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Lori Nieder 12/31/19MIAMIBEACH BO RD AND COMMITTEE CHECKLIST APPOINTEE DATE OF APPOINTMENT: 11311 BOARD/COMMITTE- Q,6. Appointed by: FOR SCANNER F R CLERK STAFF f / Scan o o Letter of Appointment TERM END:/' 1 !� TERM LIMIT:�2/�r Scan o o Letter of Reappointment o C o Ber of Appointment/Reappoint7,e� tJ2e-maileed/ to Committee Liaison on M / r Scan o o ar and Committee Application (Completed on . 1 () ) 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 ✓ 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) cc) -U3✓ Highlights of the Miami -Dade County Ethics Code ✓ Sunshine Law and Public Records — Frequently Asked Questions _ ✓ Memorandum - Solicitation by City Board and Committee Members 06- CO w— o Citywide Permit Application (Parking Department Form) o Booklet — Guide to Sunshine Amendment & Code of Ethics for Public Officers and Employees Scan U = o Source of Income Statement Scan o ca o Acknowledgment of Financial Disclosure Requirement opp hs STATISTICS REPORTING Ke(eA COPY i file n ORIGINAL for Annual Report. Received on: �l D 118 Signed by X / r� Date o� Board or Committee Member Processed on: o�" 0?,- ] p By Employee: Date /qty CI s ice Staff In' ' Is Scanned on: By Employee: A L It 1P% Date City erk' ffice Staff In�i� �� CONCLUDED & RESIGNATION LETTERS Term Expired Letter Date Processed Initials Scan o Resignation LetterI Date Processed Initials Scan o Removal Letter due to absences I Date processed Initials Scan o F:\CLER\BOARD AND COMMITTIES DATABASE\CHECKLIST MASTER\B&C Checklist 2015 MASTER.docx 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.aov OFFICE OF THE CITY CLERK, Rafael E. Granada, City Clerk Tel: 305.673.7411, Fax: 305.673.7254 Email: CityClerk@miamibeachfl.gov January 03, 2018 Ms. Lori Nieder 6340 Pinetree Dr. Miami Beach, Florida 33141 SUBJECT: Parks and Recreational Facilities Board Congratulations! You have been reappointed by Commissioner Micky Steinberg to the above referenced, board or committee named above, for a term ending: 12/31/2019. 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, V Rafael Granado City Clerk cc: Saul Frances, Parking Director Cynthia Casanova, 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 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 TO: Ms. Lori Nieder RE: Parks and Recreational Facilities Board 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 County or the State of Florida (depending on the board or committee on which I serve) on July 1 st, followiatclosing of the calendar year on which I have served. Ms. Lori Nieder Sworn to and subscribed before me this day of 2018 t4 Deputy 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. 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 Namea)�p./ I 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, of no more than $500, 60 days in jail or b Signature Updated: Thursday, December 28, 2017 Page 4of4 F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 06022014.docx may subject the person to a fine 49p bate M 1 AMI B FAC H Name: L7j Board / Com DIVERSITY STATISTICS REPORTING 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 El Female Race/Ethnic Categories What is your race? rican-AmericantBiacl< C iucasian/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 i, not Span "sh, Hispanic, Latino/a. No ED Yes Do you consider yourself Physically Disabled? No ED Yes r :�. �53:S1� �%YFf2��' u�cI3�LOCci'iVilCf SOit`'rVifldv'v';S\T 0atcnl Internat rt c^S',�Cf1t21t.t�Ut 00'{5v� P,i� V;�,.j( iii C.ilt!i infiarmation form 05-20-13 FIIVIL.doc updated; Monday, Janua(pf 28, 2015