Samuel J. Rabin, Jr. Application Package pending photo and resume \' / / S E ',d✓ c 41 .�+-d.�..j,. ..��..� _.. s:,° kjg i.��: i°;`# „i.�r 3 I�r4 #.fi
Rabin, Jr. Samuel J.
Last Name First Name Middle Initial
9 Island Avenue Unit 2101 Miami Beach FL 33139
Home Address City • State Zip Code
305-534-4734 305-358-1064 305-905-0502 sjr @miamilawyer.com
Home Telephone Work Telephone Cellular Telephone Email address
Samuel J. Rabin, Jr., P.A. Attorney
Business Name Occupation
800 Brickell Avenue Suite 1400 Miami FL 33131
Business Address City State Zip Code
Professional License(describe): The Florida Bar Expires: N/A
Please attach a copy of currently effective professional license.
Pursuant to City Code section 2-22(4)a&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 or No C D
• Demonstrates ownership/interest in a business in Miami Beach for a minimum of six months: Yes I__Ii or No In
• Are you a registered voter in Miami Beach: Yes or or No I.A
• I am now a resident of: North Beach L.I South Beach I. Middle Beach
• I am applying for an appointment because I have special abilities, knowledge and experience. Please list below:
3 i VL tiAV1
1
• Are you presently a registered lobbyist with the City of Miami Beach? Yes 1_ _i 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.
0 Ad Hoc Committee Centennial Celebration 0 Health Advisory Committee 0 Parks and Recreation Facilities Board°O
0 Affordable Housing Advisory Committee 0 Health Facilities Authority Board 0 Personnel Board
0 Art in Public Places Committee C Hispanic Affairs Committee 0 Plannin•Board *
0 Board of Adjustment' r 0 Historic Preservation Board ' ( 0 Police Citizens Relations Committee
G Budget Advisory Committee 0 Housing Authority 0 Production Industry Council
0 Committee on the Homeless 0 Marine&Waterfront Protection Authority 0 Sustainabilit Committee
0 Committee for Quality Education in MB 0 Miami Beach Commission for Women 0 Transportation,Parking,&Bicycle-Pedestrian
Facilities Committee
C.!Convention Center Advisory Board Miami Beach Cultural Arts Council 0 Visitor and Convention Authority
0 Design Review Board' * 0 Miami Beach Human Rights-Committee
0 Disability Access Committee D Miami Beach Sister Cities Program
0 Gay.Lesbian,Bisexual and Transgender 0 Normandy Shores Local Government
Enhancement Committee(GLBT) Neighborhood Improvement
* Board members are required to file Form 1 —"Statement of Financial Interest"with the State.
If you seek appointment to a professional seat (e.g., lawyer, architect, etc.) 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 License Expiration Date
.
Page l of 4
F:ICLER\SALL1aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 06022014.docx
,
Note: If applying for the Youth Center positions of the Parks and Recreations Facilities Board,please indicate your affiliation with
the Scott Rakow Youth Center and/or the North Shore Parks Youth Center:
• Please describe your past service with the City's Youth Centers(include dates of service):
• Present participation in Youth Center activities by your children:Yes Li No
If yes,please list below the names of your children,their ages and the programs in which they participate:
Child's name: Age: Program:
Child's name: Age: Program:
• Have you ever been convicted of a felony?Yes LA or No a If yes,please explain in detail:
• Do you currently have a violation(s)of City of Miami Beach Code?Yes1 or Nom"'`If yes, please explain in detail:
• Do you currently owe the City of Miami Beach any money?Yes 1_11 or No If yes,explain in detail:
o Are you currently serving on any City Board or Committee?Yes 0{or No n If yes,which board/committee?
o In what organization(s)in the City of Miami Beach do you currently hold membership?
Name' Position
Name Position
o List all properties owned or in which you have an interest within the City of Miami Beach:
9 Island Avenue Unit 2101 Miami Beach FL 33139
•Are you now employed by the City of Miami Beach?Yes Li or No_'
Which department and title?
• rsuant City Code Section 2-25 (b): Do.you have a parent n`, spouse L , child brother Li or sister who is.
Pu to y
employed by the City of Miami Beach?Yes �__�lor No Vi
If"Yes,"identify person(s)and 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 City diversity reporting requirements.
Gender: Male Female a
Race/Ethnic Categories
)
What is your race?
I____!;African-American/Black
Caucasian/White
Li Asian or Pacific Islander
LJI Native-American/American Indian
i Other—Print Race:
Page 2 of 4
F:\CLER\SALL1aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 06022014.docx
Do you consider yourself to be Spanish,Hispanic or Latino/a? Mark the "No"box if not Spanish, Hispanic, Latino/a.
4;=7
No
LI Yes
Do you consider yourself Physically Disabled?
