Marilyn Sheffman 12/31/2018MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139 vwvw.miamibeachfl.gov
OFFICE OF THE CITY CLERK, Rafael E. Granado, City Clerk
Tel: 305.673.741 1, Fax: 305.673.7254
Email: CityClerk@miamibeachfl.gov
April 20, 2017
Ms. Marilyn Sheffman
SUBJECT: Sister Cities Program
Dear Ms. Marilyn Sheffman:
Congratulations! You have been appointed by Mayor Philip Levine to the agency, board or committee
named above for a term ending: 12/31/2018.
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.
Regards,
R ael Graa'o
City Clerk
cc: Saul Frances, Parking Director
Danita Bonini, 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 E. Granado, City Clerk
Tel: 305.673.741 1, Fax: 305.673.7254
Email: CityClerk@miamibeachfl.gov
TO: Ms. Marilyn Sheffman
RE: Sister Cities Program
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: 12/31/2018.
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.
Ma yrrT n Sh an
Sworn to and subscribed before me this c96fday of
^.. ,1 . 2017
n 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.
�n
AM
BEACH
Last Name
— L` 4
First Name
BOARD AND COMMITTEE APPLICATION FORM
Middle Initial
a't1 . i'j S r m t 6
Home Address City
(;ac) X °S—". 3 Y62- 313.S/--s3g-. 3(( —7S76 —37/
Home Telephone Work Telephone Cellular Telephone
Lgg
Otto.J�
Business Name
)Fra 1 eh icy i �,a-n) 44 4, b
Business Address
State
Zip Code
-75Y9 5titki warxt.raThe-heo��,
Email address
Occupation
i 4
City
State
33i37
Zip Code
Professional License (describe): Expires:
Please attach a copy of currently effective professional license.
Pursuant to City Code section 2-22(4ja & 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 LJ or No
• Demonstrates ownership/interest in a business in Miami Beach for a minimum of six months: Yes or No
• Are you a registered voter in Miami Beach: Yes or No
• I am now a resident of: North Beach South Beach Middle Beach �1
• 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 °o
❑ Art in Public Places Committee
0 Health Facilities Authority Board
0 Personnel Board
0 Audit Committee
0 Hispanic Affairs Committee
0 Planning Board*
D Board of Adjustment **
0 Historic Preservation Board*
0 Police Citizens Relations Committee
❑ Budget Advisory Committee
0 Housing Authority
0 Production Industry Council
D Committee on the Homeless
0 Human Rights Committee
moister Cities Program
D Committee for Quality Education in MB
0 LGBT Advisory Committee
0 Sustainability Committee
❑ Convention Center Advisory Board
0 Marine & Waterfront Protection Authority
❑ Transportation, Parking, & Bicycle -Pedestrian
Facilities Committee
❑ Cultural Arts Council
0 Miami Beach Commission for Women
0 Visitor and Convention Authority
❑ 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
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eZ'
oO 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 11 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 or NoZglf yes, please explain in detail:
• Do you currently owe the City of Miami Beach any money? Yes Ze or No If yes, explain in detail:
• Are you currently serving on any City Board or Committee? Yes or No FlaIf 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 or No Lor
Which department and title?
• Pursuant to City Code Section 2-25 (b): Do you hL2,a parent U, spouse child brother or sister who is
employed by the City of Miami Beach? Yes lior 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 Li Female .•• •
Race/Ethnic Categories
What is your race?
African-American/Black
ICaucasian/White
Asian or Pacific Islander
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.
IrNo
Yes
Do you consider yourself Physically Disabled?
1 ) 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 nat e
Received in the Office of the City Clerk by:
5/3/)0! 7 m-viLvAi — c
Date Name of Applicant (PLEASE PRINT)
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
City of Miami Beach
1700 Convention Center Drive,
tvliami Beach, Florida 33139,
www.miamibeachfLaov
CITY CLERK'S OFFICE
Telephone: 305.673.741 1 Fax: 305.673.7254
CityClerk@miamibeachHl.go'
Acknowledgement of fines/suspension for Board/Committee Members for failure to comply with Miam
Dade County Financial Disclosure Code Provision Code Section 2-11.10) (2)
Board Member's Name: /CMTI
I understand that no later than July 1, of each year all members of Boards and Committees of the City c
Miami Beach, including those of a purely advisory nature, are required to comply with Miami -Dade Count
Financial Disclosure Requirements. This means that the members of City Advisory Boards, whose sole c
primary responsibility is to recommend legislation or give advice to the City Commission, must file, eve
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 fir
of no more than 5500, 60 days in jail or both.
Updated: Monday, April 20, 2015
Page 4 of 4
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7 0�
D ate
MINV\I BEACH
DIVERSITY STATISTICS REPORTING
Name: Yr- A -72(4A.)
Board / Committee: 3 1 S e t`t1 .
Appointment Date:
`.Flat0f I
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 1 Female s..
Race/Ethnic Categories
What is your race?
African-American/Black
Zr-Caucasian/White
ID 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.
['No
0 Yes
Do you consider yourself Physically Disabled?
!�No
LA Yes
C USer.S\CENTFre4\AppData\Local\Microsoft\ irrjowslTc^mparary int::rn 50N; ABC; minccity
information forrn 05.20-13 r1N.AL.doc
Updated: Monday, January 25, 2015