Rabbi Daniel Sherbill 12/31/2014 i 1 , I
_ACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139,www.miamibeachfl.gov
OFFICE OF THE CITY CLERK, Rafael Granada, City Clerk
Tel: (305)673-7411, Fax: (305)673-7254
Email CityClerk @miamibeach.gov
2/14/2013
Rabbi Daniel Sherbill
1623 Collins Avenue, Apt 820
Miami Beach, Florida 33139
SJCT{ Committee on the Homeless
Congratulations! You have been reappointed by Commissioner Michael G6ngora
to the above referenced agency, board or committee for a term ending: 12131/2014.
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.
Sinc4Eranado
Ra a
City Clerk
cc: Saul Frances, Parking Director
Katherine Martinez
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.
KAMBEACH
City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov
OFFICE OF THE CITY CLERK, Rafael Granado, City Clerk
Tel: (305)673-7411, Fax: (305)673-7254 -
Email CityClerk @miamibeach.gov
TO Rabbi Daniel Sherbill
RE: Committee on the Homeless
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, 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 appointed
for a term ending: 12/31/2014.
1 have been issued a copy of Section 2-11.1 of the Miami-Dade County Code (Conflict of Interest and
Code of Ethics Ordinance), as well as the Florida Commission on Ethics Guide to the Sunshine Amend-
ment and Code of Ethics for Public Officers and Employees, and understand that as a member of a City
of Miami Beach Board and/or Committee, I must comply with the financial disclosure* requirements of
Miami-Dade County or ithe State of Florida (depending on the board or committee on which I serve)on
July 1, following the closing of the calendar par,,on w ich I ave served.
i
Rabbi Daniel herbill
Sworn to and subscribed before me thisaoday o L, 2013.
Silvia Prieto
Deputy Clerk
*Please visit the City of Miami Beach website at www.miamibeachfl.gov under City Clerk/Board and Comm
for additional information regarding the Financial Disclosure Requirement
We are committed to providing excellent public service and safely to all who live, work and play in our vibrant, tropical,historic community.
1
MIANACITY OF A$gi BEACH
1 BEACH BOARD AND COMMITTEE APPLICATION FO RIM
5'#fn t6I�L— I �00of Al
List JyeC;D1 `/a� 1gZ M,, ir!� CA 1 0 dle Initial
,�kg A res City State Zip,C L
He Telep one Work Telephone Cellular Telephone Emai address
j) 4.Q 1 1 Position:
u iness Name
+�� OS Jed
Business Address City State tip t6de
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
for a minimum of six months.
• Resident of Miami Beach for a minimum of six (6) months:Yes F.Mor No 1
• Demonstrate an ownershi p/interest in a business in Miami Bea h for a minimum of six months:Yes dor No
• Are you a registered voter in Miami Beach: Yes ID or No
• I am now a resident of: North Beach W South Beach I_Z1 Middle Beach
• I am applying for an ap ointment because I have special abilities k owledge 7CAIK d ex erience. Please list below:
• Are you presently a registered lobbyist with Ae City of Miami Beach?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)
Affordable Housing Advisory Committee -Fine Arts Board Normandy Shores Local Government
Neighborhood Improvement
Art in Public Places Committee Gay, Lesbian, Bisexual and Transgender Parks and Recreation Facilities Board
Enhancement Committee GLBT
Beautification Committee Golf Advisory Committee Personnel Board
Board of Adjustment* Health Advisory Committee Planning Board*
Budget Advisory Committee Health Facilities Authority Board Police Citizens Relations Committee
Capital Improvements Projects Hispanic Affairs Committee Production Industry Council
Oversi ht Committee
Committee on the Homeless Historic Preservation Board Safety Committee
Committee for Quality Education in MB Housing Authority Single Family Residential Review Panel
Community Development Advisory Loan Review Committee Sustainability Committee
Community Relations Board Marine Authority Tennis Advisory Committee
Convention Center Advisory Board Miami Beach Commission for Women Transportation and Parking Committee
Debarment Committee Miami Beach Cultural Arts Council Visitor and Convention Authority
Design Review Board* Miami Beach Human Rights Committee Youth Center Advisory Board
Disability Access Committee Miami Beach Sister Cities Program Waterfront Protection Committee
* Board Required to File State Disclosure Form
If you seek appointment to a professional seat(e.g., lawyer,architect)on the Board of Adjustment, Design Review Board,
Historic Preservation Board,or Planning Board,attach a copy of your currently-effectively license,and furnish the
following information:
Type of Professional License License Number ,
License Issuance Date ,and License Expiration Date
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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 No Years of Service:
2. Present participation in Youth Center activities by your children Yes E_Z] No ED. 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:
*Have you ever been convicted of a felony:Yes ID or No Zlf es lease ex lain in detail:
Y Y yes, P
• Do you currently-have-a violation(s)of City of Miami-Beach codes:Yes U or No Z.,If yes,please explain-in detail:
• Do you currently owe the City of Miami Beach any money:Yes 4 or No&If yes, explain in detail
•Are you currently serving on any City Boards or Committees: Yes&Or No 4Z1. If yes;which board?Ila 11-&- 575
•What organizations in the City of Miami Beach do you currently hold membership in?
ts'O 1_,'1 C ,45'oZ 01�7 6P AT: SEC/ !Nll,
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 4.a or No Which department?