' No
,_,1i Yes
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:
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 the 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).
o 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).
o Sunshine Law - Florida's Government-in-the-Sunshine Law was enacted in 1967. Today, the Sunshine Law regarding open
government can be found in Chapter 286 of the Florida Statutes. These statutes establish a basic right of access to most
meetings of boards,commissions and other governing bodies of state and local governmental agencies or authorities.
o Voting conflict—Form 8B is for use by any person serving at the county,city or other local level of government on an appointed or
elected board, council, commission, authority or committee. It applies equally to members of advisory and non-advisory bodies
who are presented with a voting conflict of interest under Section 112.3143, Florida Statutes.
Upon request,copies of these laws may be obtained from the City Clerk.
I HEREBY ATTEST TO •C4 URACY AND TRUTHFULNESS OF THE APPLICATION; AND I HAVE RECEIVED, READ AND
WILL ABIDE BY - •PTER 2 •RTICLE VII, OF THE MIAMI BEACH CITY CODE, ENTITLED "STANDARDS OF CONDUCT FOR
CITY OFFIC- S,EMPLO S AND AGENCY MEMBERS AND ALL OTHER APPLICABLE COUNTY AND/OR STATE LAWS AND
STATUT ACCO'DI.` - .
NiN.9 Samuel J. Rabin, Jr.
Applic-• s Signature Date Name of Applicant(PLEASE PRINT)
Received in the City Clerk's Office by: Date
Name of Deputy Clerk Control.No.
PLEASE ATTACH A CURRENT RESUME, PHOTOGRAPH AND A COPY OF ANY
APPLICABLE PROFESSIONAL LICENSE.
ATTACH ADDITIONAL SHEETS, IF NECESSARY, TO PROVIDE REQUIRED
INFORMATION.
Page 3 of 4
F:\CLER\SALL1aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 06022014.docx
City of Miami Beach
1700 Convention Center Drive,
Miami Beach, Florida 33139,
wwvw.miamibeachfl.gov
CITY CLERK'S OFFICE CityClerk @miamibeachfl.gov
Telephone: 305.673.741 1 Fax: 305.673.7254
Acknowledgement of fines/suspension for Board/Committee Members for failure to comply with Miami-
Dade County Financial Disclosure Code Provision Code Section 2-11.1(i) (2)
Board Member's Name: Samuel J. Rabin, Jr.
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
Financial 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 they may have been recently appointed.
One of the following forms must be filed with the City Clerk of Miami Beach, 1700 Convention Center Drive,
Miami Beach, Florida, no later than 12:00 noon of July 1, of each year.
1. A"Source of Income Statement"
2. A"Statement of Financial Interests(Form 1)"
3. A Copy of your latest Federal Income Tax Return
Failure to file one of these fo ••-, :• •- • the Miami-Dade County Code, may subject the person to a fine
of no more than $500 •ays in jail or both.
dr"'•
6■\\---5
Signature Date
Updated:Tuesday,January 06.2015
Page 4 of 4
F:ICLERISALL1aFORMS\BOARD AND COMMITTEE5IBC APPLICATION REVISED 06022014.docx
LaRosa, Clara
From: Adee Gomez <adee @miamilawyer.com>
Sent: Wednesday, April 15, 2015 2:45 PM
To: LaRosa, Clara
Cc: Samuel Rabin
Subject: RE: Board and Committee application
Attachments: MBCAC Board &Committe Application Signed.pdf
Hi Clara. Attached please find Mr. Rabin's executed application. Should you require anything further, please
advise. Thanks.
Adee Gomez
Legal Assistant to Samuel J. Rabin Jr.
Samuel J. Rabin, Jr., P. A.
800 Brickell Avenue
Suite 1400
Miami, FL 33131
Phone: 305.358.1064
Fax: 305.372.1644
Email: adee @miamilawyer.corn
Email: sjr@miamilawyer.com
Website: http://Miamilawyer.com
The information contained in this electronically transmitted document is a privileged and confidential
communication. This communication is protected by state and federal law. It is unlawful for any person to
read, review, discuss or disseminate the contents without authorization from the transmitting attorney,
Samuel J. Rabin, Jr., or the person to whom this electronic message is directed. If you are not the intended
recipient, or one responsible for delivering it to the intended recipient, you are requested to delete the
document from your computer monitor and from any memory location within your computer.
From: LaRosa,Clara [mailto:ClaraLaRosa @miamibeachfl.gov]
Sent: Monday,April 13, 2015 11:55 AM
To:Adee Gomez
Subject: RE: Board and Committee application
Dear Ms. Gomez,
Thank you for your assistance.
Regards,
Ewa Atimatik..
AillialINWINIZZI
MINIMY
'II,��.j B , AC
Clara La Rosa, Office Associate III
1
OFFICE OF THE CITY CLERK
1700 Convention Center Drive, Miami Beach, FL 33139
Tel: 305-673-7411/ Fax: 305-673-7254/ www.miamibeachfl.gov
We are committed to providing excellent public service and safety to all who live, work and play in our vibrant,
tropical, historic community.
