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Rachel Schuster&AIAMIBEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139 vvvvw.miomibeachfl.aov OFFICE OF THE CITY CLERK, Rafael E. Granada, City Clerk Tel: 305.673.741 1, Fax: 305.673.7254 Email: CityClerk@miamibeachfl.gov March 20, 2017 Ms. Rachel Schuster 4141 N. Bay Rd. Miami Beach, Florida 33140 SUBJECT; Disability Access Committee Dear Ms. Rachel Schuster: Congratulations! You have been appointed by Commissioner Kristen Rosen Gonzalezto 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 Rafael Granada City Clerk cc: Saul Frances, Parking Director Valeria Mejia, 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. Granada, City Clerk Tel: 305.673.741 1, Fax: 305.673.7254 Email: CityClerk@miamibeachfl.gov TO: Ms. Rachel Schuster RE: Disability Access Committee 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: 12/31/2018. 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 1 st, following the closing of the calendar year on which I have served. i Ms. Rachel Schuster Fl . Sworn to and subscribed before me 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. -1V* MIAMI BEACH NAME: Schuster Last Name Rachel First Name CITY OF MIAMI BEACH BOARD AND COMMITTEE APPLICATION FORM Middle Initial HOME ADDRESS: 4141 N. Bay Rd. Miami Beach Florida 33140 Apt No. Home No./Street City State Zip Code PHONE: (305) 532-0306 (305) 672-1771 Home Work rmlyd80@aol.com Business Name: SB Nursing & Rehab Center Position: Administrator Address: 42 Collins Ave. Miami Beach Street City Email Address Florida 33139 - 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 No • Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six (6) months: No • Are you a registered voter in Miami Beach: No • (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: Master of Public Administration, Bachelor of Health Services Administration, Florida Licensed Nursing Home Administrator • 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: Budget Advisory Committee Choice 2: Health Facilities Authority Board Choice 3: Police/Citizens Relations 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 Licen License Issuance Date License Number 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 2. Present participation in Youth Center activities by your children ages, and which programs. List below: Child Name Age Program Years of Service: No if yes, please list the names of your children, their • 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: Yes If yes, which board? Health Advisory Committee • What organizations in the City of Miami Beach do you currently hold membership in? Name Title Miami Beach Chamber of Commerce Member • 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: Property N/A Gender: Female 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. White 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 Rachel Schuster agreed to the following terms %mon Received in the City Clerk's Office by: UVIK Name of Deputy Clerk Control No. Date 1" `�! HACH , \A I Atx,,,., L_ City of Miami Beach 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov CITY CLERK'S OFFICE Telephone: 305.673.7411 Fax: 305.673.7254 Cit,vClerk@miamibeachfl.gov 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 later than 12:00 noon of July 1, of each year. 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 Updated: Monday, April 20, 2015 Page 4 of 4 F:\CLER\SALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 06022014.docx ""®' SOURCE OF INCOME STATEMENT Section 2-11.1(1) 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 EndingLast_ Name First Name,� Middle Name/Initial 2016 S V ���( Mailing Address —Street (•!u � �, Street Name, or P.O. Box � A OL City, State, Zip /� V( - C C l S 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. ❑ Filinn nc An Fmn[nVPP /rharir nnP\ El County F Public Health Trust F1 Municipal: (Municipality) Department Position or Title Employee ID Number Work address Work telephone Employment began on/ended on Filina as a Board Member (check one) 0 County Municipal: do (Municipality) Board whereservinj( 1 A b t l Lv—a'»2 wl i Alternate address (if homeAddress is exempt) I 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 narcnn for vnnr henefit Hnwever the income of vnnr snnnsa nr anv hnsiness nartner need not be disclosed. If continued an a separate sheet, check here.[--] Name of Source of Income Address Description of the Principal Business Activity yj�qz 1 %f f ?4--4 7I 3 3 `/ �o I hereby swear (or affirm) that the information above is a true and correct statement. Signature of Person lrsclosing ,5 f6 /(:� Date signed OFFICE USE ONLY Accepted: Y / N Defirivnry: 138 SP -14 COE 2016 RECEIVED BY ELECTIONS DEPARTMENT: ❑ Hardcopy ❑ Electronic Copy Processed Date/Initials: Scanned Date/Initials: