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HomeMy WebLinkAboutSubmittal-City Clerk-Qualified ApplicantsSubmitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk QUALIFIED APPLICANTS FOR DISTRICT 5 CITY COMMISSIONER VACANCY Office of the City Clerk Miami City Hall 3500 Pan American Drive Miami, FL 33133 (305) 250-5361 www. miamigov.comlcitydsrk U � cl 3 J Ubli'1ljf r vl (1) UCc.G f"7 Q Cq ppUcLirr Submitted into the public record for item(s) 5ti1, on 11-18-2020, City Clerk YI Q �1 .7 Gi.7 CITY COMMISSION VACANCY AFFIDAVIT OF APPOINTMENT ray'+ p CITY OF MIAMI, FLORIDA 7-1 C' '� �z T STATE OF FLORIDA ) P. s COUNTY OF MIAMI-DADE )` CITY OF MIAMI ) rn r x co fq-e{jt ivtDe (hereinafter "affiant" ), being first duly sworn under penalty of perjury, deposes and says: 1. My name is C(G') p 4/42,1,01/ P1 i—) Fri 2. I am offering myself as an appointee to fill the unexpired term for the vacant office of Commissioner in District Number 5 of the City of Miami, Florida. I fully understand that I must maintain an actual and real residence within the district for the duration of my term of office. 3, I have resided in the Commission District Number 5 for a minimum of one year before qualifying, and I am a registered voter and a duly qualified elector in District 5. I am presently registered to vote in Precinct No. LI. 0 . I jprfesently reside at the following address (must include zip code)): 2 g 141:47111 -/ which is my legal address, and I have resided continually at said address from the 1 day of 0,0 g -CAC , I Ct to the present. 4. Immediately prior to residing at the above -stated address, I have resided at the hereinbelow listed addresses for the cited periods of time (list hereinbelow all addresses at which you have resided for the past five years, as well as the length of time at each address): Prior Addresses: 34-A°% For the Period: 1 z � `7 j N16-441 t 4'u I'age 1 of 3 `7+ Gyve_ Rev 1{1J2u Puge 2 of 3 5. In addition to the residence that I have listed as my present address, I also reside at the following listed addresses on a temporary basis as a secondary domicile or domiciles: 6. Affiant's spouse resides at the following address (must include city, state and zip code): /2 Z. p 8.1 --)4yee /Le 7. Affiant's minor children reside at the following address (must include city, state and zip code): /Z ( 11 'e'e irc, '( f33/3f 8. At the present time, affiant (is) {is not egistered to vote in any city, county or state other than as stipulated in subparagrap above. 9. Name and business address of affiant's employer: 6:20(\ 5 C.-W.-, &3i\f\K.a.0-0/1 c 1--Lz orvicnivli 10. Affiant's occupation: k) Y'v Affiant's business telephone numbers):( 6 J Zi3 — , 11, Affiant has been employed in the above -cited capacity for the following period of time: Pait (Note: In the event the occupation of affiant has been for a period of less than one year, or the employment period with the same employer has been for a period of less than one year, affiant shall give the name(s) and address(es) of his/her emFyer(s) and occupation(s) for the period of pne year prior to the date of this affidavit), m rrn 12. Affiant represents that he/she (is) his no currently holding another elective gr a ipointive office — whether city, county or m pal — the term of which or any parthof runs concurrently with that of the office he/she seeks, and that he/she has resigned from any office from which he/she is required to resign pursuant to F.S.99.012 and/or the City of Miami Charter. 13. Affiant represents that, if appointed, he/she shall serve in the office so appointed, Submitted into the public record for item(s) Sp 1� on 11`18-2020 City Clerk Rev. f0,2020 SIGNED THIS 1, DAY OF 14v�0> Submitted into the public record for item(s) SP.1, on 11-18-202Q, City Clerk AFFIANT BEFORE ME, the undersigned authority, by means of physical h sical or online presence appeared qrIcoi $ 3R Ile (>(e.wha, after first being duly sworn (or affirmed), deposes and states that Ye executed the foregoing to the best of 3 knowledge and belief. "g,N CITLcRK, CITY OF MIAMI, FLORIDA Did take an oath V Produced identification Type of identification produced: ?L L \V€( 1_'Cer. SilvsiORA FORGES WstyPut r StireofRota Commies on # GG 084618 My Comm, Expires Afar 19, 202t ar drEtkpistionl r Page 3 of (SEAL) Rev IW2020 FORM 1 STATEMENT OF 2019 Please print or type your name, rnailfng address, agency name, and position below: FINANCIAL INTERESTS FOR OFFICE USE ONLY: LAST NAME -- FIRST NAME MIDOLE NAME : Mo•-f110 �--G — ] F C•L occ.• S 47- MAILING ADDRESS : } 4, r r-..r v CITY : ZIP : COUNTY ' --C" C.") NAME OF AGENCY : e L` ] f?'tetet ' = f y x s D NA OF OFFICER POSITION HELD OR SOUGHT , m CHECK ONLY IF ❑ CANDIDATE OR [NEW EMPLOYEE OR APPOINTEE **** THIS SECTION MUST BE COMPLETED **** DISCLOSURE PERIOD: THIS STATEMENT REFLECTS YOUR FINANCIAL INTERESTS FOR CALENDAR YEAR ENDING DECEMSER 31, 2019. MANNER OF CALCULATING REPORTABLE INTERESTS: FILERS HAVE THE OPTION OF USING REPORTING THRESHOLDS THAT ARE ABSOLUTE DOLLAR VALUES, WHICH REQUIRES FEWER CALCULATIONS, OR USING COMPARATIVE THRESHOLDS, WHICH ARE USUALLY BASED ON PERCENTAGE VALUES [see instructions for further detaiis). CHECK THE ONE YOU ARE USING (mus eck one): n COMPARATIVE (PERCENTAGE) THRESHOLDS OR M DOLLAR VALUE THRESHOLDS PART A •- PRIMARY SOURCES OF INCOME (If you have nothing to report, NAME OF SOURCE OF INCOME [Haler sources of income to the reporting person - See instructions] write "none"' or "n/a") SOURCES ADDRESS DESCRIPTION OF THE SOURCES PRINCIPAL BUSINESS ACTIVITY rn J(, 6 70 atiS cr 4i )-- Ire s \mile " itD SC' en$. 111 d l i 1 E ` ■ 1') ) 5ad 1 n i. a (' ; { E.L " c1� 4-g -'r 4.A, 'ad) nejk) ill y Ats.qt4i MC)/ &Zi:LiZ ✓ zr�ry .,r''�L j° '(f� ,I'� % 0 1 1 ) C,- I �C ! 1 1 1 '� ik: r 7 �] (j„ '.1 e S , / & i4Jf V �ry (,1-� (w ry ` �4 o 9 .. 7 711/G 6' }! J 1r'�l PART B — SECONDARY SOURCES [Major customers, clients, (It you have nothing to NAME OF BUSINESS ENTITY OF INCOME f /1""I' and other sources of income to businesses report, write "none" or "We) NAME OF MAJOR SOURCES OF BUSINESS' INCOME ' r ow ie by the p �ng person - See ADDRESS OF SOURCE '� instructions] PRINCIPAL BUSINESS ACTIVI OF SOURCE ri /14— ni a /1 /4 n Ar- PART C -- REAL PROPERTY [Land, buildings [If you have nothing to repo ) owned by the reporting person - See instruclions] rite "none" or "rile"J You are not limited to the space on the lines on this form. Attach additional sheets, if necessary. FILING INSTRUCTIONS for when and where to file this form are located at the bottom of page 2. INSTRUCTIONS on who must file this form and how to fill it Out hem in nn nano R CC FORM 1 - Etedioe. Januarr 1 2020 incorporated by reference in Rule 144120211M. F.A.C. (Continua Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk PAGE T PART 0 —INTANGIBLE PERSONAL PROPERTY [pocks, bonds. certificates of deposit. etc. - See instructions] (If you have nothing to report, write "none" or "n1a") TYPE OF INTANGIBLE BUSINESS ENTITY TO WHICH THE PROPERTY RELATES fi i 1 J ft PART E — LIABILITIES [Major debts - See instructions) (If you have nothing to report, write 'none" or"nla") NAME OF CREDITOR e=a r: ca ADDRESS OF CREDITOR Fri f PART F — INTERESTS IN SPECIFIED BUSINESSES Ownership or positions in certain types of businesses - See instructions] ■• (If you have nothing to report, wrfte "none' or "rila'") ❑" rer■"tcc �■"rmr i��., NAME OF BUSINESS ENTITY 1OVf n1 ' 4 .4.J,flfl`,051W"r Rrr w c ADDRESS OF BUSINESS ENTITY __ Z DO).V1 f p c 1 ^]. ,1,] PRINCIPAL BUSINESS ACTIVITY (01,15t& hen ��Su ih lorF POSITION HELD WITH ENTITY C a a I OWN MORE THAN A 5% INTEREST iN THE BUSINESS - D NATURE OF MY OWNERSHIP INTEREST R)3rekPV'1.)=>1 PART G — TRAINING For elected municipal officers required to complete annual ethics training pursuant to section 112.3142, F.S. El I CERTIFY THAT I HAVE COMPLETED THE REQUIRED TRAINING. F ANY OF PARTS A THROUGH G ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE 11 SIGNATURE OF FILER: Signature: CPA or ATTORNEY SIGNATURE ONLY If a certified public accountant licensed under Chapter 473, or attorney in good standing wilh the Florida Bar prepared this form for you. he or she must complete the following statement: 1 „prepared the CE Form 1 in accordance with Section 112.3145. Florida Statutes, and the instructions to the form. Upon my reasonable knowledge and belief, the disclosure herein is true and correct. CPA/Attorney Signature - Date Signed: FILING INSTRUCTIONS: If you were mailed the form by the Commission on Ethics or a County Supervisor of Elections for your annual disclosure filing, return the form to that location. To determine what category your positron falls under, see page 3 of instructions. Local officers/employees file with the Supervisor of Elections of the county in which they permanently reside_ (If you do not permanently reside in Florida, file with the Supervisor of the county where your agency has its headquarters.) Form 1 filers who file with the Supervisor of Elections may file by mail or email. Contact your Supervisor of Elections for the mailing address or email address to use. Do not email your form to the Commission on Ethics. it will be returned. State officers or specified state employees who file with the Commission on Ethics may file by mail or email. To file by mail, send the completed form to P,Q, Drawer 15709. Tallahassee, FL 32317-5709; physical address; 325 John Knox Rd, Bldg E, Ste 200, Tallahassee, FL 32303. To file with the Commission by email, scan your completed form and any attachments as a pdf (do not use any other format), send it to CEForm1©Ieg.state.fl.us and retain a copy for your records, Do not file by both mail and email. Choose only one filing method. Form 6s will not be accepted via email. CE FORM 1 -Effective January 1. 2020 incorpaated by reference in Ryda 34.8.202[1). F.A.C. Candidates file this form together with their filing papers. MULTIPLE FILING UNNECESSARY: A candidate who files a Form 1 with a qualifying officer is not required to fife with the Commission or Supervisor of Elections. WHEN TO FILE: initially, each local officer/employee, state officer, and specified state employee must file within 30 days of the date of his or her appointment or of the beginning of employment. Appointees who must be confirmed by the Senate must file prior to confirmation, even if that is less than 30 days from the date of their appointment. Candidates must file at the same time they fite their qualifying papers. Thereafter, file by July 1 following each calendar year in which they hold their positions. Finally, file a final disclosure form (Form 1F) within 60 days of leaving office or employment. Filing a CE Form 1F (Final Statement of Financial Interests) does net relieve the filer of filing a CE Forrn 1 if the filer was in his or her position on December 31, 2019. Submitted into the public record for item(s) SP.1, ran 11-18-2020, City Clerk PAGE 2 CANDIDATE OATH — NONPARTISAN OFFICE (Do not use this farm if a Judicial or School Board Candidate) Check box only if you are seeking to qualify as a write-in candidate: 111 Write-in candidate RECEIVED 2J2O NOV ,J 6 PHH 1; 43 Cf f ,s,E L,F rHE CITY CLERK CITY OF NIAMI OFFICE USE ONLY Candidate Oath (Section6)21(1)(a), Florida Statutes) (Print name ave as you wish it to appear on the ballot. If your Iasi name consists of two or more names but has no hyphen, check box E. (See page 2 - Compound Last Names). No change can be made after the end of qualifying. Although a write-in candidate's name is not printed on the ballot, the name must be printed above for oath purposes.) am a candidate for the nonpartisan office of et t y{ ' i Lei yVI Yvi l S' e'vetC t (Office) (District #) 1 am a qualified elector of rn 1( (/yt t — _DACZP County, Florida; (Circuit #) (Group or Seat #) I am qualified under the Constitution and the Laws of Florida to hold the office to which I desire to be nominated or elected I have qualified for no other public office in the state, the term of which office or any part thereof runs concurrent with the office I seek; and I have resigned from any office from which I am required to resign pursuant to Section 99.012, Florida Statutes; and I will support the Constitution of the United States and the Constitution of the State of Florida. Candidate's Florida Voter Registration Number (located on your voter information card): to 2. 4\751 r- Phonetic spelling for audio ballot: Print name phonetically on the line below as you wish it to be pronounced on the audio ballot as may be used by persons with disabilities (see instructions on page 2 of this form): (Not applicable to write-in candidates.] Si ature of Candid e Telephone Number Email Addre ILL n 7L -1 1141 . ;C'C 33 Address City STATE OF FLORIDA ` COUNTY OF t� i• 04Y1 S State ZIP Code Sign u`ue f otary Public Print, T H . or Stamp Commissioned Name of Notary Public below Sworn to (or affirmed) and sub �sscribed before me by physics! or t ■r 0 online presence this 1( day of Bove) t7 P.te , 20 ZD +',�.o=. � Submitted SANDRA FORGES HeWryPueiC Sta�edFaaCorri ';;'�� ��s i+{yCamm. �esMar19,242i � •. 3xaF' IliVAIdkcmryA�n. into the public P Personally Known: or Produced Identification: Type of identification Produced: f L }deVe'r \ CQ 11.' DS-DE 302NP (Rev. 04120) record for itemtsj Si'..1, on 11-18-2020, City Clerk. uie iS-Z.uUU'i, t ..�. STATE OF FLORIDA COUNTY OF MIAMI-DADE i, riKavic i S First Name LOYALTY OATH Middle Initial Submitted into the public record for item(s) SP.1, on 11-18-2020 City Clerk ALe Last Name a citizen othe:,State of Florida and of the United States of America, .,. and a candidate for public office ... do hereby sole`Iflnkiswear or affirm that I will support the Constitution of the Unid States and of the State of Florida Ld c_ W Le/ L C_23 + U Signature of Candidate LJ N CITY OF MIAMI OATH OF CANDIDATE OFFICE OF(0-yri 14t (c ) 0 to 0 ts\ Before me, an officer authorized to administer oaths, personally appeared eJ I F? n co JL 4&z,76 (PLEASE PRINT NAME) who, being sworn, says he/she is a candidate for the office of Cic,. v'w. ram. ei /j r rC 0 t S � , for the City of Miami, Florida; that he/she is a qualified elector of the City of Miami, Florida; that he/she is qualified under the Constitution, the Laws of Florida, and City of Miami Charter to hold the office to which he/she desires to be elected; that he/she has taken the oath required by Section 99.021, Florida Statutes; that he/she has qualified for no other public office in the State, the term of which office or any part thereof runs concurrent with that of the office he/she seeks; and that he/she has resigned or taken a leave of absence from any office from which he/she is required to resign or take a leave of absence, pursuant to Section 99.012, Florida Statutes. lie 2(5 51- ept. / 191A. r63 tr Address City Signature of Candidate State Zrr' Cod - The Loyalty Oath and Oath of Candidate are sworn to (or affirmed) and subscribed before me by /physical or \ Signatu online presence, this dminisengOathorNotaPubFic day of 11/46eVYkl' e Personally Known: OR Produced Identification: Type of Identification Produced: Y \je i Liait se. , 20 20 1c3Clyr\ACo... Name of Notary Typed, Printed or Stamped SANDRA FORGES Hera y R.Jh,C-Sum of Ronda Ctnwniasion tl GG 984616 My Comm. Fop+es Mar 19. 2021 0.2010 Francois J. Alexandre 122 NE 78t Street, Miami FL, 33138 (954) 543-2810 Faleva0014.ginail.eorn Date: March 2020 To Whom It May Concern: -o .F" I graduated with a bachelor's degree in International Relations and a minor in Mass Communications at Florida International University. I wish to apply for the Commission Seat District 5 from the City of Miami FL. While researching opportunities in South Florida, both Private and non-profit sector, I found that the city of Miami municipality has been highly recommended for having an interest in the development of its representatives while simultaneously providing education the community needs to engage in combating and advocating for climate change/justice, environment justice, voter registration, racial, social, economic and political justice. For the past seven years, I've been building research and outreach in underserved Low -Income communities in South Florida speaking to elected officials, community leaders, grassroots organizers around various local issues facing our people. In particular, a Climate gentrification issue our Ayisyen immigrant community dealt with where over 75% oFAyisyen Americans were being evicted out of their mobile homes without proper notice in the middle of the school year. We coordinated a campaign and implemented strategies that led to a significant victory. This was a coalition led by Legal Services of Greater Miami and concerned community leaders. We took the City and the new property owner to court and won a million dollars for the remaining 100 families. rn I rn My work background has supplied me with many skills along with a wealth of knowledge and understanding when working with and for our communities in South Florida. I have been mobilizing local community members around campaigns concerning Temporary Protective Status Gentrification, Climate Change, Affordable Housing, Civic Engagement and Political Campaigns.. I have been in charge of creating committees around campaigns as well as maintaining relationships with community members and influence leaders. Within the past six years, I have stepped into the space of educating and training organizers and local leaders to maximize their full self -empowered potential goals. These experiences have greatly improved my leadership, Training, communication and coalition -building skills. Above all, it helped me recognize the importance of teamwork in achieving campaign goals and objectives, qualities that I could use at your establishment. Being the committed and diligent person that I am, I assure you a great performance both as a team member and also at an individual level. Please find further details in my Curriculum Vitae enclosed for your perusal. Thanking you, Yours Respectfully, Francois J. Alexandre Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk Francois J. Alexandre 122 NE 78th Street, Miami FL, 33138 (954) 543-2810 falexa001 @.gmaiiLcom Education: Florida international University Bachelor of Science in International Relations Minor in Mass Communications, December 2016 Employment Experience: Konscious Kontraktors Miami FL September 2017- Current Position- Founder, CEO • Konscious Kontractors with our Community in mind have created and developed 9 programs: Art Kreyol, Ti Ayiti News awareness, Ti Ayiti Kornmunity Kultural K.onversations, Ti Ayiti Klimate & Ku]ture Art Science Initiative, Ti Ayiti Kommunity Awareness Preparation Initiative, Ti Ayiti Kommunity Organic Garden And Water Initiative, Ti Ayiti Beautification And Konstruction Initiative, Ti Ayiti Youth Art Kontest, Ti Ayiti Summer Environmental Youth Initiative. • Create community -based strategies and implement programs to mitigate the impact of "climate change gentrification" in Ti Ayiti/Little Haiti. • Create community -based strategies and implement programs to mitigate the socioeconomic impact of folks residing in Ti Ayiti/Little Haiti. • Organizes hi -monthly community beautification activities "K1ean Street Mean Mind Initiatives" in Ti AyitilLittle Haiti as well as a monthly community dialogue called "Kommunity Kultural Konversations". • Organizes a weekly Drum Cirkle on Sundays at any location. • Supports low income homeowners efforts to remain in the neighborhood with Home renovation, repairs, and landscaping design services. • Provides at -risk youths with job -training skills, exposing them to kulture, arts and science initiatives. • Curating an annual "1804 Forever Youth Klimate Art Kontest Exhibition" reflecting climate change within the spirit of 1804. This is done in conjunction with local partners such as The city of Miami, Elected officials, Magic City, nonprofits organizations and the general community at large. • Curating, hosting, presenting "Art kreyol" a Multi -disciplinary artistic Platform created to represent and showcase the work of Black People within the Diaspora. • Since our inception in 2017 we have worked on a variety of Projects and initiatives. Our operational budget has grown to S50,000 plus including generating a list of volunteers to assist each particular project. • konscious Kontractors have developed leadership capacity in areas such as Landscaping, Tree Cutting, Homes/Commercial renovations, vocational training, event Coordinating and Staffing. • Konscious Kontractors have partnered and sponsored big events such as Sounds of Little Haiti, Konpa Festival, Griot Festival, Miami Dade and Broward Carnival, Madame Gougousse Haiti Cup. New Florida Majority, Miami FL July 2017- November 2017 Position Organizer: Democracy Lead Organizer • Created strategic plans on engaging marginalized and excluded communities around voter restoration, voter registration, Affordable Housing, Gentrification, Money & Politics and voter suppression. • Developed and fostered relationship growth with other Community Based Organizations (CBOs), faith leaders, community members, community leaders, business owners and other gatekeepers. • Coordinated events with CBOs aiding community members on voter registration, completing voter restoration petitions and the importance of civic engagement. • Found and developed volunteers, including training and providing Ieadership opportunities that increase the participation of marginalized communities. • Developed voter registration sites, keeping track of sites and relationships. • Followed quality control procedures for safeguarding sensitive information collected. Family Action Network Movement Miami, FL August 2015- April 2017 Position Held: Community Organizer • Developed and coordinated programs designed to promote the organization and its services to the community and the target population. • Identified other community issues happening in the Ti AyitilLittle Haiti Communities. • Worked with leaders, staff and committees to engage, educate, agitate and motivate the community tnembers to action. • Trained volunteers and staff on house calling, run successful neighborhood canvasses and phone banks while holding them accountable to goals and outcomes. • Designed and implemented training of volunteers/activists and staff; assisted in and/or coordinated work of other staff. • Guided integration of politics, community relationships and organizing support in the daily work of staff. • Maintained accurate and detailed information on community networks, relationships built, activists and volunteers recruited, assignments and assessments etc. • Contributed to the overall community and political strategy for campaign with staff • Promoted activities and services through various forms of media. The Dutch Miami, Miami Beach, FL December 2014-June 2015 Position Held: Food Runner • Delivered food to guests quickly and efficiently • Coordinated daily Front of the House and Back of the House restaurant operations • Delivered superior service and maximize customer satisfaction • Responded efficiently and accurately to customer complaints • Reviewed product quality and research new vendors • Organized and supervise shifts • Appraised staff performance and provide feedback to improve productivity y`n • Ensured compliance with sanitation and safety regulations k_ • Controlled operational costs and identified measures to cut waste. \� - ply ��D • Communicated clearly with the kitchen and front of house staff sto1 `1'�� ,,A t' • Other duties as assigned .q Submitted into the public '‘-c P'L'. record for item(s) SP.1, on 11-18-2020, City Clerk SLS hotel, Miami Beach August 2013- September 2014 Position Held: Server/Security/Food Runner • Coordinated daily Front oldie House and Back of the House restaurant operations • Delivered superior service and maximize customer satisfaction cs • Responded efficiently and accurately to customer complaints • Reviewed product quality and research new vendors r,n-', • Organized and supervise shifts cc • Appraised staff performance and provide feedback to improve productivity .•D • Ensured compliance with sanitation and safety regulations it • Delivered food to guests quickly and efficiently c • Communicated clearly with the kitchen and front of house staff • Guarded against theft and maintain security of premises • Other duties as assigned (=) Fri 16. ry C) 'r`r1 -0 .< Fri ✓ (� Comcast, Miramar FL July 2007 — May 2011 Position Held: Retention Executive • Assisted customers who want to cancel their services • Sold the benefits and value of Comcast's products and services along with identifying customers unstated needs, selling any missing lines of business to the customer, and make account changes as necessary LANGUAGE AND COMPUTER SKILLS Fluent in Spoken and Written: English, French, and Kreyol, Certified Miami -Dade County Community Emergency Relief Team Certified Hvac Technician City of Miami Department of Human Resources; Customer Service - Business Etiquette Certification City of Miami Department of Human Resources; Conflict Management Certification City of Miami Department of Human Resources; Time Management Certification City of Miami Departtnent of Human Resources; Effective Communication For Success Certification Certified Climate change instructor via FEMA Computer Skills: Microsoft Word, MS Excel, MS Power Point, Safari, and type 40 words per minute. HOBBIES AND INTERESTS Skills: I'm a fast learner, eager to learn and I take the initiative. I'tn a hard-working individual with a team working and managerial experience. I have been featured in local and national media platforms such as the New York Times, Sierra Club Magazine and Podcast, Npr, PBS, Al Jazeera Plus, Academic articles from various universities (MIT, UF, Cornell University, FIU, Barry University), Miami New Times, Huffington Post, all of South Florida Local TV Stations, Uk. Daily Mailand and the Miami Herald. I testified in front of the Council on Environmental Quality (CEQ) on the National Environmental Protection Act (NEPA). Interests: People, Family, Philanthropy, Making Money, Politics, Music, Sports, and Traveling. Submitted into the public record for item(s) SPA, on 11-18-2020, City Clerk VOLUNTEERINGIDRGAN1ZATION AFFILIATES Co -Founder of Justice 4 Miami, 2020 President of Concerned Leaders of Ti Ayiti/little Haiti since, 2018 Poetic Lakay, 2016 Sounds of Little Haiti 2016 Miami -Dade County Millennial Task Force, 2020 Miami Climate Alliance, Active member, 2016 Dream Defenders, Active Member since, 2014 Roots Collective, Active Member since, 2014 Circle of Brotherhood, Active Member since, 2016 President of Tribe Kreyol, Active since, 2019 Appointed ambassador of Ti Ayiti We Dem Zoes Entertainment Group Muce305, Active since, 2017 References: jan Mapou: 305-299-9918 Email; Janmapou@gmail.com Father Reginald: 786-704-4255 Email; Tiyogann@yahoo.com Leonie Hermantin: 786-473-5889 Email; lhermantin@gmail.com }rsz ,z a Cik CD " m c fa- Submitted into the public record for item(s) SP.1, on 11-18-2020 City Clerk INTENTIONALLY LEFT BLANK Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk CITY COMMISSION VACANCY AFFIDAVIT OF APPOINTMENT CITY OF MIAMI, FLORIDA STATE OF FLORIDA COUNTY OF MIAMI-DADE CITY OF MIAMI Jacquetta (Jacqui) B. Colyer (hereinafter "afFiant"), being first duly sworn under penalty of perjury, deposes and says: 1. My name is Jacquetta (Jacqui) B. Colyer 2. I am offering myself as an appointee to fill the unexpired term for the vacant office of Commissioner in District Number 5 of the City of Miami, Florida. I fully understand that I must maintain an actual and real residence within the district for the duration of my term of office. 3. I have resided in the Commission District Number 5 for a minimum of one year before qualifying, and I am a registered voter and a duly qualified elector in District 5. I am presently registered to vote in Precinct No. 501 I presently reside at the following address (must include zip code): which is my legal address, and I have resided continually at said address from the 1 St day of June, 1, 2009 to the present. 4. Immediately prior to residing at the above -stated address, I have resided at the hereinbelow listed addresses for the cited periods of time (list hereinbelow all addresses at which you have resided for the past five years, as well as the length of time at each address): Prior Addresses: For the Period: 2 years 10 Page 1 or3 Rev. 10i2020 5. In addition to the residence that I have listed as my present address, I also reside at the following listed addresses on a temporary basis as a secondary domicile or domiciles: 6. Affront's spouse resides at the following address (must include city, state and zip code): same as mine 7. Af'fiant's minor children reside at the following address (must include city, state and zip code): n/a S. At the present time, affiant (is) registered to vote in any city, county or state other than as stipulated in subparagrap above. 9. Name and business address of affiant's employer: Colyer Consulting - Self Employed Colyer Consulting - Self Employed 10. Affiant's occupation: (4,,) Vl L Affiant"s business telephone number(s): 11. Affiant has been employed in the above -cited capacity for the following period of time: 5 years (Note: In the event the occupation of affiant has been for a period of less than one year, or the employment period with the same employer has been for a period of less than one year, affiant shall give the name(s) and address(es) of his/her employer(s) and occupation(s) for the period of one year prior to the date of this affidavit). 12. Affiant represents that he/she (is) is hoty currently holding another elective or appointive office - whether city, county or m k ipal - the term of which or any part thereof runs concurrently with that of the office he/she seeks, and that he/she has resigned from any office from which he/she is required to resign pursuant to F.S,99.012 and/or the City of Miami Charter. I 13. Affiant represents that, if appointed, he/she shall serve in the office so appointed. Page 2 of3 Submitted into the public record for item(s) SP.J, on 11-18-2020, City Clerk Rev. 1 Of7O2O Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk SIGNED THIS 1 DAY OF IAIJNe-YYI r (:FFIANT BEFORE ME, the undersigned authority, by means of physical or % online presence appeared ,. S0.4tt. 1b CO key-- , who, after first being duly sworn (or affirmed), deposes and states that Sale. executed the foregoing to the best of )?-- knowledge and belief. �,�. CITY CL f K, CITY MIAMI, FLORIDA (SEAL) d Did take an oath Produced identification Type of identification produced: 'SYeVS U c Se- SANOg FORGES Notary Public -Size al Foga comniss'an GG0B4618 MyCarm. Expires Ma' t9, 2021 Ya[al�l Npg17.434 C7rri -C- cm, IV -'-I -, S -[ 1rn Fri m CD Page 3 of 3 Rev. 1012020 FORM 1 STATEMENT OF 2019 Please print or type your name, mailing address, agency name, and position below: FINANCIAL INTERESTS FOR OFFICE USE ONLY: LAST NAME -- FIRST NAME — MIDDLE NAME : Colyer, Jacquetta Bland R CE ED 2024 NOV .13 Ali 6= 4 4 Gc F ��%o Y TiF CITY CLERK MAILING ADDRESS : CITY - ZIP COUNTY Miami MIN Miami Dade NAME OF AGENCY : City of Miami Commission NAME OF OFFICE OR POSITION HELD OR SOUGHT : City Commissioner - District 5 CHECK ONLY IF I] CANDIDATE OR J NEW EMPLOYEE OR APPOINTEE **** THIS SECTION MUST BE COMPLETED **** DISCLOSURE PERIOD: THIS STATEMENT REFLECTS YOUR FINANCIAL INTERESTS FOR CALENDAR YEAR ENDING DECEMBER 31, 2019. MANNER OF CALCULATING REPORTABLE INTERESTS: FILERS HAVE THE OPTION OF USING REPORTING THRESHOLDS THATARE ABSOLUTE DOLLAR VALUES, WHICH REQUIRES FEWER CALCULATIONS, OR USING COMPARATIVE THRESHOLDS, WHICH ARE USUALLY BASED ON PERCENTAGE VALUES (see instructions for further details), CHECK THE ONE YOU ARE USING (must check one): El COMPARATIVE (PERCENTAGE) THRESHOLDS PR L'J DOLLAR VALUE THRESHOLDS PART A -- PRIMARY SOURCES OF INCOME (If you have nothing to report, NAME OF SOURCE OF INCOME [Major sources of income to the reporting person - See instructions] write "none" or "n!a") SOURCE'S ADDRESS DESCRIPTION OF THE SOURCES PRINCIPAL BUSINESS ACTIVITY Florida Retirement System 200 East Gaines St.; Tallahasdee FL 32399 Retirement Services Social Security 8345 Biscayne Blvd, Miami FL 33138 Retirement Services Colyer Consulting Social Services Consulting PART B -- SECONDARY SOURCES [Major customers, clients, (If you have nothing to NAME OF BUSINESS ENTITY OF INCOME and other sources of income to businesses report, write "none" or "nla") NAME OF MAJOR SOURCES OF BUSINESS' INCOME owned by the reporting person - See ADDRESS OF SOURCE instructions] PRINCIPAL BUSINESS ACTIVITY OF SOURCE NA PART C -- REAL PROPERTY [Land, buildings owned by the reporting person - See instructions] (If you have nothing to report, write "none" or "nla') You are not limited to the space on the lines on this form. Attach additional sheets, if necessary. FILING INSTRUCTIONS for when and where to file this form are located at the bottom of page 2. INSTRUCTIONS on who must file this form and how to fill it out begin on page 3. ,1.._ Submitted into the public CE FORM 1 - EltecOsa. January 1.2e20 Incorporated by reference In Rule 348202(1), F.A.C. record for item(s) SP.1, on 11-18-202Q, City Clerk • PART D — INTANGIBLE PERSONAL PROPERTY [Stocks, bonds, certificates of deposit, etc. - See instructions) (if you have nothing to report, write "none" or "nla") TYPE OF INTANGIBLE Financial Portfolio BUSINESS ENTITY TO WHICH THE PROPERTY RELATES Anieriprise, Inc. - 8353 SW 124th Street, #104, Miami FL 33156 PART E — LIABILITIES [Major debts - See instructions] (If you have nothing to report, write "none"` or "nla") NAME OF CREDITOR South Florida Educational FCU American Express ADDRESS OF CREDITOR 1498 NE 2nd Avenue, Miami FL 33132 701 Brickell Avenue, Miami FL 33131 PART F — INTERESTS IN SPECIFIED BUSINESSES [Ownership or positions in certain types of businesses - See instructions] (If you have nothing to report, write "none" or "nfa") BUSINESS ENTITY # 1 BUSINESSSNTIte# 2 c2 NAME OF BUSINESS ENTITY ADDRESS OF BUSINESS ENTITY NA PRINCIPAL BUSINESS ACTIVITY POSITION HELD WITH ENTITY OWN MORE THAN A 5°% INTEREST IN THE BUSINESS NATURE OF MY OWNERSHIP INTEREST h m C7 r PART G —TRAINING For elected municipal officers required to complete annual ethics training pursuant to section 112.3142, F.S. D I CERTIFY THAT I HAVE COMPLETED THE REQUIRED TRAINING. IF ANY OF PARTS A THROUGH G ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE ❑ SIGNATURE OF FILER: /1-I3 ---02O a FILING INSTRUCTIONS: If you were mailed the form by the Commission on Ethics or a County Supervisor of Elections for your annual disclosure filing, return the form to that location. To determine what category your position falls under, see page 3 of instructions. Local officers/employees file with the Supervisor of Elections of the county in which they permanently reside. (If you do not permanently reside in Florida, file with the Supervisor of the county where your agency has its headquarters.) Form 1 filers who file with the Supervisor of Elections may file by mail or email. Contact your Supervisor of Elections for the mailing address or email address to use. po not email your form to the Commission on Ethics, it will be returned. State officers or specified state employees who file with the Commission on Ethics may file by mail or email. To file by mail, send the completed form to P.Q. Drawer 15709, Tallahassee, FL 32317-5709; physical address: 325 John Knox Rd, Bldg E, Ste 200, Tallahassee, FL 32303. To file with the Commission by email, scan your completed form and any attachments as a pdf (do not use any other format), send it to CEForm1@leg.state.fl.us and retain a copy for your records. Do not file by both mail and email. Choose only one Minn method. Form 6s will not be accepted via email. CE FORM 1 - Errmctivn: Jarman! 1, 2020. I scarp -x[1 by raIabbbtri it Rule 348.202(1 ), F.A.0 CPA or ATTORNEY SIGNATURE ONLY If a certified public accountant licensed under Chapter 473, or attorney in good standing with the Florida Bar prepared this form for you, he or she must complete the following statement: ( prepared the CE Faun 1 in accordance with Section 112.3145. Florida Statutes, and the instructions to the form. Upon my reasonable knowledge and belief, the disclosure herein is true and correct. CPAIAttorney Signature: Date Signed: Candidates file this form together with their filing papers. MULTIPLE FILING UNNECESSARY: A candidate who files a Form 1 with a qualifying officer is not required to file with the Commission or Supervisor of Elections. WHEN TO FILE: Initially, each local officer/employee, state officer. and specified state employee must file within 30 days of the date of his or her appointment or of the beginning of employment, Appointees who must be confirmed by the Senate must file prior to confirmation, even if that is less than 30 days from the date of their appointment. Candidates must file at the same time they file their qualifying papers. Thereafter, file by July 1 following each calendar year in which they hold their positions. Finally, file a final disclosure form (Form 1F), within 60 days of leaving office or employment. Filing a CE Form 1 F (Final Statement of Financial Interests) does not relieve the filer of filing a CE Form 1 if the filer was in his or her position on December 31, 2019. Submitted into the public record for item(s) SP.1, on 11-18-2020 City Clerk CANDIDATE OATH — NONPARTISAN OFFICE (Do not use this form if a Judicial or School Board Candidate) Check box only if you are seeking to qualify as a write-in candidate: • Write-in candidate RECEIVED 2020NOV 13 A4 CFa: ; ,� �� �� t. OF rt.:Gi TY GL Ent( MrarN OFFICE USE ONLY Candidate Oath (Section 99,021(1 (a), Florida Statutes) 48-egt tta (1:.CC cu Cyle)c_ I, (J3cgtri--Coiye(fit , ute u (Print name above asyou wish it to appear on th� ballot. If your last name consists of iwd or more names but has no pPY hyphen, check box 0. (See page 2 - Compound Last Names). No change can be made after the end of qualifying. Although a write-in candidates name is not printed on the ballot, the name must be printed above for oath purposes.) am a candidate for the nonpartisan office of City Commission 5 (Office) I am a qualified elector of Miami -Dade a (District #) County, Florida; (Circuit #) (Group or Seat #) I am qualified under the Constitution and the Laws of Florida to hold the office to which I desire to be nominated or elected; I have qualified for no other public office in the state, the term of which office or any part thereof runs concurrent with the office I seek; and I have resigned from any office from which I am required to resign pursuant to Section 99.012, Florida Statutes; and I will support the Constitution of the United States and the Constitution of the State of Florida. Candidate's Florida Voter Registration Number (located on your voter information card): 109039290 Phonetic spelling for audio ballot: Print name phonetically on the line below as you wish it to be pronounced on the audio ballot as may be used by persons with disabilities (see instructions on page 2 of this form): [Not applicable to write-in candidates.) Lig , Cal erg oei@ 14100,alro Aind r St n,-tsar .• Candidate Telephone Number Email Address dress City tate ZIP Code STATE OF FLORIDA Signatu - o N .tart' Public COUNTY OF t\ \ v'ti _� Print, Ty�•r 'tame Commissioned Name of Notary Public below: Sworn to (or affirmed and subscribed before me byh physical or ''',. '' . ?ANDRiifGRGE5 } p y _ Comrmssan GG 06 5116a f l `C�n Y M Camm. Expires Mai 1$. 1 online presence tills `� day of ��'� , 20 W . •'' Y Y •... krn+N xecnr7i r+uaynir, Personally Known: or Produced Identification: - Type of Identification Produced: f� Y 'ie(= u it ' DS-DE 302NP (Rev. 04/20) Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk Rule IS-2.0001, F.A.C. STATE COUNTY 1, LOYALTY OATH OF FLORIDA �� OF MIAMI-DADS ED r + `r A /lff{` NZ/ �% [ - j �y202(I NOV .13 hi, S: r�4 I/V l Y ,1 " "�"r ��" i"• 4 - • (.2) L. 0Y i ., - _ F1(st Name Middle Willa/ a citizen of the State of Florida and of the United States of America, ... hereby solemnly swear or affirm that I will support the Constitution of the U t CL EMI r trind a candidate, for public office ... do i ted States r(diof the State of Florida, f / r / ig ature of Can date CITY OF MIAMI OATI OFFICE OF ant \OF CANDIDATE Submitted into the public f Vii t`i [ record for items) 5 Before me, an officer authorized to administer oaths, personally appeared on 11-1 City Clerk 0,ifyf o Lz t4 e_417t- e.,0 + v 4 (PLEASE PRINT NAME) who, being sworn, says he/she is a candidate for the office of 0.-[1l h'i'"ni't 6 fl O.+ , for the City of Miami, Florida; that he/she is a qualified elector of the City of Miami, Florida; that he/she is qualified under the Constitution, the Laws of Florida, and City of Miami Charter to hold the office to which he/she desires to be elected; that he/she has taken the oath required by Section 99.021, Florida Statutes; that he/she has qualified for no other public office in the State, the term of which office or any part thereof runs concurrent with that of the office he/she seeks; and that he/she has resigned or taken a leave of absence from any office from which he/she is required to resign or take a leave of absence, pursuant to Section 19.012, Florid etutes. Y I Signature Candidate 1 , Address City State ZIP Code The Loyalty Oath and Oath of Candidate are sworn to (or affirmed)and subscribed before me by V _ physical or y y 1 "{ � online prese this 1--,..) day of tAC leArA { , 20 2-0 , _ , ,„%f)Afc,f, ( e5 Sign. of J er Administering Oath or Notary Public Narne of Notary Typed, Pi -tilted or Stamped 7 Personally Known: OR Produced Identification: 1 SANDM FORGES i'. =: Notary Py51�;-SUM or Soda ` g Type of Identification Produced: F S LA.cs-+i mmu Cassbn 4 GG 48461B My Comm.ExpresMar 19.2421 JACQJJI B. COLYER Cr -7. -.3if Loaf aFe f_•I'r -_ used Brie-gy PERIENCE The Colyer Group Consultant • Social Services consultant to the following organizations. St. John Community Development Corporation, The Obama Foundation j My Brother's Keeper. Florida Rights Restoration Coalition Illinois Department of Children and Family Services / Cook County Regional Administrator ■ The Administrator for Chicago's Child Welfare Programs - both Investigations and Child Welfare (Permanency) • Provided Executive Leadership for the Chicago Region, the largest county in Illinois. Introduced strategies to track data for both Investigations and Permanency, Significantly reduced pending investigations in Cook while continuing to provide optimal daily operations. The Children's Trust Director of Neighborhood and Community Services • Executive responsibility for Program Development for children and youth living in at risk neighborhoods. • Developed strategy to use neighborhood hubs that provided rnentoring, after school, and prevention services to seven neighborhoods. The goal: All children would be supported by caring adults who would work with them through various life situations. Florida Department of Children and Families Regional Director • Executive responsibility For the overall operations and budget management for programs that provide safety net assistance to vulnerable populations - Child Care Licensing, Substance Abuse and Mental Health. ACCESS - Food Stamps. Family Safety - Child and. Adult Protective Services in Miami Dade County. • Under my leadership the Region won awards for Food Stamps accuracy and awarded a S3 million award for an innovative early child care initiative and $7 million for Prevention Programs in Early Learning (child care) settings throughout the community Budget of $150 million dollars and 1,400 employees. Submitted into the public record for item(s) 513.1, on 11-18-2020, City Clerk ( 0NTA C T colyer4109@yahoo.com 1.. DUCATION Doctoral Candidate. University of Miami M.S.W. Social Work and Social Work Education. Barry University • Miami Shores, FL B.A.. Social Science Education and Social Work Winthrop University. Pock Hill. SC 1 Submitted into the public record for item(s) SP.1, on 11-18-2421i), City Clerk Submitted into the public record for items) SPA. on 11-18-2020, City Clerk Our Kids, Inc. Director of Permanency and Prevention • Responsible for the operations of the Adoptions and Permanency initiatives.. ■ Developed innovative programs and strategies to reduce the number of chi dren removed from their homes through intensive diversion and prevention programs in child welfare • Authored grants to HHS and foundations. Policy Studies. Inc. Regional Director of Workforce Operations • Co -wrote grants for Workforce in Florida (Palm Beach and Volusia County), Nebraska (Omaha) and Arkansas (Little Pock) • Coordinated the opening of the offices from site selection, hiring. training and daily operations. • All sites achieved work force goals and contracts were increased by 20% during my tenure. Lockheed Martin 1MS, Miami, FL Deputy Project Manager • Built the South Florida Workforce Development program From start-up to maturity. Led up to 180 employees, Esther Project, Miami, FL Project Director • Provided senior level strategic direction and management for this $5-, million federal faith based welfare to work (WtW) project for 120 hard to place women. BOARD MEMBERSHIPS • AGAPE - Belen Jesuit Preparatory School - Secretary • Overtown Advisory Board - Vice President • Peace Education Foundation - Vice President • 4Ward Miami- Member AWARDS • Belen Jesuit Preparatory School (Founded the AGAPE Program) Program to provide scholarships for very bright disadvantaged teenagers. • Miami -Dade College Outstanding Faculty Member • Truth and Hope Award - Human Services Coalition • Community Services and Leadership Award - League of Women Voters Leadership Award • Women's Chamber of Commerce - Business Woman Service Award 2 Submitted into the public record for item(s) SPA, on 11-18-2020, City Clerk P c) Say Submitted into the public record for item(s) 513.1, on 11-18-2020, City Clerk INTENTIONALLY LEFT BLANK Submitted into the public record for item(s) SPA. on 11-18-2020, City Clerk ens CITY COMMISSION VACANCY AFFIDAVIT OF APPOINTMENTT CITY OF MIAMI, FLORIDA -c r C CO -n STATE OF FLORIDA ) e, COUNTY OF MIAMI-DA❑E ) -< CITY OF MIAMI ) n k1(i ri C..0 U Ct_ tO k y (hereinafter "affiant"), being first duly sworn under penalty of perjury, deposes and says: 1, My name is Mot aiCL( bct (LS 2. I am offering myself as an appointee to fill the unexpired term for the vacant office of Commissioner in District Number 5 of the City of Miami, Florida. I fully understand that I must maintain an actual and real residence within the district for the duration of my term of office. 