From: Adee Gomez [mailto:adee0miamilawyer.com]
Sent: Monday, April 13, 2015 10:54 AM
To: LaRosa, Clara •
Subject: RE: Board and Committee application
Hi Clara. Attached is Mr. Rabin's resume for your records. Also, Mr. Rabin says that he already submitted the picture. If
you need anything else, please advise. Thanks.
Adee Gomez
Legal Assistant to Samuel J. Rabin Jr.
Samuel J. Rabin, Jr., P. A.
800 Brickell Avenue
Suite 1400
Miami, FL 33131
Phone: 305.358.1064
Fax: 305.372.1644
Email: adee@miamilawyer.com
Email: sj r(amiamilawyer.corn
Website: http://Miamilawyer.com
The information contained in this electronically transmitted document is a privileged and confidential
communication. This communication is protected by state and federal law. It is unlawful for any person to
read, review, discuss or disseminate the contents without authorization from the transmitting attorney,
Samuel J. Rabin, Jr., or the person to whom this electronic message is directed. If you are not the intended
recipient, or one responsible for delivering it to the intended recipient, you are requested to delete the
document from your computer monitor and from any memory location within your computer.
From: LaRosa,Clara [mailto:ClaraLaRosa @miamibeachfl.gov]
Sent:Tuesday,April 07, 2015 4:22 PM
To:Adee Gomez
Subject: RE: Board and Committee application
Dear Ms.Gomez:
A resume and a picture are all that's required to be submitted with this application.
The Miami-Dade Source of Income Statement will be provided to Mr. Rabin when he comes in to sign his Oath.
Form 1,which can be retrieved from the Florida Commission of Ethics, is due by July 1.
Attached please find both copies. Again, neither one is required at the present moment.
Regards,
2
Mil a Aa
i
•
Clara La Rosa, Office Associate I/I
OFFICE OF THE CITY CLERK
1700 Convention Center Drive, Miami Beach, FL 33139
Tel: 305-673-7411/ Fax: 305-673-7254 / www.miamibeachfl.gov
We are committed to providing excellent public service and safety to all who live, work and play in our vibrant,
tropical, historic community.
From: Adee Gomez [mailto:adee(almiamilawyer.com]
Sent: Tuesday, April 07, 2015 3:03 PM
To: LaRosa, Clara
Cc: Samuel Rabin
Subject: FW: Board and Committee application
Hi Ms. LaRosa. The attached form asks for one of the following documents to be submitted with the application. Do you
by chance, happen to have blank forms that you could email us or direct us to where we can obtain same?
1. A"Source of Income Statement"
2. A"Statement of Financial Interests (Form 1)"
Please advise. Thanks.
Adee Gomez
Legal Assistant to Samuel J. Rabin Jr.
Samuel J. Rabin, Jr., P. A.
800 Brickell Avenue
Suite 1400
Miami, FL 33131
Phone: 305.358.1064
Fax: 305.372.1644
Email: adee@miamilawyer.corn
Email: sjrru,miamilawyer.com
Website: http://Miamilawver.com
The information contained in this electronically transmitted document is a privileged and confidential
communication. This communication is protected by state and federal law. It is unlawful for any person to
read, review, discuss or disseminate the contents without authorization from the transmitting attorney,
Samuel J. Rabin, Jr., or the person to whom this electronic message is directed. If you are not the intended
recipient, or one responsible for delivering it to the intended recipient, you are requested to delete the
document from your computer monitor and from any memory location within your computer.
From:Samuel Rabin
Sent:Tuesday,April 07, 2015 8:04 AM
To:Adee Gomez
Subject: Fwd: Board and Committee application
If you have questions on that application.
Samuel J. Rabin Jr., P.A.
3
800 Brickell Avenue-Suite 1400
Miami, FL 33131-2971
Phone: 305.358.1064
Fax: 305.372.1644
Email: sir @miamilawyer.com
Website: http://miamilawver.com
The information contained in this transmission may contain privileged and confidential information. It is intended only
for the use of the person(s) named above. If you are not the intended recipient,you are hereby notified that any
review, dissemination,distribution or duplication of this communication is strictly prohibited. If you are not the
intended recipient, please contact the sender by reply email and destroy all copies of the original message. To reply to
us directly, please send an email to sir @miamilawyer.com.
[This message is from my mobile device.]
Begin forwarded message:
From: "LaRosa,Clara"<ClaraLaRosa @miamibeachfl.gov>
Date:April 2, 2015 at 2:25:21 PM EDT
To: "sir @miamilawyer.com"' <sir@miamilawver.com>
Cc: "Hatfield, Liliam"<LiliamHatfield @miamibeachfl.gov>
Subject: Board and Committee application
Dear Mr. Samuel J. Rabin Jr.:
Ms. Liliam Hatfield, Assistant to the City Clerk at the City of Miami Beach requested I contact you in re to submittal of a
Board &Committee Application. Attached please find a copy of said form. Kindly complete it and send it back to us via
email at your earliest convenience.
Upon receipt,we will prepare all documentation relevant to your appointment to the Miami Beach Cultural Arts Council.
Regards,
4