Karen Latham 06/30/21BOARD AND COMMITTEE CHECKLIST
APPOINTEE: ____________________________________ DATE OF APPOINTMENT: ______________
BOARD/COMMITTEE: ____________________________ Appointed by: ___________________________
FOR SCANNER FOR CLERK STAFF
Scan ○ ○ Letter of Appointment TERM END: _______________ TERM LIMIT: _____________
Scan ○ ○ Letter of Reappointment
○Copy of Letter of Appointment/Reappointment e-mailed to Committee Liaison on
_____________
Scan ○ ○ Board and Committee Application (Completed on )
Scan ○ ○ Résumé/Curriculum Vitae
○Diversity Statistics Reporting (Completed on )
Scan ○ ○ 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
○Citywide Permit Application (Parking Department Form)
○Booklet – Guide to Sunshine Amendment & Code of Ethics for Public Officers and Employees
Scan ○ ○ Source of Income Statement
Scan ○ ○ Acknowledgment of Financial Disclosure Requirement
○DIVERSITY STATISTICS REPORTING Keep COPY in file and ORIGINAL for Annual Report.
Received on: _______________________ Signed by X________________________________________________
Date Board or Committee Member
Processed on: ______________________ By Employee: ________________________________________________
Date City Clerk’s Office Staff Initials
Scanned on: ______________________ By Employee: ________________________________________________
Date City Clerk’s Office Staff Initials
CONCLUDED & RESIGNATION LETTERS
Term Expired Letter Date Processed Initials Scan ○
Resignation Letter Date Processed Initials Scan ○
Removal Letter due to absences Date processed Initials Scan ○
F:\CLER\BOARD AND COMMITTIES DATABASE\CHECKLIST MASTER\B&C Checklist 2015 MASTER.docx
Karen Latham July 26, 2020
QEC Miami Beach South Pointe Elementary
8/4/2020
06/30/21 06/30/21
07/29/2020 07/29/2020
07/29/2020
8/4/2020
8/4/2020
July 26, 2020
Ms. Karen Latham
345 Michigan Ave, APT 41
MIAMI BEACH, FL 33139
SUBJECT: Committee for Quality Education in Miami Beach
Congratulations! You have been reappointed by South Pointe Elementary School PTA to the above
referenced committee named above, for a term ending: 06/30/2021.
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 sh all 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,
Rafael Granado
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
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Ms. Karen Latham
RE: Committee for Quality Education in Miami 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: 06/30/2021.
To my colleagues and to all of those I represent and serve, I pledge fairness, integrity and civilit y, 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.
________________________________
Ms. Karen Latham
Sworn to and subscribed before me this day of , 2020
________________________________
Charles 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.
4th August
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Updated: June 2020
BC@miamibeachfl.gov
BOARD & COMMITTEE FINANCIAL ACKNOWLEDGEMENT STATEMENT
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)
Last Name First Name Middle Initial
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.
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;” or
2. A “Statement of Financial Interests (Form 1)1;” or
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 Date
1 Members of the Planning Board and Board of Adjustment will be notified directly by the State of Florida,
pursuant to F.S. §112.3145(1)(a), to file a Statement of Financial Interests (Form 1) with the Miami-Dade County
Supervisor of Elections by 12:00 noon, July 1. Planning Board and Board of Adjustment members who file their
Form 1 with the County Supervisor of Elections automatically satisfy the County’s financial disclosure
requirement as a Miami Beach City Board/Committee member and need not file an additional form with the Office
of the City Clerk. However, compliance with the County disclosure requirement does not satisfy the State
requirement.
Latham Karen Y
8/4/2020
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 Last Name First Name Middle Name/Initial
Mailing Address – Street Number, Street Name, or P.O. Box
City, State, Zip
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. £
Filing as an Employee (check one)
*County * Public Health Trust * Municipal: _________________________________________________
(Municipality)
Department
Position or Title Employee ID Number
Work address Work telephone Employment began on/ended on
Filing as a Board Member (check one)
*County *Municipal: _________________________________________________
(Municipality)
Board where serving
Alternate address (if home address is exempt)Work telephone Term began on/ended on
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
SOURCE OF INCOME STATEMENT
OFFICE USE ONLY Accepted: Y / N Deficiency:________________________________ Processed Date/Initials:__________________ Scanned Date/Initials: __________________
RECEIVED BY ELECTIONS DEPARTMENT:
*Hardcopy
*Electronic Copy
138_SP-14 COE 2016
I hereby swear (or affirm) that the information above is a true and correct statement.
_______________________________________________________________________
Signature of Person Disclosing
_________________________
Date signed
8/4/2020
X
Received August 4, 2020
Office of the City Clerk
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F:\CLER\$ALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
Email: BC@miamibeachfl.gov
DIVERSITY STATISTICS REPORT
Last Name First Name Middle Initial
The following information is voluntary and has no bearing on your consideration for appointment. It is being
asked to comply with City diversity reporting requirements.
Gender:
Male
Female
Other
I prefer not to answer.
Race/Ethnic Categories:
What is your race?
African American/Black
Asian or Pacific Islander
Caucasian/White
Native American/American Indian
Other – Print Race:
I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
Yes
No
I prefer not to answer.
Do you consider yourself Physically Disabled?
Yes
No
I prefer not to answer this question.
Latham Karen Y
X
X
X
X