3. i have resided in the Commission District Number 5 for a minimum of one year before qualifying, and I am a registered voter and a duly qualified elector in District 5. I am presently registered to vote in Precinct No. : f) . I presently reside at the following address (must include zip code): 5 f\) 5 h Strcd- FL._ • 33 Li which is my legal address, and I have resided continually at said address from the 01 day of 11 OiA V1uFkic i g (f' to the present. 4. Immediately prior to residing at the above -stated address, I have resided at the hereinbelow listed addresses for the cited periods of time (list hereinbelow all addresses at which you have resided for the past five years, as well as the length of time at each address): Prior Addresses: For the Period: Ali N/A - Paget o1'3 Rev. 10/2020 Page 2 of 3 9. Name and business address of affiant's employer: 10. Affiant's occupation: Ay/ /1-- Affiant's business telephone number(s): 5. In addition to the residence that 1 have fisted as my present address, I also reside at the following listed addresses on a temporary basis as a secondary domicile or domiciles: A 6. Affiant's spouse resides at the following address (must include city, state and zip code): 7. Affiant's minor children reside at the following address (must include city, state and zip code): /V/k 8. At the present time, affiant (isr is not registered to vote in any city, countyppr =te other than as stipulated in subparagraph 3 above. =• rrt c i Affiant has been employed in the above -cited capacity for the following period of time: (Note: In the event the occupation of affiant has been for a period of Tess than one year, or the employment period with the same employer has been for a period of Tess than one year, affiant shall give the name(s) and address(es) of his/her employer(s) and occupation(s) for the period of one year prior to the date of this affidavit). 12. Affiant represents that he/she (is (is note currently holding another elective or appointive office — whether city, county or municipal -- the tern, of which or any part thereof runs concurrently with that of the office he/she seeks, and that he/she has resigned from any office from which he/she is required to resign pursuant to F.S.99.012 and/or the City of Miami Charter, 13. Affiant represents that, if appointed, he/she shall serve in the office so appointed. Submitted into the public record for item(s) SPJ, on 11-18-2020 City Clerk Rev. 10/2020 SIGNED THIS ?4 DAY OF , OVCril b r , 4-7all/ ✓1. LA AFFIANT BEFORE ME, the undersigned authority, by means of v physical or online presence appeared \\CoiI -.bau..tmc who, after first being duly sworn (or affirmed), deposes and states that ` I/2_, executed the foregoing to the best of >( knowledge and belief. CIT T LE IC, CITY OF M1AMI, FLORIDA Did take an oath Produced identification Type of identification produced: s_ a •.•4 S.WGRA+-ORGES Now)! Plot - 5�!E or FFor�a +• Cammnon#GG0,94619 : — a, IMy Comm. Elves Mar 19, 2021 Page 3 of 3 Dhve✓ (SEAL) Submitted into the public record for item(s) on 11-18-2020, City Clerk OW r i v Ct- CO m Zr7 Ms < 3 P1 CD OK CAI x cn Rev. 10/2020 FORM 1 STATEMENT OF 2019 Please print or type your name, mailing address. agency name, and position below: FINANCIAL INTERESTS FOR OFFICE USE ONLY; LAST NAME -- ux FIRST NAME — MIDDLE NAME : 1 n Si Van Gkir RECEIVED MO NOV l 8 AM 9: 55 arF. fi CITY CF MIAMim' Y ctr MAILING ADDRESS : i 1395 W it/ 5a-o -r lam- CITY : ZIP : COUNTY : r NAME OF AGENT)/ Ir`I C. U ry\ nu' S s i o n e Y`' b1 s L Ct 5 NAME OF OJ<FICE OR POSITION HELD OR SOUGHT : CHECK ONLY IF ❑ CANDIDATE OR M NEW EMPLOYEE OR APPOINTEE **** THIS SECTION MUST BE COMPLETED **** DISCLOSURE PERIOD: THIS STATEMENT REFLECTS YOUR FINANCIAL INTERESTS FOR CALENDAR YEAR ENDING DECEMBER 31, 2019, MANNER OF CALCULATING REPORTABLE INTERESTS: FILERS HAVE THE OPTION OF USING REPORTING THRESHOLDS THAT ARE ABSOLUTE DOLLAR VALUES, WHICH REQUIRES FEWER CALCULATIONS, OR USING COMPARATIVE THRESHOLDS, WHICH ARE USUALLY BASED ON PERCENTAGE VALUES (see instructions for further details). CHECK THE ONE YOU ARE USING (must check one); COMPARATIVE (PERCENTAGE) THRESHOLDS OR ❑ DOLLAR VALUE THRESHOLDS PART A -- PRIMARY SOURCES OF INCOME (If you have nothing to report, NAME OF SOURCE OF INCOME [ivlajar sources of income to the reporting person - See instructions] write "none" or "Mal SOURCES ADDRESS DESCRIPTION OF THE SOURCE'S PRINCIPAL BUSINESS ACTIVITY lk Y_°R4 4.� dGJ14±* PART B -- SECONDARY SOURCES [Major customers, clients, (If you have nothing to NAME OF BUSINESS ENTITY OF INCOME and ether sources of income to businesses report, write "none or "nla" ) NAME OF MAJOR SOURCES OF BUSINESS' INCOME owned by the reporting person - See ADDRESS OF SOURCE instructions] PRINCIPAL BUSINESS ACTIVITY OF SOURCE j — PART C •- REAL PROPERTY [Land, buildings owned by the reporting person - See instructions] (If you have nothing to report, write "none" or "Na"} rYou are not limited to the space on the lines on this form. Attach additional sheets, If necessary. FILING INSTRUCTIONS for when and where to file this form are located at the bottom of page 2. INSTRUCTIONS on who must file this form and how to fill it out begin on page 3. � j 1I d A'L Submitted into the public record for item(s) SP.1, CE FORM 1 - Effective: January 1, 2620 Incorporated by eler©nce in Rule 3a-a2112I11, F A.C. on 11-18-2020, City Clerk PAGE l PART D — INTANGIBLE PERSONAL PROPERTY [Stocks, (If you have nothing to report, write "none" TYPE OF INTANGIBLE bonds, certificates of deposit, etc. - See instructions] or "nia") BUSINESS ENTITY TO WHICH THE PROPERTY RELATES i I Submitted into f V / fr the public /V %%4-- record for item(s) SP.1 PART E — LIABILITIES [Major debts - See instructions] (1f you have nothing to report, write "none" NAME OF CREDITOR on 11-18-2020, City Clerk ar "nia") ADDRESS OF CREDITOR PART F — INTERESTS IN SPECIFIED BUSINESSES [Ownership or positions in certain types of businesses - See instr tionW (If you have nothing to report, write "none" or "nia") 2! NAME OF BUSINESS ENTITY I =en rri ADDRESS OF BUSINESS ENTITY PRINCIPAL BUSINESS ACTIVITY 7-n A < POSITION HELD WITH ENTITY y- ?.-[ m D I OWN MORE THAN A 5% INTEREST IN THE BUSINESS co) CI NATURE OF MY OVVNERSHIP INTEREST X t:Ji PART G TRAINING For elected municipal officers required to complete annual ethics training pursuant to section 112,3142, F.S. ❑ 1 CERTIFY THAT I HAVE COMPLETED THE REQUIRED TRAINING. IF ANY OF PARTS A THROUGH G ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE ❑ SIGNATURE OF FILER: Signature: Date Signed: /7_ ).9-- b CPA or ATTORNEY SIGNATURE ONLY If a certified public accountant licensed under Chapter 473, or attorney in good standing with the Florida Bar prepared this form for you, he or she must complete the following statement: , prepared the CE Form 1 in accordance with Section 112.3145, Florida Statutes, and the instructions to the form. Upon my reasonable knowledge and belief, the disclosure herein is true and correct CPA/Attorney Signature: Date Signed: FILING INSTRUCTIONS: If you were mailed the form by the Commission on Ethics or a County Supervisor of Elections for your annual disclosure filing, return the form to that location. To determine what category your position falls under, see page 3 of instructions. Local officers/employees file with the Supervisor of Elections of the county in which they permanently reside. (If you do not permanently reside in Florida, file with the Supervisor of the county where your agency has its headquarters.) Form 1 filers who file with the Supervisor of Elections may file by mail or email. Contact your Supervisor of Elections for the mailing address or email address to use. Do not email your form to the Commission on Ethics, it will be returned. State officers ar specified state employees who file with the Commission on Ethics may file by mail or email. To file by mail, send the completed form to PO, Drawer 15709, Tallahassee, FL 32317-5709; physical address: 325 John Knox Rd, Bldg E, Ste 200, Tallahassee, FL 32303. To file with the Commission by email, scan your completed form and any attachments as a pdf (do not use any other format), send it to CEForm1@teg.state,fl,us and retain a copy for your records. Do not file by both mail and email. Choose only one filing method. Form 6s will not be accepted via email. Candidates file this form together with their filing papers. MULTIPLE FILING UNNECESSARY: A candidate who files a Form 1 with a qualifying officer is not required to file with the Commission or Supervisor of Elections. WHEN TO FILE: Initially, each local officer/employee, state officer, and specified state employee must file within 30 days of the date of his or her appointment or of the beginning of employment. Appointees who must be confirmed by the Senate must file prior to confirmation, even if that is less than 30 days from the date of their appointment. Candidates must file at the same time they file their qualifying papers. Thereafter, file by July 1 following each calendar year in which they hold their positions. Finality, file a final disclosure form (Form 1F) within 60 days of leaving office or employment. Filing a CE Form 1 F (Final Statement of Financial Interests) does not relieve the filer of filing a CE Form 1 if the filer was in his or her position on December 31, 2019. CE FORM 1 - Effective: January 1.202a. Incorporated by reference in Rule 11-8.202(1 ), F.A.C. PAGE 2 CANDIDATE OATH — NONPARTISAN OFFICE (Do not use this form if a Judicial or School Board Candidate) Check box only if you are seeking to qualify as a write-in candidate: ❑ Write-in candidate 13-ECEIVED 2/1:NOV. 18 AN 9: 55 OFF1f1E. CF THE WY Y CL1RK eITY OF f IIAMI Candidate Oath (Section 99_021(1)(a), Florida Statutes) OnCv nrrirm I ICC r1h11 Y Submitted into the public record for items) SP.1, on 11-18-2020, City Clerk hyphen. check box ❑. (See page 2 - Compound Last Names). No change can be made after the end of qualifying. Although a write-in candidate's name is not printed on the ballot, the name must be printed above for oath purposes.) am a candidate for the nonpartisan office of '' 15i�l C. r) Yrirnl 55 I C��le� , t (Office) , ; I am a qualified elector of L( (0 WI — b'LCit e- County, (District ft) Florida; or elected, I with the office Statutes; (Circuit #) (Group or Seat #) I am qualified under the Constitution and the Laws of Florida to hold the office to which 1 desire to be nominated have qualified for no other public office In the state, the term of which office or any part thereof runs concurrent I seek; and I have resigned from any office from which 1 am required to resign pursuant to Section 99.012, Florida and l will support the Constitution of the United States and the Constitution of the State of Florida. Candidate's Florida Voter Registration Number (located on your voter information card): g [ 3 1 1 3-- Phonetic spelling for audio ballot: Print name phonetically on the line below as you wish it to be pronounced on the audio ballot as may be used by persons with disabilities (see instructions on page 2 of this form): [Not applicable to write-in candidates.] ( 513) -9 SI ignatur i a of Candidate Telephone Number Email Address BS5 IV W o 1'- S �--e{ 1 \`tIC•Ct-it i- iJYtG�C� 53IL(Z-- Address City State ZIP Cade STATE OF FLORIDA r� % • Signat COUNTY OF &'t MOM t L --bade. Print, Type. or o Notary Public Stamp Commissioned Name of Notary Public below' Sworn to (or affirmed) and subscribed before me by physical or ❑ online presence this `V day of w* 4•" 1 , 20 t4.J. ,• "r'o'.. SAWCAAFflRGES F 4•: ' Cprmrrisso GGO46ita T .. _ Camm.Exp eesmari .2021 .,, es,4 rawly way Ficn. l 11 � % J Y ■ Personally Known: or Produced Identification; 11 Type of Identification Produced: FL, V\\q.'✓' L C. ILL+ S-e- DS-DE 302NP (Rev. 04/20) Rule 1S-2.0001, F.A.C. LOYALTY OATH STATE OF FLORIDA COUNTY OF MJAM1-DADE Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk ikit�S First Name Middle Initial Last Name a citizen of the State of Florida and of the United States of America, ... and a candidate for public office ... do hereby soltgnINwear or affirm that I will support the Constitution of the United States and of the State of Florida, D LLJ CO x:r,i.. six i ,S�gnature of Candidate dlOt CITY OF M1AM1 OATH OF CANDIDATE OFFICE OF {' y� ���,,���ar-,��e� bi'Sl`C.1 5 Before me, an officer authorized to administer oaths, personally appeared ( (PLEASE PRINT NAME) who, being sworn, says he/she is a candidate for the office of Corpinrl( SS t,v) c kr bi Sir +C b , for the City of Miami, Florida; that he/she is a qualified elector of the City of Miami, Florida; that he/she is qualified under the Constitution, the Laws of Florida, and City of Miami Charter to hold the office to which he/she desires to be elected; that he/she has taken the oath required by Section 99.021, Florida Statutes; that he/she has qualified for no other public office in the State, the term of which office or any part thereof runs concurrent with that of the office he/she seeks; and that he/she has resigned or taken a leave of absence frorn any office from which he/she is required to resign or take a leave of absence, pursuant to Section 99.012, Florida Statutes. Address 1 City Signature of Candidate lb Y- State The Loyalty Oath and Oath of Candidate are sworn to (or affirmed) and subscribed before me by online presence, this lU day of kkoe ri r , 20 j Sig re of officer Administering Oath or Notary Public Personally Known: Type of Identification Produced: OR Produced Identification:r7Z1 b ve U C_t2 4SC 31`--I2 ZIP Code physical or Jrce3 Name of Notary Typed, Printed orjtamped SANQR l :CRCE9 NaarvP.lahr Saie Flontia Coimsso" CG,NITS My Comm. E aeas Mai 19. 2021 90xee 'rL,F rxiV 'rain Ass. IOf'_9'0 Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk INTENTIONALLY LEFT BLANK Submitted into the public record for item(s) 5121. on T1-IS 2[3O City Clerk CITY COMMISSION VACANCY AFFIDAVIT OF APPOINTMENT CITY OF MIAMI, FLORIDA STATE OF FLORIDA COUNTY OF M!AMI-DADE CITY OF MIAMI Zico Fremont (hereinafter "affiant"), being first duly sworn under penalty of perjury, deposes and says: 1. My name is Zico Fremont 2. I am offering myself as an appointee to fill the unexpired term for the vacant office of Commissioner in District Number 5 of the City of Miami, Florida. I fully understand that I must maintain an actual and real residence within the district for the duration of my term of office. 3_ I have resided in the Commission District Number 5 for a minimum of one year before qualifying, and I am a registered voter and a duly qualified elector in District 5. I am presently registered to vote in Precinct No. 5 I presently reside at the following address (must include zip code): 180 NW 49 Street. Miami FL 33137 which is my legal address, and I have resided continually at said address from the 4 day of October 10 , 2010 to the present. 4. Immediately prior to residing at the above -stated address, I have resided at the hereinbelow listed addresses for the cited periods of time (list hereinbelow all addresses at which you have resided for the past five years, as well as the length of time at each address): Prior Addresses: For the Period: Page I of 3 Rev. I e}/2021] 5. In addition to the residence that I have listed as my present address, I also reside at the following listed addresses on a temporary basis as a secondary domicile or domiciles: 6, Affiant's spouse resides at the following address (must include city, state and zip code): 119 7. Affiant's minor children reside at the following address (must include city, state and zip code): 8. At the present time, affiant (is) is no registered to vote in any city, county or state other than as stipulated in subparagraph 3 above. 9. Name and business address of affiant's employer: RA Automative 180 NW 49 ST . Miami FL 33127 10. Affiant's occupation: Owner Affiant's business telephone number(s): 786-7E8-3587 11. Affiant has been employed in the above -cited capacity for the following period of time: 3 years (Note: In the event the occupation of affiant has been for a period of Tess than one year, or the employment period with the same employer has been for a period of Tess than one year, affiant shall give the name(s) and address(es) of his/her employer(s) and occupation(s) for the period of one year prior to the date of this affidavit). 12. Affiant represents that he/she (is) is not currently holding another elective or appointive office — whether city, county or municipal — the term of which or any part thereof runs concurrently with that of the office he/she seeks, and that he/she has resigned from any office from which he/she is required to resign pursuant to F.5.99.012 and/or the City of Miami Charter. 13. Affiant represents that, if appointed, he/she shall serve in the office so appointed. Page 2 of 3 Submitted into the public record for item(s) SPA on 11-18-2020, City Clerk Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk SIGNED THIS {„ DAY OF November 2020 BEFORE ME, the undersigned authority, by means of '� physical or online presence appeared it C.v rce.+ cn+ , who, after first being duly sworn (or affirmed), deposes and states that Vie, executed the foregoing to the best of 'ts knowledge and belief. (SEAL) CITY =RK, CITY OF MIAMI, FLORIDA Did take an oath �I Produced identification Type of identification produced: L— DyieI s C - """ SANDRA FORGES Rotary' kris - State d Posida Commission II GO me s My Comm. Wires Mai 19. 2021 I •• oF� ‘sxerrrogr Name 4.0 Page 3 of3 F1 tl rri rn c3 Rev_ I0/2020 FORM 1 STATEMENT OF 2019 Please print or type your name, 'railing address, agency name, and position below: FINANCIAL INTERESTS FOR OFFICE USE ONLY: LAST NAME -- FIRST NAME -- MIDDLE NAME : Fremont Zico RECEIVED 2020 NOV ! 3 PM at 28 pr f T? CITY CLERK OF MIAMI MAILING ADDRESS : 180 NW 49 ST CITY : ZIP : COUNTY : Miami 33127 Miami - Dade NAME OF AGENCY: City of Miami NAME OF OFFICE OR POSITION HELD OR SOUGHT : City Commissioner CHECK ONLY IF ❑ CANDIDATE OR ® NEW EMPLOYEE OR APPOINTEE **** THIS SECTION MUST BE COMPLETED **** DISCLOSURE PERIOD: THIS STATEMENT REFLECTS YOUR FINANCIAL INTERESTS FOR CALENDAR MANNER OF CALCULATING REPORTABLE INTERESTS: FILERS HAVE THE OPTION OF USING REPORTING THRESHOLDS THAT FEWER CALCULATIONS, OR USING COMPARATIVE THRESHOLDS, WHICH (see instructions for further details). CHECK THE ONE YOU ARE USING (must ❑ COMPARATIVE (PERCENTAGE) THRESHOLDS OR ARE J YEAR ENDING DECEMBER 31, 2019. ABSOLUTE DOLLAR VALUES, WHICH REQUIRES ARE USUALLY BASED ON PERCENTAGE VALUES check one} DOLLAR VALUE THRESHOLDS PART A -- PRIMARY SOURCES OF INCOME (If you have nothing to report, NAME OF SOURCE OF INCOME (Major sources of income to the reporting person - See instructions) write "none" or "nfa") SOURCES ADDRESS DESCRIPTION OF THE SOURCE'S PRINCIPAL BUSINESS ACTIVITY RA Automotive 180 NW 49 ST Miami FI. 33127 PART B -- SECONDARY SOURCES [Major customers, clients, I (If you have nothing to NAME OF BUSINESS ENTITY OF INCOME and other sources of income to businesses report, write "none" or "nla") NAME OF MAJOR SOURCES OF BUSINESS' INCOME owned by the reporting person - See ADDRESS OF SOURCE instructions) PRINCIPAL BUSINESS ACTIVITY OF SOURCE N/A PART C -• REAL PROPERTY [Land, buildings owned by the reporting person - See instructions! (If you have nothing to report, write "none" or "nla") N/A Submitted into the You are not limited to the space on the lines on this form. Attach additional sheets, if necessary. public FILING INSTRUCTIONS for when record for item(s) SP.1, and where to Fite this form are the bottom 2. located at of page on 11-18-2020, City Clerk INSTRUCTIONS on who must file this form and how to Fill it out begin on page 3. CE FORM 1 . Drachm: January 1, 2V-29 Incerperaled by reference in Rule 34.8.202iII, F A.C. {Continued an reverse sidel At,E PART O — INTANGIBLE PERSONAL PROPERTY [Stocks, bonds, certificates of deposit, etc. - See instructions] (If you have nothing to report, write "none or "nia") TYPE OF INTANGIBLE BUSINESS ENTITY TO WHICH THE PROPERTY RELATES Cash- Bank Account Bank Of America, Dade Credit Union. Wells Fargo PART E — LIABILITIES [Major debts - See instructions) [If you have nothing to report, write "none" or '"nia'") NAME OF CREDITOR ADDRESS OF CREDITOR Goldman Sachs 272 South Main Street Salt Lake City, UT N ADDRESS OF BUSINESS ENTITY PART F — INTERESTS IN SPECIFIED BUSINESSES [Ownership or positions In certain types of businesses - See instrur�ons v (If you have nothing to report. write "none" or'"nia") -., e►� BUSINESS ENTITY # 1 BUSINESS EpTY # 2 AME OF BUSINESS ENTITY r jrn � Fri -� — C--1 m NIA PRINCIPAL BUSINESS ACTIVITY POSITION HELD WITH ENTITY —S— 7.1 rri rn I OWN MORE THAN A 5% INTEREST IN THE BUSINESS NATURE OF MY OWNERSHIP INTEREST PART G —TRAINING For elected municipal officers required to complete annual ethics training pursuant to section 112,3142, F.S. © I CERTIFY THAT I HAVE COMPLETED THE REQUIRED TRAINING. IF ANY OF PARTS A THROUGH G ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE L] SIGNATURE OF FILER: Signature: act"- Fremont Date Signed: 11/13/2020 CPA or ATTORNEY SIGNATURE ONLY If a certified public accountant licensed under Chapter 473, or attorney In good standing with the Florida Bar prepared this form For you, he or she must complete the following statement: prepared the GE Form 1 in accordance. with Section 112,3145, Florida Statutes, and the instructions to the form_ Upon my reasonable knowledge and belief, the disclosure herein is true and Correct. CPAIAttarney Signature: Date Signed: FILING INSTRUCTIONS: If you were mailed the form by the Commission on Ethics or a County Supervisor of Elections for your annual disclosure filing, return the form to that location. To determine what category your position fails under, see page 3 of instructions. Local officers/employees file with the Supervisor of Elections of the county in which they permanently reside. (if you do not permanently reside in Florida, file with the Supervisor of the county where your agency has its headquarters.) Form 1 filers who file with the Supervisor of Elections may file by mail or email. Contact your Supervisor of Elections for the mailing address or ernail address to use. Do not email your form to the Commission on Ethics. it will be returned. State officers or specified state employees who file with the Commission on Ethics may file by mad or email. To file by mail, send the completed form to P.O. Drawer 15709, Tallahassee, FL 32317-5709; physical address: 325 John Knox Rd, Bldg E, Ste 200, Tallahassee, FL 32303. To the with the Commission by email, scan your completed form and any attachments as a pdf (do not use any other format), send it to CEForml geg.state.flus and retain a copy for your records. Do not file by bath mail and email. Choose only on - filing method. Form 6s will not be accepted via email. CE FORM 1 - Etedive: January I, 2020, Incorporated by reference in Rule 34.8.202(1 ), F.AC. Candidates file this form together with their filing papers. MULTIPLE FILING UNNECESSARY: A candidate who files a Form 1 with a qualifying officer is not required to file with the Commission or Supervisor of Elections. WHEN TO FILE: Initially, each local officer/employee, state officer, and specified state employee must file within 30 days of the date of his or her appointment or of the beginning of employment. Appointees who must be confirmed by the Senate must file prior to confirmation, even if that is less than 30 days from the date of their appointment. Candidates must file at the same time they file their qualifying papers. Thereafter, file by July 1 following each calendar year In which they hold their positions. Finally, fife a final disclosure form (Form 1 F) within 60 days of leaving office or employment. Filing a CE Form 1 F (Final Statement of Financial Interests) does not relieve the filer of filing a CE Form 1 if the filer was in his or her position on December 31, 2019. Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk PAGE 2 CANDIDATE OATH — NONPARTISAN OFFICE (Do not use this form if a Judicial or School Board Candidate) Check box only if you are seeking to qualify as a write-in candidate: Write-in candidate RECE IV ° 2020 NOV 13 PSI 2= 28 I'rr;. E ;r,r iliE CITY CLERK CITY OF MNAt1l OFFICE USE ONLY Candidate Oath (Section 99,021(1)(a), Florida Statutes) I Zico Fremont (Print name above as you wish it to appear on the ballot. If your fast name consists of two or more names but has no hyphen, check box ❑. (See page 2 - Compound Last Names). No change can be made after the end of qualifying. Although a write-in candidate's name is not printed on the ballot, the name must be printed above for oath purposes.) am a candidate for the nonpartisan office of City commissioner 5 (Dice) (District #) I am a qualified elector of Miami -Dade County, Florida, (Circuit #) (Group or Seat #) I am qualified under the Constitution and the Laws of Florida to hold the office to which I desire to be nominated er elected; I have qualified for no other public office in the state, the term of which office or any part thereof runs concurrent with the office I seek; and I have resigned from any office from which I am required to resign pursuant to Section 99.012, Florida Statutes; and I will support the Constitution of the United States and the Constitution of the State of Florida. Candidate's Florida Voter Registration Number (located on your voter information card): 110323493 Phonetic spelling for audio ballot: Print name phonetically on the line below as you wish it to be pronounced on the audio ballot as may be used by persons with disabilities (see instructions on page 2 of this form) [Not applicable to write-in candidates.] ziko frimnt - r 1! , Zico.fremont@ gmail,com (7861 X ��--,� 768-3567 Sign e of Candidate Telephone Number Email Address 18NW 49 Street Miami Florida 33127 Address City STATE OF FLORIDA COUNTY OF�a�t -•�f : State ZIP Code Signalt Print, amilimelpiturigruppwwwwompriii Submitted of Ty r ,s'';'r".":•., : E.j'` , into otary Public Stamp Commissioned Name of SANDRA.ORGES a= NotayPuollc-StieafFlorida Commission N GG fl2A618 - myComm.ExaresMar19,2t2t the public — Notary Public below: M Sworn to (or affirmed) and subscribed before me by physical or 4 -x ❑ online presence this V...) day of 1)+�°rV \ r' 7 7A . Personally Known: or Produced Identification V/ r+ yam Type of identification Produced. (l.- 3`, we1 S U.ckf DS•DE 302NP (Rev. 04120) .s] on 11-18-2020, City Clerk Rute 1S-2,0001, F.A.C. STATE OF FLORIDA COUNTY OF MIAMI-DADE C First Narne LOYALTY OATH RECEIVED 2020 NOY 13 PM 2: 28 r,wL OF THE CITY CLERK Submitted into the public record for item(s) 5P•1 on 11-18-2020, City Clerk Tel/0ti`� Last Name a citizen of the State of Florida and of the United States of America, ... and a candidate for public office ... do hereby solemnly swear or affirm that I will support the Constitution of the United State and Q the State of Florida. 1 �Gt 4r1�� ure of Candidate CITY OF MIAMI OATH OF CANDIDATE OFFICE OF 0,54s r'c 5 Before me, an officer authorized to administer oaths, personally appeared (PLEASE PRINT NAME) who, being sworn, says he/she is a candidate for the office of r k . ,,, �, , , e,t .r , for the City of Miami, Florida: that he/she is a qualified elector of the City of Miami, Florida; that he/she is qualified under the Constitution„ the Laws of Florida, and City of Miami Charter to hold the office to which he/she desires to be elected; that he/she has taken the oath required by Section 99.021, Florida Statutes; that he/she has qualified for no other public office in the State, the term of which office or any part thereof runs concurrent with that of the office he/she seeks; and that he/she has resigned or taken a leave of absence from any office from w h he/she is required to resign or take a leave of absence, pursuant to Section 99.012, Florida Statutes. i4 l Address City r Signatur of Candidate State The Loyalty Oath and Oath of Candidate are sworn to (or affirmed) and subscribed before me by physical or nonline presence, this l - �C� day of 4i? Al_ ( , 20 2 . Signa ider Administering Oath or Notary Public Personally Known: OR Produced Identification:T—/-1 Type of Identification Produced: C L. Dr\ve it see. Narne of Notary Typed, Prin'tied or Stamped SANDRA FORGES ` r 91 c •. Notary p, c -%Me of Ronda ,} • Commission 4 G6 OB4615 f hty Carnm.,,eires F s9.2ti21 bve4J gavall HSgn Asr. iur2o2r1 From: To: Subject: Date: Attachments: Zico Fremont Camoaacns. City Zico Fremont Resume Friday, November 13, 2020 3:53:46 PM Federal Resume (1) (nod Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk 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. Zico Fremont 786-768-3567 zico.fremont .gmai1.com Submitted into the public record for iteni(s) SP.1 on 11-18-2020, City Clerk Zico Fremont 180 NW 49 ST, Miami, FL 33127 (786) 768-3567 1 zico.fremont@gmaill.com Date available to begin work: Immediately SUMMARY STATEMENT Honored Professional with eight years of managerial experience working in Government and nonprofit industry, Finance, Operations and Customer Relations. Strives to exceed professional and personal goals. Strong written and verbal communication skills. PROFESSIONAL SKILLS Education Professional Certificate in Global Financial Crisis and Financial Markets from Yale University Online . Bachelor of Science in International Relations from Florida International University. Associate in Science in Business Management and Music. Associate in Art in Liberal Arts from Miami Dade College. Employment My self -motivation, hard work and dedication all contribute to the continuing success of my employer, Technically competent, Natural leader and team player. Personal Strong work ethic with a positive approach. Expert in Multitasking, Decision making, and Effective communication. Continuously striving to achieve goals and exceed expectations. Organized and focused. Proficient in Mac and Windows platforms. Experienced in Python, html, css, C#, javascript program languages. Proficient in Quickbooks, Microsoft Office, including Word. Excel, and PowerPoint, Mastery in Business management. International Law, Business Law, Social Media Marketing, Financial management. Impeccable managerial and interpersonal skills. Competent in Creole, French and Spanish. PROFESSIONAL WORK EXPERIENCE Chief executive officer, January 2017 — Present RA Automotive, Miami FL, At RA Automotive, we make sure to offer our clients the best advice for vehicle and auto parts, as well as provide them with great customer service. Our staff works with our customers to find the solutions they need for the right price_ We're here to help inform you about our products, .so that you only buy what is necessary Submitted into the public record for item(s) SP.]., on 11-18-2020, City Clerk Treasurer, May 2019 — Present Miami Shores Village Lodge 315 F&AM, Miami Shores, FL Supervisor: Andrew Adams, (305) 967-3544 Managed and oversees financial affairs, cash flows, prepared quarterly budget, monitored and compared revenues and expenses. Organized financial reports and important financial ratios_ Translate financial concepts and information to board members. Managed checking, business, and credit accounts for members, staff, and trustees. Prepared taxes quarterly and yearly on time, Certificate of Appreciation for May 2019, January 2020, and June 2020„ OTHER WORK EXPERIENCE Financial Advisor, December 2013 — March 2020 Aegis Capital, Miami, FL Supervisor: Vijay Singh, (305) 965-8216 Ensured clients meet all tax obligations by advising, preparing, and submitting tax returns in accordance with the Internal Revenue service and United States Treasury Department. Reviewed financial records such as income statements and documentation of expenditures. Verified clients totals on recent forms for accuracy. Provided businesses and individuals with guidance in financial planning and adhering to tax laws. Library Administrative Assistant, December 2017 — March 2018 Miami Dade County Government, Miami, FL Supervisor: Janet Jean, (786) 285-4571 Typed and field administrative documents, forms, and budget sheets. Shelved government materials by the Library of Congress Classification System . Created and organized government programs for STEM. Answered directional questions and assisted patrons on web communication applications. Scheduled appointments, updated event calendars and arranged staff meetings. Managed databases and filing systems, whether electronic or paper. Answered incoming calls; directed calls to appropriate associates, mail distribution, flow of correspondence, requisition of supplies as well as additional clerical duties. Employee of the month of December. Supervisor II, December 2017 — March 2018 Community Outreach Group, Miami, FL Supervisor: Sonia Lopez, (786) 994-4571 Developed strategies team members will use to reach our foundation goal. Provided training for team members. Give team members clear instructions to perform tasks_ Monitored team members work to ensure satisfaction. Provided important health information to communities by going to each resident home, speak to occupants and inquire occupants contact information. Successfully managed and led a team of 72 members. Received distinction award for being Team leader. Director of Government Relations, October 2015 — March 2016 Manifezt Foundation, Miami, FL Supervisor: Kaven Jean Charles (305)906-6622 Identified the primary demographics of the target region to rectify the rising social -economic issues Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk involving diversification in specific industries. Prepared memos, invoices, or reports to local Government officials. Chief of Staff Assistant, October 2014 — November 2016 City Of North Miami Government, Miami, FL Supervisor: Nicole Willams Analyzed and reviewed materials on grant proposals, city code ordinance, and State statutes. Modified city financial models: prepared video media; performed due diligence on proposed funds. Arranged social media properties; assisted local officials in organizing events. Director of Government Relations Student Government, October 2014 — October 2016 Florida International University, Miami, FL Job Type: 15 hours per week, Part -Time Supervisor: Larissa Adames Participated on various university committees to plan and implement strategies to support the vision of F.l_ U_ Impacted and created advocacy for the .student body, faculty. and staff. Directed F.1. U policies and objectives to Local and State affairs. EDUCATION Bachelor of Science in International Relations, August 2015 Florida International University, Miami, FL GPA 3.0 Associate in Science in Business Management, August 2010 Miami Dade College, Miami, FL 33138 GPA 3.0 CERTIFICATIONS/ACHIEVE MENTS Financial Market Certification, June 2020 Financial Crisis Certification, September 2019 FiU Dean's List, 2015 First Generation Scholarship Recipient, 2013 School Of international And Public Affairs Award, 2015 Treasurer Appreciation Award, 2020 Submitted into the public record for item(s) SPA on 11-7` 8-2a 20, City Clerk City Of North Miami Appreciation Award, 2016 Team Leadership Appreciation Award, 2018 Miami Dade College Alumni Award, 2010 TRAINING LAUNCH CODE PREMIER ACCELERATED LEARNING WEB DEVELOPMENT, UUKil)I, DIGITAL MARKETING & CORPORATE TRAINING May - November. 2018: 700 hours University of Miami Life Science & Technology Park. Miami„ FL VOLUNTEER EXPERIENCE / COMMUNITY SERVICE Assistant Coach, August 2010 — .lune 2014 Little Haiti Optimist, Miami, FL Job Type. 13 hours per week, Part -Time Supervisor: Mane Pierre Monitored student athletes progress in academics in school and at home_ Oversaw the discipline, conduct and image of all student athletes. Assisted students in interest related activities. Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk INTENTIONALLY LEFT BLANK Submitted into the public record for item(s) SP.1, on 11-18-202Q, City Clerk fllli„,l ll,l • fr: r% CITY COMMISSION VACANCY AFFIDAVIT OF APPOINTMENT r?; a CITY OF MIAMI, FLORIDA 74 S rri `� -<,, I. —...1 STATE OF FLORIDA ) F- tn = f COUNTY OF MIAMI-DADE ) —,-, D SA CITY OF MIAMI ) IN, % Q' Michael A. Hepburn (hereinafter °`affiant°'), being first duly sworn under penalty of perjury, deposes and says: 1. My name is Michael A. Hepburn 2. I am offering myself as an appointee to fill the unexpired term for the vacant office of Commissioner in District Number 5 of the City of Miami, Florida. I fully understand that I must maintain an actual and real residence within the district for the duration of my term of office. 3. I have resided in the Commission District Number 5 for a minimum of one year before qualifying, and I am a registered voter and a duly qualified elector in District 5. I am presently registered to vote in Precinct No. 504 I presently reside at the following address (must include zip code): 645 NE 77th Street #16, Miami, FL 33138 which is my legal address, and I have resided continually at said address from the 1st day of August 2020 to the present. 4. Immediately prior to residing at the above -stated address, I have resided at the hereinbelow listed addresses for the cited periods of time (list hereinbelow all addresses at which you have resided for the past five years, as well as the length of time at each address): Prior Addresses:�>For te Period: n,;12G .t�i j�ia�e.ntk l 444. # 1 J U L 2020 to Nov 2019 l #2 OCT 2019 to May 2019 xP 8202 NE ter Ave. Miami. FL 331381 42 2402 NW 12 Ave, Miami FL 33127 tt3 1545 NW 15th 51 RD. Miami. FL 331251 114 1911 N River Dr, Miami, FL 33125 #3 APR 2019 to SEP 2018 l #4 AUG 2018 to OEC 2016 5494 N1rihEst4 Miernl Place Apartment #3. frliarTIl, Florlea 33137 c* a 2.14Ets* "r. m' sni, FL S:>ijl.3p Paige 1 L11 JUL 2001 to SEP 1982(MiamiBornlMiamiRaisedlMiamiMade) �-u Rey, 10/2020 5. In addition to the residence that I have listed as my present address, l also reside at the following listed addresses on a temporary basis as a secondary domicile or domiciles: N/A 6. Affiant's spouse resides at the following address (must include city, state and dip crsie): NIA?7-3 s t'rt 7. Affiant's minor children reside at the following address (must include city tate an ip code): Fri NIA 1r- " 8. At the present time, affiant (is) (0 not))registered to vote in any city, county or state other than as stipulated in subparagrap 3-gove. 9. Name and business address of affiant"s employer: Miami Dade College - Institute for Civic Engagement and Democracy 11380 North West 27th Avenue, Room 4204 Miami, Florida 33167 Coordinator (North Campus & Carrie P. Meek Entrepreneurial Education Center) 10. Affiant's occupation: Affiant's business telephone number(s): (305) 237-10 11. Affiant has been employed in the above -cited capacity for the following period of time: September 2020 to Present (Note: In the event the occupation of affiant has been for a period of less than one year, or the employment period with the same employer has been for a period of less than one year, affiant shall give the name(s) and address(es) of his/her employer(s) and occupation(s) for the period of one year prior to the date of this affidavit). T,+i•.i.f-i.:.0 PAC., ION Grree. B&N, Said 5P55 C45,S1 FL 531151 E Orals anDreetir1''E9 no15 NOV ;PG Ane Flora 5.5vmLma.LE5ne !l] j 117v14N ELP.O r. NAIL ZU,Me, fe! I 11.Je E a..ten»Cn.ti1. F55 o•e `A 'AT' MC' 7 �vr' P.lOi..�4- i S'Lca-.5zc•1- .�-L77100 ib'trxc;.�-i. PiiJcl Gt1'r'erHkI 5wcr C3r3 ir.[..`tr�r C-t.'h 2.6'l..) - .24.46 Twtiul riiv PAC 1 fa'ea C. 4t .,! S. a'.L15 Be,. Fl33•M raann>onc Q•NY%rI.FH:025 i, NOY2OLFF eel Flenae 61'en.55.5 Fins's-+,Y 1r 799 S& 5 !Ater. 5A5C 2a Y55.A.€Wv.31,/31 a...55 C55.5 I IEe 73 ila M1NR 2L1/n FIOV' Er1rF Sr rJc�l 1 nNec,..ibr 1-1-fin S+4',1 9 citccr.