Rabbi Solomon Schiff 12/31/2013 MIAMI BEACH
City of.Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.niiamibeachfl.gov
OFFICE OF THE CITY CLERK, Robert Parcher,City Clerk
Tel: (305)673-7411, Fax: (305) 673-7254
12/30/2011
Rabbi Solomon Schiff
2443 Meridian Avenue
Miami.Beach, Florida 33140
mom Community"Relations Board
Congratulations! You have been reappointed by Mayor Matti Herrera Bower
to the above referenced agency, board or committee for a term ending: 1213112013.
If you are unable to accept this appointment, please notify the City Clerk's Office at
(305) 673-7411.
Please read the enclosed material carefully. Again, congratulations and good luck.
Sincerely,
pParcher
City Clerk
cc: Saul Frances,.Parking Director
Lynn Bernstein
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, 2-26,2-2458, 2-459
Ordinance 2006-3543 -Amendment to City Code Section 2-22
Miami-Dade County Code Section 2-11 '1 -Conflict of Interest and Code of Ethics Ordinance
City Wide Permit Application -(Parking Department Form)
Booklet- Guide to the Sunshine Amendment and Code of Ethics for Public Officers and
Employees
We are committed to.providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community
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= Miami Beach,Florida 33139,�vww.miamibeachf!goy„ . c _
- tiit`Of-,Miami,Beach, 1700 Convention Center Drive, °
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' ' 'OFFICEOF��THE•C1TY;C1ERK-f RobertParcher,City Clerk
•Tel. 3Q567-741.1;FOX. (305)673-7254
TO Rabbi Solomon Schiff
RE' Communit Reltions Board
I do solemnly,,swear or affirm,to bear true faith,loyalty'pandallegianceitodthe Government of the
United States„the`Statelof'Florida,_and the City of'Miami-'Beach,and'to5peiform all the duties of
a member.,oftheabove;mentioned board or committee of�''the City`of'Miami Beach to which I have
been appointed fora;term;ending: 12/31/2013. __ -• '
I havetbeensissued;a,,copyaof'Section 2-11.1 of the-Miami=Dade`County=Code'(Conflict of Interest
and'Code,of Ethics�Ordinance),-aswell as theFlorida;Commission onYEthicsr,Guide�to the Sunshine , ,
Amendment and,Code:of Ethics for Public Officers Officers-ranclifjjiplbkees,and,understand,that as a member _ ,- ',•
of a City`of Miami Beach Board and/or Committee I must=comply°with the;financial'disclosure*require- - , - ..
,mentsof Miami=,Dade;County:or the State of Flonda4depending on'theiboard-,or,committee on which. `• --
-I serve),on July;1st,following the-closing of the calendar:year onawhich I have served.
' ... , - ,, , , / ',- _., .
4 III 441:.H4faii/A l' ' ' ' : ' : : :' ' - :
.x'
RabliiESolomon Schiff
•
-' , ° i -;',_,v,arr to and subscribed before me,this f61 day^ofL° ' OW, 2012 „
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,v-,,,- c-.... _ : 1, Silva ?rieto 1-
x , '3- J Deputy.Clerk ,
. , *Please visit the City of Miami Beach;website at,www.miamibeachfl.gov under City Clerk/Board and Committees= •
for additional information regarding the-Financial Disclosure Requirements.
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'r�We�are_committed'to'prov�dmg excellent public service and safety to all hve work and'play.'in,our viiirant,,tropical, histonc,community
Era tv\I AM! B EAC H CITY OF MIAMI BEACH
7 I � t()// =OARD AND COMMITTEE APPLICATION FORM
NAME:
L
ast N rst e , Mid.le Initial
HOME ADDRESS: & / _ / Le II)IA _ L / ) redif 4 A ■ al,
Apt No r se No. treet City " / tat- Zip Co'-
PHONE:
Horn Work Fax Email address " U •(JV1 t/
Business Name. Position
Address
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;or b)an individual shall demonstrate ownership/interest for a minimum of six months in a business established in the city
• Resident of Miami Beach for a minimum of six(6) months'Yes 0 or No ❑
o Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six (6) months Yes❑or No ❑
•Are you a registered voter in Miami Beach.Yes 0 or No ❑
• (Please circle one): I am now a resident of. North"Beach South Beach Middle Beach
• I am applying for an appointment because I have special abilities, knowledge and expenence Please list below
•Are you presently a registered lobbyist-with the City of Miami Beach?Yes 0 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)
0 Affordable Housing Advisory Committee 0 Marine Authority
❑Art in Public Places Committee 0 Miami Beach Commission for Women
❑Beautification Committee ❑Miami Beach Cultural Arts Council
❑Board of Adjustment* ❑Miami Beach Human Rights Committee
❑Budget Advisory Committee ❑Miami Beach Sister Cities Program
❑Capital Improvements Projects Oversight Committee ❑Normandy Shores Local Government Neigh. Improvement
❑Committee on the Homeless ❑Parks and Recreation Facilities Board
❑Committee for Quality Education in MB ❑Personnel Board
0 Community Development Advisory ❑Planning Board*
0 Community Relations Board ❑Police Citizens Relations Committee .
❑Convention Center Advisory Board ❑Production Industry Council
❑Debarment Committee
❑Design Review Board* ❑Safety Committee
❑Disability Access Committee ❑Single Family Residential Review Panel
❑Fine Arts Board ❑Sustainability Committee
❑Gay, Lesbian, Bisexual and Transgender(GLBT) ❑Transportation and Parking Committee
❑Golf Advisory Committee ❑Visitor and Convention Authority
❑Health Advisory Committee ❑Waterfront Protection Committee
❑Health Facilities Authority Board ❑Youth Center Advisory Board
❑Hispanic Affairs Committee
❑ Histonc Preservation Board
❑Housing Authority
❑Loan Review Committee *Board Required to File State Disclosure Form
Note. If applying for Youth Advisory Board, please indicate your affiliation with the Scott'Rakow Youth Center
1 Past service on the Youth Center Advisory Board' Yes 0 No❑ Years of Service
2 Present participation in Youth Center activities by your children YesO No ❑ If yes, please list the names of your children, their
ages,and which programs List below.