• Pursuant to City Code Section 2-25(b):Do you have a parent.,spouse ,child ZI brother U,or sister 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 on your consideration for
appointment. It is being asked to comply with federal equal opportunity reporting requirements.
Ethnic Origin:Ch ck one onl 1)
Ge er: Male Female
White (Not of Hispanic Origin):All persons having origins in an of the original eo les of Europe,North Africa or the Middle East.
P 9 Y peoples P
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,or
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 throu h tribal affiliation or community recognition.
Physically Challenged: Yes or No I
Employment Status: Employed 4I Retired Homemaker 4 Other
Please remember to attach a current resume and a copy of any applicable
professional license.
Attach additional sheets, if necessary, to provide required information.
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Y
NOTE: IF APPOINTED, YOU WILL BE REQUIRED TO FOLLOW CERTAIN LAWS THAT APPLY TO CITY BOARD/COMMITTEE
MEMBERS. THESE LAWS INCLUDE,BUT ARE NOT LIMITED TO,THE FOLLOWING:
• Prohibition from directly or indirectly lobbying city personnel(Miami Beach City Code section 2-459).
• Prohibition from contracting with the city(Miami-Dade County Code section 2-11.1).
• 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).
• Requirement to disclose certain financial interests and gifts(Miami-Dade County Code section 2-11.1).
• 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 HEREBY ATTEST TO THE ACCURACY AND TRUTHFULNESS OF THE APPLICATION, AND I HAVE RECEIVED, READ AND
WILL ABIDE BY CHAPTER 2, ARTICLE VII — OF THE CITY CODE "STANDARDS OF CONDUCT FOR CITY OFFICERS,
EMPLOYEES AND AGENCY MEMBERS."
C2-av 4�
3
Applica s ig Date Name of Applicant(PLEASE PRINT)
Received in the City Clerk's Office by
Name of Deputy Clerk Control No. Date
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/V\,'l A il BEA
City of Miami Beach
1700 Convention Center Drive,
Miami Beach, Florida 33139,
www.m i a m i beachfl.9ov
CITY CLERK'S OFFICE CityClerk @miomibeachfl.gov
Telephone: 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's Name- i� L, P -
I 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 to the 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
a period not to exceed sixty days, or both.
Signature Date
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I-AM I BEACH
aty of Miami Beach,
1700 Convention Center Drive,
Miami.Beach,Florida 33139,
WWW.miami6BOahfl.Pov
CITY CLERK Office Cit C1erk@miami6eachfl.gov
Tel: 305.673.7-411 , Fax: 305.673.7254
Acknowledgement.of fines/suspension for Board Meru hers for.failure
with County Financial Disclosure code Provision
t® comply
Code section 2-11 Ifi) (2)
LZ-
Board Member.name.
b4 �r�
I understand that no .:later than July If sof .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 responsib'Hity -is to recommend
legislation or give advice to-the City Commission,-must:file,:even though_you may have.been
recently appointed.
You must file one of-the-following with the City Cleric of Miami Beach,,1700 Convention
-Center.Drive, Miami beach, Florida,.by.July Leach:year..
1. A"Source of..Income.Statement" (attached) or
2. A"Financial Statement" (attached( or]
-1, A Copy of the-person'.s .current Federal income Tax Return
Failure to-fife., -according:to-the Miatxii-Dade :County Code Chapter 1, General
Provision,. Section 1-5 may subject.the-.person or firm to a fine not-to exceed
$506.00 or by imprisonment'in the-county.jail.for-a period not--to exceed sixty
days, or:both.
Al
r
-Signature: Date.:
M I A M I•DADE
® SOURCE OF INCOME STATEMENT
Please Print or Type First Name Middle Name/Initial Last Name
Disclosure
, i / For Tax Year
Name: //j//�L ce `!e Ending:
Mailing Address:
City/State/Zip:
ci 9 um
Filing as a: ® County Employee:
® Municipal Employee of:
Position held or sought:
Board where serving:� ,h�e olu 74,67 Term or Employmen
Began on:
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): ® 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:
IJescription of the Principal
Name of.Source of Income Address Adivity
I hereby ear(or affirm) that the aforesaid information is a true and correct statement.
v
Signature o person d- closing Date sign