Sabrina Cohen 12/31/2010i .
.
' Clt~ Of IIAiQmi BEC1Cli7~ 1700 Convention Center Drif e, Miami Beach, Florida 33139; vrww.mi'amibeachfl.aov
- ; - f
OFFICE OF THE CITY CLERK; Robert Parches; City Clerk . '
- ,Tel: (305) 673-741 1„ Fax: (305) 673-7254. a ~ -
' 05-20-2010 •
." -
Sabrina Gohen.
1--800 Purdy Ave
.Miami Beach, Florida 33139
~~ SDDJECT: Disability Access Committee . - ' .
- Congratulations! You have been appointed by Commissioner Ed "Tobin
• to -the agency, "board or committee named above #or a term ending: 12/31 /2010.
Pursuant to Ordinance No. 2006-3543, commencing with terms beginning on or after
January 1st, 2007, .the term of.board members who are directly appointed by a member of
tfie City Commission shall automatically: expire on December 31 of the year the .appointing
.. elected official leaves office.
If you are unable to-accept this appoinfinent.or have any questions, please-call.the City .
Clerk's Office at 305-673-7411: Please read the enclosed. materials carefully.
Congratulations again and good luck.
' Sincerely, :, ,
• ~ -
Robert Parches
. ~ -City. Clerk
. .
cc: Sauk., Frances, Parking Director ,
. Duane -Knecht
. ` '-ATTACHMENTS:
Letter of Appointment '
. . Oath ~ .
City Code Ordinance section, applicable to agency,'board or committee
' City Code Section 2-22,'2-23, 2-24,:2-25,2-26, 2-458 and 2-459 .
" ~ Ordinance No. 2006-3543 -Amendment to City Code Section 2;22 • -
.Miami-Dade County~.Code Section 2-11.1 -Conflict of~lnterest.and Code of Ethics Ordinance
City Wide Permit Application - (Parking "DepartmentlForm)
-- Booklet -. Guide"to~the Sunshine Amendment and Code of Ethics for Public Officers, and Employee
'We are.committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical,. historic community. ~ ,°
_ ~.. ~ /
m MIAMI~E.~,CH
City of Miami Beach, 1700 Convention Center D
OFFICE OF THE CITY CLERK,. Robert Parcher, City Clerk
Tel: X305) 673-741 1, Fax: ~305~ 673-7254
Miami Beach, .Florida 33139, www.miamibeachfl.gov
c :•; ~ .
TO Sabrina D. Cohen
RE: Disability Access Committee
I do solemnly swear or affirm to bear true faith, loyalty and allegiance to the Government of the
United States, the State of Florida, and the City of Miami Beach l and to perform all the duties of
a member.of the above-mentioned board. or committee of the City of Miami Beach to which I have
been appointedfor a term ending: 12/31/2010.
I have been issued a copy of Sectiori 2-11.1 of the Miami-Dade County Code (Conflict of Interest
and Code of Ethics Ordinance), as well as theF/orida Commission on Ethics Guide to the Sunshine
Amendment and Code of Ethics for Public Officers and Emp/oye ~s, and understand that as a member
of a City of Miami .Beach Board and/or Committee, I must comply with the financial disclosure' require-
ments of Miami-Dade County or the State of Florida (dep nding on the board or committee on which
I serve) on July 1st, following the closing of the calendar ear o i which I have se
~~~~~
Sabrina D. Cohen
Sworn to and subscribed before me this ~~day of ~ ~" , 2010.
s-~z~~ ~
ilvia P
*Please visit the City of Miami Beach website at www.miamibeacl
for additional information regarding the Financial Disclosure Requi
erk
under City Clerk/Board and Committees
We are commiried to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community.
. ~~~ , .
NAAAE: ~ a) \~'~
` ~ Last Name .
