Moni CohenOM MIAMI BEACH
NAME: Cohen Moni
Last Name First Name
HOME ADDRESS: 880 Lakeview Drive Miami Beach
Apt No. Home No./Street City
PHONE: (305) 867-33
Home Work
Business Name: Real Estate Enterprises Position: Broker
Address: 880 Lakeview Drive Miami Beach
Street City
Middle Initial
FL
33140
State Zip Code
moni-monicohen-com@outlook.com
Email Address
FL 33140
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:
Traveled with the Chamber to Sister cities, have served on many boards and interested in affairs involving our city
• 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: Sister Cities Program
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:
Property
880 Lakeview Drive, Miami Beach FL 33140
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 Moni Cohen agreed to the following terms on
Received in the City Clerk's Office by:
Name of Deputy Clerk Control No. Date
A' B
fir' _A H
City of Miami Beach
1700 Convention Center Drive,
Miami Beach, Florida 33139,
www.miamibeach1gov
CITY CLERK'S OFFICE
Telephone: 345.673.7411 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: F oil i QU 117 e
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.
Signature
Updated: Monday, April 20, 2015
Page 4 of 4
F:\CLER\5ALL\aFORMS\BOARD AND COMMI-1 EES\6C APPLICATION REVISED 06022014.dccx
Date
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.TIVIV T*D AM
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139 www.miomibeachfl.gov
OFFICE OF THE CITY CLERK, Rafael E. Granada, City Clerk
Tel: 305.673.741 1, Fax: 305.673.7254
Email: CityClerk@miamibeachfl.gov
May 8, 2017
Ms. Moni Cohen
RE: Sister Cities Program
Congratulations! You have been appointed by Mayor Philip Levine to the above -referenced Board or
Committee, 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 as they concern your duties, responsibilities, and
requirements as a board or committee member.
Congratulations and good luck.
Re9aFdsj,
Rel ra do
Ci y Clerk
cc: Saul Frances, Parking Director
Danila Bonini, City Liaison
ENCLOSURES:
Oath of Office/Oath of Civility/Acknowledgements
City Code/Ordinance section applicable to agency, board or committee
City Code Sections 2-22, 2-23, 2-24, 2-25, 2-26, 2-458 and 2-459
Ordinance No. 2006-3543 - Amendment to City Code Section 222
Miami -Dade County Code Section 2-11.1 - Conflict of Interest and Code of Ethics
Ordinance Citywide 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.
"'®' 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 Ending TLast Name ,Fiprst Name Middle Name/initial
2016 (20h�V `gOhi
Mailing Address — Street Number, Street Name, or P.O. Box
City, State, Zip 3 l
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 ae an F171nInVPP (rhprk nnel
County F1 Public Health Trust Ej 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)
CountyMunicipal: OL P14 i
(Municipality)
Board where serving
S 15f-4 - �` �(�s pro e'v P"
Alternate address (if home address is exempt) V PWR 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
nprcnn fnr mir hpnafit HnwavPr tha innnma of vniir snnuse nr anv 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 �a
V
I hereby swear (or affirm) that the informati above is a true and correct statement.
Al
Signature of Person Disclosing
Date signed
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
M, IAM I B E Ak'C', H
DIVERSITY STATISTICS REPORTING
Name: H Uh i ash e- r _
Board / Committee:
Appointment Date:
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?
African-American/Blac
'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.
Do you consider yourself Physically Disabled?
r;�,USBi55c V� t r2"� �i»f ocCd��OCBi PJjiCrQ50ii'r�/tY'L(C,e•'fs\T2moQr2tL' kniernvt ri 25 �Oni2�C.oJ;4r�!� (� f?^ Ix.�v m irvity
information form 05.20-13 FIN,^LAOC
Updated: Monday, January 25. 2015