Darin Feldman 12/31/19MIAMIBEACH
BOARD AND COMMITTEE CHECKLIST
�'�✓ �e (A( t J '
. / �/ 711
APPOINTEE: `- "' DATE OF APPOINTMENT.
BOARD/COMMITTEE: 4 l4 A C Appointed by: Cir wM�� c Ss�a�
l
FOR SCANNER FOR CLERK STAFF
Scan o o Letter of Appointment TERM END:/g/3///
"/>r / / TERM LIMIT: J
Scan c o Letter of Reappointment
0 fory/ fL t er of Appointment/Reappointment e-mailed to Committee Liaison on
Scan o 0 11odrd and Committee Application (Completed on JIL20)
Scan o o Resume/Curriculum Vitae
o Diversity Statistics Reporting (Completed on )
Scan o o Oath
IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
✓ City Code Ordinance Section applicable to the agency, board or committee
o ✓ 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
v
G =- 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
,.r� ✓ Memorandum - Solicitation by City Board and Committee Members
is O Citywide Permit Application (Parking Department Form)
o Booklet – Guide to Sunshine Amendment & Code of Ethics for Public Officers and Employees
Scan O o Source of Income Statement
Scan O o Acknowledgment of Financial Disclosure Requirement
O DIVERSITY STATISTICS REP TI Keep COP n f ORIGINAL for Annual Report.
Received on: Signed b
Date and o mitt Member
� golr B ,
Processed on: y Employee:
Date `'� rk's Office Staff Initials
Scanned on: —6 By Employee: G�
Date City erk's Ofe ffit Is '
L3111111
CD
CONCLUDED & RESIGNATI ERS
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
FACLER\$ALL\BOARD AND COMMITTIES DATABASE\CHECKLIST MASTER\B&C Checklist 2015 MASTER.docx
We ora committed to providinq excelient public semce and sofi?l i to all vwio live work. and picy in our vibront, tropicol. historic comniuniN
MIA/01BEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139 www.miamibeachfl.aov
OFFICE OF THE CITY CLERK, Rafael E. Granada, City Clerk
Tel: 305.673.7411, Fax: 305.673.7254
Email: CityClerk@miamibeachfl.gov
January 17, 2018
Mr. Darin Feldman
1662 Lincoln Lane #404
Miami Beach, Florida 33139
RE: Affordable Housina Advisory Committee
Dear Mr. Darin Feldman:
Congratulations! You have been appointed by the City Commission to the agency, board or committee
named above for a term ending: 12/31/2019.
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.
RegardsJGrana
Ra
City Clerk
cc: Saul Frances, Parking Director
Alba Tarre, City Liaison
ENCLOSURES:
Oath of Office/Oath of Civility/Acknowledgements
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 vvww.miamibeachfl.aov
OFFICE OF THE CITY CLERK, Rafael E. Granada, City Clerk
Tel: 305.673.7411, Fax: 305.673.7254
Email: CityClerk@miamibeachfl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Mr. Darin Feldman
RE: Affordable Housing Advisory 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: 12/31/2019.
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 Coun o)� he
State of Florida (depending on the board or committee on which I sery o1 st, followin Ye cl ing
of the calendar year on which I have served.
Mr'frinan
Sworn to and subscribed before me this day of / , 2018
vY
D'Agostin
ty Clerk
*Please visit the City of Miami Beach website at www.miamibeachfi.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.
1 � 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
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 DdVIVI 7) . -Fe.Ir)„Q LI)
I understand that no later than July 1, of each vear 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: -66 -days in iail or both.
Si
Updated: Thursday, December 28, 2017
Page 4 of 4
F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 06022014.docx
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Date
M1AMIDADE
°L4clU�'I11 SOURCE Or 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 I Last Name
mpw 9-oi-7 I Fta1dA4+-J
Mailing Address - Street Number, Street Name, or P.O. Box
(lot)K-f
City, State, Zip
First Name Middle Name/Initial
If your home address is your mailing address, and yourhomeaddress is exempt from public records pursuant to Fla. Stat. §119.07, read
instructions on the following page and check here. ❑
Filing as an Employee (check ane)
t �PulficHealth Trust F� Municipal:
(Municipality)
Department l
Position or Title Employee ID Number
Work address Work telephone Emp- o�}R�ea a an an/ended on
Filing as a Board Member (check one)
0 County
) Municipal: l �+L40 � ! " r ! r %�-Nt i - RP��V/
61 �
'" 1
(Municipality)
Board where serving 44/+(f—
Alternate
address (if home address is exempt) Work telephone Tel be¢a/en ed 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
person for your benefit. However, the income of your spouse or any business partner need not be disclosed. If continued on a separate sheet, check here.❑
Name of Source of Income
Vis(
Address I Description of the Principal Business Activity
byyswrear (or affirm) thaZnforion a true and correct statement.
ature of Person Di osi
Date signed
RECEIVED BY ELECTIONS DEPARTMENT:
❑ Hardcopy
❑ Electronic Copy -
nc_ICE USE ONLY Acc Dted: V ; N De ici_ncy Processed Date/Initials: Scanned Date/Initials:
138 SP -14 COE 2016
�Mi B F Ak"
DIVERSITY STATISTICS REPORTING
Narne: ' V Iv\
Board / Committee:
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 Female �1
RaceiEthnic Categories
What is your race?
12 African-American/Black
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 rnot
Spanish, Hispanic, Latincla.
No
Yes
Do you consider yourself Physically Disabled?
,,18No
Yes
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information forin 05-20-13 FIN AL.dOC
updated; DAonday, January 26. 2015