•t- 9i13 ci SUt te11(-00-( 1`2h2,,° 12. Affiant represents that he/she (is) is not) currently holding another elective or appointive office — whether city, county or municipal — the term of which or any part thereof runs concurrently with that of the office he/she seeks, and that he/she has resigned from any office from which he/she is required to resign pursuant to F.S.99.012 and/or the City of Miami Charter, 13. Affiant represents that, if appointed, he/she shall serve in the office so appointed. Page 2 ❑ -3 Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk Rev. I W2020 414 SIGNED THIS fI DAY OF OlNerAbe Submitted into the public record for item(s) SP.1 on 11-18-2020, City Clerk AFF{ANT BEFORE ME, the undersigned authority, by means of V physical or online presence appeared r ‘ Ci11Ote l A. \Q 4 , who, after first being duly sworn (or affirmed), deposes and states that \n� executed the foregoing to the best of k l5 knowledge and belief. (SEAL) CIRK, CITY OF MIAMI, FLORIDA Did take an oath Produced identification Type of identification produced: OisNier Lu2"ice ,.ems_ aaa__ an. --. SANDRA FORGES Natary Pub': Swe of Amex Commissan GG 084818 My Cum Expos Mar 19, 2021 a Snrw1A N9idW%Ory W. Page 3 or3 Rev. 10/2020 FORM 1 STATEMENT OF 20I9 Please print or type your name, mailing address, agency name, end position below; FINANCIAL INTERESTS FOR OFFICE USE ONLY: LAST NAME -- FIRST NAME — MIDDLE NAME : Hepburn Michael Antwan MAILING ADDRESS 645 NE 77th Street#16 c co ,=, ' = 2J CITY : ZIP : COUNTY : Miami 33138 Miami Dade c-' ] = •--` fT NAME OF AGENCY : City of Miami m -II -‹ a MC IC3 NAME OF OFFICE OR POSITION HELD OR SOUGHT : City of Miami Commissioner - District 5 r�*1 N x 0` CHECK ONLY IF -1--1p,�tr-E-- OR NEW EMPLOYEE OR APPOINTEE 4 �'t *** THIS SECTION MUST BE COMPLETED'``* DISCLOSURE PERIOD: THIS STATEMENT REFLECTS YOUR FINANCIAL INTERESTS FOR CALENDAR YEAR ENDING DECEMBER 31, 2019. MANNER OF CALCULATING REPORTABLE INTERESTS: FILERS HAVE THE OPTION OF USING REPORTING THRESHOLDS THAT ARE ABSOLUTE DOLLAR VALUES, WHICH REQUIRES FEWER CALCULATIONS, OR USING COMPARATIVE THRESHOLDS, WHICH ARE USUALLY BASED ON PERCENTAGE VALUES (see instructions for further details). CHECK THE ONE YOU ARE USING (must check one): D COMPARATIVE (PERCENTAGE) THRESHOLDS OR Q DOLLAR VALUE THRESHOLDS PART A -- PRIMARY SOURCES OF INCOME (If you have nothing to report, NAME OF SOURCE OF INCOME [Major sources of income to the reporting person - See instructions] write "none" or "nla") SOURCES ADDRESS DESCRIPTION OF THE SOURCES PRINCIPAL BUSINESS ACTIVITY Florida International University 11200 SW 8 Street, Miami, Florida 33199 Public University )Mertz Local Edition 13205 SW 137 Ave, Miami, Florida 33186 Rental Car Company PART B -- SECONDARY SOURCES [Major customers, clients, (If you have nothing to NAME OF BUSINESS ENTITY OF INCOME and of ier sources of income to businesses report, write "none'" or"n/a") NAME OF h•1AJOR SOURCES OF BUSINESS' INCOME owned by the reporting person - See ADDRESS OF SOURCE instructions] PRINCIPAL BUSINESS ACTIVETY OF SOURCE N/A PART C -- REAL PROPERTY [Land, buildings owned by the reporting person - See instructions] (If you have nothing to report, write "none" or "We") NIA You are not limited to the space on the lines on this form. Attach additional sheets, if necessary. FILING INSTRUCTIONS for when and where to file this form are located at the bottom of page 2. INSTRUCTIONS on who must fife this form and how to Fill it out begin on page 3. Submitted into the public record for item(s) SP.1 l ! On 11-18-2020, City Clerk r GE FORM 1 - Elreclee: January I. 2020 Incorporated by relerenle in Rule 3-1-8,20211 j, FAG_ (Continued on reverse side) PAGE PART D — INTANGIBLE PERSONAL PROPERTY [Stocks, bonds, certificates of deposit, etc (If you have nothing to report, write "none" or "nia") TYPE OF INTANGIBLE See instructions] BUSINESS ENTITY TO WHICH THE PROPERTY RELATES St LTniv System Op Retiretnent(SUSORP) Personal Retirement Acount via VOYA PART E— LIABILITIES (Major debts- See instructions] (If you have nothing to report, write "none" or "nia") NAME OF CREDITOR ADDRESS OF CREDITOR Federal Student Loans FedLoan Servicing, P.U. Box 69184, Harrisburg, PA 17106-9184 PART F — INTERESTS IN SPECIFIED BUSINESSES Ownership or positions in certain types of businesses - See instructions] (If you have nothing to report, write "none" or "NB") NAME OF BUSINESS ENTITY BUSINESS ENTITY # 1 BUSINESS ENTITY # 2 ADDRESS OF BUSINESS ENTITY PRINCIPAL BUSINESS ACTIVITY POSITION HELD WITH ENTITY I OWN MORE THAN A 6% INTEREST IN THE BUSINESS NATURE OF MY OWNERSHIP INTEREST N/A N/A 7.4 r C1r. �, f-l-1 PART G — TRAINING y Fri Far elected municipal officers required to complete annual ethics training pursuant to section 112.3142, F.S._- I CERTIFY THAT 1 HAVE COMPLETED THE REQUIRED TRAINING. r•) 1F ANY OF PARTS A THROUGH G ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE LJ Signature: SIGNATURE OF FILER: k Date Signed: d1/ i / 2C 6 CPA or ATTORNEY SIGNATURE ONLY if a certified public accountant licensed under Chapter 473, or attorney in good standing with the Florida Bar prepared this form for you, he or she must complete the Fallowing statement: , prepared the CE Form 1 in accordance wtth Section 112.3145, Florida Statutes. and the instructions to the form. Upon my reasonable knowledge and belief, the disclosure herein is true and correct. CPA/Attorney Signature: Date Signed: FILING INSTRUCTIONS: if you were mailed the form by the Commission on Ethics or a County Supervisor of Elections for your annual disclosure filing, return the form to that location. To determine what category your position falls under, see page 3 of instructions. Local officers/employees file with the Supervisor of Elections of the county in which they permanently reside. (If you do not permanently reside in Florida, file with the Supervisor of the county where your agency has its headquarters.) Form 1 filers who file with the Supervisor of Elections may file by mail or email. Contact your Supervisor of Elections for the mailing address or email address to use. Do not email your form to the Commission on Ethics, it will be returned. State officers or specified state employees who file with the Commission on Ethics may file by mail or email. To file by mail, send the completed form to P.O. Drawer 15709, Tallahassee, FL 32317-5709; physical address: 325 John Knox Rd, Bldg E, Ste 200, Tallahassee, FL 32303. To file wilh the Commission by email, scan your completed form and any attachments as a pdf (do not use any other format), send it to CEForml r@i leg.state.fl.us and retain a copy for your records. Do not file by both mail and email. Choose only one filing method. Form 6s will not be accepted via email, Candidates file this form together with their filing papers_ MULTIPLE FILING UNNECESSARY: A candidate who Files a Form 1 with a qualifying officer is not required to file with the Commission or Supervisor of Elections. WHEN TO FILE: Initially, each local officer/employee, state officer, and specified state employee must file within 30 days of the date of his or her appointment or of the beginning of employment. Appointees who must be confirmed by the Senate must file prior to confirmation, even if that is less than 30 days from the date of their appointment_ Candidates must file at the same time they file their qualifying papers. Thereafter, file by July 1 following each calendar year in which they hold their positions. Finally, file a final disclosure form (Forrn 1F) within 60 days of leaving office or employment, Filing a CE Forrn 1F (Final Statement of Financial Interests) does WI relieve the filer of filing a CE Form 1 if -1 2019. Submitted into the public record for item(s) SP,1, on 11-18-2020, City Clerk CE FORM 1 - EfleCave: January t. 202t7. I1 ce(peraled try reference in Rule 34-6.2O2{1 j, FA.C. PAGE 2 CANDIDATE OATH — NONPARTISAN OFFICE (Do not use this form if a Judicial or School Board Candidate) Check box only if you are seeking to qualify as a write-in candidate: ❑ Write-in candidate 1-..r(r J1=r �- j MC NOV .!•7 pm I: 26 L t ;, E OF ii'aE CI FY CLERK CITY OF MIAMI OFFICE USE ONLY Candidate Oath (Section 99.021(1)(a), Florida Statutes) r, "i\ C\~��e\ A- IeaoburN3 (Print name above as you wish it to appear on the ballot. If your fast name consists of two or more names but has no hyphen, check box 111. (See page 2 - Compound Last Names). No change can be made after the end of qualifying. Although a write-in candidate's name is not printed on the ballot, the name must be printed above for oath purposes.) am a candidate for the nonpartisan office of [, %-k 1 at. K Cox f1.1 Co in Ph i Tii c+1t1C(- 5 (Office) (Disttict #) ; I am a qualified elector of H1 Cs.. tot Oa.de C ui 1 } County, Florida; (Circuit #) (Group or Seat #) ff I am qualified under the Constitution and the Laws of Florida to hold the office to which I desire to be nominated ar elected; I have qualified for no other public office in the state, the term of which office or any part thereof runs concurrent with the office I seek; and I have resigned from any office from which I am required to resign pursuant to Section 99.012, Florida Statutes; and I will support the Constitution of the United States and the Constitution of the State of Florida. Candidate's Florida Voter Registration Number (located on your voter information card): -A--0 B Lk ---- Phonetic spelling for audio ballot: Print name phonetically an the line below as you wish it to be pronounced on the audio ballot as may be used by persons with disabilities (see instructions on page 2 of this form): (Not applicable to write-in candidates.] (r e -- 1-c,urt 1 he.p-bar N X ,c..I,1Cd . A-. )-dep.rz.N t iNi } 5€l Q " 2.o -6 8, f r"1-1 c)rl4'e,1 mtiCYlc-te1 hev bur Iv -4n Signature of Candidate Telephone Number Email Address Address City STATE OF FLORIDA j� COUNTY OF 11\AOLYYII '-.ok8 State ZIP Code Signs Pont, Submitted f Notary Public Type, or Stamp Commissioned Name of 5khd'JRA7ORGES ° WryPaw e-Start etForda Col- sso^o'GGYl4V1 1,4Cr -i Exym Via. 1.2021 i101::":7 • FYe[CN 5*try OSP Notary Public below: Sworn to (ar affirmed) and subscribed before me by physical or ❑ online presence this 11 day of �uclJ°,W er' , 20 ZO. I Personally Known; or Produced Identification: into the public Type of identification Produced: 1_ bmter L. ce (t . DS-DE 302NP (Rev. 04/20) record for item(s) SP.1, on 11-18-2020, City Clerk tote IS-2.0001. F.A.C. LOYALTY OATH STATE OF FLORIDA COUNTY OF MIAMI-DADE Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk First Name Middle Initial Last Name a citizen oegtate of Florida and of the United States of America, ... and a candidate for public office ... do her sol�nnILswear or affirm that 1 will support the Constitution of the United States and of the State of Florida. t-.) E —(4:1:r h,et.'711-) A - jtriaLPA LLJ r` i eI (1) ,_C, Signature of Candidate CITY OF MIAMI OATH OF CANDIDATE OFFICE OF irL:wiv- Cornm151crue.fl. Y 1,+cask Before me, an officer authorized to administer oaths, personally appeared C e-L r Hl,e lb r t\i (PLEASE PRINT NAME) who, being sworn, says he/she is a candidate for the office of .* , C (7) c rr. r i 7;� �+1e c for the City of Miami, Florida; that he/she is a qualified elector of the City of Miami, Florida; that he/she is qualified under the Constitution, the Laws of Florida, and City of Miami Charter to hold the office to which he/she desires to be elected; that he/she has taken the oath required by Section 99.021, Florida Statutes; that he/she has qualified for no other public office in the State, the term of which office or any part thereof runs concurrent with that of the office he/she seeks; and that he/she has resigned or taken a leave of absence from any office from which he/she is required to resign or take a leave of absence, pursuant to Section 99.012, Florida Statutes. Address A-. J- 0.A) Signature of Candidate City State ZIP Code The Loyalty Oath and Oath of Candidate are sworn to for affirmed) and subscribed before me by physical or 114 online presence, this n day of 0Vern er— , 20X . Signa 0 `Icer Administering Oath or Notary Public Personally Known' OR Produced identification:F71 Type of Identification Produced: f.L.- D`r: ve V C CE Vl Se - ra files Name of Notary Typed, Pritield or Stamped SANDRA FORGES hies ry Peen:— Sit? of Florda Cornmssun # GG 08a6t8 My Comm. Expires Mat 19, 2021 eanoei mica Raoul kwryAsp. Ior2o20 Forges, Sandra From: Sent: To: Subject: Attachments: Submitted into the public record for item(s) SP.1, on 11-15-2020, City Clerk Michael Hepburn <michael.hepbum@ymail.com> Monday, November 9, 2020 4:19 PM Campaigns, City Michael A. Hepburn M.S.Ed. I Resume Packet Michael A. Hepburn - City of Miami Commissioner from District 5 Resume.pdf 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 To: City' of Miami Commissioners 3500 Pan American Drive llriiami. Florida 33133 Attached to this email, you will find my Resume Packet for your review. Respectfully, Michael A. Hepburn, M.S.Ed. Candidate for City of Miami Commissioner from District 5 Michael A. Hepburn, M.S.Ed. 645 NE 77th Street, Miami, Florida 33138 November 10, 2020 To: City of Miami Commissioners 3500 Pan American Drive Miami, Florida 33133 Dear City of Miami Commissioners, I am confident that my education credentials. strong professional work experience, and record of service in our communities — has precisely prepared me for this opportunity to serve. 1 have worked extremely hard to become a CNANGEMAKER and champion For Affordable Housing: Safe & Secure Neighborhoods: Economic & Workforce Development: and High -Quality Education for all of us. I cnn qualified and ready for this oppor tt iry to sow: • Project Management. Effectively implemented my business acumen, and pro -active solution -based regimen to achieve objectives and targeted benchmarks. My extensive experience includes working with Fortune 500 Companies, Property Management Finns, Non -Profits. Labor Unions. Community Based Organizations. Non -governmental Organizations, Elected Officials. Professional Athletes (NBA & NFL), community stakeholders, multicultural students, parents and our remarkable senior citizens. • higher Education Administration, Serving at three types of institutions (HBCU. Private, & Public) with more than six combined years of experience. I understand the challenges and opportunities that our City of Miami children encounter from our Pre-K-through-12 schools and their assortment of post -secondary goals & dreams. • Servant Leadership. Over the last ten years — developed_ enhanced, and supported programs that focused on community building and addressed the civic empowerment gap which exist in our communities. As a Miami Herald Silver Knight Award Recipient and Legacy Miami 40 Under 40 Honoree, service to others is in my blood. I'm a Co -Founder of Allapattah Neighborhood Association and formerly served as a member of City of Miami Parks & Recreation Advisory Board: Citizen - on -Patrol with Miami Police Department, and currently serve as a (Miami Workers Center) Health & Housing Liberty in the City Steering Committee Member. Financial Budgeting. Despite limited budgets — I have used innovative, cost-effective techniques_ and private -public partnerships to execute, recruit and foster transparent & strong financial concepts to achieve organizations strategic plans. Advocacy. Attended in -person or virtually watched every City of Miami Commission Meeting held in 2020, to learn, process and disseminate vital information to my fellow district residents. During my time serving as Student Government Association Vice President at Florida International University and onward — I have utilized Parliamentary procedure (Robert's Rules of Order) rules and customs for governing meetings and I'm familiar with Mason's Manual of Legislative Procedurc/Municode. • MMiatni Made. Native son of Little Haiti, and 30+ year resident of City of Miami — I am Miami Born, Miami Raised, and Miami Made. As a graduate of Toussaint L'ouverture Elementary to attending and graduating from Miami Dade County Public Schools. From running to bus stops to catch the #9, #54, #62 Metro Buses and the Jitneys -- to playing football at Athalie Range park and basketball at Lemon City park — to now working for Can-ie P. Meek Entrepreneurial Education Center (MEEC) and traveling home to Belle Meade — I know District 5. In all honesty, my preference would be for our Miami Commission to call for a special election, so my fellow residents can cast their ballots and vote for who we would like to represent us as the next Commissioner from District 5. I-Iowever. I am ready to showcase my accomplished skill set that hopefully will set me apart from the other applicants if you chose otherwise. Please feel free to contact me at 786-390-2068 or michaelritmichaelhepburn.com if 1 can provide you with any additional information. Thank you for your kind consideration. Sincerely. a ,f[ickat,et ?r. �Fe.p1yrrvl, Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk MICHAEL A. HEPBUIRN, M.S.Ed. 645 NE 77ih Street, Miami, Florida 33 138 i (786) 390-2068 ( Michael cz+Michae!Hepburmeom SUMMARY OF QUALIFICATIONS Project Management • Directly supervised over [123] professional staff members and experience managing up to S23 Million Dollars in budgeted revenues. • Project managed over [20] client Initiatives by planning and implementing programs administrative and operational activities (including finance budgets, evaluations. event planning, curriculum design. recruitment strategy, and marketing initiatives). • Assisted with execution of logistical operations for [37] events (e.g. SB XLVI, MEAC Championships, Progressive Turnout Project). • Successfully enlisters teams, implemented strategies, and measured ROI of initiatives for all stakeholder groups. • Articulated report overviews to various administrators and community stakeholders — also interviewed prospective contractors. project managers, and vendors to deteiinine completion dates and financial projections, • Produced hi -weekly observation reports, implemented performance -based funding reviews, and initiated quarterly financial audits. Strategic Partnerships Development & Engagement • R.aised awareness of multiple assigned program initiatives through cultivating relationships with targeted prospective participants. • Conducted presentations (PowerPoint/Roundtahlesl at high schools, CFBO's, university stakeholders/philanthropic donor events. • Networked and proactively researched new revenue opportunities and identified new partnerships & player appearance activations. • Traveled across the country to facilitate partnership meetings, onboarding traininrgs and activations of corporate sponsor events. • Focused on grass -tops advocacy and relationship -building with pro/collegiate athletes, governmental officials, and corporate entities. • Served as primary point of contact for all emai Is, phone calls, and inquires related to execution of program initiatives (SalesForce CRM). Educations Administration • Oversaw management of Florida International University Golden Scholars Bridge Program. Planned, implemented, and executed operational activities including program budget. engagement, professional development curriculum design. and marketing initiatives. • Focused recruitment efforts on increasing higher education enrollment from City of Miami Senior High Schools d Miarni Northwestern, Miami Edison. Miami High, Miami Jackson, and Booker T. Washington). • Utilized experiential learning opportunities to develop my student -athletes knowledge. skills. and values through direct experiences. • Increased university brand awareness and expanded recruitment regions via marketing campaign tot 1,500) public/private high schools. • Taught Freshman Year Experience Seminar sections covering life skills, social justice, and financial literacy topics. Leadership & Advocacy • Coordinated roundtable events for youth groups, collegiate students. government officials and community/faith-based groups to collaborate and share different perspectives. • Co-founded Allapattah Neighborhood Association. and formerly served as Citizen -On -Patrol with Miami Police Department, City of Miami Parks & Recreation Advisory Board member. and Catalyst Miami — Community Leadership on the Environment. Advocacy, and Resilience Fellow. • Co -executed 5,000,000 calls campaign and captured thousands of commitment -to -votes from voters as a part of Operations Directors team with [8] offices, and [138] employees statewide. • Successfully written legislation and city ordinances (Municode), advocated for policy initiatives/constitution amendments and incorporated multicultural prograrns/services to promote inclusion, encourage social responsibility, equality, and collective success. Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk 2 WORK EXPERIENCE 'Miami Dade College Coordinator l Institute of Civic Engagement and Democracy Freelance Project Manager (Marketing & Public Affairs) Currant Title/Client: District Operations Director l Progressive Turnout Project Florida International University Success Coach l Golden Scholars Bridge Program University of Miami Senior Advisor l Miami Business School North Carolina A&T State University Lecturer & Academic Counselor l Student -Athlete Enhancement Program National Football League Players Association (AFL-CIO) Coordinator of Players Services I Players Inc. September 2020 — Present Miami, FL May 2007 — November 2020 Miami, FL February 2019 — February 2020 Miami, FL August 2016 — February 2018 Coral Gables, FL July 2015 —July 2016 Greensboro, NC June2011— June 2012 Washington, DC EDUCATION FLORIDA INTERNATIONAL UNIVERSITY Master orScience in Higher Education Administration Areas of Concentration: Student Affairs and Public Administration Bachelor of Science Physical Education — Sports Management Track MIAE,11 DADE COLLEGE Associate Arts MIA71,11 CENTRAL SENIOR HIGH SCHOOL H.S. Diploma - Academy of information Technology Magnet Miami, FL April 2014 April 2008 Miami, FL August 2006 Miami, FL June 2001 TRANSFERABLE SKILLS Proficient with Microsoft Word, SharePoint, Excel, PowerPoint l G-Suite Products l CRM l Robert's Rules of Order 1 Mason's Manual Municode Facebook, Twitter, Instaeram l Public Sector Budgeting l Advocacy I Coalition Building l Public Relations I Negotiation PROFESSIONAL AFFILIATIONS • The Omicron Chi Chapter of Kappa Alpha Psi Fraternity, Inc— Charter Member • The National Association of Academic and Student -Athlete Development Professionals (N4A) Submitted into the public record for itern(s) SP.1, on 11-18-2020, City Clerk 3 Submitted into the public record for item(s) SP,1, on 11-18-2020, City Clerk Michael A. Hepburn is Ready to Serve as your next City of Miami Commissioner —> COMMUNITY/PROFESSIONAL PUBLIC SERVICE PROFESSIONAL • Operations Director— Miami Dade, Progressive Turnout Project. • Member, National Association for the Advancement of Colored People —Miami Dade Branch. • Graduate, Health and Housing Liberty in The City Leadership Training — Miami Workers Center & Partners. • Inaugural Mentor, DCS Mentoring Program, • 2020 Honoree, Legacy Miami 40 Under40 Awardee • Fellow, Community Leadership on the Environment Advocacy and Resilience Program —Catalyst Miami. • Co -Founder, Allapattah Neighborhood Association. • Citizen -On -Patrol, City of Miarni Police Department. • Board member. City of Miami Parks & Recreation Advisory Board. • State Senator, Florida Model Legislature. • Fellow, Lawton Chiles Leadership Corps. Intern, National Football League Players Association. (AFL-CIO). • Charter Member, The Omicron Chi Chapter of Kappa Alpha Psi Fraternity. Inc. • Vice -President, Student Government Association, Florida International University. • Award Recipient, The Miami Herald Silver Knight_ • Coordinator, Institute of Civic Engagement and Democracy, Miami Dade College, • Success Coach, Golden Scholars Bridge Program, Honda International University. • Senior Advisor, Herbert Business School, University of Miami. • Lecturer & Academic Counselor, North Carolina Agricultural and Technical State University. • Player Services Coordinator, National Football League Players Association (AFL-CIO). • Principal Project Manager, Freelance Consulting. • Executive Team Leader, Target Corporation. EDUCATION • Master of Science in Higher Education Administration, Florida International University. • Bachelor of Science in Sports Management, Florida International University. • Associate Arts Degree, Miami Dade College_ • Miami Central Senior High School. • South Miami Middle School, • Toussaint L'Ouverture Elementary School "Putting People First" Mill FOR B1 CONDUITEE r0 EL Ecr siitlu EL ilErRl.R1 Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk INTENTIONALLY LEFT BLANK STATE OF FLORIDA COUNTY OF MIAMI-DADE CITY OF MIAMI Submitted into the public record for item(s) SP.1, on 11-18-ZD2.0 City Clerk y� CITY COMMISSION VACANCY AFFIDAVIT OF APPOINTMENT {, M CITY OF MIAMI, FLORIDA 1 " ) mod. (hereinafter first duly sworn under penalty of perjury, deposes and says: 1. My name i1`` "affiant:`), being 2. I am offering myself as an appointee to fill the unexpired term for the vacant office of Commissioner in District Number 5 of the City of Miami, Florida. I fully understand that I must maintain an actual and real residence within the district for the duration of my term of office. 3. I have resided in the Commission District Number 5 for a minimum of one year before qualifying, and I am a registered voter an a duly qualified elector in District 5. I am presently registered to vote in Precinct No. CF I presently reside at the following address must include zip code): which is my legal address, and I have resided continually at said address from the / day of rJ/71-' r2 / t to the present. 4. Immediately prior to residing at the above -stated address, I have resided at the hereinbelow listed addresses for the cited periods of time (list hereinbelow all addresses at which you have resided for the past five years, as well as the length of time at each address): Prior Addresses: Pig 1 of For the Period: / j 7 ./Y,91, Ref. f 012020 5. In addition to the residence that I have listed as my present address, I also reside at the following listed addresses on a temporary basis as a secondary dom'cile or domiciles: (el7//4/ r 6. Affiant's spouse resides at the following address (must include city, state and zip code): 7. Affiant's minor children reside at the following address (must include city, state and zip code): g 8. At the present time, affian+ .. - not iistered to vote in any city, coun , r sl3ete er than as stipulated in subpa a,. rap ' above.;111 c, o rri ni ifs" 9. Name and business address of affiant's employer: 10. Affiant's occupation: S ' — ef t_5'0 Affiant's business telephone numbers): 11.1.1111.1 11. Affiant has been employed in the above -cited capacity for the following period of time: (Note: In the event the occupation of affiant has been for a period of less than one year, or the employment period with the same employer has been for a period of less than one year, affiant shall give the name(s) and address(es) of his/her employer(s) and occupation(s) for the period of one year prior to the date of this affidavit). 12. Affiant represents that he/she (is (i+' urrently holding another elective or appointive office — whether city, county o mun al — the term of which or any part thereof runs concurrently with that of the offit.- re/she seeks, and that he/she has resigned from any office from which .J s .required to resign pursuant to F.S.99.012 and/or the City of Miami Charter. 13. Affiant represents that, if appointed, he/she shall serve in the office so appointedp— Pnp 2 0f + Re . 10/2020 Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk 114 SIGNED THIS ____DAY OF tINgeldtbe W20 . Submitted into the public record for item(s) SPA on 11-18-2020, City Clerk AFFIANT BEFORE ME, the undersigned authority, by means of ' physical or online presence appeared 11111+(it. 14-D!i c , who, after first being duly sworn (or affirmed), deposes and states that Ske_ executed the foregoing to the best of h r knowlede and beii.f ITY CLEI K, CITY OF MIAMI, FLORIDA /077 Did take an oath + Produced identification Type of identification produced: 4 5P#OR?. FORGES 17otary Public - RV of Hata CommsPoli#GG684518 My Excites Mar 19.2OZ1 Ih�pan N�a�ii Hg,2n n 1)ykiev' Uceif.. e- (SEAL) a., rti sin co i C3 P ate 3 of 3 [tee-. !0r2112f1 FORM 1 STATEMENT OF 2019 Please print or type your name, mailing address, agency name, and posillon below: CITY : 4 NAME OF GENCY • .�,, FINANCIAL INTERESTS ZIP : Cs UNITY ///;14/-7/ NAME OF OFFICE OR POSI]fION [r(EL OR SOUGH CHECK ONLY IF 6,— I* PATE OR ;" . EMPLOYEE OR APPOINTEE DISCLOSURE PERIOD: THIS STATEMENT REFLECTS YOUR FINANCIAL INTERESTS FOR CALENDAR YEAR ENDING DECEMBER 31, 2019. MANNER OF CALCULATING REPORTABLE INTERESTS: FILERS HAVE THE OPTION OF USING REPORTING THRESHOLDS THAT ARE ABSOLUTE DOLLAR VALUES. WHICH REQUIRES FEWER CALCULATIONS, OR USING COMPARATIVE THRESHOLDS, WHICH ARE USUALLY BASED ON PERCENTAGE VALUES (see instructions for further details). CHECK THE ONE YOU ARE USING (must ch one). 01 COMPARATIVE (PERCENTAGE) THRESHOLDS OR DOLLAR VALUE THRESHOLDS PART A -- PRIMARY SOURCES OF INCOME (Major sources of income to the reporting person - See instructions] (If you have nothing to report, write "none" or "nfa") NAME OF SOURCE SOURCE'S OF INCOME ADDRESS FOR OFFICE USE ONLY: **** THIS SECTION MUST BE COMPLETED **** DESCRIPTION OF THE SOURCE'S PRINCIPAL BUSINESS ACTIVITY r1Gr-/ fit <i/ / / PART 8 -- SECONDARY SOURCES OF INCOME [Major customers, clients, and other sources of income to businesses owned by the reporting person - See instructions] (If you have nothing to report, write "none" or "nla" ) NAME OF NAME OF MAJOR SOURCES BUSINESS ENTITY OF BUSINESS' INCOME ADDRESS OF SOURCE 4- PRINCIPAL BUSINESS ACTIVITY OF SOURCE PAR' C -- REAL PROPERTY [Land, buildings owned by the reporting person - See instructions] (If you haven thl g to report, write "none" or "n!a") Submitted into the public CE FORM t - Erie -dive: January 1. 2G20 Incorporated by reference in Rufe 34-5.202(1), F.AC record for item(s) SP,1, on 11-18-2020, City Clerk [Continued en reverse sidel You are not limited to the space on the lines on this form. Attach additional sheets, If necessary. FILING INSTRUCTIONS for when and where to file this form are located at the bottom of page 2. INSTRUCTIONS on who must file this form and how to fill it out begin on page 3. PAGE i PART ❑ — INTANGIBLE PERSONAL PROPERTY [Stocks, bonds, certificates of deposit, etc. - 5ee instructions] (if you have nothing to report, write "none" or "nia") TYPE OF INTANGIBLE BUSINESS ENTITY TO WHICH THE PROPEOY Rp,TE C7 Cr J PART E — LIABILITIES [Major debts - See Instructions] (If you have nothing to report, write "none" or "nia") NAME OF CREDITOR (/ 7i'4 ADDRESS OF CREDITOR CD 0 PART F — INTERESTS IN SPECIFIED BUSINESSES Ownership or positions in certain types of businesses - See instructions] (If you have nothing to report, write "none' or "nla") BUSIN S ENTITY # 1 NAME OF BUSINESS ENTITY ADDRESS OF BUSINESS ENTITY PRINCIPAL BUSINESS ACTIVITY POSITION HELD WITH ENTITY I OWN MORE THAN A 5% INTEREST IN THE BUSINESS NATURE OF MY OWNERSHIP INTEREST BUSINESS ENTITY # 2 e ty ?.,r7c( l . PART G — TRAINING ,f For elected municipal officers required to complete annual ethics training pursuant to section 112.3142, F_S. ❑ 1 CERTIFY THAT i HAVE COMPLETED THE REQUIRED TRAINING. IF ANY OF PARTS A THROUGH G ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE 0 SIGNATURE OF FILER: Signature: Date Signed: FILING INSTRUCTIONS: If you were mailed the form by the Commission on Ethics or a County Supervisor of Elections for your annual disclosure filing, return the form to that location. To determine what category your position falls under, see page 3 of instructions. Local officers/employees file with the Supervisor of Elections of the county in which they permanently reside. (If you do not permanently reside in Florida, file with the Supervisor of the county where your agency has its headquarters-) Form 1 filers who file with the Supervisor of Elections may file by mail or email. Contact your Supervisor of Elections for the mailing address or email address to use. Do not email your form to the Commission on Ethics it will be returned. State officers or specified state employees who fie with the Commission on Ethics may file by maii or email. To fife by mail, send the completed form to P_O. Drawer 15709, Tallahassee, FL 32317-5709; physical address: 325 John Knox Rd, Bldg E, Ste 200, Tallahassee, FL 32303. To file with the Commission by email, scan your completed form and any attachments as a pdf (do not use any other format), send it to CEForml@leg,state.tl.us and retain a copy for your records. Do not file by both mail and email. Choose only one filing method. Form 6s will not be accepted via email. CE FORM 1 • Erfeclive: January 1, 2020. Inmfo-Wee by reference en mule 34•8202(4 F.A.G. CPA or ATTORNEY SIGNATURE ONLY If a certified public accountant licensed under Chapter 473, or attorney in good standing with the Florida Bar prepared this Corm for you, he or she must complete the following statement: 1 — -- , prepared the CE Form 1 in accordance with Section 112.3145, Florida Statutes, and the instructions to the form. Upon my reasonable knowledge and belief, the disclosure herein is true and correct. CPNAttorney Signature: Date Signed: Candidates file this form together with their filing papers. MULTIPLE FILING UNNECESSARY: A candidate who files a Form 1 with a qualifying officer is not required to file with the Commission or Supervisor of Elections. WHEN TO FILE: Initially, each local officerlernployee, state officer, and specified state employee must file within 30 days of the date of his or her appointment or of the beginning of employment. Appointees who must be confirmed by the Senate must file prior to confirmation, even if that is less than 30 days from the date of their appointment. Candidates must file at the same time they file their qualifying papers. Thereafter, File by July 1 following each calendar year in which they hold their positions. Finally, file a final disclosure form (Form 1F) within 60 days of leaving office or employment. Filing a CE Form 1F (Final Statement of Financial Interests) does riot relieve the filer of filing a CE Form 1 if the filer was in his or her position on December 31, 2019. Submitted into the public record for item(s) 5P.1, on 11-18-2020, City Clerk PAGE 7 CANDIDATE OATH — NONPARTISAN OFFICE (Do not use this form if a Judicial or School Board Candidate) Check box only if you are seeking to qualify as a write-in candidate: ❑ Write-in candidate -RECEIVED 2110NaY I PH 3:07 chvrtlf CIF THE CITY Ctleillt CITY &F HAM OFFICE USE ONLY (s ndidate Oath 99 0211(1)(a), Florida Statutes) (Print name above as you wish it to : ppear on the ballot. If your last name consists of two or more names but has no hyphen, check box O. (See page 2 - Compound Last Names). No change can be made after the end of qualifying. Although a write-in candidate's name is not printed on the ballot, the name must printed above for oath purposes.) am a candidate for the nonpartisan office of I am a qualified elector of (Circuit #) (Group or Seat #) of f �`/fi (Office) 1272r ( jjf elY70.40C (1::e � r (District #) County, Florida; I am qualified under the Constitution and the Laws of Florida to hold the office to which I desire to be nominated or elected; I have qualified for no other public office in the state, the term of which office or any part thereof runs concurrent with the office seek; and I have resigned from any office from which I am required to resign pursuant to Section 99.012, Florida Statutes; and I will support the Constitution of the United States and the Constitution of the State of Florida. Candidate's Florida Voter Registration Number (located on your voter information card): Phonetic spelling for audio ballot: Print name phonetically on the line below as you wish it to be pronounced on the audio ballot as may be used by persons with disabilities (see instructions on page 2 of this form): [Not applicable to write-in candidates.] Address City STATE OF FLORIDA COUNTY OF A4(aim Sworn to (or affirmed) and subscribed before me by Lf physical or ❑ online presence this i � day of Avenitgt,, 20 70. Personally Known: or Produced Identification: V Type of Identification Produced: FL. j vte( 1) ee 4se Late Z1P Code e at tam Commissioned ry Public • Nam e Print. Type. p of Notary Public below: SANDRA FORGES Notary Fata,c -Slate of r'T,aida Cormnsart 3 GG O81BI$ MY Come. Expires Mat t9. 2Q21 tia'Qed01rNhft+ haryAuo, DS-DE 342NP (Rev. 04/20) Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk Rule 1S-2.0001, F.A.C. Submitted into the public record for item(s) SP.1, on 11-18-2O20, City Clerk LOYALTY OATH STATE OF FLORIDA COUNTY O ffIAMI-DADE 2 First Name Middle Initial /7/7/3- Lal'sit Name a citizen of the State of Florida and of the United States of America, .._ and a candidate for public office ... do hereby sow nlswear or affirm that I will support the Constitution of the United States and of the State of Florida. 65 � rT y i:J co Lt Signature of Candidate LLD — Luca CITY OF MIAMI OATH OF CA11J IDATE� OFFICE OF Arl'/,/te % f� Before me, an officer authorized to adminis r oaths!personally appeared ((&)C:t? (PLEASE PRINT NAME) who, being sworn, says he/she is a candidate for the office of 0 , for the City of Miami, Florida; that he/she is a qualified elector of the City of Miami, Florida; that he/she is qualified under the Constitution, the Laws of Florida, and City of Miami Charter to hold the office to which he/she desires to be elected; that he/she has taken the oath required by Section 99.021, Florida Statutes; that he/she has qualified for no other public office in the State, the term of which office or any part thereof runs concurrent with that of the office he/she seeks; and that he/she has resigned or taken a leave of absence from any office from which he/she is required to resign or take a leave of absence, pursuant to Section 99.012, Florida Statutes. Signature of Candidate Address City State ZIP Coda The Loyalty Oath and Oath of Candidate are sworn to (or affirmed) and subscribed before me by 011 line presenr,�,Tshis day of 1\.,0\,je.,vv\ Ptr , 202-0 er Administering Oath or Notary Public Personally Known: OR Produced Identification: Type of Identification Produced' L, Nver Name of No ary Typed. Printe physical or or Stamped I ,: :ap •' SANDRA FORGES j 1 : ha!ay llul c-Sate of Flota C; mmss p GG 04618 My Ceram. Expires Mar 19, 2021 F Sce e4tawNINOliwnerw1. k IV-_'t1al} Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk INTENTIONALLY LEFT BLANK Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk RECEIVED ZOZO OCT 27 PM I: 24 CITY COMMISSION VACANCY AFFIDAVIT OF APPOIN"YM�Y DF I�#AMThE CITYI6fl : CITY OF MIAMI, FLORIDA STATE OF FLORIDA COUNTY OF MIAMI-DADE CITY OF MIAMI Grady E. Howard } } first duly sworn under penalty of perjury, deposes and says: 1. My name is Grady E. Howard (hereinafter "affiant"), being 2. I am offering myself as an appointee to fill the unexpired term for the vacant office of Commissioner in District Number 5 of the City of Miami, Florida. I fully understand that I must maintain an actual and real residence within the district for the duration of my term of office. 3. I have resided in the Commission District Number 5 for a minimum of one year before qualifying, and I am a registered voter and a duly qualified elector in District 5. I am presently registered to vote in Precinct No. 505 presently reside at the following address (must include zip code): 7017 NW 5 Court, Rear Unit Miami, FL 33150 which is my legal address, and I have resided continually at said address from the 7 day of February 2020 to the present. 4. Immediately prior to residing at the above -stated address, I have resided at the hereinbelow listed addresses for the cited periods of time (list hereinbelow all addresses at which you have resided for the past five years, as well as the length of time at each address): Prior Addresses: For the Period: 594 NW 67 St Miami, FL 33150 April 10, 2016 until' Feb 7, 2020 Page of3 Rev. 10/2020 5. In addition to the residence that I have listed as my present address, I also reside at the following listed addresses an a temporary basis as a secondary domicile or domiciles: N/A 6. Affiant's spouse resides at the following address (must include city, state and zip code): N/A ▪ a 7. Affiant's minor children reside at the following address (must include city, grate id code): N/A 8. At the present time, affiant than as stipulated in subpar'agrapl ▪ i P ri registered to vote in any city, county or•taf� other dove. ""`' r 9. Name and business address of affiant's employer: % 61 7 41,. G (/ e,4- r 16.11 1/ / )1 l CCfir, / 10. Affiant's occupation: Consultant Affiant's business telephone number(s): 305-834-3968 11. Affiant has been employed in the above -cited capacity for the following period of time: 2009 until present (Note: In the event the occupation of affiant has been for a period of less than one year, or the employment period with the same employer has been for a period of less than one year, affiant shall give the name(s) and address(es) of his/her employer(s) and occupation(s) for the period of one year prior to the date of this affidavit). 12. Affiant represents that i h'elshe�s is noi; )currently holding another elective or appointive office — whether city, 66unty or m cipal — the term of which or any part thereof runs concurrently with that of the office eshe seeks, and that /she has resigned from any office from which h fshe is required to resign pursuant to .S.99.012 andfor the City of Miami Charter. 13. Affiant represents that, if appointed, (he/she shall serve in the office so appointed. Page 2 of Submitted into the public record for item(s) 5P.1, on 11-18-2020, City Clerk SIGNED THIS 27 DAY OF Oct. 2020 Submitted into the public record for item(s) S;_ .1. on 11-18-2020, City Clerk r , 1 AFFIANT BEFORE ME, the undersigned authority, by means of / physical or online presence appeared CiwcL( E. w i cL , who, after first being duly sworn (or affirmed), deposes and states that executed the foregoing to the best of \i is knowl dqe an,ilef. (Cot( CITY RK, CITY OF MIAMI, FLORIDA (SEAL) Did take an oath Produced identification 1 Type of identification produced: L.Ide cc - rc,n 6i d. SANDRA FORGES Now/ Qt F;-Sbt of Ada Commission M GG024618 My Comm. Expires Mar 19, 2071 Page 3 of3 cn Rev. 10/2020 FORM 1 STATEMENT OF 2019 Please print or type your name, mailing address, agency name, and position below: FINANCIAL INTERESTS a FORME . ONLY: D LAST NAME — FIRST NAME -- MIDDLE NAME : Howard Grady Eugene 411gn OCT [f1 L+f V 1 27 Pll is 26 MAILING ADDRESS ' 70l7 NW 5 CT. D{ l ii.'tC rr- ry[F ITYOLE t 4 OM Rear Unit CITY i Z[P : COUNTY : Miami, FL 33150 33150 Miami -Dade NAME OF AGENCY: City of Miami Commission Submitted into the public NAME OF OFFICE OR POSITION HELD OR SOUGHT : record for item(s) SI),1, City of Commissioner, District 5 on 11-18-2020, City Clerk CHECK ONLY IF 0 CANDIDATE OR I I NEW EMPLOYEE OR APPOINTEE J s **** THIS SECTION MUST BE COMPLETED **** DISCLOSURE THIS MANNER FILERS FEWER (see instructions STATEMENT MI PERIOD: REFLECTS YOUR FINANCIAL INTERESTS FOR CALENDAR YEAR ENDING DECEMBER 31, 2019. OF CALCULATING REPORTABLE INTERESTS: HAVE THE OPTION OF USING REPORTING THRESHOLDS THAT ARE ABSOLUTE DOLLAR VALUES, WHICH REQUIRES CALCULATIONS, OR USING COMPARATIVE THRESHOLDS, WHICH ARE USUALLY BASED ON PERCENTAGE VALUES for further details). CHECK THE ONE YOU ARE USING (must check one): COMPARATIVE (PERCENTAGE) THRESHOLDS OR [1 DOLLAR VALUE THRESHOLDS PART A — PRIMARY SOURCES OF INCOME (If you have nothing to report, NAME OF SOURCE OF INCOME [Major sources of income to the reporting person - See instructions] write "none" or "Ns") SOURCES ADDRESS DESCRIPTION OF THE SOURCES PRINCIPAL BUSINESS ACTIVITY GMA, Inc. 5941,W 67 St. Miami, FL 33150 Consulting PART B -- SECONDARY SOURCES [Major customers, clients, (If you have nothing to NAME OF BUSINESS ENTITY OF INCOME and other sources of income to businesses report, write "none" or "n[a") NAME OF MAJOR SOURCES OF BUSINESS' INCOME owned by the reporting person - See ADDRESS OF SOURCE instructions] PRINCIPAL BUSINESS ACTIVITY OF SOURCE N/A PART C — REAL. PROPERTY [Land, buildings owned by the reporting person - See instructions] (If you have nothing to report, write "none" or "We") NIA You are not limited to the space on the lines on this form. Attach additional sheets, if necessary. FILING INSTRUCTIONS for when and where to file this form are located at the bottom of page 2. INSTRUCTIONS on who must file this form and how to fill it out begin on page 3. CE FORM 1 • ETeelive. January 1, 2070 Inccrparated by reference in Rule 34.820204, FA.O. tContinued on reverse side) PAGE PART 0 — INTANGIBLE PERSONAL PROPERTY (Stocks, bands, certificates of deposit, etc. - See instructions) (If you have nothing to report, write "none" or "nia") TYPE OF INTANGIBLE BUSINESS ENTITY TO WHICH THE PROPERTY RELATES N/A PART E — LIABILITIES (Major debts - See instructions] (If you have nothing to report, write "none" or "nla"] NAME OF CREDITOR ADDRESS N/A r Submitted into th record for item(! on 11-18-2020, CI PART F — INTERESTS IN SPECIFIED BUSINESSES [Ownership or positions in certain types of businesses - See instructions] (If you have nothing to report, write "none" or"n1a'") NAME OF BUSINESS ENTITY ADDRESS OF BUSINESS ENTITY BUSINESS ENTITY # 1 7017 NW 5 Ct Miami, FL 33150 BUSINF&S EgiTY fl —if 2 r7 e public ;) SP.1, ty Clerk PRINCIPAL BUSINESS ACTIVITY Consulting POSITION HELD WITH ENTITY I OWN MORE THAN A 5% INTEREST IN THE BUSINESS NATURE OF MY OWNERSHIP INTEREST CEO Yes 100% PART G — TRAINING For elected municipal officers required to complete annual ethics training pursuant to section 112.3142, F.S. Li I CERTIFY THAT I HAVE COMPLETED THE REQUIRED TRAINING. Fri IF ANY OF PARTS A THROUGH G ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE SIGNATURE OF FILER: Signatur ,,. graziy E. 140-WarG Date Signed: 10-27-2020 FILING INSTRUCTIONS: If you were mailed the form by the Commission on Ethics or a County Supervisor of Elections for your annual disclosure filing, return the form to that location. To determine what category your position falls under, see page 3 of instructions. Local officers/employees file with the Supervisor of Elections of the county In which they permanently reside. (If you do not permanently reside in Florida, file with the Supervisor of the county where your agency has its headquarters.) Form 1 filers who file with the Supervisor of Elections may file by mail or email. Contact your Supervisor of Elections for the mailing address or email address to use. Do not email your form to the Commission on Ethics. it will be returned. State officers or specified state employees who file with the Commission on Ethics may file by mail or email. To file by mail, send the completed form to P.O. Drawer 15709, Tallahassee, FL 32317-5709; physical address: 325 John Knox Rd, Bldg E, Ste 200, Tallahassee, FL 32303. To file with the Commission by email, scan your completed form and any attachments as a pdf (do not use any other format), send it to CEFormlie leg.state.fLus and retain a copy for your records. Do not file by both mail and email. Choose only one filing method. Form 6s will not be accepted via email, CPA or ATTORNEY SIGNATURE Old If a certified public accountant licensed under Chapter 473, in goad standing with the Florida Bar prepared this form for she must complete the following statement: I, . prepay€ Form 1 in accordance with Section 112.3145, Florida Statuth instructions to the form. Upon my reasonable knowledge and disclosure herein is true and correct. CPA/Attorney Signature: Date Signed: Candidates file this form together with their filing papers. MULTIPLE FILING UNNECESSARY: A candidate who tTh 1 with a qualifying officer is not required to file with the Co or Supervisor of Elections. WHEN TO FILE: Initially, each local officer/employee, sty. and specified state employee must file within 30 dal date of his or her appointment or of the beginning of ern Appointees who must be confirmed by the Senate must fi confirmation, even if that is less than 30 days from the da appointment. Candidates must file at the same time they file their papers. Thereafter, file by July 1 following each calendar year in hold their positions. Finally, file a final disclosure form (Form 1 F) within 6 leaving office or employment. Filing a CE Form 1F (Final of Financial Interests) does not relieve the filer of filing a if the filer was in his or her position on December 31, 2019. VI d LY r attorney ou, he or d the CE s, and the belief, the 0 s a Form mmission te officer, �s of the ploymen t. le prior to to of their qualifying they days of Statement CE Form 1 CE FORM 1 - Effective: January 1, 2020. PAGE incorporated by reference in Rule 34-8.2021 t y, CANDIDATE OATH — NONPARTISAN OFFICE (Do not use this form if a Judicial or School Board Candidate) Check box only if you are seeking to qualify as a write-in candidate: Write-in candidate RECEIVED 20200CT 27 PM 1'25 Dr ;::E S Tiia_ CITY C1.:E{ 1TY Pt!Mill OFFICE USE ONLY i' Candidate Oath r (Sect/on 99.021(1)(a), Florida tutes) (Print name above as you wish it to appear on the ballot. If your last name consists of two or more names but has no hyphen, check box ❑. (See page 2 - Compound Last Names). No change can be made after the end of qualifying. Although a write-in candidate's name is not printed on the ballot, the name must be printed above for oath purposes.) am a candidate for the nonpartisan office of City of Miami Commissioner 5 (Office) ; I am a qualified elector of Miami -Dade (District #) E County, Florida; (Circuit #) (Group or Seat #) I am qualified under the Constitution and the Laws of Florida to hold the office to which I desire to be nominated or elected; I have qualified for no other public office in the state, the term of which office or any part thereof runs concurrent with the office I seek; and I have resigned from any office from which I am required to resign pursuant to Section 99,012, Florida Statutes;. and I will support the Constitution of the United States and the Constitution of the State of Florida. Candidate's Florida Voter Registration Number (located on your voter information card): 126643607 Phonetic spelling for audio ballot. Print name phonetically on the line below as you wish it to be pronounced on the audio ballot as may be used by persons with disabilities (see instructions on page 2 of this form); (Not applicable to write-in candidates.] X , _- • •1 _. ,/ j % f, ;) , ,71, A (305 )834-3968 realgradymuhammad@gmail.com Signature of Candidate Telephone Number Email Address 7017 NW 5 Ct. Rear Unit Miami FL 33150 Address City to ZIP Code STATE OF FLORIDA Itur COUNTY OF 1 ONY11 '+J e-- Prtn , Type, of Notary Public or Stamp Commissioned Name of Notary Public below- Sworn MI I to (or affirmed) and subscribed before me by physical or online presence this %1 day of 0 akt\er , 20 20 . ; .." P, SAHOitAFORGES r: NolaltPtibItc-SlsleofFfpoda � Comolssiol+# GG owe '` , =. MYComm-EwesJMrt9,2021 Personally Known; or Produced Identification: i EarboaPmph.Wm+aifrxayAsea i Type of Identification Produced. IFI-- 18eJ] [° -1-,o.0 lard, Submitted into the public DS-DE 302NP (Rev. 04/20) record Tor iltem[s) on 11-18-2020, City Clerk LOYALTY OATH Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk STATE OF FLORIDA COUNTY OF M1AMi-DADE L77 6 d v First Name Middle Initial Last Name a citizen of the State of Florida and of the United States of America, ... and a candidate for public office ... do hereby solemnly swear or affirm that I will support the Constitution of the United States and of the State of Florida Signature of Candidate CITY OF MIAMI OATH OF CANDIDATE OFFICE OF C 1i 14; Before me, an officer authorized to administer oaths, personally appeared (PLEASE PRINT NAME) who, being sworn, says helshe is a candidate for the office of oil r < i of Miami, Florida; that he/she is a qualified elector of the City of Miami, Florida; thatgyshe Constitution, the Laws of Florida, and City of Miami Charter to hold the office to which 6 elected; that helshe has taken the oath required by Section 99.021, Florida Statutes; that helsh no other public office in the State, the term of which office or any part thereof runs concurrent with he/she seeks; and that 8/she has resigned or taken a leave of absence from any office from required to resign or take a leave of absence, pursuant to Section 99.012, Florida Statutes. '101 7 Address City cry. c) to Signature of Candidate State The Loyalty Oath and Oath of Candidate are sworn to for affirmed) and subscribed before me by online presence, this-1 Sign{ure off cer day of !ministering Oath or Notary Public 0c7L-.0 bey - Personally Known: OR Produced Identification: Type of Identification Produced: i L 1div'\'1l f [61/441 ar} C,a,(A ,20 inJ 1-1 gfor l" i�r City lifid urr the e wires to be as qualified for that of the office which he/she is Fri ZIP Code physical or Name of Notary Typed, Printer Stamped SrVIORAFORGES Wary Public - Stateaf Florida Commission 8GG080618 My Comm. Expires Mar 19, 2021 Q�F . emaedurwghwuaNWri.Pan Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk INTENTIONALLY LEFT BLANK Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk CITY COMMISSION VACANCY AFFIDAVIT OF APPOINTMENT CITY OF MIAMI, FLORIDA STATE OF FLORIDA COUNTY CF MIAMI-DADE CITY OF MIAMI ANDRE D. JOYCE first duly sworn under penalty of perjury, deposes and says: 1. My name is ANDRE D. JOYCE (hereinafter "affiant"), being 2. I am offering myself as an appointee to fill the unexpired term for the vacant office of Commissioner in District Number 5 of the City of Miami, Florida. I fully understand that I must maintain an actual and real residence within the district for the duration of my term of office. 