) The spouse of the reporting person, whose name is or
( ) A child of the reporting person, whose name is
2. The following are the goods, realty, or services bang suppled by a business entity with which the public officer 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 (he political subdivision is:
(NAME OF ENTITY) (ADDRESS OF ENTITY)
4 The relationship of the undersigned public officer or employee, or spouse or critic of such officer or employ, to the busi-
ness entity named in Item 3 above b (check applicable spaces):
( ) Officer, ( ) Partner, ( ) Associate; ( ) Sole proprietor, ( ) Stockholder, ( ) Director ( ) Owner of in excess of 5% of
the swats or capital' stock in such business entity; ( ) Employe*. ( ) Contractual refaffonstep with the business entity;
( ) Other, please describe.
SIGNATURE
IONATURE
DATE SIGNED
DATE FLED iV
/
-71; ID
/lip
Woncr: UNDER enovgi0N5 or FLORIDA STATUTES w t 12.317, A FAILURE TO MAKE ANY REQUIRED DISCLOSURE CONSTTUTES (MICR PON ANO
MAY eE Kette *0 eY ONE OR MORE Of THE FOLLOWING; esREACHMENT, REMOVAL OR SUSPENSION PROM OFFICE OR EMPLOYMENT, DEMOTION.
REOUCTh0N M 5MAURY REPRIMAND. OR A CIVIL PINAt.TY NOT TO EXCEED 11t0.000.
CEFOtW4A-REV t-SS
1CONTimiED FROM PAST SIDE)
Submitted into the public
record for item(s) RE.19.
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, 2020 12:07 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 dick links or open attachments unless yr u recognize the
sender and know the content is safe.
Good Afternoon,
I am reattaching my completed form.
Sincerely,
Alisa Cepeda
From: Ketterer, Amber L. <AKetterer@miamigov.com>
Sent: Thursday, July 23, 2020 11:48 AM
To: Alisa Cepeda <acepeda@rhengineeringgroup.com>; Hannon, Todd <thannon@miamigov.com
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 Attorney
Telephone: 305-416-1859
Facsimile: 305-416-1801
aketterer@miamigov.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
1
•
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: Alisa Cepeda<acepeda@rhengineeringgroup.com>
Sent: Thursday, July 23, 2020 11:19 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.
Sincerely,
Alisa Cepeda
From: Ketterer, Amber L. <AKetterer@miamigov.com> a N
Sent: Wednesday, July 22, 2020 3:30 PM �= o
� � N
Cc: Eisenberg, Joseph <JEisenberg@miamigov.com>; Keirn, Jacob <JKeirn@miamigov.com>; Garcia, Anastassia a w M
<ANGARCIA@miamigov.com>
Subject: RE: Miami 21 Task Force Ethics Issue Update - Important Time -Sensitive Reminder . c
vi
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@miamigov.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
2
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 notitied 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 c-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/Ju120%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.
Amber L. Ketterer, Assistant City Attorney
General Government Division
c • ji
4.
o ▪ ▪ E o
City of Miami }' o
c
Office of the City Attorney v ,o rn
Telephone: 305-416-1859 —' `.1
V 1
L
Facsimile: 305-416-1801 ,E ° o
• a
aketterer(amiamigov.com cn - 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 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-
3
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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