Michelle Green 12/31/19MIAMIBEACH
BOARD AND COMMITTEE CHECKLIST
APPOINTEE: 1 I j6ie.- / Cr'l-&P DATE OF APPOINTMENT: D X
BOARD/COMMITTEE: 5(54v— Appointed by: /4/V9 Oe 6_C116roq
FOR SCANNER FOR CLERK STAFF 4p/D ,1.51119TERM �`/Scan o o Letter of Appointment TERM END:LIMIT: l�
Scan o o Letter of Reappointment
oC,ap �o at� of Appointment/Reappointment e-mailed �ttoo Committee Liaison on
Scan o o Board and Committee Application (Completed on?��o )
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 2459
✓ County Code Section 2-11.1 — Conflict of Interest and Code of Ethics Ordinance (as
M amended through December 2010)
✓ Amendments to the Code of Ethics Ordinance (September 2009 through July 2012)
✓ Highlights of the Miami -Dade County Ethics Code
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✓ Sunshine Law and Public Records — Frequently Asked Questions
✓ Memorandum - Solicitation by City Board and Committee Members
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C\j M .
L; 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 Requiren4nt
O DIVERSITY STATISTICS REPORTING Kee PY in file and ORIGINAL for Annual Report.
Received on: /_,(� Signed by X�`
Date Bo � ommittee m
Processed on: a aazl- f o By Employee:
ate Cit C 's i Staff Initial
Ar
Scanned on: By Employee:
Date City Jerk's a Sta I. Is
*ED
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 MASTER.docx
We are committed to providing excellent public service and safely 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.gov
OFFICE OF THE CITY CLERK
Telephone: 305.673.741 1
Email: CityClerk@miamibeachfl.gov
October 26, 2018
Ms. Michelle Green
3120 Pine Tree Drive
Miami Beach, Florida 33140
RE: SISTER CITIES PROGRAM
Dear Ms. Green:
Congratulations! You have been appointed by Mayor Dan Gelber to the above -referenced Board or
Committee, for a term ending 12/31/2019.
Pursuant to City of Miami Beach Code Section 2-22 (5)a.-
Notwithstanding
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.
RegaAGran
d
Rafao
City Clerk
cc: Saul Frances, Parking Director
Michele Burger, 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
MIAMI BEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
OFFICE OF THE CITY CLERK
Telephone: 305.673.741 1
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Michelle Green
RE: SISTER CITIES PROGRAM
Email: CityClerk@miamibeachfl.gov
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 1st, following the closing of the calendar year on which I have served. '
Michelle G*n
Sworn to and subscribed before me thisp` f day of October, 2018
D'A96Xin, 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.
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(1) (2)
Board Member's Name:
I&P, ff-c Gre elxj
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, 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.
Signature
Updated: Thursday, December 28, 2017
Page 4 of 4
F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 06022014.docx
M, 1 AMI Lbw' FAC H
DIVERSITY STATISTICS REPORTING
Name:
Board / Committee: � I sTC P__ C_Tt Es
Appointment Date: C)la�
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 C1 Female
Race/Ethnic Categories
What is your race?
L_J African-American/Black
ED 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 not
Spanish, Hispanic, Latino/a.
t
Do you consider yourself Physically Disabled?
No
ED Yes
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information form 05-20-13 FINAL.doc
Undated: Monday, January 26. 2015