Moni Cohen 12/31/19BOARD AND COMMITTEE CHECKLIST
APPOINTEE: ,440/1// CO lye/" DATE OF APPOINTMENT: L71/3 / /(F-
BOARD/COMMITTEE: 5(.5-1e/ie $ f (PS Appointed by: /441- 'love 6 e heze
FOR SCANNER
Scan 0
Scan 0
Scan o
Scan 0
Scan 0
tr)
N
0.
cgt
CCI
ti
Scan 0
Scan 0
Received on:
Processed on:
Scanned on:
x
U-1
Lt
FOR CLERK STAFF MOC-1 / 3 r (/
o Letter of Appointment TERM END: TERM LIMIT:
o Letter of Reappointment
o ,C9py 3f �L�r of Appointment/Reappointment e-mailed to Committee Liaison on
o Board and Committee Application (Completed on
o Resume/Curriculum Vitae J �j
o Diversity Statistics Reporting (Completed on `. Q
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)
✓ 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 Disclosure Requirement
o DIVERSITY STATISTICS RE
PORTING, Keep COPY in file ap ORIGINAL for Annual Report.
Signed by X ,)/i
ard or Committees Member
Date
Date
Date
By Employee:
By Employee:
rk's Office Staff Initials
City -rk's Office Staff Initials.,
4.1 Tit hi
n�
CONCLUDED & RESIGNATION LETTERS
Term Expired Letter Date Processed
Resignation Letter
Removal Letter due to absences
Date Processed
Date processed
Initials Scan 0
Initials Scan 0
Initials Scan o
F:\CLER\BALL\BOARD AND COMMITTIES DATABASE\CHECKLIST MASTER\B&C Checklist 2015 MASTER.docx
Ale ar ccurviirte -. to providing e<ce ent public service and sa:`eiy to all who live work and play in our vibrant trop!cai h s;:_,nc community,
MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139 www.miamibeachfl.aov
OFFICE OF THE CITY CLERK, Rafael E. Granado, Ciiy Clerk
Tel: 305.673.741 1, Fax: 305.673.7254
Email: CityClerk@miamibeachfl.gov
April 03, 2018
Ms. Moni Cohen
880 Lakeview Drive
Miami Beach, FL 33140
SUBJECT: Sister Cities Program
Congratulations! You have been reappointed by Mayor Dan Gelberto 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,
72
R ael Gr
ty Clerk
cc: Saul Frances, Parking Director
Michele Burger, 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 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
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Ms. Moni Cohen
RE: Sister Cities Program
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.
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 1st, following the closing
of the calendar year on which I have served.
Sworn to and subscribed before me this
' eJ
Ms. Moni Cohen
ries D'Agostin
Deputy 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.
MIAMI BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfl.aov
CITY CLERK'S OFFICE CityClerk@miamibeachfl.gov
Telephone: 305.673.741 1 Fax: 305.673.7254
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: .440�d. C a v/ e"'
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.
.A�
;
Signature Date
Updated: Thursday, December 28, 2017
Page 4 of 4
F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 06022014.docx
MIAMI
=al
SOURCE OF INCOME STATEMENT
Section 2-11.10) 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
(1..o4,2
2017
Mailing Address — Street Number Street Name, or P.O. Box
City, State, Zip
A4f . L.
First Name C Middle Name/Initial
/VIA+'clknfviOn
ft /}
S� o Lal(e 1,11et4)
33 / fa
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. 0
Filing as.!Employee (check one)
County Pubil
Department
Position or Title
Work address
Trust 0 Municipal:
(Municipality
Filing as a Board Member (check one)
County
Board where serving
Work telephone
Employee ID Number
ment began on/ended on
'Municipal: e` 1 O 7 / /4/-1-1 ge 41-a
(Municipality)
c�c s -1-&, e'/-rs /—�/i 4
Alternate address (if home address is exempt) Work -telephone V Term began /ended on
3g
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
11"1-6
Address Description of the Principal Business Activity
(11 y i o u s PIry re.1- --aro AL&
I hereby swear (or affirm) that the inforrpation above is a true and correct statement.
Signature of Person Disclosing
Date signed
OFFICE USE ONLY Accepted: Y / N Deficiency:
138 SP -14 COE 2016
( L. Lt aro
RECEIVED BY ELECTIONS DEPARTMENT:
❑ Hardcopy
❑ Electronic Copy
Processed Date/Initials: Scanned Date/Initials:
MINV\1 BFACH
DIVERSITY STATISTICS REPORTING
Name:
Board / Committee:
Appointment Date:
II- 3- "
1
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: Male1. Female
Race/Ethnic Categories
What is your race?
African-American/Black
ucasianivVhite
ED Asian or Pacific Islander
Native-American/American Indian
Other — Print Race:
Do you consider yourself to be Spanish, Hispanic or Latino/a? Markthe "No"boxifnot
Spanish, Hispanic, Latino/a.
*Yes
Do you consider yourself Physically Disabled?
Yes
CAUsers\CENTFraN\AppData\Local\MicrosoftWVindows\Ternadrary Internet Piles\Content.Outlook\NP4J9ONX\6C minority
information form 05-20-13 FINAL.doc
Updated: Monday, January 26. 2015