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BOARD AND COMMITTEE CHECKLIST.
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o Board and Committee Application (Completed 'Z /Q /¡ /?Í / 'f 1
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C ITY O F M IA M I B E A C H ✓
OFFICE OF THE CITY CLERK ✓
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R e ce iv ed o n :
IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
C ity C ode O rdinance S ection applicable to the agency, board or com m ittee
Ci ty C o de S ection s 2-21, 2-22, 2-23, 2-24, 2-25, 2-26, 2-458 and 2-4 59
C ounty C o de Sectio n 2-11.1 - Conflict of Interest and Code of Ethics O rdinance {as
am e nde d through D ecem ber 2010)
A m endm e nts to the C ode of Ethics O rdinance (S eptem ber 2009 thro ugh July 2012)
H ig hlights of the M ia m i-Dade Co unty E thics Code
S unshine Law and P ub lic R e cords - Frequently A sked Q uestions
M e n or an d um - S olici tatio n by Ci ty Board and Com mi tt ee M em ber s
O Ci tywi de Perm it Ap plic ation (P ar ki ng D ep ar tm en t Form )
o B ookl e t - G ui d e to S unshine Amendment & C ode of Ethics fo r Public O ffi cers and Em ployees
o S ource cf Incom e S tatem e nt
o A cknow ledgm e nt of Financial D iscl osure R equirem ent
O D IV E R S ITY S TA TI S TI C S REPORTING Beep ço P y in file and ORI GI NAL for Annual Report. !/¡ ttf ;_ 2 O . Signed by X - / )?<d-ef'P :C.--A.e~
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I /¿cj/ )¿¡]é) By Employee--+-,------------
r Date
Pro ce sse d on:
S ca nn e d o n:
CO NCLU DED & RE SIGNATI O N LETTERS
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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.
M IAM I BEACH
C ity o f M ia m i B e ach, 1700 Convention Center Drive, Miami Beach, Florida 33139 www .miamibeachfl gov
OFFICE OF THE CITY CLERK, Rafael E. Granado, City Clerk
Tel: 305.673.7411, Fox: 305.673.7254
Email: CityClerk@miomibeochfl.gov
December 18, 2019
Ms. Karen Edelstein
4955 Cherokee Ave
Miami Beach, Florida 33140
SUBJECT: Committee for Quality Education in Miami Beach
9
Congratulations! You have been reappointed by Commissioner Micky Steinberg to the above
referenced, board or committee named above, for a term ending: 12/31/2021.
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. 7 411. Please read the enclosed materials carefully.
Congratulations and good luck.
R RLG,anado
City Clerk
cc: Saul Frances, Parking Director
Dr. Leslie Rosenfeld, 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
M IA M I BEACH
C ity o f M ia m i B e a ch, 1700 Convention Center Drive, Miomi Beach, Florido 33139 www .miomibeochfl.gov
O FFIC E O F TH E C ITY C LE RK , Rafa e l E. G ra na d o , C ity C le rk
Tel: 30 5 .6 7 3 .7 4 11, Fax: 30 5 .6 7 3 .72 5 4
Em a il: C ity C lerk@ m ia m ib eachfl.g o v
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Ms. Karen Edelstein
RE: Committee for Quality Education in Mi am i Beach
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: 12/31/2021.
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.
-i±e.±4=-
Sworn to and subscribed before me this [, [, 922-0
*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
l 700 Convention Center Drive
Miami Beach, Florida 33 l 39
www _miamibeachfl.go
CITY CLERK'S OFFICE
Telephone: 305.6 73.7 411 Fax. 305.673.7254
Ci#yClerk@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: k \REN)
t ' ''
S. EDEL_t)
I understand that no later than July 1. of each year all m em bers of B oards and Com m ittees of the C ity of
M iam i B each, incl uding those of a pure ly advisory nature, are required to com ply w ith M iam i-D ade County
Financial D iscl osure Requirem ents. This m eans that the m em bers of C ity A dvisory Boards, w hose sole or
prim ary responsibility is to recom m end legislation or give advice to the C ity C om m ission, m ust file, even
though they m ay have been recently appointed.
One of the fo llow ing fo rm s must be filed wi th the C ity Clerk of M iam i B each, 1700 C onvention C enter Drive,
M iam i B each, Florida, -no later tr.an 12:00 noon of July 1, of each year.
1. A "Source of Incom e Statem ent"
2. A "S tatem ent of Financial Interests (Form 1)"
3. A C opy of your latest Federal Incom e T ax R eturn
Failure to file one of these fo rm s, pursuant to the M iam i-D ade C ounty C ode, m ay subject the person to a fine
of no m ore than $500, 60 days in jail or both.
.n .- ene ate
U p d ated : T hu rsda y , D e cem b er 28 , 20 17
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F:\CLER\$ALL\aFORMS\BOARD AND COMMIT TES'BC APPLICATION REVISED 06022014.d0cx
MIAMI
Em 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 I Last Name First Name Middle Name/Initial
2019 Z)GT/N) KN s
Mailing Address - Street Number, Street Name, or P.O. Box
122 Wes} 14qr Sheet
City, State, Zip
\[ 1CC I t=L 33/4 o
If your home address is your mailing address, and your home address is exempt from public records pursuant to Fla. Stat. $119.07, read
instructions on the following page and check here.[l
Filing as an Employee (check one)
[] Municipal:
Department
Position or Title
Work address
Filing
D County (j{ Maniciat: MIAMI B @ I+
(Municipality)
Board where serving
Co+. £o Quali+ Ed\cToN
Alternate address (if home address is exempt) I Work telephone I Term began on/ended on
3s 97 oo „y2/9- /2/2o
List below every source of income you received, along with the address and the principal activity of each source. Include your public salary. Place the sources of
income in descending order, with the largest source first. Examples of sources of income include: compensation for services, income from business, gains from
property dealings, interest, rents, dividends, pensions, IRA distributions, and social security payments. Also, include any source of income received by another
person for your benefit. However, the income of your spouse or any business partner need not be disclosed. If continued on a separate sheet, check here.[]
Name of Source of Income Address Description of the Principal Business Activity
vuA rd Edelsler», (banal)
5 FL33//
72 We r 9 Shef /At/ €
RA4ON JR M€S INVST 2900 Pouce De leon
tu$ Coral 6aleles,Fo 33/34 /U5TnUT S
I hereby swear (or affirm) that the information above is a true and correct statement.
y
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bate siáned
RECEIVED BY ELETNS DEPARTM ENT:
D Hardcopy
J Electroni boj 4 2020
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/Initials: Scanned Date/Initials: _
138_SP-14 COE 2016
MIA. t\ A If' r A rt i
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DIVERSITY STATISTICS REPORTING
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Board I Committee:
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 O Fernald-.
Race/Ethnic Categories
What is your race?
J Afican-Am erican /lack
g3casan whte
[! Asian or Pacific Islander
[? Native-American/American Indian
(i ther- Print Race.
Do you consider yourself to be Spanish, Hispanic or Latino/a? Mark the "No" box if not
Spanish, Hispanic, Latino/a.
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lves
Do you consider yourself Physically Disabled? • lve=
C:\Users\CENTaN'AppDatalocal\Micrso\Windows\Temoory interns: Files'Content.Outlook\NP4J9CNXC minority
information form O5-20-13 FINAL.doc
Updated: Monday, January 2., 2015