3. I have resided in the Commission District Number 5 for a minimum of one year before qualifying, and I am a registered voter and a duly qualified elector in District 5. I am presently registered to vote in Precinct No. 511 I presently reside at the following address (must include zip code): 1526 NW 58TH TERRACE MIAMI FL 33142 which is my legal address, and I have resided continually at said address from the 8 day of JANUARY 2004 to the present. 4. Immediately prior to residing at the above -stated address, I have resided at the hereinbelow listed addresses for the cited periods of time (list hereinbelow all addresses at which you have resided for the past five years, as well as the length of time at each address): Prior Addresses: For the Period: NIA ry Pagc 1 013 Rev. 10/2020 5. In addition to the residence that I have fisted as my present address, I also reside at the following listed addresses on a temporary basis as a secondary domicile or domiciles: NA 6. Affiant's spouse resides al the following address (must include city, state and zip code): NA 7. Affiant's minor children reside at the following address (must include city, gaterAnd zip code): NA , F, 8. At the present time, affiant (is) is not registered to vote in any city, county 3r sta otter than as stipulated in subparagrap , above. r F 9. Name and business address of affiant's employer: BROWARD PARTNERSHIP 920 NW 7TH AVENUE FT LAUDERDALE FL 33311 BRCWARD PARTNERSHIP 920 NW 7TH AVENUE FT LAUDERDALE FL 33311 10, Affiant's occupation: DIRECTOR OF RESIDENTIAL AND SAFETY Affiant's business telephone number(s): 9547793990 11. Affiant has been employed in the above -cited capacity for the following period of time: APRIL 19, 2019 (Note: In the event the occupation of affiant has been for a period of less than one year, or the employment period with the same employer has been for a period of less than one year, affiant shall give the name(s) and address(es) of his/her employers) and occupation(s) for the period of one year prior to the date of this affidavit). 12. Affiant represents that he/she (is) is no currently holding another elective or appointive office — whether city, county or municipal — the term of which or any part thereof runs concurrently with that of the office he/she seeks, and that he/she has resigned from any office from which he/she is required to resign pursuant to F.S.99.012 and/or the City of Miami Charter. 13. Affiant represents that, if appointed, he/she shall serve in the office so appointed. Page : of 3 Rcv. f 0/2O2{J Submitted into the public record for itern(s) SP.1, on 11-18-2020, City Clerk Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk. STONED THIS l3th DAY OF November 2020 BEFORE ME, the undersigned authority, by means of V physical or online presence appeared 141Yyidc.. �]. \ O1 ��. , who, after first being duly sworn (or affirmed), deposes and states that \le_ executed the foregoing to the best of %`lt., knowledge and belief. ,1,C1TY Cf K, CITY OF MIAMI, FLORIDA Did take an oath Produced identification Type of identification produced: W rORGES Wary Pao4-SIVEofR; a Comm ,on iGGOe4615 My Comm. ExWes Mar 19.2021 1 &tee uv-..4 .0104 Nan; ?kw (SEAL) ri Page 3 or3 Rev. 10/2029 FORM 1 STATEMENT OF Please print or type your name, maIling address, agency name, and position below: FINANCIAL INTERESTS 2019 LAST NAME -- FIRST NAME ---MIDDLE NAME JOYCE ANDRE MAILING ADDRESS : 1526 NW 58TH TERRACE MIAMI CITY : MIAMI NAME OF AGENCY DEMERITTE ZIP : COUNTY 33142 MIAMI-DADE NAME OF OFFICE OR POSITION HELD OR SOUGHT COMMISSIONER D5 CHECK ONLY IF D CANDIDATE OR ® NEW EMPLOYEE OR APPOINTEE FOR OFFICE USE ONLY: **** THIS SECTION MUST BE COMPLETED **** DISCLOSURE PERIOD: THIS STATEMENT REFLECTS YOUR FINANCIAL INTERESTS FOR CALENDAR YEAR ENDING DECEMBER 31, 2019. MANNER OF CALCULATING REPORTABLE INTERESTS; FILERS HAVE THE OPTION OF USING REPORTING THRESHOLDS THAT ARE ABSOLUTE DOLLAR VALUES, WHICH REQUIRES FEWER CALCULATIONS, OR USING COMPARATIVE THRESHOLDS, WHICH ARE USUALLY BASED ON PERCENTAGE VALUES (see instructions for Further details). CHECK THE ONE YOU ARE USING (must check one); ❑ COMPARATIVE (PERCENTAGE) THRESHOLDS OR 0 DOLLAR VALUE THRESHOLDS PART A -- PRIMARY SOURCES OF INCOME [Major sources of income to the reporting person - See instructions] (If you have nothing to report, write "none" or "nIa") NAME OF SOURCE OF INCOME SOURCE'S ADDRESS Broward Partnership 920 NW 7th Avenue Ft. Lauderdale FL DESCRIPTION OF THE SOURCES PRINCIPAL BUSINESS ACTIVITY Homeless Shelter PART B -- SECONDARY SOURCES OF INCOME [Major customersclients, and other sources of income to businesses owned by the reporting person - See instructions) (If you have nothing to report, write "none" or "n!a"j NAME OF BUSINESS ENTITY NA NAME OF MAJOR SOURCES OF BUSINESS' INCOME ADDRESS OF SOURCE PART C -- REAL PROPERTY [Land, buildings owned by the reporting person - See instrUctionsj (If you have nothing to report, write "none" or "nIa") �[A PRINCIPAL BUSINESS ACTIVITY OF SOURCE You are not limited to the space on the lines on this form. Attach additional sheets, If necessary. FILING INSTRUCTIONS for when and where to file this form are located at the bottom of page 2. INSTRUCTIONS on who must file this form and how to fill it out begin on page 3. PP Frinu , _ f In lnmrporated by reference in Rule 34-8.2t2t1 }. FAC. Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk PAGE 1 PART 0 — INTANGIBLE PERSONAL PROPERTY [Stocks, bonds. certificates of deposit, etc. - See instructions] (If you have nothing to report, write "none" or "nla") TYPE OF INTANGIBLE BUSINESS ENTITY TO WHICH THE PROPERTY RELATES NA PART E — LIABILITIES [Major debts - See instructions] (if you have nothing to report, write "none" or "nla") NAIVE OF CREDITOR NA ADDRESS OF CREDITOR PART F — INTERESTS IN SPECIFIED BUSINESSES [Own (if you have nothing to report, write "none" or NAME OF BUSINESS ENTITY ADDRESS OF BUSINESS ENTITY PRINCIPAL BUSINESS ACTIVITY POSITION HELD WITH ENTITY I OWN MORE THAN A 5% INTEREST IN THE BUSINESS' NATURE OF MY OWNERSHIP INTEREST ship or positions in certain types of businesses - See instrucirions irk A - BUSINESS ENTITY # 1 BUSINE S EI CITY # -[ Ca 11 ^ 4" R7 id) [fl :c- ro -‹ J1 PART G — TRAINING For elected municipal officers required to complele annual ethics training pursuant to section 112.3142, F.S. I CERTIFY THAT I HAVE COMPLETED THE REQUIRED TRAINING. IF ANY OF PARTS A THROUGH G ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE ❑ SIGNATURE OF FILER: Signature: Date Signed: November 13th, 2020 FILING INSTRUCTIONS: IF you were mailed the form by the Commission an Ethics or a County Supervisor of Elections for your annual disclosure filing, return the form to that location. To determine what category your position falls under, see page 3 of instructions. Local officers/employees file with the Supervisor of Elections of the county in which they permanently reside. (If you do not permanently reside in Florida, file with the Supervisor of the county where your agency has its headquarters.) Form 1 filers who file with the Supervisor of Elections may File by mail or email. Contact your Supervisor of Elections for the mailing address or email address to use. Do not emit your form to the Commission on Ethics. it will be returned. State officers or specified state employees who file with the Commission on Ethics may file by mail or email. To file by mail, send the completed loon to P.O. Drawer 15709, Tallahassee, FL 32317-5709; physical address: 325 John Knox Rd, Bldg E, Ste 200, Tallahassee, FL 32303. To file with the Commission by email, scan your completed form and any attachments as a pdf (do not use any other format), send it to CEForm1@ieg.state.fl.us and retain a copy For your records. Do not File by both mail and email Choose only one filing method. Form 6s will not be accepted via email. CPA or ATTORNEY SIGNATURE ONLY If a certified public accountant licensed under Chapter 473, ar attorney in good standing with the Florida Bar prepared this form for you, he ar she must complete the following statement: , prepared the CE Form 1 in accordance with Section 112.3145, Florida Statutes, and the instructions to the Form. Upon my reasonable knowledge and belief, the disclosure herein is true and correct. CPA/Attomey Signature: Date Signed: Candidates file this form together with their filing papers. MULTIPLE FILING UNNECESSARY: A candidate who files a Form 1 with a qualifying officer is not required to file with the Commission or Supervisor of Elections. WHEN TO FILE: Initially, each local officer/employee, state officer and specified state employee must file within 30 days of the date of his ar her appointment or of the beginning of employment. Appointees who must be confirmed by the Senate must file prior to confirmation, even if that is less than 30 days from the date of their appointment. Candidates must file at the same time they file their qualifying papers. Thereafter, file by July 1 following each calendar year in which they hold their positions. Finally, file a final disclosure form (Form 1F) within 60 days of leaving office or employment. Filing a CE Form 1 F (Final Statement of Financial Interests) does not relieve the filer of filing a CE Form 1 if the filer was in his or her position an December 31, 2019. CE FaiiM 1 - Elective: January 1. 2020, lncorparaied by reference le Rule 3d41.202111, FA.0 Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk PAGE 2 CANDIDATE OATH — NONPARTISAN OFFICE (Do not use this form if a Judicial or School Board Candidate) Check box only if you are seeking to qualify as a write-in candidate: ❑ Write-in candidate PE CElYED 2O20 NON 13 PM 3: 25 u . ` ► 4ur TY F tiClIAT iICLERK OFFICE USE ONLY Candidate Oath (Section 99.021(1)(a), Florida Statutes) 1, ANDRE D JOYCE (Print name above as you wish it to appear on the ballot. If your last name consists of two or more names but has no Names). No change can be made after the end of qualifying. ballot the name must be printed above for oath purposes) 5 hyphen, check box i•. (See page 2 - Compound Last Although a write-in candidate's name is not printed on the am a candidate for the nonpartisan office of COMMISSIONER (Office) ; I am a qualified elector of Miami -Dade L_I (District #) County, Florida; or elected; I with the office Florida Statutes; (Circuit #) (Group or Seat #) I am qualified under the Constitution and the Laws of Florida to hold the office to which I desire to be nominated have qualified for no other public office in the state. the term of which office or any part thereof runs concurrent I seek; and I have resigned from any office from which I am required to resign pursuant to Section 99.012, and l will support the Constitution of the United States and the Constitution of the State of Florida. Candidate's Florida Voter Registration Number (located on your voter information card): 109212001 Phonetic spelling for audio ballot: Print name phonetically on the line below as you wish it to be pronounced on the audio ballot as may be used by persons with disabilities (see instructions on page 2 of this form): [Not applicable to write-in candidates.] ANDRE D JOYCE XQQS,3-f (786) 843-8820 ANDREDJOYCE@GMAIL.COM Signature of Candl. a e � Telephone Number Email Address 1526 NW 58TH TERRACE MIAMI FL 33142 Address City STATE OF FLORIDA COUNTY OF 011fY1 ' 4 e' ,-5Eate ZIP Cade Sig Print, die Type, r}k'- :,y� of Notary Public or Stamp Commissioned Name S»ORAFOROES IVelaryPa be-Staleetflanda sotcGoa,s1a ,. .' MyCa m Envesi a 19.2t21 vraq,we�oraraarAssn. of Notary Public below: 1 Sworn to (or affirmed) and subscribed before me by ❑ physical or 'ff y��"" r online presence this k day of {Vl? wY QC ( , 20 � . r Personally Known: or Produced Identification: !v/.. Type of Identification Produced: C L- 1'el fie'( Lt uvrf_ DS-DE 302NP (Rev. 04120) Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk Rule 1S-2.0001, F.A.C. LOYALTY OATH STATE OF FLORIDA COUNTY OF MIAMI-DADE ANDRE JOYCE First Name Middle initial Last Name L17 � a citizen r;{hetate of Florida and of the United States of America, .., and a candidate for public office do here soles my sear or affirm that l will support the Constitution of the United tates and of the State of Florida. oL. is LU r7 Signaturid of Candidate CITY OF MIAMI OATH OF CANDIDATE OFFICE OF COMMISSIONER bi5 Before me, an officer authorized to administer oaths, personally appeared ANDRE D JOYCE (PLEASE PRINT NAME) who, being sworn, says he/she is a candidate for the office of C 15 s �`` for the City of Miami, Florida; that he/she is a qualified elector of the City of Miami, Florida; that he/she is qualified under the Constitution, the Laws of Florida, and City of Miami Charter to hod the office to which he/she desires to be elected; that he/she has taken the oath required by Section 99.021, Florida Statutes; that he/she has qualified for no other public office in the State, the term of which office or any part thereof runs concurrent with that of the office he/she seeks; and that he/she has resigned or taken a leave of absence from any office from which he/she is required to resign or take a leave of absence, pursuant to Section 99.012, Florida Statutes. 1526 NW 58TH TERRACE Address MIAMI City SignaturCandidate FL State The Loyalty Oath and Oath of Candidate are sworn to (or affirmed) and subscribed before me by online presence, this l' day of \O\, V\A ( , 20 2-0 Sig re c;f Officer Administering Oath or Notary Public Personally Known: OR Produced Identification: Type of Identification Produced; 'FL '►r1Yer li [ . 4 . 33142 ZIP Code physical or \ ci irCkroes Name of Notary Typed, Printe4or Stamped tl -;:;'e . 5ANDRA FORGES S I ram, v`: Wry Puolc - Stale d Poda t OcmmasanxGGOa4S 0 My Comm, Expos Mar f9. 2t21 i Om* wore Nit:4 xna' ei Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk 10/2020 ANDRE JOYCE RECEIVED 2Q20 NoY .13 PM 3: 25 Gr .,: Tl<E CITY CLEi?K Miami, FL 33142 ,andredjoyce@gmail.com 786-843-8820 Social services professional with over twenty five years of experience in the area. The experience includes Children and Family Services, Forensic Mental Health, Mental Health Services, Dually Diagnosed Co-occurring Disorders, Substance Abuse, Medical Case Management, and Homeless. Fortunate to have had the experience to work in Administration as a Staff Development and Training, Human Resources, Quality Assurance, and Asst. Director and Director. WORK EXPERIENCE Director of Residential and Safety Broward Partnership For the Homeless, MC - Fort Lauderdale, FL April 2019 to Present • Ft. Lauderdale, FL ▪ Ensures the safety and welfare of all clients, employees and visitors through direct supervision of security • Provides leadership and direction to Residential Coordinators • Oversee the day to day client activities on the shelter and ensures sufficient staffing • Serves as a leader in emergency preparedness and response activities, including fire drills and hurricane • Conduct monthly Client Town Hall Meetings and may lead these meetings, • Develop. implement and manages Agency -wide safety training for staff and clients in conjunctions with HR. • Ensure that staff is aware of program expectations for clients. • Ensure that staff is familiar with the Low Barrier Model and Housing First Model • Implement Agency -wide policies and procedures for clients as it related to their stay in shelter • Investigate and resolve client issues in a caring and compassionate manner that encourages clients to be respectful to one another. Supervised Staff and Peer Specialist Mercy Behavioral Health Center, INC - Hialeah, FL 2015 to 2019 - Hialeah, FL • Responsible for monitoring and coordinating program services and systems hosed under the Day Treatment Program. • Supervised staff and Peer Specialist. • Attended community meetings to share and network with area community partners. • Monitored the daily / weekly submission of progress notes for quality and integrity. • Monitored billing for quality and timely submission. • Prepared day treatment curriculums for clients participating in services. • Assisted clients in obtaining medical, social and economic resources, including assistance with housing, mental health Submitted into the public record for item(s) SP.1, on 11-18-202Q City Clerk Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk and substance abuse treatment. • Supervised case managers in the absence of coordinator • Provided training to case managers on the key components of Case Management Services Quality Assurance Specialist ! Human Resource Coordinator New Horizons Community Mental Health Center - Miami, EL September 2013 to July 2015 - Miami, FL • Responsible for all human resource activities to include employment, compensation, benefits, and training and development. • Interview job applicants; review application/resume; evaluate applicant skills and make recommendations regarding applicant's qualifications. • Design and conduct new employee orientations. • Administer and explain benefits to employees, serve as liaison between employees and insurance carriers. • Recommend, develop and schedule training and development courses. • Provide advice, assistance and fallow -up on company policies, procedures, and documentation. • Develop and recommend operating policy and procedural improvements. • Other duties as assigned Intake Coordinator Bayview Community Mental Health Center - North Miami, FL 2006 to 2011 • Responsible for the initial intake of clients coming into the Crisis Stabilization Unit • Made sure clients met the requirements for admission (Baker Act, Court Order, Exparte) • Checked enrollment eligibility of clients coming into the center. • Coordinated the provisions of labs, x-rays ordered by the Behavioral Health Practitioner • Had detailed knowledge of the Florida Baker Acl • Liaison to all departments and was the key communication between the various disciplines. • Spoke with insurance companies to look at the level of care in which client was receiving EDUCATIQciN1 Sociology it Criminal Justice Florida Memorial University 2012 MPA-Pendinig in Public Administration Barry University - Miami Shores, FL SKILLS Crisis Intervention Behavioral Health Human Resources Emergency Management cj • Social Work • Group Therapy G R O lit Phi Beta Sigma Fraternity Inc Present Society For Human Resource Management - SHRM Present Advisory Board- City of Miami Police Department 2014 Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk 0 r.-1 [a) CJl Submitted into the public record for item(s) SP.1. on 11-18-2020, City Clerk INTENTIONALLY LEFT BLANK Submitted into the public record for items) SP.1, on 11-1� City Clerk CITY COMMISSION VACANCY AFFIDAVIT OF APPOINTMENT=;• CITY OF MIAMI, FLORIDA 151. w— �e. -fir, STATE OF FLORIDA ) 3c-' 3. Crl COUNTY OF MV11AM1-DADS ) ..:-I 0 CITY OF MIAMI ) Christine M. King first duly sworn under penalty of perjury, deposes and says: 1 My name is Christine M. King (hereinafter °`affiant'), being 2. I am offering myself as an appointee to fill the unexpired term for the vacant office of Commissioner in District Number 5 of the City of Miami, Florida. I fully understand that I must maintain an actual and real residence within the district for the duration of my term of office. 3. I have resided in the Commission District Number 5 for a minimum of one year before qualifying, and I am a registered voter and a duly qualified elector in District 5. I am presently registered to vote in Precinct No. 504 presently reside at the following address (must include zip code): 720 NE 62 Street #505 Miami, FL 33138 which is my legal address, and 1 have resided continually at said address from the 15 day of August 2018 to the present. 4. Immediately prior to residing at the above -stated address, i have resided at the hereinbelow listed addresses for the cited periods of time (list hereinbelow all addresses at which you have resided for the past five years, as well as the length of time at each address):: Prior Addresses: For the Period: 1270 NW 131 Street October 1994 - August 2018 Pagc I of-3 Rcv lW2O2{7 5. In addition to the residence that I have listed as my present address, I also reside at the following listed addresses on a temporary basis as a secondary domicile or domiciles: 12181 Water Poppy Ct. Orlando, FL 32828 6. Affiant's spouse resides at the following address (must include city, state and zip code): 2210 North 48th Avenue Hollywood, FL 33021 7. Affiant's minor children reside at the following address (must include city, state and zip code): N/A 8. At the present time, affiant (is} s no , registered to vote in any city, county or state other than as stipulated in subparagraph 3 above. 9. Name and business address of affiant's employer: Martin Luther King EDC 6114 NW 7th Avenue Miami, FL 33127 13. Affiant's occupation: President/CEO Affiant's business telephone numbers): 30�J-757 7627 Va 11. Affiant has been employed in the above -cited capacity for the following period of time: 9 years (Note: In the event the occupation of affiant has been for a period of Tess than one year, or the employment period with the same employer has been for a period of Less than one year, affiant shall give the name(s) and address(es) of his/her employer(s) and occupation(s) for the period of one year prior to the date of this affidavit). N/A N/A 12. Affiant represents that he/she (is) (is not} 'turrently holding another elective or appointive office -- whether city, county or 4 ip31 — the term of which or any part thereof runs concurrently with that of the office he/she seeks, and that helshe has resigned from any office from which he/she is required to resign pursuant to F.S.99.012 and/or the City of Miami Charter, 13. Affiant represents that, if appointed, he/she shall serve in the office so appointed. Page 2 of 3 !Icy iC}12fl2D Submitted into the public record for item(s) SPA., on 11-18-2020, City Clerk Submitted into the public record for items)SP.1, on 11-18.2020, City Clerk SIGNED THIS 1 DAY OF November BEFORE ME, the undersigned authority, by means of 2020 presence appeared Chct5'tkA`3 , who, affirmed), deposes and states that 5Vle- executed the knowledge and belief. CITY OF MIAMI, FLORIDA / Did take an oath V. Produced identification Type of identification produced: FL£' Pagc 3 of 3 NT 16/ physical or -_ online after first being duly sworn (or foregoing to the best of Wee (SEAL) T000 9 HANNON Nalary Public - State of Florida " Commission # GC 262274 stiff' My Comm. Expires Sep 25, 202Z Banded throogn National Notary Assn, V{.,cs Li C-eviNiSe, Z3 :1 Wd £ f AON °tit Fri m P1 Rev. 1012020 FORM I STATEMENT OF 2019 Please print or type your name, mailing address, agency name, and position below: FINANCIAL INTERESTS LAST NAME -- FIRST NAME — MIDDLE NAME King Christine Margaaret MAILING ADDRESS 6116 NW 7th Avenue CITY : ZIP : COUNTY Miami 33127 Miami -Dade NAME OF AGENCY NAME OF OFFICE OR POSITION HELD OR SOUGHT : City of Miami Commission, District 5 CHECK ONLY IF a CANDIDATE OR L"NEW EMPLOYEE OR APPOINTEE FOR OFFICE USE ONLY. rw rirrr �+.J CD -t ca Fri ri **** THIS SECTION MUST BE COMPLETED * DISCLOSURE PERIOD: THIS STATEMENT REFLECTS YOUR FINANCIAL INTERESTS FOR CALENDAR YEAR ENDING DECEMBER 31, 2019. MANNER OF CALCULATING REPORTABLE INTERESTS: FILERS HAVE THE OPTION OF USING REPORTING THRESHOLDS THAT ARE ABSOLUTE DOLLAR VALUES, WHICH REQUIRES FEWER CALCULATIONS, OR USING COMPARATIVE THRESHOLDS, WHICH ARE USUALLY BASED ON PERCENTAGE VALUES (see instructions for further details). CHECK THE ONE YOU ARE USING (must check one): ® COMPARATIVE (PERCENTAGE) THRESHOLDS �R, ❑ DOLLAR VALUE THRESHOLDS PART A -- PRIMARY SOURCES OF INCOME [Major sources of income la the reporting person - See instructions] (If you have nothing to report, write "none" or "We") ivwmG ut- auurte,t OF INCOME SOURCES ADDRESS DESCRIPTION OF THE SOURCES PRINCIPAL BUSINESS ACTIVITY Martin Luther King EDC 6114 NW 7th Avenue Miami, 33127 Non Profit Advocacy Law Office of Christine King, PA 6116 NW 7th Avenue Miami, 33127 Legal Representation Property *see Part C Rental Property PARTS -- SECONDARY SOURCES OF INCOME (Major customers. clients, and other sources of income to businesses owned by the reporting parson - See instructions] Of you have nothing to report, write "none" or "nla'') NAME OF BUSINESS ENTITY NAME OF MAJOR SOURCES OF BUSINESS' INCOME ADDRESS OF SOURCE PRINCIPAL BUSINESS ACTIVITY OF SOURCE Law Office C. King, PA Doctor United Group, Inc. 3215 NW loth Terr. FL Laud Health Care i{ �f Waste Management, Inc. 2600 Wiles Road, Pompano Waste Collection PART C -- REAL PROPERTY (Land, buildings owned by the reporting person - See instructions) (If you have nothing to report, write "none" or "We") *12690 NW loth Avenue , North Miami, FL 33168 1 270 NW 131 Street, North Miami, FL 33167 CE FORM 1 - eltect,m January 1. 2 I2C Incorporates by reference .n Rule 34.8.2I}2.t1i. F,A.0 Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk You are not limited to the space on the lines on this form. Attach additional sheets, if necessary. FILING INSTRUCTIONS for when and where to file this form are located at the bottom of page 2. INSTRUCTIONS on who must file this form and how to fill it out begirt on page 3, PAGE' PART!) — INTANGIBLE PERSONAL PROPERTY [Stocks Of you have nothing to report, write "none" TYPE OF INTANGIBLE bonds, certificates of deposit, etc. - See instructions] or"nla") BUSINESS ENTITY TO WHICH THE PROPERTY RELATES 4578 Qualified Retirement Plan Miami -Dade County PART E — LIABILITIES [Major debts - See instructfonsl (If you have nothing to report, write "none" NAME OF CREDITOR i or "nla") ADDRESS OF CREDITOR Nelnet Student Loan Services PO Box 82561 Lincoln, NE 68501 PART F — INTERESTS IN SPECIFIED BUSINESSES [Ownership Of you have nothing to report, write "none" NAME OF BUSINESS ENTITY or positions in certain types of businesses or "We") pi f BUSINESS ENTITY I# 1 ,"f - See instructions] BUSINESENTITY 0 2 �i a ADDRESS OF BUSINESS ENTITY PRINCIPAL BUSINESS ACTIVITY - - ‘ "e .►- POSITION HELD WITH ENTITY C,"::- I OWN MORE THAN A5% INTEREST IN THE BUSINESS f NATURE OF MY OWNERSHIP INTEREST 3 e) PART G — TRAINING 7- For elected municipal officers required to complete annual ethics training pursuant to section 112.3142. F.S. ❑ I CERTIFY THAT I HAVE COMPLETED THE REQUIRED TRAINING. IF ANY OF PARTS A THROUGH G ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE ❑ la SIGNATURE OF FILER: CPA or ATTORNEY SIGNATURE ONLY Signature: If a certified public accountant licensed under Chapter 473, or attorney In good standing with the Florida Bar prepared this form for you, he or she must complete the following statement: I, , prepared the CE Form 1 in accordance with Section 112,3145, Florida Statutes, and the Date Signed: Instructions to the form. Upon my reasonable knowledge and belief, the disclosure herein is true ano correct, CPA/Attorney Signature:: 13 November 2020 Date Signed: FILING INSTRUCTIONS: If you were mailed the form by the Commission on Ethics or a County Supervisor of Elections for your annual disclosure filing, return the form to that location. To determine what category your position falls under, see page 3 of instructions. Local officers/employees file with the Supervisor of Elections of the county in which they permanently reside. (If you do not permanently reside in Florida, file with the Supervisor of the county where your agency has its headquarters.) Form 1 filers who file with the Supervisor of Elections may file by mail or email. Contact your Supervisor of Elections for the mailing address or email address to use. Do not email your form to the Commission on Ethics. it will be returned. State officers or specified state employees who file with the Commission on Ethics may file by mail or email. To file by mail, send the completed form to P.O. Drawer 15709, Tallahassee, FL 32317-5709; physical address: 325 John Knox Rd, Bldg E, Ste 200, Tallahassee, FL 32303. To file with the Commission by email, scan your completed form and any attachments as a pdf (do not use any other format), send it to CEForml@leg.state.fl.us and retain a copy for your records. Do not file by both (nail and email. Choose only one filing method. Form 6s will not be accepted via email. Candidates file this form together with their filing papers. MULTIPLE FILING UNNECESSARY: A candidate who files a Form 1 with a qualifying officer is not required to file with the Commission or Supervisor of Elections. WHEN To FILE: Initially, each local officer/employee. state officer, and specified state employee must file within 30 days of the date of his or her appointment or of the beginning of employment. Appointees who must be confirmed by the Senale must file prior to confirmation, even if that is less than 30 days from the date of their appointment_ Candidates must Ole at the same time they file their qualifying papers. Thereafter, file by July 1 following each calendar year in which they hold their positions. Finally, file a final disclosure form (Form 1F) within 60 days of leaving office or employment. Filing a CE Form 1F (Final Statement of Financial Interests) does not relieve the filer of filing a CE Form 1 if the filer w r h c nr hpr nncifinn nn fnr:Pmber 31. 2019. Submitted into the public CE FORA " - EiluctNe January ' 21t211. Incoraaraied try rwlerence in ,14..fn 1A-8.2I}2I' I. F.A.C. record for item(s) SP.1, on 11-18-2020j City Clerk °'Aek 2 CANDIDATE OATH — NONPARTISAN OFFICE (Do not use this form if a Judicial or School Board Candidate) Check box only if you are seeking to qualify as a write-in candidate: ❑ Write-in candidate RECEIVED LULJ NOV 13 PM to 22 Lrf,'E OF THE. Cl,3 Y.CLERK+ CITY fl ` MIAMI OFFICE USE ONLY Candidate Oath (Section 99.021(1)(a), Florida Statutes) I, Christine M, King (Print name above as you wish it to appear on the ballot. If your last name consists of two or more names but has no hyphen, check box ®. (See page 2 - Compound Last Names). No change can be made after the end of qualifying. Although a write-in candidate's name is not printed on the ballot, the name must be printed above for oath purposes.) am a candidate for the nonpartisan office of City of Miami COmmission 5 (Office) ; I am a qualified elector of Miami -Dade (District #) 8 County, Florida; (Circuit #) (Gaup or Seat #) I am qualified under the Constitution and the Laws of Florida to hold the office to which I desire to be nominated or elected; I have qualified for no other public office in the state, the term of which office or any part thereof runs concurrent with the office 1 seek; and I have resigned from any office from which I am required to resign pursuant to Section 99.012, Florida Statutes; and I will support the Constitution of the United States and the Constitution of the State of Florida. Candidate's Florida Voter Registration Number (located an your voter information card); 109230069 Phonetic spelling for audio ballot: Print name phonetically on the line below as you wish it to be pronounced on the audio , ballot as may be us d by persons with disabilities (see instructions on page 2 of this form): [Not applicable to write-in candidates.] (305 ? 917-5736 christinekingcampagin@gmaii.com Signature o d ate Telephone Number Email Address 720 N 62 Street #505 Miami FL 33138 Address City State ZIP Cade STATE OF FLORIDA r ' Signature of Nota Pub k COUNTY OF in t tt'M 1 r. 'r,� tCPrint, Type, or Stamp Commissioned Name of Notary Public below: Sworn to (or affirmed) and subscribed before me by ` iphysical or �-. _ 1 r� , ❑ online presence this 1 �s day of 0 DV•zi Butt, 20 jai!' # :•i1,,U., TOW g HArrH(}K _ ,� No[ar Public - State or Florida , 5.4 It .41 Cnmrnrssian re GG 262214 Personally Known: or Produced Identification: ( •tea nod My Comm. Ettarrs Sep 25, 2022 Bonded through haleuh+ Notary Assn. 1 r Type of Identification Produced; Ft. 6r.1I f ,j, I.-ti C-R I SI . Submitted into the public AMMIL DS-DE 302NP (Rev. 04120) record for item(s) SP.1, on 11-18-2020. City Clerk Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk STATE OF FLORIDA COUNTY OF MIAMI-DADE LOYALTY OATH ifp Christine M g ;c` [ti King c.�,cr� [ First Name Middle Initial Last Name a citizen of the State of Florida and of the United States of America, ... and a c didate for pu6raffi ct.;y . do hereby solemnly swear or affirm that I will support the Constitution of the United St tes a ad of the Stater Fiteda. 1- CITY OF MIAMI OATH OF CAND ATE OFFICE OF Commission, District 5 Before me, an officer authorized to administer oaths, personally appeared Christine M. King (PLEASE PRINT NAME) who, being sworn, says he/she is a candidate for the office of Commission , District 5 , for the City of Miami, Florida; that he/she is a qualified elector of the City of Miami, Florida; that he/she is qualified under the Constitution, the Laws of Florida, and City of Miami Charter to hold the office to which he/she desires to be elected; that he/she has taken the oath required by Section 99.021, Florida Statutes; that he/she has qualified for no other public office in the State, the term of which office or any part thereof runs concurrent with that of the office he/she seeks; and that he/she has resigned or taken a leave of absence from an office from which he/she is required to resign or take a leave of absence, pursuant to Section 99.012, Florida Salutes. Sig 720 NE 62 Street #505 Miami i FL 33138 Address City State ZIP Code The Loyalty Oath and Oath of Candidate are sworn to (or affirmed) and subscribed before me by physical or Ionline presence, this 1i day of t'J DJe Signature of Officer Admit`itsteniTC th or Notary Public Personally Known' OR Produced Identification: Type of Identification Produced: r L t) (i \e.i r ti1 ‘DrAdk 6. I- CAI) o -r% Name of Notary Typed, Printed or Stamped raoo B HANNON Notary Public - State of Florida n°/` Commission k GG 262214 My Comm. Expires Sep 25, 2022 Banded through National Notary Assn. 1 E1, 2l020 u - � L L, a E aj cu 4-5 • o • o0 4-0 ra r-i -13 L 0 7( ICHRISTINE M. FORDE-KING, ESQ. 720 NE 62 Street #505 Miami, Florida 33138 Email: fordekine@live.com OVERVIEW Christine King was born in Guyana and moved to Miami at the age of 5. She attended Allapattah Elementary School, Westview Middle School. and Miami Central Sr. High School. She has proudly served the community for many years and is known for her passion to serve. Before becoming an attorney, Christine worked as Chief of Constituent Services for a Miami - Dade County Commissioner and later as an executive with the Community Action Agency (CAA). 1-ler career with the county spanned eighteen years. She is now President and CEO of the Martin Luther King Economic Development Corporation and a practicing attorney. Christine is married with three beautiful children. EDUCATION Juris Doctor Degree, 2007 Shepard Broad Law Ctr., Nova Southeastern Univ., Ft. Lauderdale, FL Achievements: Pro Bono Honors Program (Silver Level); Law Student Advisor: Black Law Student Association Member Bachelor of Arts Degree in Public Administration (B.P.A.), 1999 Barry University, Miami, Florida Associate in Arts Degree (AA), 1993 Miami -Dade Community College, Miami, Florida BAR AFFILIATIONS Florida Bar (Member in Good Standing) 2010 PROFESSIONAL EXPERIENCE 2010 — Present 2011 — Present 1993-2011 MIAMI-DADE COUNTY, Miami, Florida Law Office of Christine King Practicing Attorney MIA,M -DADE COUNTY, Miami, Florida Martin Luther King Economic Development Corporation (MLKEDC) President and CEO MiAM1-DARE COUNTY, Miami, Florida Community Action Agency (CAA) Special Assistant to Executive Director (07-11) CAA Contracts officer (01-07) CAA Public Information Officer (97-01). MIAMI-DADE COUNTY, Miami. Florida Miami -Dade Board of County Commissioners District 2 Coordinator (94-01). Aide to County Commissioner James Burke (93-94) w r NI fti m rn a Submitted into the public record for item(s) on 11-18-2020, City Clerk 2009 — 2012 Barry University, Miami, Florida Adiunct Professor / American Government COMMUNITY INVOLVEMENT *Bake House *Camillus House *Foundation of Community Assistance and Leadership •Law Offices of Carlos J. Martinez Equal Justice Initiative •Dade Leg& Aid/Put Something Back Program Homeowners Association - President Guardian Ad Litem Program — Volunteer Guardian *Board of Directors • Pro Bono Attorney as ;11 £ ? AOU uza :7 F Submitted into the public record for items) SP.1, ❑n 11-18-2020, City Clerk INTENTIONALLY LEFT BLANK STATE OF FLORIDA COUNTY OF MIAMI-DADE CITY OF MIAMI Submitted into the public record for item(s) Sp.1, on 11-18-2020, City Clerk CITY COMMISSION VACANCY AFFIDAVIT OF APPOINTMENT = x CITY OF MIAMI, FLORIDA `' (=, -C 1 N 3n q. 1.-= V( /1 /'7 4 //-7 CC L (hereinafter "affiant"), being fi st duly sworn under penalty of perjury, deposes and says: 1. My name is 1 1? a , /17 2. f am offering myself as an appointee to fill the unexpired term for the vacant office of Commissioner in District Number 5 of the City of Miami, Florida. I fully understand that I must maintain an actual and real residence within the district for the duration of my term of office. 3. I have resided in the Commission District Number 5 for a minimum of one year before qualifying, and I am a registered voter and a duly qualified elector in District 5. l am presently registered to vote in Precinct No. _' l presently reside at the following address (must include zip code): which is my legal address, and I have resided continually at said address from the Y - day of r / L , �- /'�- to the present. 4. Immediately prior to residing at the above -stated address, I have resided at the hereinbelow listed addresses for the cited periods of time (list hereinbelow all addresses at which you have resided for the past five years, as well as the length of time at each address): Prior Addresses: For the Period: / page I of3 Rc�. 10/2020 5. In addition to the residence that I have listed as my present address, 1 also reside at the following listed addresses on a temporary basis as a secondary domicile or domiciles: /V. 6. Affiant's spouse resides at the following address (must include city, state and zip code): r/ 7. Affiant's minor children reside at the following address (must include city, state and zip code): /j _ o 8. At the present time, affiant (isc (iSt registered to vote in any city, county 4r te other than as stipulated in subparagraph' above. cs'+ o 9. Name and business address of affiant's employer: c nMOP C Fri 10. Affiant's occupation: Affiant's business telephone number(s); 11. Affiant has been employed in the above -cited capacity for the following period of time: (Note: In the event the occupation of affiant has been for a period of less than one year, or the employment period with the same employer has been for a period of Tess than one year, affiant shall give the name(s) and address(es) of his/her employer(s) and occupation(s) for the period of one year prior to the date of this affidavit). 