Child's name Age Program
Child's name Age Program
F\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC Application doc
•Have you ever been convicted of a felony' Yes ❑ or No yes, please explain in detail
• Do you currently have a violation(s) of City of Miami Beach codes Yes ❑or Islivt If yes, please explain in detail:
• Do you currently owe the City of Miami Beach any money' Yes 0 or No If yes, explain in detail
• Are you currently serving on any Ci y ds or Committees Yes dNo 0. If yes, which board?
• What organizations in the City of Miami Beach do you currently hold membership in?
Name. Title.
Name. Title
• List all properties owned or have an interest in, which are located within the City of Miami Beach.
• I am now employed by the City of Miami Beach Yes ❑or No❑. hich department?
• Pursuant to City Code Section 2-25(b): Do you have a parent 0, spouse 0, child 0, brother 0, or sister 0 who is employed by the
City of Miami Beach? Check all that apply Identify the department(s)
The following Information is voluntary and is neither part of your application nor has any bearing onyour consideration for appointment. It is
being asked to comply with federal equal opportunity reporting requirements. _
Gender: ale ❑ Female
Eth5rc Origin: Check one only(1)
C,White (Not of Hispanic Origin):All persons having origins in any of the 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 Pacific Islands. This area includes,for example,China, India,Japan,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 tribal affili 'on or community recognition.
Physically Challenged: Yes❑bNVo❑.
Employment Status. Employed ❑ Retired Homemaker❑ Other❑
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:
o Prohibition from directly or indirectly lobbying city personnel (Miami Beach City Code section 2-459)
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)
o Requirement to disclose certain financial interests and gifts(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 you have business or immediate family ties (CFR 570.611)
Upon request, copies of these laws may be obtained from the City Clerk.
"I here f t t• accur t 1, Iness of the appli ation and have received, read and will abide by Chapter 2,
Arti �; 1�� • ;� ' 1- tl� Cod 1;k,-11 •nduct for City c r$ mployees and Agency Members."
1 if! Ai V
Applicant's Signature 11 gate Name of Applicant(PLEASE PRINT)
Received in the City Clerk's Office by Date _/ /2010 Control No Date:_/_/2010
Name of Deputy Clerk
I \
MIAMI• •
'COUNTY _ - SOURCE OF INCOME STATEMENT
Please Print or Type First Name Middle Name/Initial Last Name
Disclosure
Jltj e For Tax Year Name: SI,2O,1O,t1 1 S i Ending: ,
1
Mailing Address:
City/State/Zip:
^:�� cor-�eri • Number:
Filing as a: ® County Employee:
® Municipal Employee of:
Position held or sought:
Board where serving: C g Term or Employ nt
Began on: I / ;-.
Department where employed:
Work Address:
If your home address is exempt from public records pursuant to
Florida Statutes§119.07 please check here(read-instructions): 0 Work Telephone:
Home Address:
Street Address
City State Zip Code
Please list below in descending order with the largest source first, the name, address and
principal business activity of 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 partner need not be disclosed. If continued on a
separate sheet, check here:
Description of the Principal
Name of Source o In ome Address Business Activi
minimarmilm
111111110WRIUM/111,9M11-4 2121111
s ✓ t'�.�
hereby swear(or affirms) that th- at.. esaid information is a true and correct statement.
!1 / / lidio -
Signature of person disclosing Date signed
MIAMI BEACH
City of Miami Beach,
1700 Convention Center Drive,
Miami Beach, Florida 33139,
www.miamibeachfl.pov
CITY CLERK Office CityClerk@miamibeachfl.gov
Tel: 305.673.7411 , Fax:305:673.7254
Acknowledgement of fines/suspension for Board Members for failure
to comply with Miami-Dade County Financial Disclosure Code Provision
Code Section '2-11.1(i) (2)
Board Member name: I41 f t r s-;)0,440A)
I r�-
understand that no later than July 1, of each year all members of Boards and
Committees of the City of Miami Beach, including those of a purely advisory nature, are
required to comply with Miami-Dade County Disclosure Requirements. This means that the
members of City Advisory Boards, whose sole or primary responsibility is to recommend
legislation or give advice.tothe City Commission,must file, even`though you may have been
recently appointed.
You must file one of the following with the City Clerk of Miami Beach, 1700 Convention
Center Drive, Miami Beach, Florida, by July 1 each year.
1. A "Source of Income Statement" (attached).or
2. A"Financial Statement" (attached( or]
3. A Copy of the person's current Federal Income Tax Return
Failure to file, according to the Miami-Dade County Code Chapter 1, General
-Provision, Section 1-5 may subject the person or firm to a fine not to exceed
$500.00 or by imprisonment in the county jail for period not to exceed sixty
days, or both.
• ,' If a l
Signature. O Date: