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Rachel Edelstein 06_08_2018.!� ;� � ' � a � �--� � � �, ��f a �--� : s i �f3 � ° � �� i � s 5 a '�a y ; ;i: il � �� n�.�� ,��D ��D �Oi!�i�ITTEE ��1E��CLIS�' � . � '�l�' " — 41NTMENT: �/.��ri APPOINTcE. �,�4IE;�'�C/ � r� �� DQ.1 E 0� APP' . ,AJ� %� r n � BOARD/COMMI i TEE: "/,�ilt-'f �(�()�� SS/�Cpp inted by: I�� S S/��:' � � � � �� FOR SCANNER FOR CLERK STAFF ��Gn c c Le�ter oi Appoiniment Scan o o Let�er oT Reappointment „ t �/R�a� oin`ment e-m=iled to Commi�re Liaison o Co y of Le cr o� Appom�m2n �, p � � P C� S�an c o Boar �nd Corn iuee Applica�ion (Completed on /��// �� Scar c O RCJU�T'IE/Curricufurn Vita� o Div�rsiy Siaiistics Reporting (Completed on )� S�a�t o o Oaih Scar o Scan o '�cC9IVc� OCl IiL1PORTANT 1N�Or�MATfON FOR BOARD AND COI�Jf+AlTT�EE MEP�IBERS BOOK ✓ City Cod= Ordinanc2 Section aoplicabl- io tn2 ag�ncy, board or cornmii?2e ✓ Ciy Code Seciions 2-21, 2-22, 2-23, 2-24, 2-25, 2-26, 2^58 and 2-459 ✓ County Cod= S=c�ion 2-11. i— Conifici of fnt�r2st 2rd Code oT Eihics Ordinance amended thraugn Decemb�r 2010) ✓ Amendmen�s to the Cod� oi E'tnics Ordinanc� (S�pt�m�� 2009 'th�ough Ju!y 2012) ✓ Highligh�s o� the P�iiami-D�de Counfy Efhics Code ✓ Suns�ine L�w� and Public R=cords — Frequently �sk��d �ues�.ions ✓ M�morandum - Solicita�ion by Ciy Board Gnd Comm: ie� �Ae.mb�rs � Cit��rrid2 Perrri�. F;pplicaiion (Parkina Deparm�n't Form) v R�J:J1'�l— �:+iC.G �G �Ull��lln: n!?l�; ^�^'' '£' 0� E��,!�.. 'Or t''iJ��;IC G'iiiC�f� c�,4 Fii�DiOy��c, .� �811� CO�: � Source or" Incom� S�a,emer: C^,ckno��r,�ledgmen� o� Financial Di�c[�sure R�quir�m�ni v p{4'�RSI I Y ST�TfSTICS R_r O� i(�� neep COPY in File ar� ORIGWAL �cr Annua( R�por. �/ vZg � r� Sigtl2d by � �G�U.� ��''%'�?.�. r " � ci: ard or Co��m��tee I`dic'1"ibci C rcCC= \' �/ �' � ' rc..,:.......d on: % �� B� Emplo, e.,. � �� DG�e �Ci't�� k's O��ic� S:M�� Ini:i=!s Scanned on: / [ ��/� By Ernployee: � � DY-� Ciy �rk's Oiiice Si�r I't�iy� � �, �-� � � r�-[ t'�T'1 -:� c-' � �� L. i erm Expir2d Le+��r I Dat� Processed �, Iniii2P.s Resignation Le,i'ter R:.rr�ov21 Leiier du2 to �bsences Dat2 rrocess�d i Dai� p�oCc�scd -\ � i; \,1\1 Cn _�vu�L ` :? i(1�i.F l r{n� , ..c� ��o�.�,� �:�ti � co� : � � ; i=� �a �a�, .s" ��; isr;��=;sr`;�,s�.c cr�:.�h��. _ __ r ��,�.�_ �._ -.-..., �. �. . _�_ _- _- - ,� . � lnitial:s ��? ------�— Ini'tiair Scan o , �� ✓,1ii °,''v'i: City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.qov OFFICE OF THE CITY CLERK, Rafael Granado, City Clerk Tei: (305) 673-7411, Fax: (305) 673-7254 September 05, 2017 Ms. Rachel Edelstein RE: Youth Commission Dear Ms. Rachel Edelstein: Email: RachelEdelstein@hotmail.com Congratulations! You have been appointed by Commissioner John Aleman to the above-referenced Board or Committee, for a term ending: 06/08/2018. 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 again and good luck. Regar �� Rafael Granado City Clerk � c:Saul Frances, Parking Director Dr. 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 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, woric and play in our vibrant, tropical, historic community. NIIAMlBEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 331 39 www.miamibeachfl.aov OFFICE OF THE CITY CLERK, Rafael E. Granado, Ciy Clerk Tel: 305.673.741 1, Fax: 305.673.7254 Email: CilyClerk@miamibeachfl.gov Oath of Office Oath of Civility and Acknowledgements TO: Ms. Rachel Edelstein RE: Youth Commission 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: 06/08/2018. 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 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. �� ""-�-' r�/ `�� Ms. Rac�eiEdelstein Sworn to and subscribed before me thi � day of �, 2017 � C r es D'Agostin eputy 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 se�vice and safety to all who live, work and play in our vibrant, tropical, historic community. � MIAMIBEAL�I NAME: Edelstein Last Name HOME ADDRESS: 4955 Cherokee Avenue Apt No. Home No./Street PHONE: 305-865-0683 Home Business Name: Work Rachel First Name Miami Beach City Position: CITY OF MIAMI BEACH BOARD AND COMMITTEE APPLICATION FORM S Middle Initial FL 33140 State Zip Code RachelEdelstein@hotmail.com Email Address Address: Street City 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: No • Are you a registered voter in Miami Beach: No •(Please circie 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: • 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 onlv three f31. choices will be observed bv the Citv Clerk's Office. (Regular Boards of City) Choice 1: Youth Commission Choice 2: Choice 3: * Board members are required to file Form 1—"Statement of Financial InteresY' 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 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 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: P' - 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 • Are you currently serving on any City Boards or Committees: No • 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? If yes, please explain in detail: If yes, which board? • List all properties owned or have an interest in, which are located within the City of Miami Beach: 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 Physicaily 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. "1 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 Edelstein agreed to the following terms on Received in the City Clerk's Office by: l�s l J�/' J 5�� `' " � �� ( / � � Y � I � � r � Name of Deputy Clerk `� Control No. Date � i � �` s-�: ` � `��i �� #'�,��°S ��.�� -�-,, ! . i � j E� i;� � i }-.'_-� �.. :�� City of Miami Beach 1700 Convention Center Drive, Miami Beach, F(orida 33139, wwvv.miamibeachfl.aov CITY CLERK'S OFFICE Telephone:305.b73.7411 Fax:305.b73.7254 CityClerk@miami'aeachfl.gov Acknowledgement of fines/suspension for Board/Cortimittee Members for failure to comply with Miami- Dade County Financial Disclosure Code Provision Code Section 2-11.1(i) (2) � Board Member's Name: /��`'`�C� ��,�� Tr�' � J_� . . �� _. . __ . I understand that no later than July 1, of each vear ail members of Boards and Committees oi the City oi Miami Beach, including those of a purely advisory nature, are required to comply with Miami-Dade County Financial Disclosure Requirements. This means thai the members of City Advisory Boards, whose sole or primary responsibility is to recommend legisiation or give advice to the City Commission, must file, ev�n 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, Fforida, no later than 12:00 noon of July 1, of each year. 1. A"Source of income Sta?