Susan Schermer 12/31/2019MIAMIBEACH
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
December 16, 2016
Ms. Susan Schemer
4530 N. Michigan Avenue
Miami Beach, Florida 33140
SUBJECT: Cultural Arts Council
Dear Ms. Susan Schemer:
Congratulations! You have been reappointed by the City Commission to the above referenced board or
committee, for a term ending: 12/31/2019.
If you are unable to accept this appointment or have any questions, please call the Office of the City Clerk
at 305.673.7411.
Please read the enclosed materials carefully. Congratulations and good luck.
Respect : Ily,
R.f ranado
City Clerk
cc: Saul Frances, Parking Director
Max Sklar, City Liaison
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 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.
MIAMIBEACH
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: Ms. Susan Schemer
RE: Cultural Arts Council
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: 12/31/2019.
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 Florida Commission on Ethics Guide to the Sunshine Amendment
and Code of Ethics for Public Officers 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 the
State of Florida (depending on the board or committee on which I serve) on July 1st, following the closing
of the calendar year on which I have served.
Ms. Susan Schemer
/ 7
Sworn to and subscribed before me this e O ij day of Ep , 2019.
,o �A-SON
Deputy Clerk ` R1AJ/.,-a(Z,.
*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.
We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community.
MIAMI BEACH
Last Name
4�oN.frf'th rn
Home Address
BOARD AND COMMITTEE. AP
(CATION FORM
First Name
City
Home Telephone Work Telephone
Business Name
Middle Initial
State Zip Code
74c/ 1/ •`)ic se her 111 e r e �'i 11 .icr►k
Cellular Telephone Email address
Occupation
Business Address
City
State
Zip Code
Professional License (describe): Expires:
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 l or No
• Demonstrates ownership/interest in a business injmi Beach for a minimum of six months: Yes or No Zi
• Are you a registered voter in Miami Beach: Yes Ld or No
• I am now a resident of: North Beach F,Zi South Beach Zi Middle Beach
• I am applying for an appointment because I have special abilities, knowledge and experience. Please list below:
• Are you presently a registered lobbyist with the 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 Office of the City Clerk.
Affordable Housing Advisory Committee
0 Health Advisory Committee
0 Parks and Recreation Facilities Board o0
Art in Public Places Committee
0 Health Facilities Authority Board
0 Personnel Board
0 Audit Committee
0 Hispanic Affairs Committee
0 Planning Board**
0 Board of Adjustment''
❑ Historic Preservation Board*
0 Police Citizens Relations Committee
0 Budget Advisory Committee
0 Housing Authority
0 Production Industry Council
= Committee on the Homeless
0 Human Rights Committee
0 Sister Cities Program
0 Committee for Quatity Education in MB
0 LGBT Advisory Committee
0 Marine & Waterfront Protection Authority
0 Sustainability Committee
0 Transportation, Parking, & Bicycle -Pedestrian
Facilities Committee
0 Convention Centar Advisory Board
+t'Cultural Arts Council
0 Miami Beach Commission for Women
0 Visitor and Convention Authority
0 Design Review Board *
0 Normandy Shores Local Government
Neighborhood Improvement
0 Youth Commission
El Disability Access Committee
* 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 1 of 4
F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 06142016.docx
°O 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 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 or No I_ If yes, please explain in detail:
• Do you currently have a violation(s) of City of Miami Beach Code? Yes ❑ or No If yes, please explain in detail:
• Do you currently owe the City of Miami Beach any money? Yes rj or No If yes, explain in detail:
• Are you currently serving on any City Board or Committee? Yes or No LD If yes, which board/committee?
• In what organization(s) in the,\City of Miami Beach do you currently hold membership?
C 1r11)(a 1 �-- r +S dodo& t/
Name
Position
Name Position
• List all propertyes owned or in which you have an interest within the City of Miami Beach:
115 3d N. i<L 1 i t..c (-Ain
• Are you now employed by the City of Miami Beach? Yes or No 4'
Which department and title?
• Pursuant to City Code Section 2-25 (b): Do you have arent , spouse E.:3, child brother Zi or sister who is
employed by the City of Miami Beach? Yes 4ior No
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
dtwo comply with City diversity reporting requirements.
Gender: Male LI Female L
Race/Ethnic Categories
What is your race?
African-American/Black
Caucasian/White
I Asian or Pacific Islander
�1 Native-American/American Indian
Page 2 of 4
F:\C LER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 06142016.docx
Other— Print Race:
Do you consider yourself to be Spanish, Hispanic or Latino/a? Mark the "No" box if not Spanish, Hispanic, Latino/a.
No
Yes
Do you consider yourself Physically Disabled?
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 THE ACCURACY AND TRUTHFULNESS OF THE APPLICATION; AND I HAVE RECEIVED, READ AND
WILL ABIDE BY CHAPTER 2, ARTICLE VII, OF THE MIAMI BEACH CITY CODE, ENTITLED "STANDARDS OF CONDUCT FOR
CITY OFFICERS, EMPLOYEES AND AGENCY MEMBERS AND ALL OTHER APPLICABLE COUNTY AND/OR STATE LAWS AND
STATUTES ACCORDINGLY."
Applican
Date
/0/2//4,
Name o Applicant (PLEASE PRINT)
Received in the Office of the City Clerk by: f ' vv i �/► Q &i tib ._
Name of Deputy Clerk Control No. Date
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\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 06142016.docx
MIAM BEACH
City of Miami Beach
1700 Convention Center Drive,
Miami Beach, Horida 33139,
www.miamibeachfl.gov
OFFICE OF THE CITY CLERK
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: &San eArko rie--
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 forms, pursuant to the Miami -Dade County Code, may subject the person to a fine
of no more than $500, 60 days in jail or both.
3Z/10a/i?
Signature
Updated: Tuesday, October 04, 2016
Page 4 of 4
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Da e
AIAM
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DIVERSITY STATISTICS REPORTING
Name: 60 6 drvl e, Q
Board / Committee:
Appointment Date:
edfluati C
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Pursuant to City of Miami Beach Ordinance 2009-3632, the City is required to annually
prepare and present a report to the City Commission identifying the City's diversity
statistics. This form allows board and committee applicants and members to voluntarily
self -identify their race, ethnicity, disabled status and gender.
Please check the appropriate box for each category:
Gender: Male LJ Femal _ II
Race/Ethnic Categories
What is your race?
AA' 'can-American/Black
Caucasian/White
Asian or Pacific Islander
Native-American/American Indian
Other — Print Race:
Do you consider yourself to be Spanish, Hispanic or Latino/a? Mark the "No" box if not
Spanish, Hispanic, Latino/a.
o
Yes
Do you consider yourself Physically Disabled?
No
Yes
C:\Users\CENTFraNAppData\LOCai\MicrO50ft\Wir;d0w5\Te .DOraN !ntirnet Fi es\Co l ent.outiook\N=419CN i..BC minority
information form 05-20-13 FINAL.doc
Updated: Monday, January 26, 2015
tAAW\ BEA
DIVERSITY STATISTICS REPORTING
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Name: 4 (f S (/1 - C n
Board / Committee:
Appointment Date:
tJ 0 J r a
( / /6//
.00011(3
Pursuant to City of Miami Beach Ordinance 2009-3632, the City is required to annually
prepare and present a report to the City Commission identifying the City's diversity
statistics. This form allows board and committee applicants and members to voluntarily
self -identify their race, ethnicity, disabled status and gender.
Please check the appropriate box for each category:
Gender: Male 0 Female
Race/Ethnic Categories
What is your race?
�1 frican-American/Black
Caucasian/White
0 Asian or Pacific Islander
-14
0 Native-American/American Indian
Other— Print Race:
Do you consider yourself to be Spanish, Hispanic or Latino./a? Mark the "No" box if not
Span1sh, Hispanic, Latino/a.
No
0 Yes
u consider yourself Physically Disabled?
No
Yes
C:1Js2rs10EV T FraN�AppGa.a_o.3\�Ici .SOi,\'nd0t,vs\
moorary Internet Files\Content. Outlook\NP4 J9CNk,BC minority
information form 05-20-13 FINAL.doc
Updated: "Monday, January 26, 2015
MIAMI•DADE
COUNTY
SOURCE OF INCOME STATEMENT
Section 2-11.1(i) of the County Ethics Code requires that certain employees and public officials file a financial disclosure Statement on a yearly basis by July 1st
of every year.
Disclosure for Tax Year Ending
2016
Last Name
►.,.t r
First Name
Middle Name/Initial
Mailing Address — Street Number Street Name, or P.O. Box
City, State, Zip
If your home address is your mailing address, and your home address is exempt from public records pursuant to Fla. Stat. §119.07, read
instructions on the following page and check here. ❑
Filing as a Board Member (check one)
E County
•W Municipal:
‘.1.( &.vLt.
a0
(Municipality)
Board where serving
a ( r' U e,
Alternate address (if home address is exempt)
Work telephone
Term began on/ended on
List below every source of income you received, along with the address and the principal activity of each source. Include your public salary. Place the sources of
income in descending order, with the largest source first. Examples of sources of income include: compensation for services, income from business, gains from
property dealings, interest, rents, dividends, pensions, IRA distributions, and social security payments. Also, include any source of income received by another
m business artner 1,............... be disclosed.
If continued on a separate sheet, check here.D
person for your benefit. flUVLUG e income or your opous or a
e m/ p
r County 0 Public Health Trust Municipal:
(Municipality)
Department
Position or Title
Employee ID Number
Work address
Work telephone
Employment began on/ended on
Filing as a Board Member (check one)
E County
•W Municipal:
‘.1.( &.vLt.
a0
(Municipality)
Board where serving
a ( r' U e,
Alternate address (if home address is exempt)
Work telephone
Term began on/ended on
List below every source of income you received, along with the address and the principal activity of each source. Include your public salary. Place the sources of
income in descending order, with the largest source first. Examples of sources of income include: compensation for services, income from business, gains from
property dealings, interest, rents, dividends, pensions, IRA distributions, and social security payments. Also, include any source of income received by another
m business artner 1,............... be disclosed.
If continued on a separate sheet, check here.D
person for your benefit. flUVLUG e income or your opous or a
e m/ p
Name ofSource``of Income
Address
Description of the Principal Business Activity
''
1,3)a % r�N5
At &tI r I"1 /
666g
•
p�0
y
C C ((Al -Cee-t-{4
I hereby swear (or affirm) that the information above is a true and correct statement.
Signature of Person Disclosing
RECEIVED BY ELECTIONS DEPARTMENT:
❑ Hardcopy
Electronic Copy
OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/Initials:
138 SP -14 COE 2016
Scanned Date/Initials:
ALAA,l
City of Miami Beach
1700 Convention Center Drive,
Miami Beach, Florida 33139,
www.miamibeachfl.gov
CITY CLERK'S OFFICE CityClerk@miamibeachfl.gov
Telephone: 305.673.7411 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(1) (2)
Board Member's Name:
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 forms, pursuant to the Miami -Dade County Code, may subject the person to a fine
of no more than $500, 60 days in jail or both.
Updated: Monday, April 20, 2015
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