12. Affiant represents that he/she (is) (is not currently holding another elective or appointive office — whether city, county or municipal the term of which or any part thereof runs concurrently with that of the office he/she seeks, and that he/she has resigned from any office from which he/she is required to resign pursuant to F.S.99.012 and/or the City of Miami Charter. 13. Affiant represents that, if appointed, he/she shall serve in the office so appointed. Page 2 of3 Submitted into the public record for item(s) S on 11-18-2020, City Clerk Revs. 10/2020 SIGNED THIS Z DAY OF NeW0g2ef , 20Z0 i Submitted into the public record for itern(s) on 11-18-2020, City Clerk AFFIANT BEFORE ME, the undersigned authority , y, by means of physical or online presence appeared Revrari S, 1-4. LIAC.0( r who, after first being duly sworn (or affirmed), deposes and states that Slite- executed the foregoing to the best of r14' knowledge and belief. qr CITY CLERK, CITY OF MIAMI, FLORIDA Did take an oath Produced identification Type of identification produced: 1 be cai-evi ta 5440RAFORG€S M 1aty Pak -Stale atF4xida Cam,tiaan /Ga O848aa hiy Carom. EOM bier 14, 20121 amwr rizzip ruarraut Page 3 jf 3 (SEAL) :€7 D Rev. 10/2020 FORM 1 Please print or type your name, mailing address, agency name, and position below: STATEMENT OF 2019 FINANCIAL INTERESTS LAST KU E� FIRST N in, MIDDLEME — CQE . E/- f EVO iv1AILING ADDRESS 2_Io 41,141,1b S � 2 CITY i+c4.71)r NAME OF AGENCY : ZIP COUNTY r 13 i % NAME OF OFFICE OR POSITION HELD OR SOUGHT r CHECK ONLY IF >fiqi 01 a I SS/0410 19f 'I(75 / -T---(3Rf NEW EMPLOYEE OR APPOINTEE 1-(d kDUSE ONLY: 0NQV-2 All 10:19 OF(iCE OF THE CITY CLAM. CITY OF MIAMI Submitted into the public record for item(s) SPA., on 11-18-2020, City Clerk '*** THIS SECTION MUST BE COMPLETED **** DISCLOSURE PERIOD: THIS STATEMENT REFLECTS YOUR FINANCIAL INTERESTS FOR CALENDAR YEAR ENDING DECEMBER 31, 2019. MANNER OF CALCULATING REPORTABLE INTERESTS: FILERS HAVE THE OPTION OF USING REPORTING THRESHOLDS THAT ARE ABSOLUTE DOLLAR VALUES, WHICH REQUIRES FEWER CALCULATIONS, OR USING COMPARATIVE THRESHOLDS, WHICH ARE USUALLY BASED ON PERCENTAGE VALUES (see instructions for further details). CHECK THE ONE YOU ARE USING (must cf}eck one): ❑ COMPARATIVE (PERCENTAGE) THRESHOLDS OR DOLLAR VALUE THRESHOLDS PART A -- PRIMARY SOURCES OF INCOME [Major sources of income to the reporting person - See instructions] (If you have nothing to report, write "none" or "rural NAME OF SUUI-412,h OF INCOME SOURCES ADDRESS DESCRIPTION OF THE SOURCE'S PRINCIPAL BUSINESS ACTIVITY Al r-nl' 191— i U Eiji / 4.2 S9• itilaiiv 1-; 3/ : ai/ It1,-- )11iO4- PART B •- SECONDARY SOURCES OF INCOME [Major customers, clients, and other sources of income to businesses owned by the reporting person - See Instructions] (if you have nothing to report, write "none" or "nia") BUSINESS ENTITY OF BUSINESS' INCOME OF SOURCE ACTIVITY OF SOURCE 0;1;1.1 VIA PART C — REAL PROPERTY [Land, buildings owned by the reporting person - See instructions] (If you have nothing to report, write "none" or "nfa") ! V •r It , L !5Mr L �3 / You are not limited to the space on the lines on this form, Attach additional sheets, if necessary. FILING INSTRUCTIONS for when and where to file this form are located at the bottom of page 2. INSTRUCTIONS on who must file this form and how to fill it out begin on page 3. CE FORM 1 • Effective: January 1, '2020 Inwrpwnled by reference in Rule 34.8.202111, FA.C. (Conllnued on 'Indorse sIde) PAGE NAME OF BUSINESS ENTITY ADDRESS OF BUSINESS ENTITY PRINCIPAL BUSINESS ACTIVITY POSITION HELD WITH ENTITY I OWN MORE THAN A 5°%, INTEREST IN THE BUSINESS NATURE OF MY OWNERSHIP INTEREST PART n — INTANGIBLE PERSONAL PROPERTY [Stocks. bonds. certificates of deposit, etc. - See instructions] (If you have nothing to report, write "none" or "We") TYPE OF INTANGIBLE A YIS Aida) PART E — LIABILITIES [Major debts - See instructions] (If you have nothing to report, write "none" or "We") NAME OF CREDITOR BUSINESS ENTITY TO WHICH THE PROPERTY RELATES ADC Submitted into the public record for item(s) SP.1 on 11-18-2020, City Clerk rA%t4i/-lt:/ PART F — INTERESTS IN SPECIFIED BUSINESSES Ownership or positions in certain types of businesses - See instri 3Gtior� (If you have nothing to report, write "none' or "n/a") _ , ,'r►a _/� - r BUSINESS ENTITY # 1 BUnSEESSITITY # 2 ItN1I t 71 —' 1 Q 3 ir7 r, IT; D r g RI G PART G — TRAINING For elected municipal officers required to complete annual ethics training pursuant to section 112.3142, F.S. 1 CERTIFY THAT I HAVE COMPLETED THE REQUIRED TRAINING. IF ANY OF PARTS A THROUGH G ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE SIGNATURE OF FILER: Signature: Date Signed: 16_ _ 0W LI mow■ CPA or ATTORNEY SIGNATURE ONLY If a certified public accountant licensed under Chapter 473, or attorney in good standing with the Florida Bar prepared this form for you, he or she must complete the following statement: prepared the CE Form 9 in accordance with Section 112.3145, Florida Statutes, and :he instructions to the form, Upon my reasonable knowledge and belief, the disclosure herein is true and correct. CPA/Attorney Signature: Date Signed: FILING INSTRUCTIONS: If you were mailed the form by the Commission on Ethics or a County Supervisor of Elections for your annual disclosure filing, return the form to that location. To determine what category your position fails under, see page 3 of instructions. Local officers/employees file with the Supervisor of Elections of the county in which they permanently reside. (lf you do not permanently reside in Florida, file with the Supervisor of the county where your agency has its headquarters.) Form 1 filers who File with the Supervisor of Elections may file by mail or email. Contact your Supervisor of Elections for the mailing address or email address to use, Do not email your form to the Commission on Ethics, it will be returned. State officers or specified state employees who file with the Commission on Ethics may file by mail or email. To file by mail, send the completed Form to P.0, Drawer 15709, Tallahassee, FL 32317-5709; physical address: 325 John Knox Rd, Bldg E, Ste 200, Tallahassee, FL 32303. To file with the Commission by email, scan your completed form and any attachments as a pdf (do not use any other format), send it to CEFormi rx@Ieg.state.fl.us and retain a copy for your records, Do not file by both mail and email. Choose only one filing method. Form 6s will not be accepted via email. Candidates fife this form together with their filing papers. MULTIPLE FILING UNNECESSARY: A candidate who files a Form 1 with a qualifying officer is not required to file with the Commission or Supervisor of Elections. WHEN TO FILE: Initially, each local officer/employee, state officer, and specified state employee must file within 30 days of the date of his or her appointment or of the beginning of employment, Appointees who must be confirmed by the Senate must file prior to confirmation, even if that is less than 30 days from the date of their appointment. Candidates must file at the same time they file their qualifying papers. Thereafter, file by July 1 following each calendar year in which they hold their positions. Finally, file a final disclosure form (Form 1F) within 60 days of leaving office or employment. Filing a CE Form 1 F (Final Statement of Financial Interests) does not relieve the filer of filing a CE Form 1 if the filer was in his or her position on December 31, 2019. CE FORM 1 - Etfeetive" January 1, 211=121.1. PAGE 2 Interpo (ed by reference in Rule 34-B.292t11. F.A.C. CANDIDATE OATH — NONPARTISAN OFFICE (Do not use this form if a Judicial or School Board Candidate) Check box only if you are seeking to qualify as a write-in candidate: ❑ Write-in candidate RECEIVE° 2020 NOV -2 till IO: 20 OFF tZE11YOF nit CITY MIAMCLEM C. OFFICE USE ONLY Candidate Oath (Section 99.021(1)(a), Florida Statutes) (Print name above as you wish it to appear an the ballot, If your last name consists of two or more names but has no hyphen, check box (See page 2 - Compound Last Names). No change can be made after the end of qualifying. Although a write-in candidates name is not printed on the ballot, the name must be printed above for oath purposes.) am a candidate for the nonpartisan office of (Circuit #) (Gaup or Seat #) !1- �L cry ; I am a qualified elector of (Office) (District #) -- County, Florida; 1 am qualified under the Constitution and the Laws of Florida to hold the office to which 1 desire to be nominated or a#ected; have qualified for no other public office in the state, the term of which office or any part thereof runs concurrent with the office I seek; and I have resigned from any office from which I am required to resign pursuant to Section 99.012, Florida Statutes; and 1 will support the Constitution of the United States and the Constitution of the State of Florida. Candidate's Florida Voter Registration Number (located on your voter information card): % J ' 7 <1 Phonetic spelling for audio ballot: Print name phonetically on the line below as you wish it to be pronounced on the audio ballot as may be used by persons with disabilities (see instructions on page 2 of this form): (Not applicable to write-in candidates-] Signature of Candidate telephone Number c V h al_ Email Address .6) , ram" Address City STATE OF FLORIDA COUNTY OF Mto Sworn to (or affirmed) and subscribed before �m�e�,by ❑ physical or ❑ online presence this day of e''l t , 20 245. Personally Known, or Produced Identification: AF Type of Identification Produced: FlOY-1-44/4 DS-DE 302NP (Rev. 04/20) State ZIP Code Sigt: Notary ublic Print, Type, or Stamp Commissioned Name of Notary Public below: .•`� .aGB.. FRANCES LLOP-Noy =Notary Public -State of Florida .- Commission # GG 905986 My Commission Expires August 27, 2023 Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk Rule 15-2.0001, F.A.C. LOYALTY OATH STATE OF FLORIDA COUNTY OF MIAMI-DADE 1, KZ'"t/i2t S y 1 f(eivi First Name Middle Initial Last Name a citizen of the State of Florida and of the United States of America, ... and a candidate for public office ... do hereby solemnly swear or affirm that I will support the Constitution of the United States and of the State of Florida. Signature of Candidate G r.3 CITY OF MIAMI OATH OF CANDIDATE OFFICE OF CITY OF MIAMI COMMISSIONER Before me, an officer authorized to administer oaths, personally appeared A/ vi . M- Li'v Go(vi (PLEASE PRINT NAME) ti 9 0 who, being sworn, says he/she is a candidate for the office of City of Miami Commissioner, District-. , for the City of Miami, Florida; that he/she is a qualified elector of the City of Miami, Florida; that he/she is qualified under the Constitution, the Laws of Florida, and City of Miami Charter to hold the office to which he/she desires to be elected; that he/she has taken the oath required by Section 99.021, Florida Statutes; that he/she has qualified for no other public office in the State, the term of which office or any part thereof runs concurrent with that of the office he/she seeks; and that he/she has resigned or taken a leave of absence from any office from which he/she is required to resign or take a leave of absence, pursuant to Section 99.012, Florida Statutes. Signature of Candidate sio NI1/11 1 Lai' k.1- fII(.sA; Address City State ZIP Code The Loyalty Oath and Oath of Candidate are sworn to (or affirmed) and subscribed before me this 71 day of 06*211C 20 . Signalcre of affider Adminisl&nng Oath or Notary Public Personally Known: OR Produced ldenti1 cation: Type of Identification Produced: [Pei Ael, (D ,,, ..+,,,, FRANCES LLOP-NOY �'—�' =Notary Public -State of Florida •z Commission N GG 905986 My Commission Expires `'•° +«' August 2t. 2423 a e of typed, #rented or Stamped Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk October 26, 2020 RE: District 5 Dear Decision Making Professional: Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk City of Miami Commissioner This letter is to express my strong interest in the City of Miami Commissioner District 5 Whether the issues are communication, quality, or productivity, I work effectively in finding solutions towards the desired results. The greatest satisfaction in my career is derived from the support, direction, and leadership that I provide. My experience has enabled me to deliver quantifiable results and build effective teams by providing excellent communications, encouraging involvement, and sharing responsibilities. I can add exceptionally good value by applying these skills to the City of Miami. I submit my resume for your consideration, from which you will see the successes I have experienced. l would be happy to become part of the continuing success of the City of Miami. Sincerely, Reveran Lincoln revlincoln2020@gmail.com 305.763.0820 n CP C$ St Ell 0 r v crk VI c 1 Reveran Lincoln 210 Northwest 15'h Street Apartment #2 Miami, Florida 33136 Phone: (305) 763-0820 Email: revlinco1n2020 a@gmail.com Objective: Seeking the position of City of Miami Commissioner District 5 Skills: Community Servant Strong interpersonal Skills Strong Organizational Skills Community Activist Strong Leadership Q r▪ ri Career Overview • Reveran Lincoln was married for 54 years engaging in Import and Export business in British Guyana. Reveran Lincoln, her husband and her 8 children moved to Canada in 1952. • Reveran Lincoln started a clothing business in Toronto Canada in 1973 Her business migrated to Montreal Quebec Canada in 1985 in the fashion clothing district. • She bought various buildings and continued in the real estate field and clothing business industry. • She became a teacher once the family moved to Quebec. • The family realized that they can make more money in the clothing business than real estate. The Family continued the business until the passing of her husband. • in 1998 Reveran Lincoln moved to Miami Beach • Reveran Lincoln stated taking a crash courses in ethics at Miami Dade College - Wolfson Campus • In 2000 Reveran Lincoln came to the OverTown community to help by starting a corporation called People Helping People Reliance in 2002. • Reveran Lincoln became an activist once her program People Helping People started • Reveran Lincoln engaged in real estate in OverTown district 5 • She is actively involved with various political efforts and groups to help Overtown • Reveran Lincoln decided to register as a candidate for commissioner of District 5 • Reveran Lincoln is perfect candidate to make massive changes in for District 5 • She posses leadership skills that people can trust • Education Fyrish- British Guyana Congregational School References Available Upon Request Submitted into the public record for item(s) SP.1, en 11-18-2020, City Clerk Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk INTENTIONALLY LEFT BLANK Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk CITY COMMISSION VACANCY AFFIDAVIT OF APPOINTMENT CITY OF MIAMI, FLORIDA STATE OF FLORIDA COUNTY OF MIAMI-DADE CITY OF MIAMI Robert Malone, Jr. first duly sworn under penalty of perjury, deposes and says: I. My name is Robert Malone, Jr. (hereinafter "affiant"), being 2. I am offering myself as an appointee to fill the unexpired term for the vacant office of Commissioner in District Number 5 of the City of Miami, Florida. I fully understand that I must maintain an actual and real residence within the district for the duration of my term of office. 3. I have resided in the Commission District Number 5 for a minimum of one year before qualifying, and I am a registered voter and a duly qualified elector in District 5. I am presently registered to vote in Precinct No. 512.0 I presently reside at the following address (must include zip code): 1825 NW 47th Terrace Miami, FL 33142 which is my legal address, and I have resided continually at said address from the 1 day of January 2009 to the present. 4. Immediately prior to residing at the above -stated address, I have resided at the hereinbelow listed addresses for the cited periods of time (list hereinbelow all addresses at which you have resided for the past five years, as well as the length of time at each address): Prior Addresses: For the Period: NIA O CI W C3 .70 Nast I t '3 «e+,. IUrg20 Submitted into the public record for item(s) SP.1, on 11-18-2020 City Clerk 5. In addition to the residence that ! have listed as my present address, I also reside at the following listed addresses on a temporary basis as a secondary domicile or domiciles: N/A 6. Affiant's spouse resides at the following address (must include city, state and zip_oodl N/A - c, 7. Affiarnt's minor children reside at the following address (must include city, sta'nPzip 2 code): N/A r cP 8. At the present time, affiar i) is not) registered to vote in any city, county or state other than as stipulated in subparfgrip -3 ove. 9. Name and business address of affiant`s employer: Miami -Dade County Public Schools, 1450 NE 2nd Avenue, Miami, FL, 33132 US Dept. of Education, 400 Maryland Avenue, SW, Washington, DC, 20202 10. Affiant's occupation: interventionist/inStructar Affiant's business telephone number(s): (7 - 1919 11. Affiant has been employed in the above -cited capacity for the following period of time: 02/2013 (Note: In the event the occupation of affiant has been for a period of less than one year, or the employment period with the same employer has been for a period of less than one year, affiant shall give the name(s) and address(es) of his/her employer(s) and occupation(s) for the period of one year prior to the date of this affidavit). 12. Affiant represents that he/she (is) is not) currently holding another elective or appointive office — whether city, county or m Iclpal — the term of which or any part thereof runs concurrently with that of the office he/she seeks, and that he/she has resigned from any office from which he/she is required to resign pursuant to F.S.99.012 and/or the City of Miami Charter. 13. Affiant represents that, if appointed, he/she shall serve in the office so appointed, Pae 2 of Ilev. I0/2020 Submitted into the public record for item(s) 5P.1, on 11-18-2020, City Clerk SIGNED THIS ) DAY OF OCA-Ober , AFFI NT BEFORE ME, the undersigned authority, by means of physical or online presence appeared o r ' M&o►ete. J'►C, , who, after first being duly sworn (or affirmed), deposes and states that Vie_ executed the foregoing to the best of IntS knowledge and b, CITY CITY OF MIAMI, FLORIDA (SEAL) Did take an oath Produced identification Type of identification produced: F %YG,r ibaraialmillialhaftwillwalbilliabarlire il ,,••'; ...,g,, SANDRA FORGES I 1 e Way Fob% - kteafFlrida M Camniss•on#GGC8 618 1 ';a"��"� . MyCann ExagesMar 19,2021 cp A Q rn PagC 3 al 3 ficu. 10/2020 FORM 1 Please print or typo your name, mailing address, agency name,, and position below; STATEMENT OF f 2019 FINANCIAL INTERESTS, ONLY: ILA 48 0 or OFF ;CE OF iljECITY CLERK CITY IF 1�]i LAST NAME -- FIRST NAME — MIDDLE NAME Robert, Jr. Malone MAILING ADDRESS P.O. Box 371555 CITY ' ZIP ; COUNTY Miami 33137-1555 Miami -Dade NAME OF AGENCY City of Miami NAME OF OFFICE OR POSITION HELD OR SOUGHT Commissioner, District 5 CHECK ONLY fF 0 CANDIDATE OR ® NEW EMPLOYEE OR APPOINTEE Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk **** THIS SECTION MUST BE COMPLETED DISCLOSURE PERIOD: THIS STATEMENT REFLECTS YOUR FINANCIAL INTERESTS FOR CALENDAR YEAR ENDING DECEMBER 31, 2019. MANNER OF CALCULATING REPORTABLE INTERESTS: FILERS HAVE THE OPTION OF USING REPORTING THRESHOLDS THAT ARE ABSOLUTE DOLLAR VALUES, WHICH REQUIRES FEWER CALCULATIONS, OR USING COMPARATIVE THRESHOLDS, WHICH ARE USUALLY BASED ON PERCENTAGE VALUES (see instructions for further details), CHECK THE ONE YOU ARE USING (must check one): COMPARATIVE (PERCENTAGE) THRESHOLDS Q E DOLLAR VALUE THRESHOLDS PART A — PRIMARY SOURCES OF INCOME [Major sources of income to the reporting person - See instructions] (If you have nothing to report, write "none" or "nfa") INHmt ut- Suu1-tLE OF INCOME SOURCE'S ADDRESS DESCRIPTION OF THE SOURCES PRINCIPAL BUSINESS ACTIVITY Dade County Schools 1450 NE 2nd Ave, Miami, FL 33132 Interventionist/Instructor US Dept of Education 400 Maryland Ave SW, Washington, DC Peer Reviewer/Pane] Monitor PART B — SECONDARY SOURCES OF INCOME [Major customers, clients, and other sources of income to businesses owned by the reporting person - See instructions] Ili you have nothing to report, write "none" or "n/a") NAME OF BUSINESS ENTITY OF BUSINESS' INCOME OF SOURCE ACTIVITY OF SOURCE n/a PART C -- REAL PROPERTY [Lai d, buildings owned by the reporting person - See instructions] (If you have nothing to report, write "none" or "Na"] n/a You are lines an sheets, not limited to the space on the this farm. Attach additional if necessary. INSTRUCTIONS for when to file this form are at the bottom of page 2. on who must fife and how to fill it out on page 3. t FILING and where located INSTRUCTIONS this form begin C E FOR d 1 . mime Januar" 1 2D20 ineorporaied try reference In Rut& ad-a.2o2m, (Continued an reverse side) PAGE 1 PART D — INTANGIBLE PERSONAL PROPERTY jSlocks, (If you have nothing to report, write "none" TYPE OF INTANGIBLE bonds, certificates of deposit_ etc. - See instructions) or "nfa") BUSINESS ENTITY TO WHICH THE PROPERTY RELATES nla tlla PART E — LIABILITIES [Major debts - See Instructions] (If you have nothing to report, write "none" NAME OF CREDITOR or "c/a") ADDRESS OF CREDITOR nla nla PART F — INTERESTS IN SPECIFIED BUSINESSES (If you have nothing to report, write "none' NAME OF BUSINESS ENTITY Ownership or positions in certain types of businesses or "ilia") BUSINESS ENTITY # 1 - See instructions] BUSINESS ENTITY # 2 ct Q ADDRESS OF BUSINESS ENTITY Ills --AI Ilia PRINCIPAL BUSINESS ACTIVITY POSITION HELD WITH ENTITY -& rn i OWN MORE THAN A 5% INTEREST IN THE BUSINESS csi-, "t"r" r= NATURE OF MY OWNERSHIP INTEREST 1 * fl —+ <-y PART G — TRAINING r r For elected municipal officers required to complete annual ethics training pursuant to section 112.3142, FS. 9 co ❑ I CERTIFY THAT 1 HAVE COMPLETED THE REQUIRED TRAINING. IF ANY OF PARTS A THROUGH G ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE ❑ v SIGNATURE OF FILER: CPA or ATTORNEY SIGNATURE ONLY Signature: �/ + v 1'"l�+rn If a certified public accountant licensed under Chapter 473, or attorney in good standing with the Florida Bar prepared this form for you, he or she must complete the following statement: I, prepared the CE Form 1 in accordance with instructions to the form. disclosure herein is true CPA/Attorney Signature' Date Signed: Section 112.3145, Florida Statutes. and the Upon my reasonable knowledge and belief, the and correct. Date Signed: (jj� U nn L 3 4■ y L (_.. 0 FILING INSTRUCTIONS: If you were mailed the form by the Commission on Ethics or a County Supervisor of Elections for your annual disclosure filing, return the form to that location. To determine what category your position falls under, see page 3 of instructions. Local officers/employees Hie with the Supervisor of Elections of the county in which they permanently reside. (If you do not permanently reside in Florida, file with the Supervisor of the county where your agency has its headquarters.) Form 1 filers who file with the Supervisor of Elections may file by mail or email. Contact your Supervisor of Elections for the nailing address or email address to use. Do not email your form to the Commission on Ethics. it will be returned. State officers or specified state employees who file with the Commission on Ethics may file by mail or email. To fife by mail, send the completed form to P.O. Drawer 15709, Tallahassee, FL 32317-5709; physical address: 325 John Knox Rd, Bldg E, Ste 200. Tallahassee. FL 32303. To file with the Commission by email, scan your completed form and any attachments as a pdf (do not use any other format). send It to CEForm1@leg.state.fLus and retain a copy for your records. Do not file by both mail an email. Choose onlyane filing method. Form 6s will not be accepted via elnail. Candidates file this form together with their filing papers. MULTIPLE FILING UNNECESSARY: A candidate who files a Form 1 with a qualifying officer is not required to file with the Commission or Supervisor of Elections. WHEN TO FILE: initially, each local officerlemployee= state officer, and specified state employee must file within 30 days of the date of his or her appointment or of the beginning of employment Appointees who must be confirmed by the Senate roust file prior to confirmation, even if that is less than 30 days from the date of their appointment. Candidates must file at the same time they file their qualifying papers. Thereafter, file by July 1 fallowing each calendar year in which they hold their positions. Finally, file a final disclosure form (Form 1F) within 60 days of leaving office or employment. Filing a CE Form 1 F (Final Statement of Financial Interests) does not relieve the filer of tiling a CE Form 1 if the filer was in his or her position an December 31, 2019, CE FORM 1 - Erfestrve. January 1 7522 Innorporaled b4 nafestate in Rule 34-8.20211 Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk PAGE 2 CANDIDATE OATH - NONPARTISAN OFFICE (Do not use this Form if a Judicial or School Board Candidate) Check box only if you are seeking to qualify as a write-in candidate: ❑ Write-in candidate RECEIVEQ 2020 OCT 30 10: 48 Lit Fi<E. OF ThE CITY CLEM CITY OF MIAMI OFFICE USE ONLY Candidate Oath (Section 99.021(1)(a), Florida Statutes) I, Robert Malone, Jr. (Print name above as you wish it to appear an the ballot. If your last name consists of two or more names but has no hyphen, check box J. (See page 2 - Compound Last Names). No change can be made after the end of qualifying Although a write-in candidate's name is riot printed on the ballot the name must be printed above for oath purposes.) am a candidate for the nonpartisan office of City of Miami Commission (Office) (District if) 5 : I am a qualified elector of Miami -Dade (Circuit #) (Group or Seat lt) County, Florida; 1 am qualified under the Constitution and the Laws of Florida to hold the office to which I desire to be nominated or elected; I have qualified for no other public office in the state, the term of which office or any part thereof runs concurrent with the office 1 seek; and 1 have resigned from any office from which I am required to resign pursuant to Section 99,012, Florida. Statutes: and 1 will support the Constitution of the United States and the Constitution of the State of Florida. Candidate's Florida Voter Registration Number (located on your voter information card) 105027640 Phonetic spelling for audio ballot: Print name phonetically on the line below as you wish it to be pronounced on the audio ballot as may be used by persons with disabilities (San instructions on page 2 of this form): (Not applicable to write-in candidates.) roe-BUHRT MAH-loen JUHR-NUR Signature of Candidate 1825 NW 47th Terrace 1786) 512-1919 Telephone Number Miami FL dr.malonejr@gmall.com Email Address Address City n State STATE OF FLORIDA COUNTY OF['Aliari1-ks:-.)..A.e. Sworn to (or affirmed) and subscribed before me by V." hysical or ❑ online presence this .) day of l„ CAVbe,r' Personally Known: or Produced identification: Type of identification Produced. C L Dr 1 VCi ay) DS-DE 302NP (Rev. 04120) 33142 ZIP Code Sign a/lrebf otary Public Print. T e, or S amp Commissioned Name of Notary Public below' SAff0JRA 'ORGES Miry quo 7c- State of Florida Commisaicn *GC O8491S Fly Comm. ExooLis Mar 19. 2021 BD^ded ' ? Natag Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk ale 1S-2.0001, F.A.C. LI STATE OF FLORIDA COUNTY OF MIAMI-DADE Robert RtezitletyOATH MOOCT 30 AM I0: �4.By� Of t .4 E Vf l i`iE CITY CLEi.ti CITY 6F MIAMI Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk Malone First Name Middle Initial Last Name a citizen of the State of Florida and of the United States of America, ... and a candidate for public office ... do hereby solemnly swear or affirm that I will support the Constitution of the United States and of the State of Florida. Signature of Calndidate CITY OF MIAMI OATH OF CANDIDATE OFFICE OF Commissioner, District 5 Before me, an officer authorized to administer oaths, personally appeared Robert Malone, Jr. (PLEASE PRINT NAME) who, being sworn, says he/she is a candidate for the office of City of Miami Commissioner, District 5 for the City of Miami, Florida; that he/she is a qualified elector of the City of Miami, Florida; that he/she is qualified under the Constitution, the Laws of Florida, and City of Miami Charter to hold the office to which he/she desires to be elected; that he/she has taken the oath required by Section 99.021, Florida Statutes; that he/she has qualified for no other public office in the State, the term of which office or any part thereof runs concurrent with that of the office he/she seeks; and that he/she has resigned or taken a leave of absence from any office from which he/she is required to resign or take a leave of absence, pursuant to Section 99.012, Florida Statutes. -1825 NW 47th Terrace Miami Address v Signature of Candidate FL 33142 Stale ZIP Code The Loyalty Oath and Oath of Candidate are sworn to (or affirmed) and subscribed before me by Zphysical or 7.111 online presence this Ot.,+ day of Sign - of itffc er Administering Oath or Notary Public Personally Known: OR Produced Identification_ Type of Identification Produced; f l.— DC -%vex( License. ,20?.n . 'at a V Name of Notary Typed, sled or Stamped aul._0 SANDRA FORGES NoviryPut*—Suit alFlorida CommissonV GG 08461a My Comm. Ewes Maf 40, 2021 BMW Oa* VittA91 WA/ (0,2020 My Verizon - Profile Order online and get your device shipped directly to your home. verizon 1 My Profile Quick links Security Contact & Billing Email address Provide the email address that we should use to contact you. DRMALONEJR ci'GMAIL.COM Page l of 5 Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk c Contact numbers PI wide the prone nurneers where we can best reach: yor.. 786.23 7 ,824! Cri b e" Caw risr CO Billing address Let us know where to send your bell. Have a question about changing addresses? See FAQs Address* 1825 NW47TH TE Apt/Suite/Other Cancel �uL Chat with us https://myvpostpay. vcrizon.com/uikicct/securelprofile/conta.ctbil I ing/billingAddress I 0/28/2020 My Verizon - Profile Or tr)nllne and get your device shipped directly to your home. M%AMI ve ri zon State* FL Page 2of5 Submitted into the public record for items) SPA, on 11-18-2020, City Clerk Zip code* 33142 n Service Addresse Tell us where you use the service so we can calculate the right taxes and surchartres_ Have a question about changing addresses? See FAQs Sarre es billing address cJ �� o 7436.428.8335 [R©BERT" MA! f:NEI 7-. 7i 6.512.1019 [RO 1ERT M©LONEJ e• " c. in d o..--., sr) in C, a = rn -c — c. Payment settings Change your Auto Pay. paper • tree billing and preferred payment nielhod . Payment Settings Top Device Brands Sanlaling Apple LG aVL .7AV Chat with us Motorola https://myvppostpay.vcrizott.comlui/acc(/seclrre/profireIeojltactbilling/bil1ingAddress 10/28/2020 My Verizon - Profile Order online and get your device shipped directly to your home. verizonv My Profile Quick finks Security Contact & Billing Page 1 of 5 Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk } cm - OD Email address Provide the email address that we should use to contact you. DA.M.4LONEJ: Ei@GMAIL.COM Contract rat:mbers Provide the phone numbers where we can Kest reach you. 786.237.8247 Killing addres.3rri Lei us know where tosend your hill at'={ C] 1825 NW 47TH TE ' a MIAM1, {.k_ 33142 �, G o in a Fri Service Addresses Tell us where you use the service so we can calculate the right taxes and surcharges. Have a question about changing addresses? See FAQs Same as billing address 786.428.8335 [ROBERT MALONE].7A7 Chat wi Line 786.512.1919 (ROBERT MOLONE] Edit Line https://myvpostpay.veri on.com/ui/acclisecurelprofile/contactbi1l ingiserviceAdciress 10/28/2020 Submitted into the public record for item(s) SP,1, on 11-18-2020, City Clerk City of hlianni Commission Attention: Todd Hannon, City Clerk City of Miami City Hall 3500 Pan American Ave Miami, FL 33133 Via Hand Delivery and Electronic Mail Dr. Robert Malone, Jr. P.O. 13ox 371555 Miami, Florida 33137-1555 cell (786) 512-1919 email dr.nialoneit@grriail.com October 27, 2020 Re: City opliami CommiryiO/. j r ❑irflrei 5 I ',raw' Dear Commissioners and Cite• Clerk As a lifelong resident, civic leader and youth advocate of the City of Miami District 5 Commission, 1 would like to enter my name in consideration to replace outgoing Commissioner Keon I Iardemon. As the former President of the Hadley Park I Iotneowners Association working alongside such instrumental Figures in our community such as IIershel Haynes, Henry Goa and Nancy Dawkins, the founding president of the local chapter of the AARP, therc is a need for someone who represents the community to step up and answer this call to serve. Please sec my professional resume attached to this letter which should demonstrate my deep ties and affection for this community as well as my experience in government affairs. I ani reach' to serve on Day One should 1 be selected to join the cin- commission. I respectfullk° request an oppornu°utr to meet with city commissioners before the November 18, 2020 special meeting. If you have any questions about my- application, please feel free to contact me directly. Thank you. Very truly yours, Dr. Robert Malone, Jr. DR. ROBERT MALONE, JR., M.S., Ph.D. P.O. Box 371555 ■ Miami, Florida 33137-1533 • cell (786) 312-1919 ■ email dr.msiloncjr t? mil.com PROFILE • Liberty City civic leader and past president of the I Iadley Park Homeowners Association • Veteran educator and youth advocate working with Inner City comrnunities of Nliarni IP Experienced peer reviewer for the United States Department of Education • Media personality and contributor to the Miami Herald and Miami Tunes editorial pages • Former legislative aide and intergovernmental consultant • Helped over 5,000 families of high achieving students cam academic scholarships • ll'lenrored thousands of at -risk youth youths from college to elementary school level • Former college lecturer in Criminology/Criminal Justice EDUCATION • Ph.D. in Educational Leadership, Florida A&M University, Tallahassee, FI. • Master of Science in Criminology, Florida State University, Tallahassee, FL • Bachelor of Science in Criminology, Florida State University, Tallahassee, FL • Associate of Arts, Univer:sitr of -Florida, Gainesville. FL :1 pril 2007 December 1992 1pri1 1991 April 1939 PROFESSIONAL EXPERIENCE Consultant, Self -Proprietor, Miami, FL, 3/2017-Present • Provides consulting services to non -profits, local, stare and federal government agencies in the area of youth advocacy, crime prevention and education. o Provide research and community outreach for film projects and media coverage. o Assessed the Teen Court division under the Miami -Dade Economic Advocacy Trust (1IDE T) organization in the :ueas of personnel, budget, resources. and deliver- of services to develop improvement strategies through capacity- building and process improvement. • Trains educators, parents and students in retention strategies, classroom management and violence prevention techniques. Peer Reviewer/Panel Monitor, U.S. Department of Education, Washington DC, 3/201 b-Present • F. aluates applications from post -secondary education programs to support low income and first generauon students through federal programs such as Upward Around, Talent Search and Gear Up. v ae o Assesses the Technical Review Forms (TRF) from each Peer Reviewer. o Ensures applications receive an objective, fair, and equitable evaluation. CL o Developed partnerships between corninunities and schools seeking funding. +-, C . afr F urs Os o • Served as a reading lnter-entiosist and substitute teacher for at -risk school student populations N o implement reading intervention strategies to assist students in increasing performance level do in reading. o Provide on -call academic instruction and guidance at schools from Miami Jackson and Miami Edison High Schools; and Sltadowlawn Elementary. 0 o Assist students with completing college applications, preparing essays, guiding financial ,aid applications, developing college preparedness, and reaching out to parents or guardians. Interventionist/Instructor, Dade County Schools, M.iuni, FL, 02/2013-Present Consultant, 13roward County Schools, Ft. Lauderdale, FL, 12/2011-2/2012 • Provided training and resources for school in at -risk, economically -challenged communities. o Led classroom management activities with teachers. o Provided grant opportunities relating to tolerance, bullying, violence prevention. Submitted into the public record for item(s) 5 on 1.1-1 City Clerk ROBERT MALONE. JR„ M.S., PH.D. o Trained for educators and students in secondary schools on violence prevention and coimnunica non. University Representative/Recruiter, American Inter -Continental University South Florida, Weston, FL, 5/09-11/10 • Represented the college to prospective high school students and establishing relationships with guidance counselors, teachers and school administrators. o Identified target school populations For recruitment and community outreach_ o Advised students regarding school career options through education and scholarship opportunities. o Organized college visitations/presentations for potential students, o Surpassed 8Oa.0 of goals in submission of high school student lead generations, Sr. University Representative/Recruiter, Florida A&M University, Tallahassee. FL, 8/00-3/08 • helped manage a multi -trillion dollar scholarship/recruitment program for Florida A&M University tinder the Office of Student _affairs. o Provided group presentations for high school students in cities throughout the L.S. with approved universin, marketing materials. o .assisted in developing enrollment and rccntitment strategies organized recruitment fairs for potential academic scholars in high school. o Maintained approximately 500 to 600 university- student scholarship files, calculated scholarship awards, processed admission and scholarship applications, o Organized student activities for scholars, supervised university student workers and informed incoming students of enrollment and in -state status_ o Counseled and advised families and potential ;students on financial aid packaging, career planning and college preparation. Criminal Justice Adjunct Instructor, Brown Mackie Career College, Miami, FL, 1/08-5/08 • Instructed courses in the field of Criminal justice. o Provided a foundation for students interested in the areas of Iaw enforcement, corrections, and related areas in the expanding criminal justice sa-stern. o Taught standards and principles of the legal held along with substantive and procedural law; investigating facts: and research were also discussed. Supervisor/Counselor, Black Male College Explorers Program (B.NI.C.E.P )-Pre-Collegiate Program, Tallahassee, FL, 6/00-7/00 - 6/03-7/03, 6/06-07/06 • Responsible for providing oversight and organizing activities addressing the personal, athletic, acadenic, and leadership development needs of at -risk young men during the 8 week summer college program. o Supervised 7-8 mentors during the length of the program. o Managed the program for a total of O= O participants. Criminal Justice Adjunct Instructor, Tallahassee Community College, Tallahassee, FL, 8/03-8/04 • Instructed courses in the field of Criminal Justice. o Provided a foundation for students interested in the areas of the law enforcement, corrections. and related areas in the expanding criminal justice system_ o Discussed standards and principles of the legal field along with substantive and procedural law; investigating facts; and research. Research Associate, Institute of I-tealth and Hurnan Services Research, Tallahassee, FL, 4/97-12/99 • Evaluated community -based programs funded by the Florida Department of Community Affairs Teaching Assistant and Class Instructor, Florida State University, Tallahassee, FL, 8/96-12/98 • Conducted classroom instructions as a Teaching Assistant at Florida State L'niversity, School of Social Work. Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk ROBERT MALONE, JR., M.S., PH.D. Group Treatment Leader, Better Outlook Center Juvenile Halfway House, ML''uni, FL, 9/9-1--1U/95 • Supervised a group treatment program for M-80 juvenile offenders. • Created and implemented treatment plans including individual counseling. o Coordinated group treatment activities. o Developed a re-entry process for juveniles in consultation with parents. Legislative Assistant, Srate Representative Larcenia Bullard, Miami, FL, 8/93-9/94 • Responsible for the daily operations of the district office for State Senator Larcenia Bullard when she was a State Representative, o addressed constituent services to resolve conmiunin- concerns. o Provided bookkeeping for the office budget. o attending conrnnunit3- meetings to develop community relationships. SOFTWARE EXPERTISE Microsoft Office Suite (Word, PowerPoint, Excel); Zoom (Video Conferencing) COMMUNITY/UNIVERSITY SERVICE Community Youths against Violence Volunteer judge, Speech Therapy Contest for Troubled Youth (The Links) Educational Excellence School Advisory Council (EESAC) Needs assessment Chair, Urban Partnership Drug Free Community Coalition Lindley Park I Iomeowners Association, President N.A.A.C.P., Executive Board Member } Iampton House Community Trust, Advisor 5000 Role Models of Excellence, Member Board Member, The Enterprise Zone Advisor- Council Career Day Participant at Miami Edison Senior }Iigh School, Miami, P1 Principal for the Day at the School for Applied Technology, Miami, Fl Liberty City Community Action Agency Chairperson of In -State Appeals Committee (FAMU), Tallahassee, Fl 2019 2015-19 7012 2012 20 [2-13 2010 2008 2008 2008-12 2008 2008 2008 2003-t1T AWARDS/ORGANIZATIONS Certificate of Participation, National Young Readers Day Awarded best counselor Black Male College Explorers Program Florida \&I [ University Job Performance Bonus Award Certificate of Appreciation for Participation in the Guide Right Retreat Program for Young Men Kappa Alpha Psi Fraternity, Inc. Awarded Best Counselor Award for the Black Male College Explorers Program (B.N1.C.E.P.) Awarded Best Staff Role Model Award for the Black Male College Explorers Program (B.M.C.E.P.) Awarded the Delores Auzenne Doctoral Fellowship 1998-00 Florida State University's Seminole Torchbearers Leadership Award 1991 National Young Leader. Delegate for the Congressional Youths Leadership 1990 Conference (Georgetown University) Member of the Tallahassee Alumni Chapter. of Kappa Alpha Psi Fraternity, Inc. 2002 Member of the New Providence 365 Prince flail Affiliated, Free and Accepted 1993 Masonic Lodge (Miami, FL) 2008 2006 2002 2002 2000-03 2002 Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk INTENTIONALLY LEFT BLANK Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk CITY COMMISSION VACANCY AFFIDAVIT OF APPOINTMENT CITY OF MIAMI, FLORIDA STATE OF FLORIDA COUNTY OF MIAMI-DADE CITY OF MIAMI ) ) RECEIVED 2010 NOV -2 AM 9. 57 OF 1M @LEAK CITY O.M1Afl Py$ iZ tC fC 0146 i pH O L . 15 (hereinafter 'afflant"), being first duly sworn under penalty of perjury, deposes and says: 1, My name is '1 ' � ' l< CJ. ]' l l c, J 2, I am offering myself as an appointee to fill the unexpired term for the vacant office of Commissioner in District Number 5 of the City of Miami, Florida. I fully understand that l must maintain an actual and real residence within the district for the duration of my term of office. 3. I have resided in the Commission District Number 5 for a minimum of one year before qualifying, and I am a registered voter and a duly qualified elector in District 5. I am presently registered to vote in Precinct No. 2.2_ . I presently reside at the following address (must include zip code): 6 l (-1-- s•r i ter, .A-fr, J-4 /L6 r T I r4 ..3I .7 which is my legal address, and I have resided continually at said address from the % 0 'day of /PiZ rL 663 to the present. 4. Immediately prior to residing at the above -stated address, I have resided at the hereinbelow listed addresses for the cited periods of time (list hereinbelow all addresses at which you have resided for the past five years, as well as the length of time at each address): Prior Addresses: J,6C: r Mf g 33b27 For the Period: 1 9' 0 --;60.5. rm , 7 •/(r 3) yRS, Pagel of3 Rev 102020 Submitted into the public record for item(s) Sp.1, on 11-18-2020 City Clerk 5. In addition to the residence that I have listed as my present address, I also reside at the following listed addresses on a temporary basis as a secondary domicile or domiciles: 6. Affiant's spouse resides at the following address (must include city, state and zip code): 7. Affiant's minor children reside at the following address (must include city, state and zip code): 8. At the present time, affiant (is) is no ]registered to vote in any city, county or slate other than as stipulated in subparagraph 3 above. 