�m�nE" 2. A"Statemen't of Financial fnterests (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 oT no more Tnan $500, 60 days in jai! or botn. ��.�� -�.�-�_. Signature Updaied� Monday, April 20, 2015 Page 4 or 4 F:\C�ER\SALUGFORNIS\60ARD AND COMiti11�EcS�6C AP?IICAl IU�t REVIScD Oo"�22014.ticcx ,v/:��'�:�ci7 ate MIAMI•DADE �l�l'liY�1 SOURCE OF INCOME STATEMENT Section 2-11.1(i) 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 N e 2016 �Q�� ( 5 �t +� Mailing Address — Street Number, Street Name, or P.O. Box �- � � S C� �k:i�C.Q-2 City, State, Zip fir;t Na�/�C��j/ Middle Name/Initial f/� �� ,��C;iU.� ��C� l �L � � ��"-�C3 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. ❑ Fi19ng as an Employee (ct�eck one) 0 County �] Public Health Trust � Municipal: Department Position or Title Work address Filing as a Board Member �check one� � County Board where serving c��;�� Wark telephone �Municipai: N� L /�r�'�' � � ' �f�N`r`'t ` � � , v�l (Municipality) Empioyee I� Num6er Empioyment 6egan on/ended on J r�-f�"►' ! (Municipality) Alternate address (if hom� address is exempt) Work telephone Term began n/ended o ��7 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 dea!ings, interest, rents, dividends, pensions, IRA distributions, 2nd social security payments. Also, inciude any source of income received by another person for your benefit. Ho�vever, the income of your spouse or any business partner need not be disclosed. if continued on a separate sheet, check here.❑ Name af Source of Income Address Description of the Principal Business Activity � I hereqy swear (or affirm) that the information above is a true and correct statement. ��y�� .�i�-- Signature of Person Disclo ng �/�,��i� Daie signed RECEIVED BY ELECTIONS DEPARTMENT: ❑ Hardcopy ❑ Electronic Copy ��r;�G 1 i$c QAI� V ar�gn,tcri: V/ �i nAp��;a��,; Pror,essed Dateilnitials: Scanned �ate/Initials: 138_SP-14 COE 2015 �,�� _ �� DI�JERSIiY STATISTICS REP4RTING .��ls� 1 �^pC� � � `� *�✓ Narne: l Board / Committee: `�aU-�-vj CO�✓��SSio� U Appointment Date; �/,�.� �/7 Pursuant to City of Miami Be�.cn Ordinance �009-3632, the Ciiy is required to annually prepare and present a repor� io the City Ccmmission identiiying the City's diversity statistics. This form aliows board and committee appficants and members to volun�arily self-identify their race, ethnicity, disabled status ana gender. Piease check the appropriate bax for each categary: Gender: ��iale � Fe�rla�e�! RacelEthnic Categories G'4�hat is your race? �� A;r;can-A^ie;�can/Bfa�k � Ca��cas�an;MJhi�e � � A,s;an o� Pacific is!and�r. fi Y Na�ive-,SmerlCaCl�a.m��ic�n ;��dian � OtneY _ P;int Ra�.,. Do you consider yourself `o be Spanish; Hisrar.i� cr L.�tirola? �n✓'�rk the "No" b�,{ �`nc� S�anrs,n, N,;spanic, Latinoi�. � No � Yes Do you consider yourseff Pnysical(y Disabled? � iV o � Yes ��\ o-cf C ��nn^ �rr �'�t,� • �;;�: � "n -, "��i: � ' "'t�i:i(1 � �� Q (� .,�i�,,.,,.1v�.lV 't'fc: �-�ru�.=fc11! OCci�t�J� .OSOiii'� IfiC�"v•:�fS1T?,T,nvfc !i'�.[,.... �. . ...,, ,. .�(?i:^�..(:�.,. Ot��r�'=.J..�.i�;C.�..liliii�:illV informaiion farm 0�-2u-13 FIN;-`,�.dr�c �i��ara:�: PAonday, Januanf 2g. 2�t5