Sabrina Cohen 12/31/17AA I A /`0, 1 B E A C H
BOARD AND COMMITTEE CHECKLIST
j RECEIVE
APPOINTEE: 00 ► e " DATE OF APPOINTMENT:
BOARD/COMMITTEE: 1 54111 _j0jjAG 15 I'm 3: 39
AppOA9
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i-Lz-mm t e
FOR SCANNER FOR CLERK STAFF OFFICE OF THE CITY CLERK
Scan o o Letter of Appointment
Scan o o Letter of Reappointment
o Copy of Letter of Appointment/Reappointment e-mailed to Committee Liaison on
Scan o o Board and Committee Application (Completed on
Scan o o Resume/Curriculum Vitae
o Diversity Statistics Reporting (Completed on
Scan o o Oath
Scan o
Scan 0
Received on:
Processed on
Scanned on:
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 (as
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 Committee Members
o Citywide Permit Application (Parking Department Form)
o Booklet — Guide to Sunshine Amendment & Code of Ethics for Public Officers and Employees
o Source of Income Statement ,- \
O Acknowledgment of Financial
DIVE SITY STATISTICS REI
l� Signed by
Date / %
/ By Employee:
�l- Date
/ /� / By Employee:
Date
D� Icsure quirement
'OR NG Ke COPY in fileiand OFt'IGINAL for Annual Report.
-
1 and or Co itte
Qit/Zlerk's Office Staff Initials
CWClerk's Office Staff Initials
CONCLUDED & RESIGNATION LETTERS
Term Expired Letter
Date Processed
Initials Scan O
Resignation Letter
Date Processed
Initials Scan o
Removal Letter due to absences
Date processed
Initials Scan o
F:\CLER\BOARD AND COMMITTIES DATABASE\CHECKLIST MASTER\B&C Checklist 2015 Ih.docx
We are committed to providing excellent public service and safely to oll who live, work and ploy 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 Granada, City Clerk
Tel: (305) 673-7411, Fax: (305) 673-7254
Email CityClerk@miamibeach.gov
November 15, 2016
Ms. Sabrina Cohen
1800 Purdy Ave
Miami Beach, Florida 33139
SUBJECT: Disability Access Committee
Congratulations! You have been reappointed by Commissioner Ricky Arriola to the above referenced,
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 and good luck
Regards,
afae ado
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 Ordinance
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.aov
OFFICE OF THE CITY CLERK, Rafael Granada, City Clerk
Tel: (305) 673-7411, Fax: (305) 673-7254
Email CiyClerk@miamibeach.gov
TO: Ms. Sabrina Cohen
RE: Disability Access Committee
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 whch I ss v) on f1�ly lsy,foftwing the closing
of the calendar year on which I have served. \\ j
Ms. Sabrin
Sworn to and subscribed before me this day of 201
Aof .MDeputy 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.
k M
I
1 HACH
iV kif \
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
CityClerk@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: � d k f c 6a GL) � eV�
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,, pur
of no,more than $500, 60 days injail or
1
Signature
Updated: Monday, April 20, 2015
to the Miami -Dade County Code, may subject the person to a fine
Page 4 of 4
F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 06022014.docx
Date
DIVERSITY STATISTICS REPORTING
Name: -a. b t►ha, o oh ch
Board / Committee: �t I [ i n Ct e-Cle—:,SS (y-a_rn rt-� �/ E
Appointment Date: 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 ID Female,
K'
Race/Ethnic Categories
What is your race?
FA African-American/Black
Caucasian/White
Asian or Pacific Islander
Native-American/American Indian
Other — Print Race:
I
D you consider yourself to be Spanish, Hispanic or Latino/a? Mark the "No" box if not
S anish, Hispanic, Latino/a.
No
Yes
Do you consider yourself Physically Disabled?
C:\Users\CENTFraN\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\NP4J9CNX\BC minority
information form 05-20-13 FINAL.doc
Updated: Monday, January 26, 2015