9. Name and business address of affiant's employer: =) t- L 1 C A-4P/ - ()i . P1,7 If lb/ C L . �,t�' T 6 /I r A-'6 j rb,i4 G" f }u c .A.) L. L ( .—" 701 '7 *VA.) 1 `3 ,1 V t Lit .� �1 bf !, C . 3 /4 Y r t uti?1-�-,ce 10. Affiant's occupation: ek iu.467 Y C�,.u;/2i 0'on ; it aA � C 3, '`e/ ie449/yz74rior Affiant's business telephone number(s): 7 72. - 2656- 6_c a ... 11. Affiant has been employed in the above -cited capacity for the following period of time: Zm13- L. rc 5)fiery Cc.�. -2 Cagle sac;1111 /12070rc15 ; 1a26), (Note: In the event the occupation of affiant has been for a period of Tess than one year, or the employment period with the same employer has been for a period of Tess than one year, affiant shall give the name(s) and address(es) of his/her entplayer(s) and occupation(s) for the period of one year prior to the date of this affidavit). A-01 12. Affiant represents that he/she its (is not)}currently holding another elective or appointive office — whether city, county or mu i /pal — the term of which or any part thereof runs concurrently with that of the office he/she seeks, and that he/she has resigned from any office from which he/she is required to resign pursuant to F.S.99.012 and/or the City of Miami Charter. 13. Affiant represents that, if appointed, he/she shall serve in the office so appointed, Pop 2 of l Rev 1 O,2 20 CJ4 rn� 1 rn m SIGNED THIS 2, DAY ❑F61.'X'C- 102,0 Submitted into the public record for item(s) SPA, on 11-18-2O2O, City Clerk AFFIANT BEFORE ME, the undersigned authority, by means of physical or online presence appeared t'i CAC— O. eVIS., who, after first being duly sworn (or • affirmed), deposes and states that executed the foregoing to the best of Y1ls knowledge and b (SEAL) z'o' CITY CITY OF MIAMI, FLORIDA Did take an oath Produced identification �, y Type of identification produced: L AJ ' VCy' lit C_.e_in'Sr SANDRA FORGES �'� *1o1 Putk-SdealFa'+da a � ""� Common GG 0846.18 ]� = MyCohm Ewes Mar IS 2021 Page 3 of 7 Rev 111-2970 Submitted into the public record for item(s) SP,1, on 11-18-2020, City Clerk FORM 1 STATEMENT OF 2019 Please prim or type your name, mailing address. agency name. and position homer. -�C FINANCIAL INTERESTS FOR OFFICE USE ONLY: LAST NAME -- FIRST NAME — MIDDLE NAlIE • C Ur.U5 P;+r, c 14, O'Kezrli 2020 NOV -2 AM 9: 57 OFF iiE O 'i[iE CITY CLE if( CITY OF t1I ANTI MAILING ADDRESS '- 7E/ ArX q-3 6, 67' CITY ZIP COUNTY fri rPAMi (FL,) -; - iA .dm,g1-� It- NAME OF AGENCY NAME OF OFFICE OR POSITION HELD OR SOUGHT . Po CHECK ONLY IF ANDIOATE On EW EMPLOYEE OR APPOINTEE *""' THIS SECTION MUST BE COMPLETED '"""` DISCLOSURE PERIOD: THIS STATEMENT REFLECTS YOUR FINANCIAL INTERESTS FOR CALENDAR YEAR ENDING DECEMBER 31, 2019. MANNER OF CALCULATING REPORTABLE INTERESTS: FILERS HAVE THE OPTION OF USING REPORTING THRESHOLDS THAT ARE ABSOLUTE DOLLAR VALUES. WHICH REQUIRES FEWER CALCULATIONS, OR USING COMPARATIVE THRESHOLDS, WHICH ARE USUALLY BASED ON PERCENTAGE VALUES (see instruclions for further details)_ CHECK THE ONE YOU ARE USING (must check one): LSd COMPARATIVE (PERCENTAGE) THRESHOLDS 9$ ❑ DOLLAR VALUE THRESHOLDS PART A --PRIMARY SOURCES OF INCOME (If you have nothing to report, NAME OF SOURCE OF INCOME IMajor sources of income to the reporting person -See instructions] write "none" or "real SOURCE'S ADDRESS DESCRIPTION OF THE SOURCE'S PRINCIPAL BUSINESS ACTIVITY Prj/ iMM-r,-.I C iIEkT _e7 17- k„,i J S ,ova A)L)( comA+iL�r!1 1 Tit 4wVc iobef JT {i;r:ilit,U, cP `,05r �i it: 0.1 ►/ .3i3 / 17 V- ►� FCALt3 4i fIe poLrid..r- Li-C` / AC62U5.51 rxi:,./4' - Jj� r Tr I4'fd r l-+ ire.- J1 CCr IF l°4rlc ALC PART B — SECONDARY SOURCES IMtejor customers. clients. (If you have nothing to NAME OF BUSINES%%S ENTITY OF INCOME and other sources of Income to businesses report, write "none" or "Ma"} NAME OF MAJOR SOURCES OF BUSINESS' INCOME owned by the reporting parson - See ADDRESS OF SOURCE instructions] PRINCIPAL BUSINESS ACTiVITY OF SOURCE etiiii PART C — REAL PROPERTY (Land, buildings owned by the repotting parson - See insuucllonsT (If you have nothing} to report, Write "none" or "rile°') You are not limited to the apace on the tines on this farm. Attach additional sheets, if necessary. FILING INSTRUCTIONS for when and where to file this form are located at the bottom of page 2. INSTRUCTIONS on who must the this form and how to fill it out begin on page 3. FORM 1- Er{ecrir'e Janwo 1. 2028 Incorwrated Dr WEranre in Ru0 31-1 t 2t1 } FAC IConfinood an rererse sick} CY rn Submitted into the public record for iitern(s)SP.1r on 11-18-2Q20, City Clerk PART D — INTANGIBLE PERSONAL PROPERTY [Stocks, bonds, cenlficates of deposit, e1c - See instructions' Of you have nothing to report, write "none" or "We") TYPE OF INTANGIBLE BUSINESS ENTITY TO WHICH THE PROPERTY RELATES Ar-clila-r-Art OfeCtlacO.r Ei 6go /16 LAw)'+` >4b A-1jiC13 giant rri- u LLC rk iti fuglYCifOzog Bret igro5 7017 tI jl lid-r(,croe , )'f fnf, irtek A 33 1 `/7 PART E — LIABILITIES [Major debts - See instructions] Of you have nothing to report, write "none" or "rite^} NAME OF CREDITOR ADDRESS OF CREDITOR Nof rr! PART F — INTERESTS IN SPECIFIED BUSINESSES Ownership or positions in certain types of businesses - See instructions] Ili you have nothing to report, Write "none' or "rural BUSINESS ENTITY & 1 BUSINESS ENTITY = 2 NAME OF BUSINESS ENTITY ADDRESS OF BUSINESS ENTITY PRINCIPAL BUSINESS ACTIVITY POSITION HELD WITH ENTITY I OWN MORE THAN A 5% INTEREST IN THE BUSINESS NATURE OF MY OWNERSHIP INTEREST .4;4 ,i,4 1/4 PART G — TRAINING For elected municipal officers required to complete annual ethics training pursuant to section 112 3142, F.S ❑ I CERTIFY THAT I HAVE COMPLETED THE REQUIRED TRAINING. IF ANY OF PARTS A THROUGH G ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE rj SIGNATURE OF FILER: Date Signed: /f 6,52, FILING INSTRUCTIONS: If you were mailed the form by the Commission an Ethics or a County Supervisor of Elections for your annual disclosure fling, return the form to that location. To determine what category your position falls under, see page 3 of instructions. Local officerslemployees file with the Supervisor of Elections of the county in which they permanently reside. (It you do not permanently reside in Florida, filo with the Supervisor of the county whore your agency has its headquarters.) Form 1 fliers who file with the Supervisor of Elections may fife by mail or email. Contact your Supervisor of Electrons for the mailing address or email address to use. Do not email your tom lo the Commission on Ethics, it will be returned. Stare officers or specified stare employees who file with the Commission on Ethics may file by mail or email. To file by mail, send the completed form to P.G. Drawer 15709, Tallahassee FL 32317-5709; physical address: 325 John Knox Rd, Bldg E, Ste i200, Tallahassee, FL 32303. To file with the Commission by email, scan your completed form and any attachments as a pdf (do not use any other format), send it to CEForm1tle .slate.fLus and retain a copy for your records. Do not fife by both mail and email. Choose only one filing method. Form Bs will not be accepted via email. CPA cr ATTORNEY SIGNATURE ONLY If a certified pcbric accountant licensed under Chapter 473, or attorney in good standing wdh the Florida Bar prepared this form for you, he or she muss complete the fallowing statement: prepared the CE Form 1 in accordance with Section 112.3145, Florida Statutes, and the Instructions to the roan. Upon my reasonable knowledge aria belief, the disclosure herein is true and correct CPAIAttorney Signature: Date Signed: Candidates file this form togothor with their filing papers_ MULTIPLE FILING UNNECESSARY: A candidate who files a Form 1 with a qualifying officer Is not roquirod to file with the Commission or Supervisor of Elections. WHEN TO FILE: initially, each local officerlemployee, state officer, and specified state employee must file within 30 days of the date of his or her appointment of of Iite beginning of employment. Appointees who must be confirmed by the Senate must fie prior to confirmation, even if that is less than 30 days from the date of their appointment. candidates must file at the same time they tile their qualifying papers. Thereafter, file by July 1 following each calendar year in winch they hold their positions. Finally, fie a f+nal disclosure form (Form 1F) within ttire da f leaving office or employment. Filing a CE Form 1F (Finar'3tal tit of Financial Interests) does not relieve the tiler of filing aLE Faso 1 if the filer was in his or her position on December 31. 2011; p --t 3-‹ CE fOnhi 1 - EFectir.. January 1 .2E10.. Ineor{wurared by referancs In Fain 341242(tl_ FA C 3,0 t,17 GT1 Fri I1 Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk CANDIDATE OATH — NONPARTISAN OFFICE { Do not use this form if a Judicial or School Board Candidate) way Check box !y If you are seeking to qualify as a write-in candidate: ■ Write -In candidate r \.I.... �1 ' ,-r.• 02� NOV AM 9: 57 Cri f ;OE O r . �I ii..Ct r f CLERK CITY r WWI OFFICE USE ONLY Candidate Oath {Section 99,021{1)(a), Florida Statutes} I, 1 kria 1� w C:A-16 (Print name above as you wish it to appear on the ballot. If your lest name consists of two or more names but has no hyphen, check box E. (See page 2 - Compound Last Names). No change can be made after the end of qualifying Although a write-in candidate's name is not printed on the ballot, the name must be printed above for oath purposes.) am a candidate for the nonpartisan office of ,Al T;gNPI el Ty Cort.444i33 revui 5- (Office) (District A-)/4 , /u ; I am a qualified elector of ArMir f Z4 L PA1E County, #) Florida: or elected: I the office Statutes: (Circuit #) (Group or Seat #) I am qualified under the Constitution and the Laws of Florida to hold the office to which I desire to be nominated have qualified for no other public office in the state, the term of which office or any part thereof runs concurrent with I seek; and I have resigned from any office from which I am required to resign pursuant to Section 99.012, Florida and I will support the Constitution of the United States and the Constitution of the State of Florida.7 Candidate's Florida Voter Registration Number {located on your voter information c� card!: i el( 0 I 0 7 Phonetic spelling for audio ballot: Print name phonetically on the line below as you wish it to be pronounced on the audio ballot as may be used by persons with disabilities {see instructions on page 2 of this form}: {Not applicable to write-in candidates.] X Z1 1 (7-?2,) 06 - 6 Si �Onature oCandida[4e Number Erna 7/i(tirLt CC��rr3 '�LF%deli �L G.470jc] 3r 7 Address City STATE OF FLORIDA { 1 COUNTY OF ' ��,�l th '� k - S ZIP Code Si ttjre P +, yoe, , f Notary Public or Stamp Commissioned blame of Notary Public y,,.�,,p ,'•.,• SA.' 0RA FORGES ", WarYPstiic-Slaneof%tea . •j+u . Gomrassiln tGGr08461a -z" I MyCo�tm.Expires Afar112021 oF? , ' prcut + aall+dayAun iwkw.• M Sworn to (or affirmed) and sub�ssf�ribed before me by Ur'/ physical or rki `�, day or vcr Tait , 2020_ I� online presence this ' 0 / Personally Known: or Produced Identification: te Type of identitieatton Produced: FL- Driver' LtC.QY1C DS-DE 302NP (Rev. D4f20) Rule 1S-2.0001, F.A.C. Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk STATE OF FLORIDA COUNTY OF MIAMI-DADE WIC First Name LOYALTY OATH Middle Initial Last Name RFTFWED 2020 NOY -2 OF F;,,E aF TNT CITY CFI a citizen of the State of Florida and of the United States of America, ... and a candidate for public office ... do hereby solemnly swear or affirm that I will support the Constitution of the United States and of the State of Florida. Signature of Candidate CITY OF MIAMI OATH OF CANDIDATE OFFICE OF ex CGS -t. T7, ,0-� 4 5T 5 Before me, an ofjJper authorized to administer oaths, personally appeared /1 7'' cic 6, u r t,l6:u_5 (PLEASE PRINT NAME) who, being sworn, says he/she is a candidate for the office of CO-9 -' 1 3-1-%' &) reZS T for the City of Miami, Florida; that he/she is a qualified elector of the City of Miami, Florida; that he/she is qualified under the Constitution, the Laws of Florida, and City of Miami Charter to hold the office to which he/she desires to be elected; that he/she has taken the oath required by Section 99.021, Florida Statutes: that he/she has qualified for no other public office in the State, the term of which office or any part thereof runs concurrent with that of the office he/she seeks; and that he/she has resigned or taken a leave of absence from any office from which he/she is required to resign or take a leave of absence, pursuant to Section 99.012, Florida Statutes. r71/ Address 1 City Signature of Candidate State ZIP Code f The Loyalty Oath and Oath of Can idate are sworn, to (or affirmed) and subscribed before me by 71 physical or bn n online presence, this - day or 'NJ111Je.YY►be , 20 Z-0 Sign .( a of ffi&ar Administering Oath or Notary Public Personally Known: OR Produced Identification Type of ldentilication Produced: F L b(1 IC V� L1 C. Q r1SC. Name of Notary Typed, Printer] orbtamped SANDRAfORGES Ne^aryPutk-StalecfPonca oximissen 4 GG 084819 My Caro Eons 19,2021 isosa tfreaiil ramnaNaarlAac 10 Y24 AM 9: 57 rYCLEM fA�'J! Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk Industry Rio. & Consulting Capacity Federal License: Florida Licenses: (All Current-201 T) FCC — Registration Number (FRN): 0.024937187. Call Sign: K.14NTH, T Station Privileges: Primary. Operator Privileges: Technician r' Effective Date: October 2, 2015. Expiration Date: October 2, 2025. Federal Certifications: D 1227043: G 1206873: W 1264076. DHS/FEMA LS :6 WV zb ?ON QZQx (Acquired in 2013): G557: Rapid Needs Assessment (Formerly G250.7). 097-RESP: Mass Fatalities incident Response (G386). Florida Certifications: Florida Founda[ion Basic Emergency Management Academy (2013). FDLE Certification: Police Officer: 1.992-1999. (BLE 141 - Police Academy). Field: Director: FEMA G557 Tactical S.A. Corp. (2016--Current). Crisis Security Management & Operations In Post Earth Quake Haiti: (Task Begin Dare: January 14, 2010-Dominican Republic And Haiti): (Principal: NBC Universal—inc1udi[lc MS NBC). Police Officer/Civilian Contractor: (1992-1999)/(2004-2016): (Undercover Narcotics,. Multi -Agency Auto -Theft Task Farce: Miami -Dade Caunty)/ (Tactical Safety Consultant On Operations ci Protocols In Several Cities to Haiti): (Cities include: City Soleil, Croix Des Bouquet, Petionville, Petit Goave, Thomazeau). Office: Affiliated Advisor As Seen On: Member Nation Security Council Facebcok. Authored Code Enforcement Legislation: Ordinance 02-11, City of Opa Locka, Florida. Vice Chair: Florida Governor's "Front Porch" Council — Opa Locka/Miami Gardens: (Crime Prevention Committee Chairman: 2003-2008). Education: Florida Agricultural & Mechanical University: 1982-1985; (Undergraduate Major: Electronic Engineering cL Technology - FFT). Query: Local Jail Card Reveals ID Thief Using My Name & Info. On His Multiple Arrests, Patrick Q_i v+ ine_ot4 et-,taticsri@tunall.co.m; FASSPa.IT: MATTHEW: Chapter 10; Verse 28. 2020 NOV -2 AM 9: 58 MrAMI a L Patrick O'Keith Owens 961 NW 43Rd St Miami FL 33127 Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk Voter Information Card M'rarri-L?Zcle Crn:n r. Fi Tarjeta de lninrumacii n del Elector =rrrdadr, ,Mi.erii-Datte. FL Kat Eniemasyon Vote Konte tvtiarni-Dade, FL Bring photo identification when voting. Para votar, presen to una ident?n '-t con €otograria. Tanpri pore you pre'; idantifikasyon ki een Into w 5ou le w'ap van v3te. Voting Location I Centro de 4otacion Moore Park 765 NW 36 St Precinct No. Date of Birth hum. del Recinlo Fecha de Narimiunto Nim. 6iwo Viit tla d I E sk ' 522 3/7/1988 ut rsso Ev Tf�•A E=Wrt:xtF 05/10/15 Registration Na. Ntim, de fnscripcion Nirn, Enskripsyon 109307907 Lokal Riwo Vi t Registration Date Fcaha de inscril�cisin DM n npsuon PartyAi{iliaiinn I Par'.rdista I Pali Poiitik NO PARTY AFFILIATION Penelope 7ownsley Supervisor of Elections j Supervisera de File cciong j Sip ,ize Eleksyon r.arcar�.yure io.rr.: rrmerpym'_-r1r..:n.;y;r...y, arm nco.:need uei,,:v_ c. _,9r . dr ,r;r roc 4w.:..o.e&:;rc . e :us distirem ecumar st«iru 11.,fiir.bpat, w.91r peu:earezarran ki ny9 d Wok ld Nei antes la ko- Congress State Senate State House Congrreso Senadn Estatal Camara [stela! kon a Sena Eta a Lachanm Eta a 24 39 109 County Commission Comisirin del Condado Knn9isyon !Conte 3 School Board Junta Facolar Asanhle Estikasyon 2 Municipality I atunicipio I Minisipalite MIAMI Community Council Consejo cum uniiaria Konsev l(ominote N/A !,111M1,iw1W1.aoA Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk C,O.P,S., C.O.P.S., and more C.O.P.S. Continuity Of Public Safety Continuity Of Public Service Continuity Of Public Stability A brief peek into [who is Pat.Owensj? Support expressed via vote: • Twice for H.W, • Once for Dale_ • Twice for W. • Twice for Obama (999 dropped out of the 2012 contest, and I just couldn't do Mitt). • Jeb 3 times (including the lost to Chiles) • Attended Rick Scott's Inaugural Address & Invitational Dinner. • Fully support Governor DeSantis. Also, I'm in full support of electing a Sheriff for Miami -Dade county, and I believe the City of Miami's Civilian Investigative Panel (CIF') should sunset as soon as legally possible, as to not do so only indicates a lack of confidence in the competence of the Miami Police Department. The MPD is competent enough to NOT need a CIP. Quick tidbit; I created friendly individual nicknames for our wonderful Miami City Commissioners (see A. Barrera for further info). Note: I believe the primary long-term objective of a CRA should be to operate toward sunsetting. Patrick Owens, Chairman Community Relations Board City Of Miami, Florida Thank you. Po o rx'► rri Submitted into the public record for item(s) 513.1, on 1111-1— City Clerk OPERTION: QUALITY OF LIFE T- tfcrriihrea0 Itasor rttu.- r� erN Eljorfeiti rift ab+ d7-AgLF — Commercial Residential Private Sector Safety Protocols Partnering Secure Data Firewailing Technology Network Engineering Covenants Code The Law 7- f Community Roundtable Tears Builder For Miami's Liberty Square HOUSING MIAMI-DARE couNTy-s. EMERGENCY MANAGEMENT HOMELAND SECURITY Mayor's Office C6.61.44'.aztY L eety e,Try eutookyry Local State Federal Government Bureaucratic Partnering Licensed Security Professionals Law Enforcement Partnering 0 2c, ccera ACf; GlV 5 6frirt: ;4—2c07,5c1 E L ntr .4c1 `- c°o.mmo 1/ii iuf a• t,J t C i,n7Z -AryC�, ( 8G:6 WV 2-AON010Z m M Q c/opor nt aiuf T.)0 u ,-RW=.5 w Hez r 0-63 3 f4SL-S, n .,u1-,06-, /+4,4 ecArli.reAftrodu IaUsiZev Submitted into the public record for items) SP.1, on 11-18-2020, City Clerk March 5, 2020. Arthur Nc riega, City Manager. Attention: Mayor, Commission, City Attorney, Re: Possible Solution To Wynwood Dispute_ CO 2SlLJATOR: Person or body acting as a Mediator between Two(2) disputing people or groups, and who provides a non -binding settlement proposal. RED TEAM: "Red Teaming' is the practice of rigorously challenging plans, policies, systems and assumptions by adopting an adversarial approach in order to gain new perspective via creating scenarios of tangible risks. RFCFIVED 2020 NOV -2 AM 9: 58 01-r, 'il° ii:eCITY GI.ETEK CITY OF MIAMI Please take note that the Miami Code of Ordinances Chapter 2, Article XI, Code Section 2-831 & 2-335, Ordinances (11742, 11999, 12015, 12434, 12970 and 13526), Division 12, Section 2- 1151.(purpc,e, powers and duties), Subsection (4) specifically delineates how the Community Relations Board shall be governed when acting as Conciliator. Therefore, and under Division 12, Section 2-1151 (4), it is my intent to establish a Seven(7) member "Chairman's Red Team Task Force" (RTTF) as CR3 Chair. Tine intent is to assign the CR3.'s 3 Officers to serve. as RTTF Co-chairs, and that the remaining 4 RTTF members would be representatives from Wynwood's disputing sides, i.e. 2 from the. Wynwtcd Business Improvement District (BM), and 2 from Moishe Mare. It is my hope that the RTTF can convene in the meeting room at City Hail, upon authorization by the City Manager. CRB Officers: Patrick Owens, Chairman Jason Manowitz, Vice Chairman Leslie Puzo, Esquire, Parliamentarian Respectfully, Patrick Owens, Chairman Community Relations Board 77 r5 A41'+-CSC .A'T3 (Y A e-er E r tuC &T_ 6.,Q5 nrapf dfY 2_0 Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk Surrounding Neighborhoods Of The Park Access To Parking For General Public Department Partners Solid Waste; Parks Recreation -r::a::.�.c•�.rr ..yr.a r. i I/ / (Tilt: 1. bil .- C644u-k.ar e Acsv,tfb 'ME 4C6 C/ Mt -Tie'" 7 !/ co/4z-7 i e- f& A 7)417,,Ur FviLY cv s-'4 ! 'STCA) Clt' t- % c. " . QC �, - -& C e- cs�2 r r,' fi cri� E r C6 • Iv ur- 643 , 5� uM62 1 i t CLudCC No S ,NC& T Rr ,l26/7 1 7-Jura ,rio c z4 C el#P-,r/1T.+ Movcr;06, " /2Lr3.v$ . / MORNINGSME PARK Today, Tomorrow, Together Covenants Code The Law Community Roundtable On Park Issues Community Relations Board Syr CD CD cn Local State Federal Government Partnering With Non -Profits Licensed Security Professionals Law Enforcement Partnering OFFICE OF EVIERGEti CY MANAGEMENT City Of Miami Mayor's Office [Police & Fire] L)6 UI.j "Triple T" Initiative State Red Tape Elimination IGovernor's Office County Sheriff/ Police Chiefs Liaison Lurrrilr-rv-E- 1,-r4 AMC) 1.-'•v71? 714 43. Submitted into the public record for item(s) SP.1 on 11-18-2020, City Clerk S.MA.R.T, Volunteer Mobilization Facilitator 1 I Local Police/ Private Security Roundtable Of Volunteers - -3 - 1 - I - Federal Red Tape Elimination DITSIFEMA cn co 1 Round Table Activations Catastrophic Weather Warning Alert /Fire And I17dustria1 Catastrophes / Road & Bridae And Other Environmental fiaprds Requiring Maio!. Traffic Redirection Via On -Location Human Interaction / P 0.D. Strategy / Radio Communications Unified Command Chanel. Safety Mobilization Active Round Table rrl rn State Red Tape Elimination Liaison Governor's Office Military Veterans Information Swap Clinic identifiers i Submitted into the public record for item(s) SP.1, on 11-18-2020. City Clerk S.M.A.R.T. -2 Knowledge Transfer Registration Center Military Vets Documen ted Immigrants Knowledge Transfer Paring Volunteer Nloliilization Facilitator Ground Zero Federal Red Tape Elimination Liaison D HS/FE:17'A Documented Immigrants Identified Skills *ONE COMMUNITY — ONE GOAL* r by Military Veterans can be given at the local National Guard Arrnory Y Skills Swaps by lnifnirants can be facilitated via the local Carpenter's Union Safe Meaningful And reciprocal Trades Submitted into the public record for item(s) SPA., on 11-18-2020, City Clerk S.M.A.R.T. -2 Full Name: Address: Date of Birth: Passport Number: (if applicable) Email: Gender: Military Veterans PERSONAL DATA 7.4 rP Male I i=emale Si(ILLSETS AVAILABLE FOR KNOWLEDGE SWAP r Urban And/Or Jungle Survival Methodologies Self Defense r Communication Methodologies T First Responder r Team Leader Protocols Documented Immigrants r Outside Labor r Vehicle Operations (Heavy Mechanics) Inside Labor (Finishincs & other ❑etaiiing) r Work Culture Insight I — Plumbing (Inside & Outside) Roofing i— Electrical (Inside & Outside) Windows r Hand Machine Operations (Heavy or Small) Ir tr Paving (Cement/Concrete or Asphalt) INTAKE/VETTING Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk INTENTIONALLY LEFT BLANK Submitted into the public record for item(s) SP.1. on 11-18-2O2o, City Clerk °t3,' .11 r� it CITY COMMISSION VACANCY AFFIDAVIT OF APPOINTMENT CITY OF MIAMI, FLORIDA STATE OF FLORIDA COUNTY OF MIAMI-DADE CITY OF MIAMI Ronald Page, MPA , ' , r' first duly sworn under penalty of perjury, deposes and says: 1. My name is Ronald Page, MPA .-P (hereinafter "affiant'), being 2. I am offering myself as an appointee to fill the unexpired term for the vacant office of Commissioner in District Number 5 of the City of Miami, Florida. I fully understand that 1 must maintain an actual and real residence within the district for the duration of my term of office. 3. I have resided in the Commission District Number 5 for a minimum of one year before qualifying, and I am a registered voter aid a duly qualified elector in District 5. I am presently registered to vote in Precinct No. I presently reside at the following address (must include zip code): 1155 NW 2nd Ave APT 7 Miami, FL 33136 which is my legal address, and 1 have resided continually at said address from the 61 day of April 2010 to the present. 4. Immediately prior to residing at the above -stated address, I have resided at the hereinbelow listed addresses for the cited periods of time (list hereinbelow all addresses at which you have resided for the past five years, as well as the length of time at each address): Prior Addresses: For the Period: 1744 NW 154st Miami, FL 33054 96,91/2915- {This is my mrlhers address. l SphI my lime among bt,[h addresses). Page 1 ❑r3 1tcv. 10/2020 rage 2 of 5. In addition to the residence that I have listed as my present address, 1 also reside at the following listed addresses on a temporary basis as a secondary domicile or domiciles: Listed in Q4. 6. Affiant's spouse resides at the following address (must include city, state and zip code): N/A 7. Affiant's minor children reside at the following address (must include city, state and zip code): 1155 NW 2nd Ave APT 7 Miami, FL 33136 (1/2 the tirne with me, the other 1/2 with my son's mother). 0' 8. At the present time, affiant (is) (i ,tio_t egistered to vote in any city, county or state other than as stipulated in subparagraph 3 above. 9. Narne and business address of affiant's employer: SSA 8501 W Sunrise Blvd STE 100, Plantation, FL 33322 SSA 8501 W Sunrise Blvd STE 100, Plantation, FL 33322 10. Affiant's occupation: Contact Representative and Sales Represetative Affiant's business telephone numbers):1-800-772- 2 13 11 Affiant has been employed in the above -cited capacity for the following period of time: 1. 09/15/2019 2. 12/16/2019 ---,o SC4 ) + ,�' _ l( t .1 Est Fa (Note: In the event the occupation of affiant has been for a period of less than one year, or the employment period with the same employer has been for a period of Tess than one year, affiant shall give the name(s) and address(es) of his/her empioyer(s) and occupation(s) for the period of one year prior to the date of this affidavit). N/A =''T N/A 12. Affiant represents that he/she (is) ('Ls-n4 currently holding another electiveRr a„3poi Tile office -- whether city, county or mun ! — the term of which or any paM thieofns concurrently with that of the office he/she seeks, and that he/she has resiignefrom any office from which he/she is required to resign pursuant to F.S.99.012 and/or the City of Miami Charter. 13. Affiant represents that, if appointed, he/she shall serve in the office so appointed. Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk Rev, 10/21120 Submitted into the public record for item(s) S13.1, on 11-18-2020, City Clerk SIGNED THIS y DAY OF BEFORE ME, the undersigned authority, by means of V7 physical or online presence appeared , who, after first being duly sworn (or affirmed), deposes and states that \ ' executed the foregoing to the best of \'1 3 knowledge and belief. CITY CLERK, CITY OF MIAMI, FLORIDA L, Did take an oath (SEAL) Produced identification Type of identification produced: 1 L C V•&.0 ,.• * ;x• 7E4,.. TOGC B HANNON 1 •''` � Notary PubL!C - State of Florida S ▪ s• .' . Cornmlcsidpo : CG 262214 77c ]it°My Comm. E.Gires Seo 25. 2022 Bonded through hdt4or.aNdtary Assn Page or Rev. )0/2020 FORM 1 STATEMENT OF Please print or type your name, mailing address, agency name, and position below: 2019 FINANCIAL INTERESTS LAST NAME -- FIRST NAME — MIDDLE NAME Page Ronald MAILING ADDRESS 1155 NW 2nd Ave APT 7 CITY : Miami ZIP 33136 COUNTY : Miami -Dade NAME OF AGENCY City of Miami NAME OF OFFICE OR POSITION HELD OR SOUGHT District 5 Commissioner f CHECK ONLY IF ID CANDIDATE OR [ NEW EMPLOYEE OR APPOINTEE FOR OFFICE USE ONLY: Cirri • CD Z cti n r— W rrt rn **** THIS SECTION MUST BE COMPLETED **** DISCLOSURE PERIOD: THIS STATEMENT REFLECTS YOUR FINANCIAL INTERESTS FOR CALENDAR YEAR ENDING DECEMBER 31, 2019. MANNER OF CALCULATING REPORTABLE INTERESTS: FILERS HAVE THE OPTION OF USING REPORTING THRESHOLDS THAT ARE ABSOLUTE DOLLAR VALUES, WHICH REQUIRES FEWER CALCULATIONS, OR USING COMPARATIVE THRESHOLDS, WHICH RE USUALLY BASED ON PERCENTAGE VALUES (see instructions for further details). CHECK THE ONE YOU ARE USING (nuts check one): COMPARATIVE (PERCENTAGE) THRESHOLDS OAF DOLLAR VALUE THRESHOLDS PART A — PRIMARY SOURCES OF INCOME [Major sources of income to the reporting person - See instructions] (If you have nothing to report, write "none" or "nfa") NAMir 01- SuuKuk OF INCOME SOURCE'S ADDRESS DESCRIPTION OF THE SOURCE'S PRINCIPAL BUSINESS ACTIVITY Social Security Administration 8501 W Sunrise Blvd Plantation, FL 33322 Federal Gov. Employee S L Realty and Property Manage 1 155 NW 2nd Ave APT7 Miami FL 33136 Sales Associate PART B -- SECONDARY SOURCES OF INCOME [Major customers, clients, and other sources of income to businesses owned by the reporting person - See instructions] (If you have nothing to report, write "none" or "n/a" ) NAME OF BUSINESS ENTITY L NAME OF MAJOR SOURCES OF BUSINESS' INCOME ADDRESS OF SOURCE PRINCIPAL BUSINESS ACTIVITY OF SOURCE N/A PART C -• REAL PROPERTY [Land, buildings owned by the reporting person - See Instructions] (If you have nothing to report, write "none" or "nla" ) N/A Submitted into the public record for item(s) 5P.1., on 11-18-2020, City Clerk You are not limited to the space on the lines on this form. Attach additional sheets, if necessary. FILING INSTRUCTIONS for when and where to file this form are located at the bottom of page 2. INSTRUCTIONS on who must file this form and how to fill it out begin on page 3. GE FORM 1- Effective: January 1, 2O2il tContinued an reverse side] PAGE Incorprualed by ra[erence in Ruler 34-8.20211l. F.A.G. PART D — INTANGIBLE PERSONAL PROPERTY IS:asks. bonds, certificates of deposit, etc. - See instructions] (If you have nothing to report, write "none" or "n!a") TYPE OF INTANGIBLE N/A BUSINESS ENTITY TO WHICH THE PROPERTY RELATES PART E — LIABILITIES [Major debts - See instructions] (If you have nothing to report, write "none" or "ilia") NAME OF CREDITOR ADDRESS OF CREDITOR Navient (Student Loans) 1 I23 Justison St, Wilmington, DE 19801 PART F — INTERESTS IN SPECIFIED BUSINESSES Ownership or positions in certain types of businesses - See instructOsj (If you have nothing to report, write "none' or"n/a") ,.. GP NAME OF BUSINESS ENTITY 1( F� rau....nra�Q.LPv i2r » c %,.. --0 - ADDRESS OF BUSINESS ENTITY _ '4.c PRINCIPAL BUSINESS ACTIVITY .�(;- POSITION HELD WITH ENTITY 471;A l I OWN WORE THAN A 5% fNTEREST IN THE BUSINESS I la d NATURE OF MY OWNERSHIP INTEREST PART G — TRAINING For elected municipal officers required to complete annual ethics training pursuant to section 112.3142, F.S. D I CERTIFY THAT I HAVE COMPLETED THE REQUIRED TRAINING. IF ANY OF PARTS A THROUGH G ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE ❑ SIGNATURE OF FILER: Signature: Date Signed: 10/30/2020 FILING INSTRUCTIONS: If you were mailed the form by the Commission on Ethics or a County Supervisor of Elections for your annual disclosure filing, return the form to that location. To determine what category your position fails under, see page 3 of instructions. Local officers/employees file with the Supervisor of Elections of the county in which they permanently reside. (If you do not permanently reside in Florida, file with the Supervisor of the county where your agency has its headquarters.) Form 1 filers who file with the Supervisor of Elections may file by mail or email_ Contact your Supervisor of Elections for the mailing address or email address to use. Do not emeil your form to the Commission on Ethics, it will be returned. State officers or specified state employees who file with the Commission on Ethics may file by mail or email. To file by mail, send the completed form to P.O. Drawer 15709, Tallahassee, FL 32317-5709; physical address: 325 John Knox Rd, Bldg E, Ste 200, Tallahassee, FL 32303. To file with the Commission by email, scan your completed form and any attachments as a pdf (do not use any other format), send it to CEForm1 ct [eg.state.tl.us and retain a copy for your records. Do not file by both mail and email. Choose only one filing method. Form 6s will not be accepted via email. CPA or ATTORNEY SIGNATURE ONLY If a certified public accountant licensed under Chapter 473, or attorney in good standing with the Florida Bar prepared this Form for you. he or she must complete the following statement: prepared the CE Form 1 in accordance with Section 112.3145, Florida Statutes, and the instructions to the form. Upon my reasonable knowledge and belief, the disclosure herein is true and correct. CPA/Attorney Signature: Date Signed: Candidates file this form together with their filing papers. MULTIPLE FILING UNNECESSARY: A candidate who files a Form 1 with a qualifying officer is not required to file with the Commission or Supervisor of Elections. WHEN TO FILE. Initially, each local officer/employee, state officer, and specified state employee must file within 30 days of the date of his or her appointment or of the beginning of employment. Appointees who must be confirmed by the Senate must file prior to confirmation, even if that is less than 30 days from the date of their appointment. Candidates must file at the same time they file their qualifying papers. Thereafter, fife by July 1 following each calendar year in which they hold their positions. Finally, file a final disclosure form (Form 1F) within 60 days of leaving office or employment. Filing a CE Form 1 F (Final Statement of Financial Interests) does not relieve the filer of filing a CE Form 1 if the Submitted into the public" .n19' record for item(s) SP.1, on 11-18-2020, City Clerk CE FORM 1 - Effounva January 1. 2020. Incorporated by refnrance in Rule 34431040 I, FAC. PAGE 2 CANDIDATE OATH — NONPARTISAN OFFICE (Do not use this form if a Judicial or School Board Candidate) Check box only if you are seeking to qualify as a write-in candidate: Q Write-in candidate RECEIVED 1010 NOV -4 PSI 3: 30 OFf,E€7r THE Cl1`!CLEM CITY OF MIAMI OFFICE USE ONLY Ronald Page, MPA R e Candidate Oath (Section 99.021(1)( ), Florida Statutes) (print name above as you wish it to appear on the ballot. If your last name consists of two or more names but has no hyphen, check box O. (See page 2 - Compound Last Names). No change can be made after the end of qualifying, Although a write-in candidate's name is not printed on the ballot, the name must be printed above for oath purposes.) am a candidate for the nonpartisan office of City of Miami 5 (Office) (District #) ; I am a qualified elector of Miami -Dade (Circuit #) (Group or Seat #) County, Florida; I am qualified under the Constitution and the Laws of Florida to hold the office to which I desire to be nominated or elected; I have qualified for no other public office in the state, the term of which office or any part thereof runs concurrent with the office seek; and I have resigned from any office from which t am required to resign pursuant to Section 99.012, Florida Statutes; and I will support the Constitution of the United States and the Constitution of the State of Florida, Candidate's Florida Voter Registration Number (located on your voter information card): 115984646 Phonetic spelling for audio ballot: Print name phonetically on the line below as you wish it to be pronounced on the audio ballot as may be used by persons with disabilities (see instructions on page 2 of this form): (Not applicable to write-in candidates.) X Signat re of Candid e 1155 NW 2nd Ave APT 7 Address 1786 i 202-9589 Telephone Number Miami City STATE OF FLORIDA COUNTY OF -lx`r11 — [ �« Sworn to (or affirmed) and subscribed before me by U physical or Q online presence this kV, day of , 20 IC? Personally Known: or Produced Identification: - Type of Identification Produced: FL U C r 5 Li .e+1"1 DS-DE 302NP (Rev. 04/20) FL Stale rpage003@fiu.edu Email Address 33136 ZIP Code Signature of Notary L'llhlic� Print, Type, or Stamp Commissioned Name of Notary Public below: Toils ti HANNON Notary Public - State or Florida Comnthsinn A GG 262274 '''gn ?+' My Comm, Expires Sep 75, 2022 1 Bonded through Nationii Notary Assn. Submitted into the public record for item(s) SP.1. on 11-18-2O2O, City Cleric S-2.0001, F.A.C. LOYALTY OATH STATE OF FLORIDA COUNTY OF MIAMI-DADE Submitted into the public record for item(s) SP,1, on 11-18-202D, City Clerk Ronald Page First Name Middle Initial Last Name a citizen of the State of Florida and of the United States of America, and a candidate for public office ,.. do hereby solemnly swear or affirm that I will support the Constitution of th United States and pt the State of Florida. Signature of Cal tdidate CITY OF MIAMI OATH OF CANDIDATE OFFICE OF District 5 City Commissioner Before me, an officer authorized to administer oaths 4 ri 0 CA (PLEASE PF 1T NAME) ersonaily appeared who, being sworn, says he/she is a candidate for the office of S ` t ei C� C-1 LC: ' !for the City of Miami, Florida; that he/she is a qualified elector of the City of Miami, Florida; that he/she is qualified under the Constitution, the Laws of Florida, and City of Miami Charter to hold the office to which he/she desires to be elected; that he/she has taken the oath required by Section 99.021, Florida Statutes; that he/she has qualified for no other public office in the State, the term of which office or any part thereof runs concurrent with that of the office he/she seeks; and that he/she has resigned or taken a leave of absence from any office from which he/she is required to resign or take a leave of absence, pursuant to Section 99.01 Florida States. 1155 NW 2nd Ave Apt 7 Miami Wititt/ Signature of Candidate FL 33136 Address City State ZIP Code The Loyalty Oath and Oath of Candidate are sworn to (or affirmed) and subscribed before me by j—/physical or online presence. this day of l ' -eel "1l L_'C . 