' - HOME ADDRESS: ~~ yG ~~V' ~'~'~ Vim,
Apt No. ouse No./Sti
PHONE: ~~ ~v'~~ ~ ~-~'G
C0'CV CDF !!filA!!ft! EiEAC'H
~~ARD ~~l,D COl~EI!!lT7EE APPLlC.~TlO~! F~R~
1 i~(~
First Name Middle Initial
' City State Zip Code
- Home Work Fax Email address
Basiriess Name: ~7~'V~`~QI~i` ~.~~ ,~1 ~o~~ri1 ~~k1,t) ~~ Position: ~ ~' ~ ~J 1
Address:. : ~ ~ rn e~~ ~ PA ~ ~ ~
° No. ~ Street ~ City State .Zip Code
.Professional License (describe) Expires: Attach a copy of the license
Pursuant to City Code section 2-22(4) a and b: Members of agencies, boards, and committees shall be affiliated with the city; this
requirement shall be fulfilled in the following ways: a) an individual shall have been a resident of the city for a minimum of six
. months; orb).an individual shall demonstrate ownership/interest f~o~ a minimum of six months in a business established in the city:
• Resident of Miami Beach for a minimum of six (6) months: Yes`~TI or No ^
• Demonstrate an ownership/interest in a business i~i Miami Beach for a minimum ofsix (6) months: Yes or No ^n
.Are you a registered voter in Miami Beach: Yes ~ or No ^
• (Please circle one): J' am now a resident of: North Beach' , Soutfi- a Middle Beach
• f am applying for an appointment because I have special abilities, knowledge a x erience. Please list below:
• Are you presently a registered'tobbyistwith the City of Miami Bi ach? Yes ^ or No
Please list, your preferences in order of ranking [1] first choice [2] second choice, and [3] third choice. Please note that only three (3)
choices-will be observed by the City Clerk's Office. (Regular Boards of City)
S'': a
^ Affordable Housin Adviso Committee ~ ^Housin Authorit
^ Art in Public Places Committee ~ ^ Loan Review Committee
^ Beautification Committee ~ ^ Marine Authorit '
^ Board of Ad'ustmenf~ ~ . ^ Miami Beach Commission for Women
^ Bud et Adviso Committee ~ ^ Miami Beach~Cultural Arts Council
Ca ital Im rovements Pro'ects Oversi ht Committee ( ^ Miami Beach Sister Cities Pro ram
^ Committee on the Hor-ieless ~ ^ Normand Shores Local Government Nei halm rovement
^ Coriimittee' for Qualit Education in MB ~ ^ Parks and Recreation Facilities Board
^Communit Develo meet Adviso ~ ^ Personnel Board
^Communit Relations Board ~ ^ Plannin Board" ~ _
^ Convention Center Adviso Board ~ ^ Police Citizens Relations Committee
^'Debarment Committee j ^ Production Indust Council
Desi n Review Board" ~ ^ Public Safet Adviso ~ Committee
Disabili Access Committee ~ ^ Safef Committee
^ Firie Arts Board { ^ Sin le Famil Residential Review Panel
^Ga ,Lesbian, Bisexua6and Trans- ender GLBT ~ ^Sustainabilit Committee
^ Golf Adviso Committee ~ ^ Trans arenc Reliabilit & Accountabili Committee "TRAC"
^ Health Adviso Committee ~ ^ Trans ortation and Parkin Committee
^ Health Facilities Authorit Board ~ ^ Visitor and Convention Authorit
^ His anic Affairs Committee ~ D Waterfront Protection Committee
^'Historic Preservation Board ~ ^ Youth Center Adviso Board
` ~ .: '
~ *Board Required to File State Disclosure Form
.Note: if applying for Youth Advisory Board, please indicate your af' liation with the Scott Rakow Youth Center.
1. Past~service on the Youth Center Advisory Board: Yes ^ No ^ Y ears of Service:
2. Present participation in-Youth Center activities by your childre Yes^ No ^. If yes, please list the names of your children, their
i
ages, and which programs List below:
Child's name:. i ge: Program:
Child's name: A ge:. Program:
F:\CLER\$ALI:\aFORMS\BOARD AND COMMITTEES\BC Application0626 9 NEW.doc
• Have you ever been convicted of a felony: Yes ^ or Noll I~f yes, please explain in
• Do you currently have a violation(s) of City of Miami.
codes: Yeas ^ or No~ If yes, please explain in detail:
• Do you currently owe the City of Miami Beach any money: Yes ^ or No~. If yes, explain in detail
. -~
• Are you currently serving on any City Boards or Committees: Yes ^ or No ~. If yes; which board?
• What organizations in the City of Miarni Beach do you currently hold membership in?
Name: I Title:
Name: ~ Title:
• List alt properties owned or have an interest in, which are Located within the City of Miami Beach:
__ _C~ ~ r a.c~ --- . S J y~ ~~ ~-~, r^ ~ ~ o ~~
i
• I am now employed by the City of Miami Beach: Yes ^ or No^. Which department?
