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BOARD AND COMMITTEE CHECKLIST
APPOINTEE: ~~Ji__¡,, _ . . _ DATE OF APPOINTMENT: ¡h,,v/ ;;;;èi
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o Letter of Appointment
o Lettef of Reappointment
o ?W f '.;::!d'~pointmenUReappointment )':-! to Committee
o Board and Committee Application (Completed on ~J-1/, ~~
o Résumé/Curriculum Vitae
o Diversity Statistics Reporting (Completed on ,.;L,/ Z o
o Oath
Liaison or
scanned
MPORTANT INFORMATION FOR OARD 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
Y 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
Scan O
Scan O
Received on:
Processed on:
Scanned on:
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 REPORTING Keep çoPy in file and ORIGINAL for Annual Report.
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Date 3ardor66##e Member
;). i.~~ By Employee~----,,,----------------
Date 2 Cerk's,Off
2~ ê(~ ~By Employee: -~--,1/-~--+-------------
Date
CONCLUDED & RESIGNATION LETTERS
Term Expired Letter Date Processed Initials Scan O
Resignation Letter Date Processed Initiais Scan O
Removal Letter due to absences Date processed #EECETVE.. o
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FICLERO ARD AN D COMMIT TIES DATABA SE\CHECKLIST MASTE RB&c Checklist 2015 MASTE .¿Ee "
CIT OF MIAMI BEACH
FF F THii öi CLE'
/Ve are committed to oroviding excellent public serics and safely to cll who live. work, and pay in our vibrant, troicci historic community.
M IAM I BEACH
City of Miami Beach, 1700 Convention Center Drive, Miomi Beach, Florida 33139 www miamibeachfl gov
OFFICE OF THE CITY CLERK, Rafael E. Granado, City Clerk
Tel: 305.673.7411, Fax. 305.673.7254
Email: CityClerk@miamibeachfl.gov RECEIVED
FEB 3 2020
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
January 24, 2020
Ms. Amy Rabin
331 West 28th St
Miami Beach, Florida 33140
RE: Miami Beach Commission For Women
Dear Ms. Amy Rabin:
Congratulations! You have been appointed by Mayor Dan Gelberto the above-referenced Board or
Committee, 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 as they concern your duties, responsibilities, and
requirements as a board or committee member.
Congratulations again and good luck.
Regards,
/ll1, Rafliiado
y City Clerk
cc: Saul Frances, Parking Director
Tathiane Trofino, 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)
We arBooklett ed@uide itinthe Gens bin e: even dmesatantd @ode feEthois ssfo pBeyu boliu@Officer srapichEmisplayeesunity.
MI A MI BEACH
City of Miami Beach
l 700 Convention Center Drive
Miami Beach, Florida 33139
www._miamibegchh._gov
CITY CLERK'S OFFICE
Telephone: 305.673.7411 Fax: 305.673.7254
Cit/Clerk@miamibeachfi.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: A1ny ~ b \ Y'.: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 form s 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 form s, 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
2-320
Date
Updated: Thursday, December 28, 2017
RECEIVED
FEB 3 2020
CITY OF MIAMI BEACH
OFF ICE OF THE CITY CLERK
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F:\CLER\$ALL\aFORMS\SOARD AND COMMITTEES'BC APPLICATION REVISED 06022014.docx
M IA M I BEACH
City of Miami Beach, 1700 Convention Center Drive, Miomi Beach, Florido 33139 www miomibeochfl.gov
OFFICE OF THE CITY CLERK, Rafael E. Granado, City Clerk
Tel: 305.673.7411, Fax: 305.673.72 54
Email: CityClerk@miamibeachfl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
RECEIVED
FEB 3 z02
QITy OF MlAMl BEAO
OFFICE óF iiié cir ck
TO: Ms. Amy Rabin
RE: Miami Beach Commission For Women
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.
M .Amy Rabi
Sworn to and subscribed before me this 3 day o~
a±. =#too.
Deputy Clerk
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*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.
M IA.NI r"rA. ri i
+. 'Hlbt,+ti
DIVERSITY STATISTICS REPORTING
Name: A, Ea ru
soararcmmtee: MB cm. t [Lu_her
Appointment Date: L24.2
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 an d committee applicants and members to voluntarily
self-identify their race, ethnicity, disabled status and gender.
P lea s e ch eck the appropriate b o x for each category:
Gender: Male O Female~
Race/Ethnic Categories
e }eta
What is your race? i African-Am erican/sack
i Caucasian/white
O Asian or Pacific Islander
[ Native-American/American Indian
L] 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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Do you consider yourself Physically Disabled?
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information farm 05-20-13 FINAL.doc
Updated: Monday, January 23, 2015