20 9,0 . t9 t �Ad ! S ature of Officer rn` isterin� Personally Known: Oath or Notary Public OR Produced Identification: Type of fdenlifiication Produced: ¶ L r (i —e-r,S Name of Notary Typed, Panted or Stamped TOM 6 HANNON , Notary Public • State of Flonda ` S a. Commission a GG 262224 } r). My Comm, Ex]ires Sep 25 2622 Bonded through Nationdl Notary ASV, 100)20 Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk RONALD "RON'" PAGE, MPA Miami. Florida Rpa2e003rci'.Fu.edu EDUCATION & CERTIFICATIONS Florida International University, (Miami. FL) Graduate School: MFA c/o 2019 Ph. D, EGD: 2024 Doctor of Philosophy in Public Affairs Honors: Pi Alpha Alpha Honor Society o President Errieritais Masters of Public .Administration Program Committee o Student Representative The International Public Management Association fin. Human Resources o Student Representative Government Finance Officers Association (FIU Chapter) o Co-Fotatrder Councillor Student O"r gani.utions o Rcpresenatii e fbr Government Finance Officers Association (FIUChapter) American Society for Public Administration o Member Master of Public Administration Graduate Certificates in: Public Finance, Procurement, and Contract Management Academy of Leaders Graduate Track. Public Policy Honors: Pi Alpha Alpha Honor Society o President Emeritus Masters of Public Administration Program Corrrrrrittee o Student Representative The International Public Management A ssocicrtion for Hannan Resources o Student Representative Government Finance Officers Association (FIU Chapter) o Co -Founder{ Council for Student Grgani:ations o Representativei r Government Finance Officers Association (FIUChapter) American Societe: for Public Administration o Member Capstone: Policy Brief Medicare fraud, waste and abuse Florida International University, (Miami, FL) Undergraduate: BPA c/o 20I8 Bachelors of Public Administration Undergraduate Certificate in: Leadership Studies Honors: Pi Alpha Alpha Horror Society o Member Dean 's List 2017-201 8, with an Upper level 3.71 GPA. Capstone: Exploring the Correlation of Crime and Property Value Gold Coast Schools (Miami, FL) Certification (2017) Real Estate Sales Associate License Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk Miami Police Training Center (Miami FL) Certification (2012) Certified Police Officer Certification o Class Leader EXPERIENCE S L Realty and Property Management LLC Miramar, FL Sales Associate 12/19/2019-Present • Generating client leads to buy, sell, and rent property. • Counseling clients on market conditions, prices, and mortgages. • Developing a competitive market price by comparing properties. • Creating lists for real estate sale properties. with information location, features, square footage. etc. • Showing properties to potential buyers and renters. • Presenting purchase offers to sellers. • Facilitating negotiations between buyers and sellers. • Reviewing purchase contracts to ensure terms are met. • Promoting properties with ads, listings, and open houses. • Preparing loyalty contracts, purchase agreements. rental agreements, deeds and other documents for each real estate transaction. • Arrange for title searches to determine whether clients have clear property titles. Social Security Administration Atlanta Region (Plantation, FL) Recent Pathways Graduate Contact Represenrtative 09/ 1 6/20 1 9-Present • Interviewing beneficiaries to explain technical provisions. Eliciting relevant facts and resolves problems with payments or eligibility. Provides beneficiaries with information/instructions about eligibility and benefits being paid under retirement, survivors, and disability and Medicare insurance programs; the Black Lung program and Supplemental Security Income. Also furnishing information to inquirers about work incentive provisions, compliance with the various beneficiary reporting requirements and submitting appropriate reports to continue, suspend or terminate monthly payments. • Completing SSI abbreviated applications, making. determination of ineligibility to SSI benefits when reason for denial is clear. Considers all nonmedical eligibility requirements including all possible exclusions to income and resources before denying claims. Documents reason for denials and inputs systems record creating denial notices and protecting claimants' appeal rights. • tdentifying persons requiring representative payees in most post entitlement situations. Selects the payee through qualifications, and at specified intervals. reassessing the continuing suitability of current payees. • Identifying Title XVI overpayments. Determining amount of excess payment and resolves overpayment by recovery, waiver and/or determination that the overpayment did not exist or is uncollectible. Documents SSI file and issues appropriate notices. • Receiving requests for waiver of overpayment in Title XVI cases. Completes Request for Waiver and Recovery Questionnaires. Verifies allegations as necessary. Determines if individuals are without fault in causing overpayments and if other waiver provisions are met. Documents decisions and generates notices ofdecision and appeal rights. Submitted into the public record for itern(s) SP.1, on 11-18-2020, City Clerk • Investigating case situations and reconciles discrepancies causing interruption in the receipt of monthly benefits. Decides when critical payment system (CPS) and/or immediate payment (IP) procedures should be used in sensitive or dire need situations. Completes documentation and snakes payment authorization. Checks for outstanding overpayment, withholding (SMI), computing any underpayment due, determining payment amount and posting the system. • Investigating case situations and reconciles discrepancies causing interruption in receipt of monthly benefits or Medicare payments; pursues to completion incidents of dissatisfaction with Medicare reimbursement rates or other practices which are remedial through administrative processes. • Providing information and advice about specific retirement options and computes estimated monthly benefits payable at various ages to enable individuals to make retirement decisions that will affect them the rest of their lives. • Answering questions and resolves problems concerning Medicare payment. Pursues to completion incidents of dissatisfaction with Medicare reimbursement rates or other practices. Providing assistance in the preparation of Medicare claims and appeal fours. Explains and processes requests about state buy -In rules and initiates action with State agencies to enroll individuals. Explains options about initial enrollment periods (IEP), general enrollment periods (GEP) and special enrollment periods (SEP) and provides complete information that will allow individuals to decide the most advantageous month to enroll. Takes and processes enrollment applications, and, if necessary, secures evidence for entitlement to an SEP. Makes equitable relief and good cause recommendations concerning the month of enrollment and premium surcharges. • Processing even the most complex Social Security Number applications. Codes, evaluates evidence per legislative requirements and checks documents for authenticity. Initiating contacts with beneficiaries or others to obtain omitted reports and clarify inconsistent or incomplete reports. Investigates and resolves systems -identified discrepancies and questionable situations. • Identifying need for social services of people interviewed and refers theta to appropriate private, nonprofit or government organizations supplying such services. I-Iandles Medicaid eligibility questions, including resolution and referral, as appropriate. • Identifying situations with public affairs implications or problems and issues of such complexity or magnitude to warrant referral and refers them to superiors or other organizational components. • As assigned, participates in training sessions as an instructor. • Performing cashier duties through the use of the Third Party Draft System for the payment of certain administrative expenses (such as claims evidence, local travel, small purchases, etc.). Maintaining accurate receipts and controls to account for all draft activity and is responsible for safeguarding drafts. Ensuring the drafts are issued for authorized purposes. htputs payment information into the Agency's central accounting system via PC Email. The Office of Inspector General far the United States Department of Health and Human Services (Office of Investigations) Miami Region (Miami Lakes) 05/1212019-09/13/2019 Summer Pathways Internship 2019 Student Trainee (Program Support Assistant) • Identifying various data required for use by management. • Identifying various resources required to support programoperations. Submitted into the public record for item(s) SP.1. on 11-18-2020, City Clerk • Writing reports of study findings for multiple projects, • Researching and investigating new or unproved business and management practices for application to agency programs and operations. • Creating an Action plan. • Evaluating the success of projects in attaining their productive goals. • Assisting in assembling data and consolidating and preparing reports assigned for projects. • Typing memorandums, reports and other documents as assigned and reviews for correctness and conformance to organizational policies. • Accruing data from Polaris and NCMEC to investigate labor exploitation and sex trafficking. • Accruing data of labor and sex trafficking exploitation to be presented at appropriations committee by Special Agents in Charge (Miami) and an Assistant Inspector General of Investigations. • Creating External Directory. • Accruing data for Project Child Virtue and Project Safety -Net. • Accruing Data for Genetic Testing Scam. • Assisting in researching and collecting, data, studies, and patterns, on regional/nationwide healthcare fraud activities in support of the prevention of HHS related fraud. • Assisting in preparing and/or reviewing written memorandums to support investigations and other work assignments. • Assisting in utilizing databases and technologies to more effectively and efficiently support cases. Conducts searches and data analysis, inputs complaints and prepares reports, utilizes claims data systems such as ONE PI as well as NCIC, Sunbiz. and DMV databases to further investigations, inputs billing data and bank records into various computer software databases and applications. • Performing various administrative functions to support the day to day operations of the office assists with ad hoc assignments, as directed by management. Participate in intra and/or inter regionalibranch activities as directed by management. • Reviewed legal documents (subpoenas) to assist with pending civil and criminal cases • Prepared reports and presentations directed by Management. • Reviewed MRO inspection report with ASAC and discuss implementing changes to Standard Operating Procedures. • Assisted Administrative Officer with time keeping. • A presenter during recruitment at local universities. Independent Contractor 0 1 /2014-05/2019 Marketing Research Auditor • Ensuring compliance with company procedures. Examining records, reports, operating practices, and doeurnentation. Recommending new policies and procedures. • Verifying assets and liabilities by comparing items to documentation. • Apprising adequacy of internal control by completing audit questionnaires. • Maintains internal control systems by updating audit programs and questionnaires; recommending new policies and procedures. • Communicating audit findings by preparing a final report; discussing findings with auditees. • Compiling with federal, state, and local legalrequirements. • Enforcing adherence to policies and procedures; advising management on needed actions.. • Preparing special audit and control reports by collecting, analyzing. and summarizing operating information and trends. City of Miami Police Department (Do the Right Thing of Miami, Inc.) Submitted into the public record for items) SPA on 11-18-2020, City Clerk 12/2010-09/2011 Administrative Assistant to a Director in the Community Relations Unit • Chaired. summer "community coming together to help the environment • Administered administrative support to ensure efficient operation of the office. • Critiqued all reports. • unproved Organizing and scheduling. • Minute and note taker during board meetings. • Liaise with executive and senior administrative staff to handle requests and queries. • Grant Writer, Bank of America 05/2010-09/2010 Summer Internship 2010 Student Leader • Washington, D.C., National Leadership Summit (Civic, social and business leadership skills development). • Alumni project for Boys and Girls Club of America. • Developed co -curricular community engagement programs RECOGNITION Awards • Student Leader Awardee, Bank of America (Merrill Lynch). Awarded by Mr, Gene Schaefer (President of Bank of America) 11 /2010 • Certificate of Acltievement, City of Miami. Awarded by: Chief Miguel Esposito (Chiefof the City of Miami Police Department) and The Honorable Tomas Regalado (Mayor of the City of Miami) 06/2010 • 5,000 Role Model of Excellence Program Award. Awarded by: Congresswoman Frederica Wilson (U.S. Congresswoman of District 17) 06/2010 • Presidents Education Awarded by: Sec. Arne Duncan (Sectary of Education) and President. Barack Ohama (President of The United States of America) 05/2010 SERVICE Community Involvenm.ent (Volunteer) • Mt. Calvary Missionary Baptist Church 09/1991-Present • Parents of Murdered Kids Member01/2014-Present • 5,000 Role Model Mentor (Miami Central Sr. High School) 09/2010-Present • Boys and Girls Club of America (North West) 05/2010-08/2014 • Shirting Knights of Hope Mentoring Program 1 2/2009-03/2010 Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk INTENTIONALLY LEFT BLANK Submitted into the public record for item(s) SPA on 11-18-2020, City Clerk ` fi RECEIVED 7020 NOV _13 PM 4: ZS CITY COMMISSION VACANCY AFFIDAVIT OF APPOINTMENT CITY OF` CITY CLER Non CITY OF MIAMI, FLORIDA STATE OF FLORIDA COUNTY OF MIAMI-DADE CITY OF MPAMI Mark L. Pitts } ) • first duly sworn under penalty of perjury, deposes and says: . My name is Mark L. Pitts (hereinafter "affiant"), being 2. I am offering myself as an appointee to fill the unexpired term for the vacant office of Commissioner in District Number 5 of the City of Miami, Florida. I fully understand that l must maintain an actual and real residence within the district for the duration of my term of office. 3. I have resided in the Commission District Number 5 for a minimum of one year before qualifying, and 1 am a registered voter and a duly qualified elector in District 5. I am presently registered to vote in Precinct No. 511 I presently reside at the following address (must include zip code): 1274 NW 55 Terrace, Miami, Florida 33142 which is my legal address, and I have resided continually at said address from the 1 day of Septem ber 1993 to the present. 4_ Immediately prior to residing at the above -stated address, i have resided at the hereinbelow listed addresses for the cited periods of time (list hereinbelow all addresses at which you have resided for the past five years, as well as the length of time at each address): Prior Addresses: For the Period: 2980 NW 59 Street 10/05/1978 - 09/01/1993 Pare 1 of 3 Rev. 1O/2020 5. In addition to the residence that I have listed as my present address, I also reside at the following listed addresses on a temporary basis as a secondary domicile or domiciles: N/A 6. Affiant's spouse resides at the following address (must include city, state and zip code): N/A T,INJ _ ca' :fJ CC1 7. Affiant's minor children reside at the following address (must include city, e *Id code): 413,1riX w im N/A 5n -� 8. At the present time, affiant (is) Is no) registered to vote in any city, county or tea other than as stipulated in subparagraph 3 above. 9. Name and business address of affiant's employer: Miami Dade County, 111 NW lst Street, Miami 33128 Miami Dade County, 111 NW lst Street, Miami 33128 10. Affiant's occupation: Courtroom Clerk Affiant's business telephone number(s): 305-679 2999 11. Affiant has been employed in the above -cited capacity for the following period of tirne: 19 years (Note: In the event the occupation of affiant has been for a period of Tess than one year, or the employment period with the same employer has been for a period of Bess than one year, affiant shall give the name(s) and address(es) of his/her employer(s) and occupation(s) for the period of one year prior to the date of this affidavit). 12. Affiant represents that he/she (is) is not) currently holding another elective or appointive office — whether city, county or mun pal — the term of which or any part thereof runs concurrently with that of the office he/she seeks, and that he/she has resigned from any office from which he/she is required to resign pursuant to F.S.99.012 and/or the City of Miami Charter. 13. Affiant represents that, if appointed, he/she shall serve in the office so appointed. Page 2 of 3 Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk Rev. I Q;'O O Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk 44 SIGNED THIS 1 DAY OF 0a2 BEFORE ME, the undersigned authority, by means of V/ physical or online presence appeared Mark. L. '► S , who, after first being duly sworn (or affirmed), deposes and states that executed the foregoing to the best of ' 1g knowledge andbelief. vC1TY G 2K, CITY OF MIAMI, FLORIDA Did take an oath Produced identification (SEAL) Type of identification produced: L- by=oier % C-eelSre.. gib Am.__ _.,"__.011..__-a_ SANDRAF©RGES Nry Pick -5b1eofFor a Commission a GG 084618 MyComm. ExpresMar 19,1021 r •• rn Page 3 of 3 Rev. 1 O'2Q2P FORM 1 Pease print or type your name, mailing akiress, agency name, and position below; STATEMENT OF FINANCIAL INTERESTS 2019 LAST AME — FIRST LAME — MIDDLE NAME : 1\1 S l"1ki \Ic \,' tp i MAILING ADDRESS : 1'1bw� CITY: iP[i ZIP : COUNTY : NAME OF AGENCY : NAME OF OFFICE OR POSI OION HELD OR SOUGHT : kr e y C ii� WI+ t \ sy4lt li j t S\‘ l \ CHECK ONLY IF • N81trPA- OR ® NEW EMPLOYEE CR APPOINTEE FOR OFFICE USE ONLY: CD ▪ P, rn — d }11 p1 ** THIS SECTION MUST BE COMPLETED **** DISCLOSURE PERIOD: THIS STATEMENT REFLECTS YOUR FINANCIAL INTERESTS FOR CALENDAR YEAR ENDING DECEMBER 31, 2019. MANNER OF CALCULATING REPORTABLE INTERESTS: FILERS HAVE THE OPTION OF USING REPORTING THRESHOLDS THATARE ABSOLUTE DOLLAR VALUES, WHICH REQUIRES FEWER CALCULATIONS, OR USING COMPARATIVE THRESHOLDS, WHICH APSE USUALLY BASED ON PERCENTAGE VALUES (see instructions for further details), CHECK THE ONE YOU ARE USING (musstt,check one): ❑ COMPARATIVE (PERCENTAGE) THRESHOLDS OR DOLLAR VALUE THRESHOLDS PART A — PRIMARY SOURCES OF INCOME [Major sources of income to the reporting person - See instructions] (If you have nothing to report, write "none" or "nee) INPAlt car ut suiut OF INCOME SOURCE'S ADDRESS DESCRIPTION OF THE SOURCES PRINCIPAL BUSINESS ACTIVITY 4►11 W . .,+n1y 11\ \ \ \ 0\ (\'1 . � 1 \ Yco, Fit_. >t WAN ")q t,i,iAtt PART B — SECONDARY SOURCES OF INCOME [Major customers, clients, and other sources of income to businesses owned by the reporting person - See instructions] Of you have nothing to report, write "none" or "n/a"] NAME OF BUSINESS ENTITY NAME OF MAJOR SOURCES OF BUSINESS' INCOME ADDRESS OF SOURCE PART C -- REAL PROPERTY [Land, buildings owned by the reporting person - See instructions] (if you have nothing to rep�o]rt, write "none" or "We") iv Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk CC FORM 1 - Eflectiw• January 1, 2620 (Continued an reverse side) lncerperafed by reference in Rule 34-$ 262{1y, F.A.C. PRINCIPAL BUSINESS ACTIVITY OF SOURCE You are not limited to the space on the lines on this Form. Attach additional sheets, if necessary. FILING INSTRUCTIONS for when and where to file this form are located at the bottom of page 2. INSTRUCTIONS on who must file this form and how to fill it out begin on page 3. PAGE 1 PART i7 — INTANGIBLE PERSONAL PROPERTY [Stocks, bonds, cerlifcates of deposit, etc. - See instructions] (If you have nothing to report, write "none" or "nla") TYPE OF INTANGIBLE BUSINESS ENTITY TO WHICH THE PROPERTY RELATES mom PART E — LIABILITIES [Major debts - See instructionsi (If you have nothing to report, write "none" or "nil") NAME OF CREDITOR 1, ADDRESS OF CREDITOR PART F — INTERESTS IN SPECIFIED BUSINESSES Ownership or positions in certain types of businesses - See instructions] (If you have nothing to report, write "none" or "n!a"'j \ BUSINESS ENTITY tt '1 NAME OF BUSINESS ENTITY ADDRESS OF BUSINESS ENTITY PRINCIPAL BUSINESS ACTIVITY POSITION HELD WITH ENTITY I OWN MORE THAN A 5% INTEREST IN THE BUSINESS NATURE OF MY OWNERSHIP INTEREST PART G — TRAINING BUSINESS ENTITY # 2 = Q 7:1c) Fri €a Y c y y-•� a -� r— rn For elected municipal officers required to complete annual ethics training pursuant to section 112.3142, F.S. c I CERTIFY THAT I HAVE COMPLETED THE REQUIRED TRAINING IF ANY OF PARTS A THROUGH G ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE Q SIGNATURE OF FILER: Signature: Date Signed: :y, r t\''11.9 FILING INSTRUCTIONS: If you were mailed the form by the Commission on Ethics or a County Supervisor of Elections for your annual disclosure filing, return the form to that location. To determine what category your position fails under, see page 3 of instructions. Local officers/employees file with the Supervisor of Elections of the county in which they permanently reside. (IF you do not permanently reside in Florida, fife with the Supervisor of the county where your agency has its headquarters.) Form 1 filers who file with the Supervisor of Elections may file by mail or email. Contact your Supervisor of Elections for the mailing address or email address to use. Do not email your form to the Commission on Ethics it will be returned State officers or specified state employees who file with the Commission on Ethics may file by mail or email. To file by mail, send the completed form to P,C. Drawer 15709, Tallahassee, FL 32317-5709; physical address: 325 John Knox Rd, Bldg E, Ste 200, Tallahassee, FL 32303. To file with the Commission by email, scan your completed form and any attachments as a pdf (do not use any other format), send it to CEForml@leg.stale.f.us and retain a copy for your records. Do not file by both mail_and email. Choose only one filing method. Form 6s will not be accepted via email. CPA or ATTORNEY SIGNATURE ONLY if a certified public accountant licensed under Chapter 473, or attorney in good standing with the Florida Bar prepared this farm for you, he or she must complete the following statement , prepared the CE Form 1 in accordance with Section 112.3145, Florida Statutes, and the instructions to the form. Upon my reasonable knowledge and belief, the disclosure herein is true and correct. CPA/Attorney Signature: Date Signed: Candidates file this form together with their fling papers. MULTIPLE FILING UNNECESSARY: A candidate who files a Form 1 with a qualifying officer is not required to file with the Commission or Supervisor of Elections. WHEN TO FILE: Initially, each local officer/employee, state officer, and specified state employee must file within 30 days of the date of his or her appointment or of the beginning of employment. Appointees who must be confirmed by the Senate must file prior to confirmation, even if that is less than 30 days from the date of their appointment. Candidates must file at the same time they file their qualifying papers_ Thereafter, file by July 1 following each calendar year in which they hold their positions. Finally, file a final disclosure form (Form 1 F) within 60 days of leaving office or employment. Filing a CE Form 1 F (Final Statement of Financial interests) does not relieve the filer of filing a CE Form 1 if the filer was in his or her position on December 31, 2019. CE FORM 1 - Elrective: January i. 2020. Insaearated try reference in Rule 34-8.202111, F.&C. Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk PAGE 2 CANDIDATE OATH — NONPARTISAN OFFICE (Do not use this form if a Judicial or School Board Candidate) Check box only if you are seeking to qualify as a write-in candidate: ❑ Write-in candidate REC EIVFD 2020 NOV t 3 PM ii 26 OFF; EE OF THE CI'l Y CLERIC CITY OF MIAMI OFFICE USE ONLY Candidate Oath (Section 99.021(1)(a), Florida Statutes) I, Mark L. Pitts (Print name above as you wish it to appear on the ballot. If your last name consists of two or more names but has no hyphen, check box E. (See page 2 - Compound Last Names). No change can be made after the end of qualifying_ Although a write-in candidate's name is not printed on the ballot the name must be printed above for oath purposes.) am a candidate for the nonpartisan office of j ' 6( k\\ttiifll Z,, .j i s Ui`1 iA 5 , (Office) ; I arn a qualified elector of Miami -Dade l -.t (District #) County, Florida; (Circuit #) (Group or Seat #) I am qualified under the Constitution and the Laws of Florida to hold the office to which I desire to be nominated or elected; I have qualified for no other public office in the state, the term of which office or any part thereof runs concurrent with the office I seek; and 1 have resigned from any office from which I am required to resign pursuant to Section 99.012, Florida Statutes; and I will support the Constitution of the United States and the Constitution of the State of Florida. Candidate's Florida Voter Registration Number (located on your voter information card): 109615769 Phonetic spelling for audio ballot: Print name phonetically an the line below as you wish it to be pronounced on the audio ballot as ay be used by persons with disabilities (see instructions on page 2 of this form): Not applicable to write-in candidates.] // ,r, r• tL / X v1 `` (305) 7251073 mark] Itts hotmall.cam Signature of Ca didate Telephone Number Email Address 1274 NW 55 Terrace Miami Florida 33142 Address City tat) ZIP Code STATE OF FLORIDA Sig urn of Notary Public COUNTY OF riLianelk - j Print, Type, or Stamp Commissioned Name of Notary Public below: II to affirmed)and subscribed before me by'°��,. or Physical or �1N online presence this 13 day of i \k.M1 i , 2 ZO. 4 "Sworn � . r I��ary�a6i�-StalevfFarCa 5Pak-st f • C mrnissen t GG 3Iii3t8 -: '` g -' MyCamm.EzriresMa 12021 1 I Personally Known: or Produced Identification: J( ' ., Ft'..: { orix 1 N"LM1i FerriAsir. I Type of Identification Produced: f L. -Dc1 tf of Lj1ceyj' Ci ikrr if.l.! O..f.. i.i..— ...Li:- DS-DE 302NP (Rev. 04/20) record for item(s) SP.1. on 11-18-2020, City Clerk 1S-2.0001, F.A.G. STATE OF FLORIDA COUNTY OF MIAMI-DADE Mark First Name LOYALTY OATH Submitted into the public record for item(s) SPA., an 11-18-2020, City Clerk L Pitts Middle Initiai Last Name a citizen ot4be!State of Florida and of the United States of America, ... and a candidate for public office ... do hereby soigktnlyswear or affirm that l will support the Constitution of the nited Sta s and of the State of Florida. C) -ad `=a 1 1!- C') Y4 Sign uri-6f Candidate tf I } CITY OF MIAMI OATH OF CANDIDATE OFFICE OF tA\ttvilti\ ).' Before me, an officer authorized to administer oaths, personally appeared Mark L. Pitts (PLEASE PRINT NAME) who, being sworn, says he/she is a candidate for the office of �f� t S i .gtti .) , for the City of Miami, Florida; that he/she is a qualified elector of the City of Miami, Florida; that he/she is qualified under the Constitution, the Laws of Florida, and City of Miami Charter to hold the office to which he/she desires to be elected; that he/she has taken the oath required by Section 99.021, Florida Statutes; that he/she has qualified for no other public office in the State, the term of which office or any part thereof runs concurrent with that of the office he/she seeks; and that he/she has resigned or taken a leave of absence from any office from which he/she is required to resign or take a leave of absence, pursuant to Section 99,012, Florida St-, tes. 1274 NW 55 Terrace Sign .tureb . didate Miami Florida 33142 Address City State ZIP Code 1/1 The Loyalty Oath and Oath of C�ja�ndidate are sworn gto (or affirmed) and subscribed before me by physical or 111 online presence, this 1 �J day of I\A(Vr? YYl Dey- , 20 2-0 Signet r Administering Oath or Notary Public Personally Known: OR Produced Identification Type of Identification Produced: FL 1 sverr L_ ci SAt iDRA FORGES Wary Po -S aofkgda Cctrgrnisso a GG Ga1618 MyCr m_Ex,rasMar13.2021 IV* 01:4 Naser4 koli+yMra $ 10,20211 Submitted into the public record for item(s) S on 11-1 City Clerk MARK PI FTSS Phone: (305)725-1073 Email: Mark L.Pitts hotreail.corn Strong people -skills, excellent communication skills, upbeat -friendly attitude/personality, organized, and creative. Experience with Microsoft Office applications: Word, Excel, PowerPoint, Outlook. Proficient in (1) promotions/marketing (2) sports marketing (3) public relations (4) advertising Education Connecticut School of Broadcasting, Devie,FL, 2005 Miami Dade Community College 1998-2000 Professional Experience Broadcasting Intern Miami Heat a Review web site articles. y� • Research broadcasting information on the internetzee Video Tape Operator Channel 7 News Miami, FL 08/08-09f06 7.4 Miami, Fl 02/07 Responsible for brainstorming, planning, and execution of a variety of different marketing programs. ▪ Assist with Event preparation and setup for special events • Build local and national support with an enthusiastic attitude ce Assist with event planning for business etiquette seminars_ ei • Interact with print, broadcast, radio and web journalists. r,rn A Proofread and edit materials as needed. c Answer phones as needed. oR= • Set up and confirm media interviews_ :Ire 3n Responsible for assisting the AudioA'ideo Department through publicity strategies and Public Relations. • Gathered information and researched stories used for newscast. • Pulled stories from news wires o identified and retrieved video files for newscast ▪ Learned to operate editing equipment ® Organized and maintained tape library ® Numbered, logged and shelved all tapes • Assisted in the duplication needs of the department o Edited rough cuts as assigned • Served as production assistant Judicial Clerk Juvenile Clerk of Courts Miami, FL 05/01 -present Responsible for managing the administrative activities of the clerk's office. • Informs clients and attorneys with juvenile records inquiries, courtroom updates • Provide status reports on open and closes cases o Transports court documents to designated court offices • Identifies and responds to judges needs in a timely and efficient manner o Maintains liaison and coordinates court operations with representatives of allied government agencies a Assures that personal conduct and communications foster a positive work atmosphere • Acts as liaison with various governmental agencies on a variety of court matters Technical Skills Software: Microsoft® Word, Excel, Project, PowerPofnt Hardware: Character Generator, Teleprompter, Switcher, 360 Machines, Audio Board, Cool Edit. Control Hoard nnnrrtirut 4rtroul tif Jru The Nation's Oldest and Largest Group of Communications Schools 3538 uirtiT liniuErtittg Briuc, Dailies ,,Iurii i 33328 >rtifie ttl t crF Bttts Iftui eurrro. fuiig rntupirt.ti training itt rabic atth trirui.intt brnabrasting ttni IjA rrreiurl t uttureb itt. tntrtinu itt the firth of rnttunitttiratintts nprratinttn Diploma a Submitted into the public record for item(s) SP.1, on 11-18-2020 City Clerk INTENTIONALLY LEFT BLANK Submitted into the public record for item(s) SPA., on 11-18-2020, City Clerk T � CITY COMMISSION VACANCY AFFIDAVIT OF APPOINTMENTr,rr' CITY OF MIAMI, FLORIDA STATE OF FLORIDA COUNTY OF MIAMI-DADE CITY OF MIAMI Stephanie Thomas } 3 first duly sworn under penalty of perjury, deposes and says: 1. My name is Stephanie Thomas (hereinafter "affiant"), being 2. I am offering myself as an appointee to fill the unexpired term for the vacant office of Commissioner in District Number 5 of the City of Miami, Florida. I fully understand that I must maintain an actual and real residence within the district for the duration of my term of office. 3. I have resided in the Commission District Number 5 for a minimum of one year before qualifying, and 1 am a registered voter and a duly qualified elector in District 5. I am presently registered to vote in Precinct No. 515 presently reside at the following address (must include zip code): which is my legal address, and I have resided continually at said address from the 1 day of August 2018 to the present. 4. Immediately prior to residing at the above -stated address, I have resided at the hereinbelow listed addresses for the cited periods of time (list hereinbelow all addresses at which you have resided for the past five years, as well as the length of time at each address): Prior Addresses: For the Period: Page 1 of3 7/2017 - 8/2018 4/2006 - 7/2017 Rev 10.'3020 Page 2 vf3 5. In addition to the residence that I have listed as my present address, I also reside at the following fisted addresses on a temporary basis as a secondary domicile or domiciles: N/A 6. Affiant's spouse resides at the followin+ address must include city, state and zip code): 7. Affiant's minor children reside at the following address (must include city state<an tip code): -- = 8. At the present time, affiant (is) 6 not' registered to vote in any city, county olistfp other than as stipulated in subparagraph 3 above. 9. blame and business address of affiant's employer: City of North Miami, 776 NE 125 St, North Miami, FL 33161 City of North Miami, 776 NE 125 St, North Miami, FL 33161 10.Affiant's occupation: Assistant to CP&D Director Affiant's business telephone number(s): 305-893-651 1 11. Affiant has been employed in the above -cited capacity for the following period of time: 2002 - present (Note: In the event the occupation of affiant has been for a period of less than one year, or the employment period with the same employer has been for a period of less than one year, affiant shall give the name(s) and address(es) of his/her employer(s) and occupation(s) for the period of one year prior to the date of this affidavit). 12. Affiant represents that he/she (is) is not) -"currently holding another elective or appointive office — whether city, county or municipal — the term of which or any part thereof runs concurrently with that of the office he/she seeks, and that he/she has resigned from any office from which he/she is required to resign pursuant to F.S.99.012 and/or the City of Miami Charter. 13. Affiant represents that, if appointed, he/she shall serve in the office so appointed. Submitted into the public record for item(s) SP.J. on 11-18-2020 City Clerk Rev. I W2020 Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk `Ch SIGNED THIS 1`b DAY OF (Iev+n.bef , . Aty= IANT BEFORE ME, the undersigned authority, by means of v physical or online presence appeared ,eVki1I e -1I \O( S , who, after first being duly sworn (or affirmed), deposes and states that executed the foregoing to the best of he,- knowledge and belief. 1 -fo-CITY LEI K, CITY OF MIAMI, FLORIDA Did take an oath Produced identification Type of identification produced: FL. Dot\levy. cit v1 , SANDRA FORGES t.t lyPat-Stale of Rota Commissi n GGD84818 My Conm. E%[ares Mar 19,202f 4 cF g. 8acwvyplgi,wag kettyasa (SEAL) Pape 3 of Rev. I O. O20 FORM 1 STATEMENT OF FINANCIAL INTERESTS 2019 Please print or typo your name, mailing address, agency name, and position below: RECEIVED w 2010 NOV 13 AM 10: 36 o G f ;i lilt YGF L•IE WY CLERK tilAMIIi 0 LAST NAME -- FIRST NAME — MIDDLE NAME : ! -1 rill at l k (j i i CITY : _ ZIP : COUNTY f1 NAME OF GENCY: CC111t'n 1 1cner i, 1 NAME OF OFFICE OR POSITION HELD OR SOUGHT : CHECK ONLY IF &tCATe" OR NEW EMPLOYEE OR APPOINTEE **** THIS SECTION DISCLOSURE PERIOD THIS STATEMENT REFLECTS YOUR FINANCIAL INTERESTS MANNER OF CALCULATING REPORTABLE INTERESTS: FILERS HAVE THE OPTION OF USING REPORTING FEWER CALCULATIONS, OR USING COMPARATIVE (see instructions for further details). CHECK THE ONE LI COMPARATIVE (PERCENTAGE) THRESHOLDS MUST BE COMPLETED **** ENDING DECEMBER 31, 2019. DOLLAR VALUES, WHICH REQUIRES USUALLY BASED ON PERCENTAGE VALUES one): DOLLAR VALUE THRESHOLDS FOR CALENDAR YEAR THRESHOLDS THAT ARE ABSOLUTE THRESHOLDS, WHICH ARE YOU ARE USING (must check OR rs7' r PART A •- PRIMARY SOURCES OF INCOME (If you have nothing to report, NAME OF SOURCE OF INCOME [Major sources of income to the reporting person - See instructions] write "none" or "ilia") SOURCE'S ADDRESS DESCRIPTION OF THE SOURCES PRINCIPAL BUSINESS ACTIVITY r; i- (,C r tt Id to li 7)6, Alf 1 _ s - L.41 Pie.f i PART B -- SECONDARY SOURCES [Major customers, clients, (If you have nothing to NAME OF BUSINESS ENTITY OF INCOME and other sources of income to businesses report, write "none" or "nfa") NAME OF MAJOR SOURCES OF BUSINESS' INCOME owned by the reporting person - See ADDRESS OF SOURCE instructions] PRINCIPAL BUSINESS ACTIVITY OF SOURCE 14/14- PART C -- REAL PROPERTY [Land, buildings owned by the (If you have nothing to report, write "none" or "nla" reporting person - See instructions] ) into the public for item(s) SP.1, 11-18-2O2O, City Clerk You lines sheets, are not limited to the space on the on this form. Attach additional if necessary. INSTRUCTIONS for when where to file this form are at the bottom of page 2. on who must file form and how to fill it out on page 3. j �j Submitted 1 Y record FILING and located INSTRUCTIONS this begin on CE FORM i - Effective. January 1, 2020 incorporated by reference in Rule 34- 202(11, F.A.C. (Continued on reverse nuual PAGE 1 Fe PART D — INTANGIBLE PERSONAL PROPERTY [Stacks, bonds, certificates of deposit, etc. - See instructions] (if you have nothing to report, write "none" or"nla") i TYPE OF INTANGIBLE BUSINESS ENTITY TO WHICH THE PROPERTY RELATES N PART E — LIABILITIES [Major debts - See Instructions] (If you have nothing to report, write "none" or "nla") NAME OF CREDITOR R[C IiiED 7117fl NM I n Ry 10.2i OFf .,‘E CIF TEiE CITY CLERK CITY CF_MIAMI ADDRESS OF CREDITOR ac, e 6tfri 31109 P i / k6v3ho Nti 6,1 7)-4 7 5J-- ,‘I - INT R STS IN SPECIFIED BUSINESSES Ownership or positions In certain types of businesses - See Instructions] (If you have nothing to report, write "none ' or "nee) fO. RT NAME OF BUSINESS ENTITY ADDRESS OF BUSINESS ENTITY BUSINESS NTITY # 1 o A - PRINCIPAL BUSINESS ACTIVITY POSITION HELD WITH ENTITY I OWN MORE THAN A 514 INTEREST IN THE BUSINESS NATURE OF MY OWNERSHIP INTEREST BUSINESS E TITY # 2 N ft Submitted into the public record for items) SP.1, on 11-18-2020, City Clerk PART G — TRAINING For elected municipal officers required to complete annual ethics training pursuant to section 112.3142, F.S. El I CERTIFY THAT I HAVE COMPLETED THE REQUIRED TRAINING.. IF ANY OF PARTS A THROUGH G ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE Q SIGNATURE OF FILER: Signature: CPA or ATTORNEY SIGNATURE ONLY If a certified public accountant licensed under Chapter473. or attorney in good slanding with the Florida Bar prepared this form for you, he or she must complete the following statement: , prepared the CE Form 1 in accordance with Section 112.3145, Florida Statutes, and the instructions to the form. Upon my reasonable knowledge and belief, the disclosure herein is true and correct. CPA/Attorney Signature: Date Signed: - FILING INSTRUCTIONS: If you were mailed the form by the Commission on Ethics or a County Supervisor of Elections for your annual disclosure filing, return the form to that location. To determine what category your position falls under, see page 3 of instructions. Local officers/employees file with the Supervisor of Elections of the county in which they permanently reside. (If you do not permanently reside in Florida, file with the Supervisor of the county where your agency has its headquarters.) Form 1 filers who file with the Supervisor of Elections may file by mail or email. Contact your Supervisor of Elections for the mailing address or email address to use. Do not email your form to the QAmMiasign on Ethics. it will be returned. State officers or specified state employees who file with the Commission on Ethics may file by mail or email. To file by mail, send the completed form to P_d. Drawer 15709, Tallahassee, FL 32317-5709; physical address: 325 John Knox Rd, Bldg E, Ste 200, Tallahassee, FL 32303. To file with the Commission by email, scan your completed form and any attachments as a pdf (do not use any other format), send it to CEForml@aleg.state,fl.us and retain a copy for your records. Do not file by both mail and email. Choose only one filing method. Form 6s will not be accepted via email. Candidates file this form together with their filing papers. MULTIPLE FILING UNNECESSARY; A candidate who files a Form 1 with a qualifying officer is not required to file with the Commission or Supervisor of Elections. WHEN TO FILE: Initially, each local officer/employee, state officer, and specified state employee must file within 30 days of the date of his or her appointment or of the beginning of employment. Appointees who must be confirmed by the Senate must file prior to confirmation, even if that is less than 30 days from the date of their appointment. Candidates must file at the same time they file their qualifying papers. Thereafter, file by July 1 following each calendar year in which they hold their positions. Finally, file a final disclosure form (Form 19 within 60 days of leaving office or employment. Filing a CE Form 1 F (Final Statement of Financial interests) does not relieve the filer of filing a CE Form 1 if the filer was in his or her position on December 31, 2019. CE FORM 1 - Effective- Janaary 1. 2020. lncorpnraled by reverence in Rule 34-0.202(1 ),F.A.C. PAGE 2 CANDIDATE OATH — NONPARTISAN OFFICE (Do not use this form if a Judicial or School Board Candidate) Check box only if you are seeking to qualify as a write-in candidate: ❑ Write-in candidate RECEIVED 2020 NOV j 3 An 10: 36 [)1'r,,.:t OF THE 'CITY CLERK CITY OF MIAMI OFFICE USE ONLY Candidate Oath (Section 99.021(1)(a), Florida Statutes) I, Stephanie Thomas (Print name above as you wish it to appear on the ballot. If your last name consists of two or more names but has no hyphen, check box ❑. (See page 2 - Compound Last Names). No change can be made after the end of qualifying. Although a write-in candidate's name is not printed on the ballot, the name roust be printed above for oath purposes.) am a candidate for the nonpartisan office of Commissioner 5 (Office) ; I am a qualified electorof Miami -Dade (District #) County, Florida; (Circuit #) (Group or Seat #) I am qualified under the Constitution and the Laws of Florida to hold the office to which 1 desire to be nominated or elected; I have qualified for no other public office in the state, the term of which office or any part thereof runs concurrent with the office I seek; and I have resigned from any office from which I am required to resign pursuant to Section 99.012, Florida Statutes; and I will support the Constitution of the United States and the Constitution of the State of Florida. Candidate's Florida Voter Registration Number (located on your voter information card): 1 09291899 Phonetic spelling for audio ballot: Print name phonetically on the line below as you wish it to be pronounced on the audio ballot as may be used by persons with disabilities (see instructions on page 2 of this form): [Not applicable to write-in candidates.] X 4 ? stephthomascampaign @gmail.com � ,3 Signature of Candidate Telephone Number Email Address Address City Stet ZIP Code STATE OF FLORIDA Sign t)e f Notary Public COUNTY OF Mla'YY14 -- Print, e, or Stamp Commissioned Name of Notary Public below: J e Sworn to (or affirmed) and subscribed before me by physical or , 11n 1- El' online presence this 10 day of .�t)Y.A( Ee{ , 4 2-0 . t �j .,: SANCRAr6RGES i.!t:.;: .? Not3ryPetr-c-Sin cif Fpmla ; z • : •' Ccmmiss�cn k GG ON 618 � •`• My ea m.Etwes Mar 19,,2021 I ! @ 4 ( Personally Known: or Produced Identification: " ,,oF".,. Bea* o mn macro vcrin*ssf, • �` tde ` Type of Identification Produced: — 2�II)4eJ5 L-C (W.., Submitted into the public record fnr ifprr tc1 co T DS-DE 302NP (Rev. 04/20) on 11-18-2020, City Clerk lie IS-2.0001, F.A.C. LOYALTY OATH STATE OF FLORIDA COUNTY OF MIAMI-DADE Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk Thvv5 First Flame Middle Initial Last Name ll7 C> t5 a citizu ofte Mate of Florida and of the United States of America, ... and a candidate for public office ... do hereoli*nlear or affirm that I will support the Constitution of the United States and of the State of Florida. L.L1 03 !It, fmil c, 'ignature of Cdndidate ,�r- 4 CITY OF MIAMI OATH OF CANDIDATE OFFICE OF Cc+'nrt11& 1+c,' Before me, an officer authorized to administer oaths, personally appeared �L .yam (PLEASE PRINT NAME) who, being sworn, says he/she is a candidate for the office of .Q1,I rVi+ #1EE5a— , for the City of Miami, Florida; that he/she is a qualified elector of the City of Miami, Florida; that he/she is qualified under the Constitution, the Laws of Florida, and City of Miami Charter to hold the office to which he/she desires to be elected; that he/she has taken the oath required by Section 99.021, Florida Statutes; that he/she has qualified for no other public office in the State, the term of which office or any part thereof runs concurrent with that of the office he/she seeks; and that he/she has resigned or taken a leave of absence from any office from which he/she is required to resign or take a leave of absence, pursuant to Section 99.012, Florida Statutes. Signature of Caridid Address t� a, I h (IC City StaEe at ZIP Code The Loyalty Oath and Oath of Candidate are sworn to (or affirmed) and subscribed before me by , physical or online presence, this \'11.%day of �W1bet , 20 ZQ Signature Offs er »dministering Oath or Notary Public Personally Known: OR Produced Identification: Type of Identification Produced: Name of Notary Typed, Prince 5ANDRAFCRGES r Stamped 4atary Role -Stale of Rota _ Co/mission 9 GG 02461i 1012 l.f1 earn Submitted into the public record for item(s) SP.1, on 11-18-2D20 City Clerk STEPHANIE S THOMAS Biography With a healthy dose of tenacity, compassion, commitment, ingenuity, dedication, integrity, and a love for family and community, Stephanie Thomas brings a wealth of experience to just about any role. A seasoned public sector professional with nearly two decades of service, Stephanie is the embodiment of infectious selflessness. It is no surprise then that this dedicated public servant is ready to fight for her district, making a choice to serve the community in which she was born and raised —and still lives today, in the same house. A proud Haitian -American whose parents migrated from Haiti in the 1960s, Stephanie recounts her childhood with a palpable fondness. She especially relishes memories of family outings to the historic Gesu Roman Catholic Church as well as her tenure at Edison Elementary School, Morningside Elementary School, Nautilus Middle School, and Miami Beach Senior High School. An avid learner, Stephanie went on to earn her Associates's Degree in Pharmacy from Miami -Dade College, a Bachelor of Science in Health Information Management, as well as a Master's in Health Informatics & Managements Systems from Florida International University, and a Master's degrees concentrating in Public Administration from the University of Miami. But she's not done. A devoted wife and mother of two young adults, Stephanie will Health Sciences (DHSc) from the Eastern Virginia Medical School (May her Doctorate in 2021). It's little wonder she finds herself eager to use her experiences as a public servant, wife, mother, volunteer, and healthcare professional & enthusiast to serve District 5 and the City of Miami. Her public service includes: City of North Miami • Deputy City Clerk (City of North Miami) • Community Planning & Development • Business Tax Receipt Manager, CBTO • Constituent Services Coordinator • Confidential Secretary (Mayor & Council) Affiliations, Memberships & Volunteerism • American Society for Public Administration (ASPA) South Florida Chapter • American Health Information Management Association (AHIMA) 11t1V114 AO All" • Florida Association of Business Tax Officials (FABTO) 3!d?i0 �k11 1,H1 JO *�` i JAB CZ : I Hd .0 I' AON 0ZOZ O3A:n Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk • Florida Association of City Clerks (FACC), Chair of the By-Laws/Manual Revisions Committee • Florida Bar Association Health Law Section ▪ Florida Bioethics Network (FBN) • Haitian -American Chamber of Commerce of Florida (HACCOF) • Health Council of South Florida (HCSF) • Health Information Management Society (HIM555) • Health Law Section — The Florida Bar • International Institute of Municipal Clerks (II MC) • National Forum for Black Public Administrators (NFBPA), South Florida Chapter, Event Committee Chair • Pi Alpha Alpha National Honor Society for Public Affairs & Administration, University of Miami Chapter Her husband Shawn, a double organ recipient, Stephanie makes it her mission to bring awareness to organ donation and counts the following among her chief concerns for her beloved District 5: • Affordable Housing • Bridging socioeconomic gaps • Climate Control • Economic Development • Education • Gentrification • Healthcare • Homeownership • Maternal Mortality • Safety & Infrastructure "I think it's time to invoke Gandhi. Ifs time for me to STEP up and 'be the change" — Ste phanie Thomas, Candidate, City of Miami's District 5. Needless to say, Stephanie draws on her name in her commitment to the community, choosing to STEP in and STEP out to ensure its safety, development, and prosperity. 4 4 C C,3 • i Co.) Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk Q*,�� rSSTEPHANIE THOMAS 4lp��4 I pgandcompany@aol.com V\ EDUCATION Eastern Virginia Medical School August 2018 - present Doctorate of Health Sciences (CHSc) University of Miami Master in Public Administration Florida International University Master of Science Health Informatics & Management Systems Bachelor of Science Health Information Management Miami -Dade College Associate in Arts EXPERIENCE Coral Gables, FL June 2018 Miami, FL August 2013 May 1999 Miami, FL June 1997 City of North Miami, North Miami, FL 2002 - Present Community Planning & Developrnent 2020 - Present Business Tax Receipt Manager, CBTO 2017 — 2020 • Enforces Local Business Tax Receipt Ordinances • Maintains records on Local Business Tax Receipts and completes related reports. • Issues Local Business Tax Receipts and permits as appropriate. ■ Ensures that all active businesses in the City have the required Business Tax Receipts ■ Assists in administering the Business Tax functions, including the application process, fee assessment and collection, and Business Tax issuance. • Researches and analyzes data and information relative to Business Tax Receipts ■ Assists in resolving complex and sensitive customer service issues, either personally, by • telephone or in writing. Deputy City Clerk, M MC 2014 - 2017 • Perform follow-up activities resulting from Council meetings, including distributing minutes, ensuring that resolutions and ordinances are in proper format and are signed; track committee and commission actions; prepare letters of acceptance/rejection • Recommend and coordinate the development and maintenance of computerized applications and systems; maintain centralized records management system, archive, and records retention ▪ Index, process, copy, distribute, file, and certify copies of ordinances, resolutions, official minutes, and other public records; maintain and update Municipal Codebooks Prepared and publish legal & public notices in coordination with City Departments Assist City Clerk in the administration of municipal elections • Perform duties as Supervisor of Municipal Elections • Assist in the development and preparation of annual budget • Process and execute passport applications • Issue Business Tax Receipts (BTR) Constituent Services Coordinator 2010 - 2014 Confidential Secretary 2002 - 2010 • Principal administrative aide to the Mayor and five -member Council • Supervised staff of three or more Decreased office expenditures 15% by implementing needed controls on stock/supplies and standardizing ordering procedures Submitted into the public record for items) SPA, on 11-18-2020, City Clerk • Scheduled and maintained meetings and appointments for Mayor and City Council • Coordinated travel logistics far conferences and seminars • Attended board, committee, community meetings and conferences on behalf of the department. • Directed complex projects and events from concept to fully operational status, including prospective letters to sponsors, bringing in more than over $150,000 through the years • Served as a resource for members of the public seeking assistance across government services • Managed office budget of $100,000 Barry University, Miami Shores, FL 1999 - 2001 Administrative Assistant - Student Health Services and Alumni Relations Served as executive assistant to the management team, handled a busy phone system, functioned as primary liaison to customers, and ensured a consistently positive customer experience • Helped drive a 10% increase in student services and alumni participation/enrollment • Created automated daily stats report that reduced inaccuracies, providing management with important decision - ma king tools ▪ Earned a reputation for maintaining a positive attitude and producing high -quality work • Trained, supervised, and evaluated interns and volunteers • Expertise in ICD-9-CM, CPT coding, and electronic medical record -keeping and retention • Maintained database of Alumni and minutes for board meetings • Assisted Alumni Board and staff in coordinating Homecoming Vicente Roger, MD, and Associates, Bay Harbor, FL 1993 -1999 Medical Billing and Collections Manager • Trained, supervised daily activities of staff, evaluated staff performance, and coached management skills • Document specialist in auditing medical records for ICD-9-CM and CPT coding and record retention • Knowledge of licensing, reimbursement, and accreditation standards. Provided ongoing training to staff on the intricacies of insurance submissions, codes, and intake procedures to minimize rejections for referrals • Built mutually respectful relationships with third -party payers, HMOs, PPOs, Medicaid, and independent commercial carriers • Responsible for patient billing and correspondence Julian H. Groff, MD, and Associates, North Miami Beach, FL 1990 - 1994 Medical Billing and Collections Manager • Maximized reimbursement by ensuring accurate iCD-9-CM and CPT coding • Conducted audits of providers' selected codes compared to chart documentation • Built mutually -respectful relationships with third -party payers, HMOs, PPOs, Medicare, Medicaid, workers' compensation (WC) carriers, and independent commercial carriers • Collected $50,000 in bad debt previously denied by Medicare, Medicaid, and other insurance carriers • Responsible for accounts receivable accounts valued over $500,000 • Maintained verbal and written communication between patients and insurance carriers Harold Weiner, MD, and Associates, Miami Beach, FL 1988 -1994 Medical Administrative Assistant MEMBERSHIPS & AFFILIATIONS International Institute of Municipal Clerks (IIMC) Florida Association of City Clerks (FACC), Bylaws and Manual Committee Chair Florida Association of Business Tax Officials (FABTO) American Society for Public Administration (ASPA) South Florida Chapter Pi Alpha Alpha Honor Society (UM) National Forum for Black Public Administrators (NFBPA), South Florida Chapter, Event Committee C1Nir r Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk October 29, 2020 Samuel Blatt 212 [ N. Bayshore Drive Apt. 906 Miami, FL 33137 SENT VIA EMAIL : krussell@miamigov.com The Honorable Commissioner Ken Russell City of Miami — City Hall 3500 Pan American Drive Miami, FL 33133 REF: CITY OF MIAMI DISTRICT 5 APPOINTMENT Dear Commissioner Russell: It is with great pleasure and enthusiasm that I write this letter of support for Stephanie Thomas to be appointed Commissioner of City of Miami District 5. I have personally worked with Stephanie as a public servant in government for more than three years, and I know her character and passion for serving others. The City of Miami would benefit tremendously by having her sit on your dais and serve its residents. Stephanie is the ideal candidate because of her integrity and compassion for her District. Stephanie moved to District 5 in 1978, attended the local public schools and universities, and began her professional career in public service while still residing in District 5. Stephanie does not covet power or elected office for the sake of it, but rather because of her deep commitment to serving the community. She has been a public servant for over 18 years, working in government for the Mayor and Council Office, Finance Department, Community Planning Development Department as a Deputy City Clerk who understands the importance of Creating and adopting Resolutions and Ordinances. In her capacity as a loyal and respected civil servant, Stephanie sits on various boards that impact and influence legislation. I ask that you appoint a true compassionate champion for District 5. One who will be a role model and will give back tirelessly to the district that has shaped her to be a future pilar in the community. I thank you for your time and sincere consideration. Sincerely, saote.ai Sktt Samuel Blatt, CEcD 341313 �hft��3d, �,41 2 LIJ 3! f I .1011:." J30 e AON010Z 03A 1333 a Submitted into the public record for item(s) SP.1. on 11-18-2020, City Clerk October 29, 2020 Samuel Blatt 2121 N. Bayshore Drive Apt. 906 Miami, FL 33137 SENT VIA EMAIL : mreyes@miamigov.com The Honorable Commissioner Manolo Reyes City of Miami -- City Hall 3500 Pan American Drive Miami, FL 33133 REF: CITY OF MIAMI DISTRICT 5 APPOINTMENT Dear Commissioner Reyes: It is with great pleasure and enthusiasm that I write this letter of support for Stephanie Thomas to be appointed Commissioner of City of Miami District 5. I have personally worked with Stephanie as a public servant in government for more than three years, and I know her character and passion for serving others. The City of Miami would benefit tremendously by having her sit on your dais and serve its residents. Stephanie is the ideal candidate because of her integrity and compassion for her District_ Stephanie moved to District 5 in 1978, attended the local public schools and universities, and began her professional career in public service while still residing in District 5. Stephanie does not covet power or elected office for the sake of it, but rather because of her deep commitment to serving the community. She has been a public servant for over 18 years, working in government for the Mayor and Council Office, Finance Department, Community Planning Development Department as a Deputy City Clerk who understands the importance of creating and adopting Resolutions and Ordinances. In her capacity as a loyal and respected civil servant, Stephanie sits on various boards that impact and influence legislation. I ask that you appoint a true compassionate champion for District 5. One who will be a role model and will give back tirelessly to the district that has shaped her to be a future pilar in the community. I thank you for your time and sincere consideration. Sincerely, Samuel Blatt, CE&D 11 ' ' 1 i ° 11.1 3 . Alle7. Y14 10/kinaii! 3 ',Ai1 'iZ: Ikd £I kONa101 0 \1 3] Submitted into the public record for item(s) 5P.1, on 11-18-2020, City Clerk Samuel Blatt 2121 N. Bayshore Drive Apt. 906 Miami, FL 33137 SENT VIA EMAIL : adiazdeiaportilla@miamigov.com The Honorable Commissioner Alex Diaz de la Portilla City of Miami — City Hall 3500 Pan American Drive Miami, FL 33133 REF: CITY OF MIAMI DISTRICT 5 APPOINTIMIENT Dear Commissioner Diaz de la Portilla: October 29, 2020 It is with great pleasure and enthusiasm that I write this letter of support for Stephanie Thomas to be appointed Commissioner of City of Miami District 5. 1 have personally worked with Stephanie as a public servant in government for more than three years, and 1 know her character and passion for serving others. The City of Miami would benefit tremendously by having her sit on your dais and serve its residents. Stephanie is the ideal candidate because of her integrity and compassion for her District. Stephanie moved to District 5 in 1978, attended the local public schools and universities, and began her professional career in public service while still residing in District 5. Stephanie does not covet power or elected office for the sake of it, but rather because of her deep commitment to serving the community. She has been a public servant for over 18 years, working in government for the Mayor and Council Office, Finance Department, Community Planning Development Department as a Deputy City Clerk who understands the importance of creating and adopting Resolutions and Ordinances. In her capacity as a loyal and respected civil servant, Stephanie sits on various boards that impact and influence legislation. 1 ask that you appoint a true compassionate champion for District 5. One who will be a role model and will give back tirelessly to the district that has shaped her to be a future pilar in the community. I thank you for your time and sincere consideration. Sincerely, 9 - Samuel Blatt, CEcD W3 i4,11J a 11 i'.1JV :ZI Nd £ I %ON O OZ Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk October 29, 2020 Samuel Blatt 2121 N. Bayshore Drive Apt. 906 Miami, FL 33137 SENT VIA EMAIL : jcarollo@miamigov.corn The Ilonorable Commissioner Joe Carollo City of Miami — City Hall 3500 Pan American Drive Miami, FL 33133 REF: CITY OF MIAMI DISTRICT 5 APPOINTMENT Dear Commissioner Carollo: It is with great pleasure and enthusiasm that I write this letter of support for Stephanie Thomas to be appointed Commissioner of City of Miami District 5. I have personally worked with Stephanie as a public servant in government for more than three years, and I know her character and passion for serving others. The City of Miami would benefit tremendously by having her sit on your dais and serve its residents. Stephanie is the ideal candidate because of her integrity and compassion for her District. Stephanie moved to District 5 in 1978, attended the local public schools and universities, and began her professional career in public service while still residing in District 5. Stephanie does not covet power or elected office for the sake of it, but rather because of her deep commitment to serving the community. She has been a public servant for over 18 years, working in government for the Mayor and Council Office, Finance Department, Community Planning Development Department as a Deputy City Clerk who understands the importance of creating and adopting Resolutions and Ordinances. In her capacity as a loyal and respected civil servant, Stephanie sits on various boards that impact and influence Iegislation. I ask that you appoint a true compassionate champion for District 5. One who will be a role model and will give back tirelessly to the district that has shaped her to be a future pilar in the community. I thank you for your time and sincere consideration. Sincerely, c5a-4,K-4,4-fer We,1,,K-eof Samtrel l t qilia N 1I PIW JO A112 )4dJ1 A1I J 3H1 'iZ :Z1wd C I hats Beat Submitted into the public record for item(s) SPA./ on 11-18-2020, City Clerk November 1, 2020 SENT VIA EMAIL: adiazdelaportilla@miamigov.com The Honorable Commissioner Alex de la Portilla City of Miami- City Hall 3500 Pan American Drive Miami, FL 33133 REF: CITY OF MIAMI DISTRICT 5 APPOINTMENT Dear Commissioner Diaz de la Portilla, It is with extreme pleasure and enthusiasm that I write this letter in support of Stephanie Thomas to be appointed Commissioner of City of Miami District 5. I believe that Stephanie is the epitome of the ideal commissioner not only because of how immensely devoted she is to giving back to her community, but for her passion and the drive she has to make a change for the better. Not only has she been a resident in District 5 since 1978, but she has also attended school and raised her children, who attend college and one of whom plans to join the United States Coast Guard upon graduation in 2021. Stephanie has more than enough experience with how local governments operate and what it takes to be an exceptional civil servant because she has been one for well over 18 years for the City of North Miami. Therefore, she understands the commitment and dedication it takes to be a commissioner. She is already a member of various boards and a very well appreciated, respected, and loyal public servant. I urge you to appoint the ideal person for District 5. Someone who will exhaust every resource available and never stop fighting or giving back to the residents of District 5. That person is Stephanie Thomas. If Stephanie is not appointed, a special election is preferred. Thank you for your time and consideration. Sincerely, ,.i Ariaya a Va District 5 resident 5927 NE 4 Court INVWl 33 A11 Wc1110 `A110 3111.40 37'1a'1 'iZ I Hd tf LION Diaz Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk November 1, 2020 SENT VIA EMAIL: krusseell@miamigov.com The Honorable Commissioner Ken Russell City of Miami- City Hall 3500 Pan American Drive Miami, FL 33133 REF: CITY OF MIAMI DISTRICT 5 APPOINTMENT Dear Commissioner Russell, It is with extreme pleasure and enthusiasm that I write this letter in support of Stephanie Thomas to be appointed Commissioner of City of Miami District 5. I believe that Stephanie is the epitome of the ideal commissioner not only because of how immensely devoted she is to giving back to her community, but for her passion and the drive she has to make a change for the better. Not only has she been a resident in District 5 since 1978, but she has also attended school and raised her children, who attend college and one of whom plans to join the United States Coast Guard upon graduation in 2021. Stephanie has more than enough experience with how local governments operate and what it takes to be an exceptional civil servant because she has been one for well over 18 years for the City of North Miami. Therefore, she understands the commitment and dedication it takes to be a commissioner. She is already a member of various boards and a very well appreciated, respected, and loyal public servant. I urge you to appoint the ideal person for District 5. Someone who will exhaust every resource available and never stop fighting or giving back to the residents of District 5. That person is Stephanie Thomas. If Stephanie is not appointed, a special election is preferred. Thank you for your time and consideration. Sincerely, 4rgyp, Ariay. na V: District 5 resident 5927 NE 4 Court IWVIW 319 A112 Wdria A110 3H1 30 3 '.J.40 hZ:ZIWJ CI AOHOIIll a! 11.]O3 i Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk November 1, 2020 SENT VIA EMAIL. jcarol]o@miamigov.com The Honorable CommissionerJoe Carollo 3500 Pan American Drive Miami, FL 33133 REF: CITY OF M]AM1 DISTRICT 5 APPOINTMENT Dear Commissioner Rollo, It is with extreme pleasure and enthusiasm that I write this letter in support of Stephanie Thomas to be appointed Commissioner of City of Miami District 5. I believe that Stephanie is the epitome of the ideal commissioner not only because of how immensely devoted she is to giving back to her community, but for her passion and the drive she has to make a change for the better. Not only has she been a resident in District 5 since 1978, but she has also attended school and raised her children, who attend college and one of whom plans to join the United States Coast Guard upon graduation in 2021. Stephanie has more than enough experience with how local governments operate and what it takes to be an exceptional civil servant because she has been one for well over 18 years for the City of North Miami. Therefore, she understands the commitment and dedication it takes to be a commissioner. She is already a member of various boards and a very well appreciated, respected, and loyal public servant. urge you to appoint the ideal person for District 5. Someone who will exhaust every resource available and never stop fighting or giving back to the residents of District 5. That person is Stephanie Thomas. If Stephanie is not appointed, a special election is preferred. Thank you for your time and consideration. Sincerely, pp" tip Am iay. na V= I District 5 resident 5927 NE 4 Court !WVJW 3G] A11:, h'f113All33H/..d0J `J 0 h? :Z! 4J C I AO? O7,0Z Submitted into the public record for item(s) SP.1, on 11-18-202D, City Clerk November 1, 2020 SENT VIA EMAIL: mreyes@miamigov.com The Honorable Commissioner Manolo Reyes City of Miami- City Hall 3500 Pan American Drive Miami, FL 33133 REF: CITY OF MIAMI DISTRICT 5 APPOINTMENT Dear Commissioner Reyes, It is with extreme pleasure and enthusiasm that I write this letter in support of Stephanie Thomas to be appointed Commissioner of City of Miami District 5. I believe that Stephanie is the epitome of the ideal commissioner not only because of how immensely devoted she is to giving back to her community, but for her passion and the drive she has to make a change for the better. Not only has she been a resident in District 5 since 1978, but she has also attended school and raised her children, who attend college and one of whom plans to join the United States Coast Guard upon graduation in 2021. Stephanie has more than enough experience with how local governments operate and what it takes to be an exceptional civil servant because she has been one for well over 18 years for the City of North Miami. Therefore, she understands the commitment and dedication it takes to be a commissioner. She is already a member of various boards and a very well appreciated, respected, and loyal public servant. I urge you to appoint the ideal person for District 5. Someone who will exhaust every resource available and never stop fighting or giving back to the residents of District 5. That person is Stephanie Thomas. if Stephanie is not appointed, a special election is preferred. Thank you for your time and consideration. Sincerely, E�rw.+••-- ri OP Ariay. na V. District 5 resident 5927 NE 4 Court liWWVIW 30 NV313 A113 31i1 3O 3,".JA0 a :ZI Wd C i hON a o2 Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk October 14, 2020 SENT VIA EMAIL: krussell@rniamigov.com The Honorable Commissioner Ken Russell City of Miami — City Hall 3500 Pan American Drive Miami, FL 33133 REF: CITY OF MLAM1 DISTRICT 5 APPOINTMENT Dear Commissioner Russell: With great pleasure and enthusiasm, I write this letter of support for Stephanie Thomas to be appointed Commissioner of City of Miami District 5. Stephanie is the ideal candidate because of her integrity and compassion for her District. Stephanie moved to District 5 in 1978, attended the local public schools and universities, and began herprofessional career in public service while still residing in District 5. She has been a public servant for aver 18 years, working in government for the Mayor and Council Office, Finance Department, Community Planning Development Department as a Deputy City Clerk who understands the importance of creating and adopting Resolutions and Ordinances. In her capacity as a loyal and respected civil servant, Stephanie sits on various boards that impact and influence legislation. I ask that you appoint a true compassionate champion for District 5. One who will be a role model and will give back tirelessly to the district has shaped her to be a future pillar in the community. Thank you for your time and sincere consideration. Sincerely, Dr. Ev4idiC. P(.kney Dr. Enid C. Pinkney Organization, Founding President, Emeritus, Historic Hampton House Community Trust, Inc.: JVW313A112 WEITIO AU3!'41. 0 3;'.3jt tZl 1.1cI £ i &IOH 41QZ 03A1333d Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk October 14, 2020 SENT VIA EMAIL: mreyes rr�miamigov.com The Honorable Commissioner Manolo Reyes City of Miami — City Hall 3500 Pan American Drive Miami, FL 33133 REF: CITY OF MTAMI DISTRICT 5 APPOINTMENT Dear Commissionner Reyes: With great pleasure and enthusiasm, I write this letter of support for Stephanie Thomas to be appointed Commissioner of City of Miami District 5. Stephanie is the ideal candidate because of her integrity and compassion for her District. Stephanie moved to District 5 in 1978, attended the local public schools and universities, and began her professional career in public service while still residing in District 5. She has been a public servant for over 18 years, working in government for the Mayor and Council Office, Finance Department, Community Planning Development Department as a Deputy City Clerk who understands the importance of creating and adopting Resolutions and Ordinances. In her capacity as a Ioyal and respected civil servant, Stephanie sits on various boards that impact and influence legislation. I ask that you appoint a true compassionate champion for District 5. One who will be a role model and will give back tirelessly to the district has shaped her to be a future pillar in the community. Thank you for your time and sincere consideration_ Sincerely, ate. tvu:d'C. P&vtkvtey Dr. Enid C. Pinkney Organization, Founding President, Emeritus, Historic I-Iampton House Community Trust, Inc.:: V431IWV 3A 13 2uf�!A!{31IVJ.j0 Wd c r AON O3AGG3 Submitted into the public record for item(s) SP.1, on 11-18-2020. City Clerk October 14, 2020 SENT VIA EMAIL: adiazdelaportilla@u,miamigov.com The Honorable Commissioner Alex Diaz de la Portilla City of Miami — City Hall 3500 Pan American Drive Miami, FL 33133 REF: CITY OF MIAMI DISTRICT 5 APPOINTMENT Dear Commissioner Diaz de la Portilla: With great pleasure and enthusiasm, I write this letter of support for Stephanie Thomas to be appointed Commissioner of City of Miami District 5. Stephanie is the ideal candidate because of her integrity and compassion for her District. Stephanie moved to District 5 in 1978, attended the local public schools and universities, and began her professional career in public service while still residing in District 5. She has been a public servant for over 18 years, working in government for the Mayor and Council Office, Finance Department, Community Planning Development Departziient as a Deputy City Clerk who understands the importance of creating and adopting Resolutions and Ordinances. In her capacity as a loyal and respected civil servant, Stephanie sits on various boards that impact and influence legislation. I ask that you appoint a true compassionate champion for District 5. One who will be a role model and will give back tirelessly to the district has shaped her to be a future pillar in the community. Thank you for your time and sincere consideration. Sincerely, Dr. ErZd,C. P1:44krucy Dr. Enid C. Pinkney Organization, Founding President, Emeritus, Historic Hampton House Community Trust, Inc.: li4bl1.13D h!I^ col'd3-l3 A113 111 JO 3„'".J30 s (°I Z :Zl 1'd C I A ON OUR 0]Al]3i Submitted into the public record for item(s) SPA, on 11-18-2020, City Clerk October 14, 2020 SENT VIA EMAIL: jcarollo�}a miamigov.com The Honorable Commissioner Joe Carollo City of Miami — City Hail 3500 Pan American Drive Miami, FL 33133 REF: CITY OF MIAMI DISTRICT 5 APPOLNTMENT Dear Commissioner Corollo: With great pleasure and enthusiasm, I write this Ietter of support for Stephanie Thomas to be appointed Commissioner of City of Miami District 5. Stephanie is the ideal candidate because of her integrity and compassion for her District. Stephanie moved to District 5 in 1978, attended the local public schools and universities, and began her professional career in public service while still residing in District 5. She has been a public servant for over 18 years, working in government for the Mayor and Council Office, Finance Department, Community Planning Development Department as a Deputy City Clerk who understands the importance of creating and adopting Resolutions and Ordinances. In her capacity as a loyal and respected civil servant, Stephanie sits on various boards that impact and influence legislation. I ask that you appoint a true compassionate champion for District 5. One who will be a role model and will give back tirelessly to the district has shaped her to be a future pillar in the community. Thank you for your time and sincere consideration. Sincerely, Dr. Eve C. 3'+�4(41ey Dr_ Enid C. Pinkney Organization, Founding President, Emeritus, Historic Hampton House Community Trust, Inc.: fkJVU.1.d0 A1IZ t-'bin333 AII0 3111 13 :l' J20 `:-.I Z:ZI14d C1"AUNOZOZ Q ADD3] Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk INTENTIONALLY LEFT BLANK Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk CITY COMMISSION VACANCY AFFIDAVIT OF APPOINTMENT CITY OF MIAMI, FLORIDA STATE OF FLORIDA COUNTY OF MIAMI-DADE CITY OF MIAMI Jeffrey Watson first duty sworn under penalty of perjury, deposes and says: 1.My name is Jeffrey Watson (hereinafter "affiant"), being 2. I am offering myself as an appointee to fill the unexpired term for the vacant office of Commissioner in District Number 5 of the City of Miami, Florida. I fully understand that I must maintain an actual and real residence within the district for the duration of my term of office, 3. I have resided in the Commission District Number 5 for a minimum of one year before qualifying, and I am a registered voter and a duly qualified elector in District 5. I am presently registered to vote in Precinct No. 518 I presently reside at the following address (must inclu ip code): 43 NW 39th st % c., A__ 3 3 11,7 which is my legal address, and I have resided continually at said address from the 23 day of April 1997 to the present. 4, Immediately prior to residing at the above -stated address, I have resided at the hereinbelow listed addresses for the cited periods of time (list hereinbelow all addresses at which you have resided for the past five years, as well as the length of time at each address): Prior Addresses: For the Period: Pagel or3 Rev. 1012020 Submitted into the public record for item(s) SP.1. on 11-18-202Q, City Clerk 5. In addition to the residence that I have listed as my present address, I also reside at the following listed addresses on a temporary basis as a secondary domicile or domiciles: 54 NW 401h Si Miami 33127; Mhough not my p.intary res-denro I owned a sy ordary raafJerce.JGlilcia at 1B11 121h Si NW Washington 6G 20009 From 1954-2018 6. Affiant's spouse resides at the following address (must include city, state and zipcodj: 54 NW 40th St Miami 33127 g rn 7. Affiant's minor children reside at the following address (must include city, sits arm! code): r`1 n — m r none 8. At the present time, affiant (is) is not) than as stipulated in subparagrap •ove. r CJi stered to vote in any city, county or silte other 9. Name and business address of affiant's employer: t 1 10. Affiantsaccupation: Economic Development Consultant Affiant's business telephone number(s): {202}573-4890 11. Affiant has been employed in the above -cited capacity for the following period of time: 5 years (Note: In the event the occupation of affiant has been for a period of less than one year, or the employment period with the same employer has been for a period of less than one year, affiant shall give the name(s) and address(es) of his/her employer(s) and occupation(s) for the period of one year prior to the date of this affidavit). 12. Affiant represents that he/she (is) 's not) u ently holding another elective or appointive office — whether city, county or municr al — the term of which or any part thereof runs concurrently with that of the office he/she seeks, and that he/she has resigned from any office from which he/she is required to resign pursuant to F.S.99.012 and/or the City of Miami Charter. 13, Affiant represents that, if appointed, he/she shall serve in the office so appointed. Page 2 of Rev. 11V2020 SIGNED THIS 17 DAY OF 11Ne ir Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk AFFIANT BEFORE ME, the undersigned authority, by means of " physical or online presence appeared . • e \ Jo- kchel affirmed), deposes and states that \Yl� executed the foregoing to the best of ']lS knowledge and belief. re -CITY LRK, 0 CITY OF MIAMI, FLORIDA Did take an oath Produced identification Type of identification produced: „t v'A"'••. SANCRA "CRGES ha+ar!rP Et-Sam#Fulda :. ,_ Commis=IGG 460a y Cemm.50es Mar 19.2021 3c+t; 21txtgl wt04 w,Wm I , who, after first being duly sworn (or -'Loy; Driver LiCR (SEAL) Page 3 of 3 Rev. I0/202 1 FORM 1 STATEMENT OF Please print or typo your name. mailing address, agency name, and posltlon below: FINANCIAL INTERESTS 2019 LAST NAME — FIRST NAME — MIDDLE NAME : Watson Jeffrey MAILING ADDRESS 54 N W 40th St CITY Miami ZIP 33127 COUNTY; Dade NAME OF AGENCY : City of Miami NAME OF OFFICE OR POSITION HELD OR SOUGHT : District 5 Comrlslssioner CHECK ONLY IF Q CANDIDATE OR EMPLOYEE OR APPOINTEE FOR OFFICE USE ONLY: x **** THIS SECTION MUST BE COMPLETED **** DISCLOSURE PERIOD: THIS STATEMENT REFLECTS YOUR FINANCIAL INTERESTS FOR CALENDAR YEAR ENDING DECEMBER 31, 2019. MANNER OF CALCULATING REPORTABLE INTERESTS: FILERS HAVE THE OPTION OF USING REPORTING THRESHOLDS THAT ARE ABSOLUTE DOLLAR VALUES, WHICH REQUIRES FEWER CALCULATIONS, OR USING COMPARATIVE THRESHOLDS, WHICH ARE USUALLY BASED ON PERCENTAGE VALUES (see instructions for further details). CHECK THE ONE YOU ARE USING (must check one]' 0 COMPARATIVE (PERCENTAGE) THRESHOLDS ❑ DOLLAR VALUE THRESHOLDS PART A — PRIMARY SOURCES OF INCOME [Major sources of in me to the reporting person - See instructions] Of you have nothing to report, write "none" or'We "j NAME OF SOURCE OF INCOME SOURCES ADDRESS DESCRIPTION OF THE SOURCE'S PRINCIPAL BUSINESS ACTIVITY Consulting 54 NW 40th St Economic Development Cansulta PART 6 -- SECONDARY SOURCES OF INCOME [Major customers, clients. and other sources of income to businesses owned by the reporting person - See instructions) (lf you have nothing to report, write "none" or "Na") NAME OF BUSINESS ENTITY lie NAME OF MAJOR SOURCES OF BUSINESS' INCOME ADDRESS OF SOURCE PRINCIPAL BUSINESS ACTIVITY OF SOURCE 'ART C — REAL PROPERTY [Land. buildings owned by the repersirg person - See instructions] jj jr (If you have clothing to report, write "none" or "nIa") Nhhe. Submitted into the public record for item(s) SP.J, on 11-18-2020, City Clerk GE FORM ! - Efreczres Jan;rary I, 202n Incoreoialed by reference in Rabe 34-62G2i1 j, F.A.C. You are not limited to the space on the lines on this form. Attach additional sheets, if necessary. FILING INSTRUCTIONS for when and where to file this form are located at the bottom of page 2. INSTRUCTIONS on who must file this form and how to fill it out begin on page 3. .Continued on reverse sirleJ PAGE 1 PART 0 — INTANGIBLE PERSONAL PROPERTY (Stocks, bonds, certi'ricates of deposit, etc. - See instructions; (If you have nothing to report, write "none" or "nla") TYPE OF INTANGIBLE TLD Entertainment Media BUSINESS ENTITY TO WHICH THE PROPERTY RELATES The Now Corp CBD PART E— LIABILITIES [Major debts - See instructions1 (If you have nothing to report, write "none" or "nla") NAME OF CREDITOR ADDRESS OF CREDITOR NONE •=-i r; -,i Fri FART F —INTERESTS IN SPECIFIED BUSINESSES Ownership or positions in certain types of businesses- See instrueij nsl-_ (—) (If you have nothing to report, write "none' or "nla") a :- BUSINESS ENTITY 01 BUS1F1B$6 ENTILY # NAME OF BUSINESS ENTITY ADDRESS OF BUSINESS ENTITY PRINCIPAL BUSINESS ACTIVITY POSITION HELL} WITH ENTITY I OWN MORE THAN A 5% INTEREST IN THE BUSINESS NATURE OF MY OWNERSHIP INTEREST PART G --• TRAINING For elected municipal officers required to complete annual ethics training pursuant to section 112.3142, F.S. N/A. NIA i ' l IF A I CERTIFY THAT I HAVE COMPLETED THE REQUIRED TRAINING. NY OF PARTS A THROUGH G ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE Q SIGNATURE OF FILER: Signature: Jeffrey W I'L' Date Signed: November 13th 2020 FII:ING INSTRUCTIONS: If you were mailed the form by the Commission on Ethics or a County Supervisor of Elections for your annual disclosure filing, return the form to that location. To determine what category your position falls under, see page 3 of instructions. Local officers/employees file with the Supervisor of Elections of the county in which they permanently reside. (if you do not permanently reside in Florida, file with the Supervisor of the county where your agency has its headquarters) Form 1 filers who file with the Supervisor of Elections may file by mail or email. Contact your Supervisor of Elections for the mailing address or email address to use. too not email your form to the Commission on Ethics. it will be returned. State officers or specified state employees who file with the Commission on Ethics may file by mail or email. To file by mail, send the completed form to P.O. Drawer 15709, Tallahassee, FL 32317-5709: physical address: 325 John Knox Rd, Bldg E, Ste 200, Tallahassee; FL 32303. To file with the Commission by email... scan your completed form and any attachments as a pdf (do not use any other format), send it to CEForm1@Ieg,state.fi.us and retain a copy for your records. Do not File by both mail and email. Choose only one Fling method. Form 6s will not be accepted via email. CPA or ATTORNEY SIGNATURE ONLY If a certified public accountant licensed under Chapter 473, or attorney in good standing with the Florida Bar prepared this form for you, he or she must complete the following statement: prepared the CE Form 1 in accordance wits, Section 112.3145. Florida Statutes, and the instructions to the form, Upon my reasonable knowledge and belief, the disclosure herein is Irue and correct. CPAIAttomey Signature: Date. Signed: Candidates file this form together with their filing papers. MULTIPLE FILING UNNECESSARY: A candidate who files a Farm 1 with a qualifying officer is not required to file with the Commission or Supervisor of Elections. WHEN TO FILE: Initially, each local officer/employee, state officer, and specified state employee must file within 30 days of the data of his or her appointment or of the beginning of employment. Appointees who must be confirmed by the Senate must fife prior to confirmation, even if that is less than 30 days from the date of their appointment. Candidates must file at the same time they file their qualifying papers. Thereafter, file by July 1 following each calendar year in which they hold their positions. Finally, file a final disclosure form (Form 1 F) within 60 days of leaving office or employment. Filing a CE Form i F (Final Statement of Financial Interests) does not relieve the filer of filing a CE Form 1 if the filer was in his or her position on December 31, 2019. C;E FORM 7 - EilacLree: January 1, 2029. fribnpordlad by reference in Rule 31-8.2o2(7], FAC, Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk CANDIDATE OATH — NONPARTISAN OFFICE (Do not use this form if a Judicial or School Board Candidate) Check box only if you are seeking to qualify as a write-in candidate: ❑ Write-in candidate I-3ECEIVED 2020 HOY .! 7 PH ti: 52 t+ f+ t OF HE C1TY CLERK C1TY OF MIAMI' OFFICE USE ONLY Candidate Oath (Section 99.021(1)(a), Florida Statutes) 1, Jeffrey Watson (Print name above as you wish it to appear an the ballot if your last name consists of two or more names but has no hyphen, check bar O. (See page 2 - Compound Last Names). No change can be made after the end of qualifying. Although a write-in candidate's name is not printed on the ballot, the name must be printed above for oath purposes.) am a candidate for the nonpartisan office of City Commissioner (Circuit #) (Group or Seat #) 5 (Office) (District #) I am a qualified elector of Miami -Dade Q County Florida; I am qualified under the Constitution and the Laws of Florida to hold the office to which I desire to be nominated or elected; I have qualified for no other public office in the state, the term of which office or any part therenf runs concurrent with the office I seek; and ! have resigned from any office from which I am required to resign pursuant to Section 99.012, Florida Statutes: and I will support the Constitution of the United States and the Constitution of the State of Florida. Candidate's Florida Voter Registration Number (located on your voter information card)• 109166886 IMF Phonetic spelling for audio ballot: Print name phonetically on the line below as you wish It to be pronounced on the audio ballot as may be used by persons with disabilities (see Instructions on page 2 of this form): Pot applicable to write-in candidates.] X ore of Candidate Address STATE OF FLORIDA COUNTY OF HO-MI- ( 202 ) 5734800 Telephone Number AAIcw City Sworn to (or affirmed) and subscribedfore me by physical or IIIonline presence this 4 3 day of +'� 1414't' •'-'/`'! 2(} 24 Personally Known: or Produced Identification' Type of Identification Produced: DS-DE 302NP (Rev. 04/20) watsonjeffrey@hotmail.com FL, State ignature of Notary P I is Print. Type, or Stem Comm i0 p neo Name of Notary Public below Email Address 33/D--7 ZIP Code L%)RETLARAMO$ t ? lifY C0Mt Is51ON t GG 213654 rn z _ °`•' EXPIRES: May 4, 2022 Bonded llw Notary Pahlle tl+lderrltiter6 Submitted into the public record for item(s) Sp.2, on 11-18-202O, City Clerk Rule 1S-2.0001, F.A.C. Submitted into the public STATE OF FLORIDA COUNTY OF MIAMI-DADE Jeffrey est Name 1.0 a en the -ate of Florida and of the United States of America,.. and a candidate for public office ... do hey sol m wear or affirm that I will support the Constitution of the United States and of the State of Florida. C._s Lt, . :;>- c5 cv record for item(s) SPA., LOYALTY OATH on 11-18-2020, City Clerk Watson Middle Initial Last Name Signature of Candidate CITY OF MIAMI OATH OF CANDIDATE OFFICE OF Commissioner Before me, an officer authorized to administer oaths, personally appeared Jeffrey Watson (PLEASE PRINT NAME) who, being sworn, says he/she is a candidate for the office of Commissioner , for the City of Miami, Florida; that he/she is a qualified elector of the City of Miami, Florida; that he/she is qualified under the Constitution, the Laws of Florida, and City of Miami Charter to hold the office to which he/she desires to be elected; that he/she has taken the oath required by Section 99.021, Florida Statutes; that he/she has qualified for no other public office in the State, the term of which office or any part thereof runs concurrent with that of the office he/she seeks; and that he/she has resigned or taken a leave of absence from any office from which he/she is required to re-sign or take a leave of absence, pursuant to Section 99.012, Florida Statutes. 54 NW 40th ST Address Signature of Candidate Miami \ Florida 33127 City State The Loyalty Oath and Oath of Candidate are sworn to (or affirmed) and subscribed before me by online presen e, this 1 3 day of November tulle of Officer Adminis ng Oath or Notary Public Personally known: Type of Identification Produced: OR Produced Identification: ZIP Code physical or OttEftll#MCS COMIASSION$ GO 243844 r WY42022 g odwriv ld P,Ric►loderra7lr• Nance of Mi ry ype rioted or Stamped p• - c OCY'C r7r _ J C C Forges, Sandra From: Sent: To: Subject: Attachments: Submitted into the public record for item(s) SP.1, on 11-18-2020, City Clerk jeffrey watson <watsonjeffrey@hotmail.com Wednesday, November 18, 2020 9:41 AM Forges, Sandra Re: Special City Commission - City Commission District 5 Vacancy - Meeting Guidelines 1HW-Bio (15).docx 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. fyi, i was asked to send this to you for commission colleagues From: Forges, Sandra csfo rges@ m is migov.com> Sent: Tuesday, November 17, 2020 6:56 PM To: jeffrey watson <watsonjeffrey@hotmail.com> Subject: RE: Special City Commission - City Commission District 5 Vacancy - Meeting Guidelines Great! Thank you for letting me know. We will see you tomorrow. Have a good evening. Sandra fcrgcs, Alt5A Elections Coordinator City of Miami — Clerk's Office 3500 ran American Drive Miami, rL33 9 33 3_05 -2 50-536 9 8 : 30 5-858-1610 l:sforgesCcr7miam igov.com From: jeffrey watson[mailto:watsonjeffrey@hotmail.com] Sent: Tuesday, November 17, 2020 6:55 PM To: Forges, Sandra 4sforges@miamigov.com> Subject: Re: Special City Commission - City Commission District 5 Vacancy - Meeting Guidelines 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. Thank you received! Get Outlook for Android From: Forges, Sandra <sforges@miamigov.com> Sent: Tuesday, November 17, 2020 5:09:35 PM To: Watsonleffrey@hotmail.com <Watsonieffrey@hotmail.com> Subject: FW: Special City Commission - City Commission District 5 Vacancy - Meeting Guidelines Good afternoon Mr. Watson, Attached is the public notice outlining the various methods for public comment for the November 18, 2020 special meeting pertaining to the City Commission District 5 vacancy. 1 Jeffrey Watson Submitted into the public record for item(s) SP.1, on 11-18-202O, City Clerk 2.02-573-4890 Jeffrey H. Watson is the CEO of Solairgen Energy Corp. a renewable energy developer and operator of solar parks and wind farms with 435 MW's of projects under development, to respond to the need for innovative renewable energy solutions in markets that are energy deficient and over reliant on fossil fuels. Solairgen is currently developing projects in Africa, the Caribbean and Central America using three different types of technologies. Mr. Watson is a seasoned economic development and finance professional with expertise in nonprofit, public and corporate strategy with a consistent history of working beyond traditional infrastructure strategies to leverage networks, partnerships and cultural assets for optimized outcomes for cities and state Governments. Having over 30 years of experience in economic development consulting and financial and business strategy development in public and private sectors within the U.S. and multinational markets Mr. Watson Founded J. Watson & Company, an economic development consulting and government relation firm in 1996. Additionally, Mr. Watson Altgen Capital Partners, a private equity company that invests in small cap companies Prior to founding J. Watson & Company, Mr. Watson was a Vice President for Government Relations at The Jefferson Group, a Washington, DC based consulting firm, where he formulated legislative strategy for public and non-profit entities seeking to obtain federal financial assistance. Mr, Watson's national public career includes serving as an Interim Assistant and Deputy Assistant to the President for Intergovernmental Affairs in the White House under the Clinton Administration. Mr. Watson served as a Director of the Presidential transition team and served in various states as a State Field Director and ultimately the Deputy National Field Director of the Clinton/Gore 1992 Presidential election campaign. At the White House, Mr. Watson coordinated the development of the Administration's policy initiatives and facilitated communications between the White House and state and local government officials. Prior to joining the Clinton White House, Mr. Watson served as a Senior Administrative Assistant for Mayor of Miami Xavier Suarez, and also served as Finance Administrator for the City of Miami's Department of Development and Housing Conservation Agency where he successfully directed the City's efforts to obtain federal funding (i.e. HUD Section 108 loans and Section 312 loans) for retirement of debt and commercial rehabilitation projects. Mr. Watson served as Senior Tax Accountant with Arthur Anderson & Company CPA's and Senior Auditor for Coopers and Lybrand CPA's, Mr. Watson currently serves as a board of director member for the Institute of Caribbean Studies. He has served as member of the board of directors for RENEX Corp. (a publicly traded dialysis company) and Vice Chair of the Miami -Dade County Housing and Finance Authority.. Mr. Watson was presented with an Honorary Degree by Miami Dade College, received the African - American Achievers Award sponsored by JM Family Enterprises, Inc., and received a National Community Service Award sponsored by Support Network, Inc.