• Pursuant to City Code Section 2-25 (b): Do you have a parent ^, spouse ^, child ^, brother ^, or sister ^ who is employed by the
City of Miami Beach? Check all that apply: Identify. the department(s):
i
The following information is voluntary and is neither part ofyour application nor has any bearing on your consideration for appointment. It is
being. asked to comply with federal equal opportunity reporting requirements.
Gender: ^ Male ~ Female
~hnic Origin:
Check one only (1)
l
.
11Vhite (Not of Hispanic Origin): All persons having origins in any of th
original peoples of Europe, North Africa or the Middle East.
(] African-American/Black (Not of Hispanic Origin): All persons having origins in any of the Black racial. groups of Africa.
^ Hispanic: All persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race.
^Asian or Pacific Islander; All'persons having origins:in any of the original peoples of the far East, Southeast Asia, the Indian Subcontinent, on
the Pack Islands. This area includes, for example, China, India, Jap i n, Korea, the Philippine Islands and Somoa.
American Indian or Alaskan Native: All persons having origins
in any of the original peoples of North America, and who maintain
,
Cultural identification through trib f affiliation or community recognitio .
~
Physically Challenged: Yes ts
or No^.
Employment Status: Employed.. ^ Retired ^ Homema ker ^ Other ^ ~ ~ ~1.~ ~-Y''~~~ ~~ ti~~' 1°v ~C~ ~~'
NOTE: If appointed, you will be required to follow certain laws which apply to city board/committee members. ~
These laws include, but are not limited to, the following:
I
o Prohibition from directly or indirectly lobbyin ci erso
nel (Miami Beach Cit Code section2-.459 .
9 tY P
Y )
~
~
o Prohibition from contracting with the city (Miami-Dade County Code section 2-11.1).
o Prohibition. from lobbying before board/committee you have served on for period of one year after leaving office (Miami
Beach City Code section 2-26).
l
o Requirement to disclose certain. financial interests and
ifts (Miami-Dade County Code section 2-11.1).
(re: CMB Community Development Advisory Committee): prohibition, during tenure and for one year after leaving office,
from having any interest in or receiving any benefit from Community Development Block Grant funds for either yourself ,
or those with.whom yoia have business or immediate family ties (CFR 570.611).
Upon request, copies of these laws may be obtained from the City Clerk.
~.
I
"I hereby attest to the accuracy and truthfulness of the application and have received, read and will abide by Chapter 2,
rticleYll- of the City Code "Standards of Conductfor City Officers, Employees and Agency Members."
''~ 2~ c~
Applicant's Signature Date T Name of Applicant (PLEASE PRINT)
Please attach a copy of your resume to this application
NOTE: Applicat~ons__w~ll_remain on file for a perod of one (1)_calendar_year:
Received in the City Clerk's Office by : - ~ Date: S 010 Control No. ~~ Date: ~~ /~
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~r~.y
. i
'
MI®DADE ®~ ~
S RCE O I~NCOMf STATEMENT
.Please Print. or Type First Name ~ Middle Name Initial Last Name
Disclosure
For Tax Year
Name:. ~' ~.~ r; ~ ~ a, C b~e ~/ Endin
9' 2~ 1 D
Mailing Address: ~ ~0 n ~~, r~~ ~~ ~„ ~,~ 2 ~- p ~
City/state/zip: M ~ o, tM t l e aL~ ) ~L ~ 3 I~
Social Security Number:
filing as a: ® County Employee: ~
Municipal Employee of: -
Position held or sought: ~ ,~ 5 ~~ , ~ fi ' ~ ~~~ ~0 „^ ~, -~.~
Board where serving;. ~ Term or Employment
Began on:
Department where employed: ~ '
WorkAddress:
8f your home address is exempt from public records Pi rsuant to
Florida. Statutes § 119.07 please check here (read instructions): ® Work Telephone:
. ~i~
Home Address: ~~~1~ . ~YS s~Cj~i~'e
reet Address
City ~ State Zip Code
Please list below in descending order with Ithe largest source first, the name, address and
principal business activity ®f every source of your income including public salary you
received or any person received for your benefit or use during the disclosure period. The
income of your spouse or any business paitner need not be disclosed. If continued on a
separate sheet, check here: ~
Name of Source of Income_ _ ~
` - Ad _ ~
dress ~..: Descrpt~on~of the Principal
: ". ; _ Business"Active .. `
Na v^~
I _
I hereby .swear (or affirm) that the aforesa I d information is a true and. correct statement.
Signature of perso disclosing. ~ Date signed