Marcella Paz Cohen 12/31/2017MIAMIBEACH
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
January 04, 2017
Ms. Marcella Paz Cohen
P.O Box 40-3232
Miami Beach , Florida 33140
SUBJECT: Committee on the Homeless
Dear Ms. Marcella Paz Cohen:
Congratulations! You have been appointed by Commissioner Kristen Rosen Gonzalezto the agency,
board or committee named above for a term ending: 12/31/2017.
Pursuant to City of Miami Beach Code Section 2-22 (5)a,"Notwithstanding any other provision of the City
Code or of any resolution, commencing with terms beginning on or after January 1, 2007, the term of
every board member who is directly appointed by a member of the City Commission shall automatically
expire upon the latter of: December 31 of the year the appointing City Commissioner leaves office or
upon the appointment/election of the successor City Commission member."
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 again and good luck.
Rei, ds,
RFafael Granado
City Clerk
cc: Saul Frances, Parking Director
Alba Tarre, 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
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. Marcella Paz Cohen
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: 12/31/2017.
I 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.
1111 M. 4 ah
Ms arce - 'az ohen
Sworn to and subscribed before me this
Ramon Quezada
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.
We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community.
m MIAMIBEACH
NAME: Paz Cohen
Marcella
CITY OF MIAMI BEACH
BOARD AND COMMITTEE APPLICATION FORM
Last Name
First Name Middle Initial
HOME ADDRESS: P.O Box 40-3232 Miami Beach
Florida 33140
Apt No. Home No./Street
PHONE: 305.793.2025
City
State Zip Code
miaminizintl@gmail.com
Home
Business Name: South Pointe Drive Realty
Work
Address: 500 South Pointe Drive
Position: Realtor
Miami Beach
Email Address
Florida
33139
Street
City
State
Zip Code
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
• Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six (6) months: Yes
• Are you a registered voter in Miami Beach: Yes
• (Please circle one): I am now a resident of: 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? 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)
Choice 1: Committee on the Homeless
Choice 2:
Choice 3:
• 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
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: No
Years of Service:
2. Present participation in Youth Center activities by your children No if yes, please list the names of your children, their
ages, and which programs. List below:
• Have you ever been convicted of a felony: No If yes, please explain in detail:
• Do you currently have a violation(s) of City of Miami Beach codes: No If yes, please explain in detail:
• Do you currently owe the City of Miami Beach any money: No
If yes, please explain in detail:
• Are you currently serving on any City Boards or Committees: No If yes, which board?
• What organizations in the City of Miami Beach do you currently hold membership in?
• I am now employed by the city of Miami Beach: No Which department?
• List all properties owned or have an interest in, which are located within the City of Miami Beach:
Gender: none
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.
Race/Ethnic Categories
What is your race? Mark one or more races to indicate what you consider yourself to be. none
Other Description:
Are you Spanish/Hispanic/ Latino? Mark the "No" box if not Spanish / Hispanic / Latino. No
Physically Challenged: No
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 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 hereby attest to the accuracy and truthfulness of the application and 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."
I Marcella Paz Cohen agreed to the following terms on
Received in the City Clerk's Office by:
Name of Deputy Clerk
Control No. Date
MIAMI BEACH
Lou,
BOARD AND COMMITTEE APPLICATION FORM
irst Name 2O f Sr Middle Initial,
frit) s V City
Last Name
-Vc, 51 Cf-I'c
Home Address
State Ip Code
V23 a
Home Telephone Work Telephone
ellular T@ phone
Name
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Business
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tion
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Email add ess
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—33l3(3
Business Address City
State
Zip C
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 or No
• Demonstrates ownership/interest in a business in Miami Beach for a minimum of six months: Yes Z1 or No
• Are you a registered voter in Miami Beach: Yes or No
• I am now a resident of: North Beach Zi South Beach Zi Middle Beach Zi
• 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
❑ Health Advisory Committee
❑parks and Recreation Facilities Board °O
❑ Art in Public Places Committee
❑ Health Facilities Authority Board
❑ Personnel Board
❑ Audit Committee
❑ Hispanic Affairs Committee
0 Planning Board**
0 Board of Adjustment**
0 Historic Preservation Board*
0 Police Citizens Relations Committee
0 Budget Advisory Committee
❑ Housing Authority
0 Production Industry Council
0 Committee on the Homeless
0 Human Rights Committee
0 Sister Cities Program
0 Committee for Quality Education in MB
0 LGBT Advisory Committee
0 Sustainability Committee
0 Convention Center Advisory Board
0 Marine & Waterfront Protection Authority
0 Transportation, Parking, & Bicycle -Pedestrian
Facilities Committee
0 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
0 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 If yes, please explain in detail:
• Do you currently have a violation(s) of City of Miami Beach Code? Yes Zi or NoZt If yes, please explain in detail:
• Do you currently owe the City of Miami Beach any money? Yes Zi or No If yes, explain in detail:
• Are you currently serving on any City Board or Committee? Yes or No EZ If yes, which board/committee?
