Jill Swartz 06/30/18MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 331 39 www.miamibeachfl.aov
OFFICE OF THE CITY CLERK, Rafael E. Granada, City Clerk
Tel: 305.673.741 1, Fax: 305.673.7254
Email: CityClerk@miamibeachfl.gov
May 31, 2017
Ms. Jill Swartz
6081 N Bay Road
Miami Beach, FL 33140
RE: Committee for Quality Education in Miami Beach
Dear Ms. Jill Swartz:
Congratulations! You have been appointed by Miami Beach Senior High PTA to the above -referenced
Board or Committee, for a term ending: 06/30/2018.
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.
Regards j
Rafa6l Granado
City Clerk
cc: Saul Frances, Parking Director
Leslie Rosenfeld, 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.
MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 331 39 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
Oath of Office
Oath of Civility
and
Acknowledgements
RE: Committee For Quality Education in Miami Beach
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: 06/30/2018.
To my colleagues and to all of those I represent and serve, I pledge fairness, integrity and civility, in all
actions taken and all communications made by me as a public servant.
I hereby acknowledge that 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 that I understand that as a member of
the above -referenced City of Miami Beach Board 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.
L fls. J if t'Swartz J
Sworn to and subscribed before me this 6 day of2017
Charles D'Agostin
Deputy Clerk
We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community.
MI®RADE 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 Last Name First Name Middle Name/Initial
2016 5 WCt V-+ Z -z- I. I
(
Mailing Address — Street Number, Street Name, or P.O. Box
0�g1 IQ ibLA
City, State, Zip
VivU a ck--� F--c-
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. ❑
Filina as an Emnlovee (check one)
0 County F1 Public Health Trust E] Municipal:
(Municipality)
Department
Position or Title
Employee ID Number
Work address
Work telephone
Employment began on/ended on
Filinn as a Board Member (check one)
0 County fZ Municipal: L 4 L'11ti 'P-C�'i)
(Municipality)
Board where serving (('�QQ�
CJwr m j'14e- f. � r' QL)a 1 Cu �cci�l (✓► c d w� lk ���+r%�J
Alternate address (if home address is exempt) V 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
nerson for vour benefit. However. the income of vour spouse or anv business Dartner need not be disclosed. If continued on a separate sheet, check here.❑
Name of Source of Income
Address
Description of the Principal Business Activity
Laces-� 1 � � �
I hereby swear (or affirm) that the information above is a true and correct statement.
n
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
City of Miami Beach
1700 Convention Center Drive,
Miami Beach, Florida 33139,
www.miamibeachfi.gov
CITY CLERK'S OFFICE
Telephone: 305.673.7411 Fax: 305.673.7254
Cit, Clerk@miamibeachfl.aov
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 S W rtZ
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.
Signatu
Updated: Monday, April 20, 2015
Page 4 of 4
F'.\CLER\5ALL\aF0RMS\B0ARD AND COMMITTEES\BC APPLICATION REViSED 06022014.dccx
�l 21�� 7
Date
MIAP1ilBEP,CN
DIVERSITY STATISTICS REPORTING
Name: J-1 11
Board / Committee:
Appointment Date:
� k"Ja V—I ki � -2—
I-tlu 06j0Cd(-0y3 %- 4071 1, &-Uaj
6-1 -31 / /
Pursuant to City of Miami Beach Ordinance 2009-3832, 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/Black,
c a u, c a s 1: a n iAA1 h it e
Asian or Pacific Islander
Native-American/American indian
Other — Print Race:
Do you consider yourself to be Spanish, Hispanic cr Latinola? Mark the "No" box if not
Spanish, Hispanic, Latino/a.
Nc
ID Yes
Do you consider yourself Physically Disabled?
No
Q Yes
information form 05-20-113 FINALAOC
Updated: Monday, 2'6.20;5
3
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_ BOARD AND COMMITTEE CHECKLIST
APPOINTEE: ..,i i ( I
�Wq V- +--?— DATE OF APPOINTMENT:
BOARD/COMMITTEE: Ed
VCA, Appointed baa
FOR SCANNER FOR CLERK STAFF �� ►vk p -r4
Scan o c Letter of Appointment
Scan o oLetter of Reappointment
o Copy of Letter of Appointment/Reappointment e-mailed to Committee Liaison
Scan o o Board and Committee Application (Completed on
Scan o o Resumt-/Curriculum Vitae )
Scan o
o Diversity Statistics Reporting (Completed on )
o Oath
IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
City Code Ordinance Section applicable to the agency, board or committee
✓ City Code Sections 2-21, 2-22, 2-23, 2-24, 2-25, 2-26, 2-458 and 2-459
County Code Section 2-11.1 - Conflict of Interest and Code of Ethics Ordinance
amended through December 2010)
Amendments to the Code of Ethics Ordinance (September 2009 through July 2012)
✓ Highlights of the Miami -Dade County Ethics Code
Sunshine Law and Public Records - Frequently Asked Questions
Memorandum - Solicitation by City Board and Commitee �Aembers
O Citywide Permit Application (Parking Department Form)
O B` Gide shine "
G'Gklet — to Sun dment a. CO s ' nc•,,
rin1en de GI Etii!Ga tort Pub;lc Vii!�ers and Employee;
Scan O O Source 01 Income Statement
Scan O 0 Acknowledgment of Financial Disclosure Requirement
O DIVERSITY ST^,TISTICS RE PO ING 'veep COPY in Fi e ana ORiGii.AL ter Annua[ Repos.
Received on: �'2_83
J
Signed by
Date
Gar or Committee by -mb-ar
Processed: L�_18'
on
By Employee:
�]Date &// t erk's Oiiice Staff itiais
Scanned on: / ` By Employee:
Date
City rk's Office Staff Initials
CSCE ESN.TI LETTERS
kovi U v Itu
Term Expired Letter
Date Processed
Init
Date ials Scan o
Resignation Letter D Processed I
e
Initials Scan o
RemGV21 Letter due to absences I Date processed
Initials Scan 0
:�.CL EMBOARD AND CONI? ,,11TT1=S DATAB,AS��,C�EC
K.LIST MASTER',B&C Checklist 20 i 5 !h.docx