Barbara Kaufman 12/31/22BOARD 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
Barbara Kaufman 11/10/2020
MB Commission for Women Commissioner Arriola
12/31/2022 12/31/2023
11/10/2020
11/10/2020
11/10/2020
11/23/2020
11/23/2020
11/23/2020
Digitally Completed/BK
Ofthe caIendar yea巾On Which l have served.
Swom to and subscribed before me this day of
Charles D’Agostin
Deputy CIerk
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Section 2-11.1(i) ofthe County Ethics
Of every year.
SOURCE OF INCOME STATEMEN丁
ode requires that certain emp10yeeS and public officials file a financiai disclosure Statement on a yearIy basis by JuIy 「st
DiscIosure for Tax Year Ending
2019
st Name Fi「§t ∥ame Middle Name/initial
aufman Ba「ba「a D
Ma柵g Add「ess - Street Number,
6417 Pinetree Dr Ci「cIe
「eet Name, 0「 P,0. Box
City, State, Zip
Miami Beach, FL 33141
lf your home add「ess is your ma冊
instructions on the fo=0Wing page
Filing as am暮mpioyee (cheek
address, and your home address is exempt from p剛C reCOrds pursuant to FIa・ Stat・ §119・07, read
nd check here. □
□County ロPu輔CHe 皿Trust □Municipal:
Depa巾m e鵬
Position or Title Emp10yee lD Number
Work address EmpIoyment began on/ended on
円帽mg as a Board問ember Q
□ county 田帆nicipal:Miami Beach Commission fo「 Women lssues
(Municipality)
Board where serving
Miami Beacβ
Alter旧te a関「e§S (if home a関res is exempO Term began on/ended on
List beiow eve「y source of income yo
income in descending order, With the
PrOPerty deaIings言いtereSt, 「entS, div
PerSOn for your bene皿However, thencome of your spouse or any business partner need not be
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飢ds, Pe[Sions, lRA distr剛tions, an。 social secu「ity payments. AisqL inc哩e any SOurCe Of inponle r?Ceiyed型ano曹
d料請d高c(后誼山前Jn a sepa「ate sheet, Checkhere,□
Description of the P「incipal Business ActiYfty
Lion FinanciaI L 301 W41 Street, Miami Beach Dividens/inte「est
Social Security Admi istration 1200 Rev Abraham Wood Bivd
Birmingham, A」 35285
Social Security Benifits
Raymond James &880 Ca刷on Parkway
Saint Peterbu「g, FL 33716
lRA Dist「ibution
(Or affirm) that the formation above is a true and correct statement.
Date signed
RECEIVEDBYEしECTiONS0EPARTMENT:
口Hardcopy
□EIectronicCopy X
Received November 23, 2020
Office of the City Clerk
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City of Miqmi Beqくh, pARKINc
1 755 Me「idian Avenue, Sui†e 2OO/Mi
A ci†ywide (CW圧arking
parking spaces. A CW
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看MPOR丁AN丁NO丁E:
any u=neCeSSa「y enforc
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informa†ion may lead †○ †
Piease no†e †ha† †his new
†he new ca「d please h01d
†o †ry †he o†her side o白h
un両he ga†e opens.
ACKNOWLEDGEM看N
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Board Member ln書o細m
C団CI丁YWIDE (CW) BOARD & COMM!丁TEES..ARTM.NT PARKING APPLICATlON
mi Beach, FL 33139/Ph. (3O5) 673-7505 o「 (305) 673-7OOO ext. 6200
perm旧s hono「ed a† me†ered parking spaces and res†「ic†ed residen†ial zones
arking perm旧S NOT honored in prohibi†ed areas. An Access Card w川be
a= Ga「age (G7) access.
u「 vehic-e license pIa†e serves as your ,′parking pe「mi†′′・ in order †o avoid
en† ac†ions, it∴s impor†an両a† 0U「 reCOrds reflec† †he mos† cu「「en† and
a「ding you「 vehicie license pid†e・ lnaccura†e and/o「 。∪†da†ed vehicle
e issuance of pa「king c剛on(s) and/o・ †he †。Wing of your vehicle.
access ca「d CANNO丁be h0le-PUnChed or perfora†ed in any ma=ne「・ To use
†he card a† c-ose proximity †○ †he reader un†冊e ga†e opens. You may need
card. Please ensure you h01d †he en†ire su「face o白he ca「d agains† †he reader
: I acknowledge †ha書shouId my aくくeSS ca「d be IosIしSIIOlen or
ponsib案e lo paγ a !]0.00 replacemen書fee・
Da†e of App=ca†ion:11111I2020
Appiican† Name:Ba「bara Kaufman
Boa「d/Comm冊ee Name:Miami Beach Commission for Women lssues
Address:6417 Pinet「ee DrCi「cle, Miami Beach, FL 33141
E-Maii Add「ess:bdkmiami@gma=・COm
Work Phone:Home Phone
CeIIPhone: (305)32仁 P「efer「ed Co両ac† Me†hod:
Vehicle lnfo「ma書ion
GQZD34
Ap坤cqn†Signa†u「e:
a† 1755 Me「idian Avenue, 2nd floor. WorkingPIease provide signed f
hou「s q「e 8:30 †0 5:○○
e-moi書
†he Parking Depar†men† loca†ed
o「em〇両〇・ う ′
OARD & COMMITT龍PARKING APPしICA丁ION -APPしICAN丁NAME
a巾menl Sec
PERMIT SYSTEM GARAGE ACCESS
汗o†ion Dq†e:iD Ca「d Se「ia席;
Pr面Name:P「而Nqme:
Si9nq†u「e:后 Signq†u「e:居
Da†e issued:Da†e Com