• In what organization(s) in the City of Miami Beach do you currently hold membership?
Name
Position
Name Position
• List all properties owned or in which you have an interest within the City of Miami Beach:
• Are you now employed by the City of Miami Beach? Yes La or No 11
Which department and title?
• Pursuant to City Code Section 2-25 (b): Do you have a parent La, spouse D, child brother or sister who is
employed by the City of Miami Beach? Yes Lor 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 to comply with City diversity reporting requirements.
Gender: Male LJ Female LI
Race/Ethnic Categories
What is your race?
African-American/Black
Caucasian/White
�.e Asian or Pacific Islander
L1 Native-American/American Indian
Page 2 of 4
F:\CLER\$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.
—t No
Yes
Do you consider yourself Physically Disabled?
LD No
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."
Applicant's Signature
Date Name of Applicant (PLEASE PRINT)
Received in the Office of the City Clerk by:
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\$ALL1aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 06142016.docx
MIAMI BEACH
City of Miami Beach
1700 Convention Center Drive,
Miami Beach, Florida 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:
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 Tater 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.
Signature Date
Updated: Wednesday, November 23, 2016
Page 4 of 4
F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 06142016.docx
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.
AO
Disclosure for Tax Year Ending
2,oJ6
Last Name
P&L G041,v
First Name
iti 0.4 ct>>
Mailing Address — treet Number Street Name, or P.O. Box
Middle Name/Initial
City, State, Zip 1����vim"/ P/C(Se_I�'Y✓1. a J (. "33 l 0
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. ❑
ling as an Employee (check one
Filing as a Board Member (check one)
County
Municipal: jM ;00,0 ; ►3-60,04
(Municipality)
Board where serving
Cvy%'
-ce v n t 24 /
emse-toff
Alternate address (if home address is exempt)
Work telephone
Term began on/ended on
/toiC
-
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
GerSGn for vnur benefit However the income of your spouse or any business partner need not be disclosed. If continued on a separate sheet, check here.❑
Name of Source of Income
Address
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)
County
Municipal: jM ;00,0 ; ►3-60,04
(Municipality)
Board where serving
Cvy%'
-ce v n t 24 /
emse-toff
Alternate address (if home address is exempt)
Work telephone
Term began on/ended on
/toiC
-
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
GerSGn for vnur benefit However the income of your spouse or any business partner need not be disclosed. If continued on a separate sheet, check here.❑
Name of Source of Income
Address
Description of the Principal Business Activity
S 0 3—tvt�� i w A—elf U� `e_
�
�i
.---4_,...4 .I
I hereby swear (or affirm) that the information above is a true and correct statement.
Signatuon Disclosing
Date sign4d
RECEIVED BY ELECTIONS DEPARTMENT:
Hardcopy
❑ Electronic Copy
OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/Initials: Scanned Date/initials:
138 SP -14 COE 2016
.• J%
,1 } i
City of Miami Beach
1700 Convention Center Drive,
Miami Beach, Florida 33139,
www.miamibeachfl.aov
CITY CLERK'S OFFICE
Telephone: 305.673.7411 Fax: 305.673.7254
CityClerk@miamibeachfl.gov
Acknowledgement of fines/suspension for BoardlCommittee Members for failure to comply with Miami -
Dade County Financial Disclosure Code Provision Code Section 2-11.1(1) (2)
Board Member's Name: AlOje,girio.... ?G,% Co 11-e,v)
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.
CS
Signat - D
Updated: Monday, April 20, 2015
Page 4 of 4
F:\CLER\SALL.aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 00022014.docx
MIAMI BE
1-7
DIVERSITY STATISTICS REPORTING
Name: M O1/4/fL 11/G,- ?<Az. Co ev►
Board / Committee: (0Y+)yr) ;_4 vh -ts gem dess
Appointment Date: g/3/7-0/(
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 ED Female
Race/Ethnic Categories
What is your race?
D African-American/Black
D Caucasian/White
0 Asian or Pacific Islander
1-1 Native-American/American Indian
a) Other – Print Race: 4 i
Do you consider yourself to be Spanish, Hispanic or Latino/a? Mark the "No"box ifnot
Spanish, Hispanic, Latino/a.
0 No
St Yes
Do you consider yourself Physically Disabled?
-No
ED Yes
C:\UsersiCENTFraN\AppData\L ocaf,MicrosoftlWindows\Ternoorary Internet F-itesnLontent.OutIock\NP41,
information form 05-20-13 F:'INAL.doc
Updated: Monday, January 26, 2015