Beth Edwards 06/30/22d RM14a 4
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BOARD AND COMMITTEE CHECKLIST /
APPOINTEE: 34 DATE OF APPOINTMENT:
BOARD/COMMITTEE: /!� Appointed by: 9
FOR SCANNER FOR CLERK STAFF
Scan o o Letter of Appointment TERM END: /30/')-4RM LIMIT:
Scan o o Letter of Reappointment
o�Vy ciL aitte of Appointment/Reappointment a-md to Committee Liaison on
Scan o o Board and Committle Application (Completed on,?
Scan o o R6sum6/Curriculum Vitae i
o Diversity Statistics Reporting (Completed on ) p1 --
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 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
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 Requirement
/O DIVERSITY STATISTICS REEPPORTI p COPY' file and ORIGINAL for Annual Report.
Received on: Signed by /0
Date �ard r mi ember
Processed on: k1,P_,3 / By Employee:
I Dat j k's a Staff Initials -
Scanned on: g/ �3 ID" 1 By Employee: Z�r
Date C CIe ffice aff Initials
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
FXLERWARD AND COMMITTIES DATABASE\CHECKLIST MASTERIB&C Checklist 2015 MASTER.docx
t ve ore ccmmi r s ro providincl excellent public service and safety to ail v o live, work, and play in cut vibiont, tropical, historic community.
NAdAtAl BEACH
City .of Miami Beach, )700 C*onvPn9ion C onier i,ive, dA'ami lkoch, Florida 3:� 13��'vws-�.v,miacni{ac��{o�l.cac?v
OFFICE C 'THE CV, CLEW, Rc4ml E. Granudo, Coy Clak
Tel. 305A73.741 1, Fax. 30,5.673.7254
Emil: C:iP @mIam&hfl.goy
August 06, 2021
Ms. Beth Edwards
5900 Collins Ave. #1806
Miami Beach, Florida 33140
SUBJECT: Committee for Quality Education in Miami Beach
Congratulations! You have been appointed to the above -referenced Board or Committee as a
representative for Feinberg Fisher K-8 Center PTA, for a term ending: 06/30/2022.
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 305.673.7411. Please read the enclosed materials carefully.
Congratulations and good luck.
Regards,
Rafael Granado
City Clerk
cc: Monica Beltran, 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
AA1AAA1 BEACH
City of Miami Beach, 1ZOO Canvention Cerner Dive, ANarni Beach, I Iorkk 331:39 www_miomibeochH.ao+r
OFFICE OF THE CMI CLEW, Rafael E. Gramado, City CIA
TL4: 305.673.7411, Fax: 305.673.7254
Email: CilyCtcrkQNniamil eoM.gom
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Ms. Beth Edwards
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: 06/30/2022.
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 1 st, following the closing
of the calendar year on which I have served.
Ms. Beth Edwards
Sworn to and subscribed before me this s-" - day of 2021
D'Agostin
uty Clerk
*Please visit the City of Miami Beach website at www.miarnibeachfi.gov under City Clerk/Board and
Committees for additional information regarding the Financial Disclosure Requirements.
101 1 AM% I B EAC H
Chy of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BCOmiamibeachfl.gov
Telephone: 305.673.7411
F -11.29"I' 4 el Ilk"ea,1111 ra i l LII
STATE OF FLORI A
COUNTY OF
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (check (J) all that apply):
n/I am a resident of the City of Miami Beach for six months or longer.
l9' 1 have an ownership interest (for a minimum of six months) in a business established in the
City of Miami Beach (for a minimum of six months).
VI am a full-time employee of a business (for a minimum of six months) and I am based in an
office or other location of the business that is physically located in Miami Beach (for a
minimum of six months).
"Ownership Interest" means the ownership of ten percent (1091o) or more (including the
ownership of 10% or more of the outstanding capital stock) in a business.
"Business" means any sole proprietorship, sponsorship, corporation, limited liability company,
or other entity or business association.
Under penalties of perjury, I declare that I have read the foregoing document and that the facts
state in ' ar
ee
S. at Daff
Printed Name
NOTARY \ /
Sworn to (or affirmed) and subscribed before me, by means of ❑ physical presence or online
notarization, this I day of,14( 4 S ��� , 20 Eby
L� 4E'd
JJ
W S (City of Miami Beach Board/Committee Member).
Produced ID
Form of Identification
e,?sonall no
Signa ure ofXary4l6blic
Name of Notary, Typed, Printed, or Stamped
(NOTARY SEAL)
Charles J. DAgostin
NOTARY PUBLIC
STATE OF FLORIDA
Comm# GG168171
sN 19�� Expires 12/14/2021
MIAMI BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33134
w9 -w
OFFICE OF THE CITY CLERK
Email: BC(a-).miamibeachfl.gov
Telephone: 305.673.741 1
A
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:
l Male
Female
Other
E�11 I prefer not to answer.
Race/Ethnic Categories:
What is your race?
0 African American/Black
Asian or Pacific Islander
Caucasian/White
Native American/American Indian
Other —Print Race:
1 prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
Z�1 Yes
- No
0 1 prefer not to answer.
Do you consider yourself Physically Disabled?
19LYes
No
I prefer not to answer this question.
Page 6 of 6
F:ICLER\$ALL\REGIBOARD AND COMMITTEE APPLICATIONS FINAL DRAFTSIBOARD AND COMMITTEE APPLICATION REG FINAL.doox
Updated: June 2020
A-4A[BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www. miom ibeachfl.aov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7.41 1
Acknowledgement of fines/suspension for Board/Committee Members for failure to comply with Miaml-
Dade County Financial Disclosure Code Provision Code Section 2-11.1(i) (2)
aaZWAAAJQ� &4�_
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,
Q= 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 or a 0 0 days in jail, r 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.
Page 5 of 6
F:\CLER\$ALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
CearFrom= k Pent Form
MW--- ADE
ei'�T111R, �7 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 Last Name First Na9,,Middle Name Initial
2020 CA a) W's T
Mailing Address – Street Number, Street Na , or P.O. Box
City, Stat
f e/
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 10e.
Filinq as an Employee (check one)
County [:] Public Health Trust E] Municipal:
(Municipality)
Department
Position or Title
Employee ID Number
Work address —]`Work
telephone
Employment began onlended on
Filing as a Board Member (check one)
Countyunicipal: tD6' f t` 1
(Municipality)
Board where serving /
Alternate address (if home address is exempt) Work telephone Ter began onlended on
List below every source of income you received, along with the address and the principal activity of each source. Include your j wblic salary. Place tKe 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 anothp
person for your benefit. However, the income of vour spouse or anv business partner need not be disclosed. If continued on a separate sheet, check here. u
I
hereby §VeaAor aff� jrm)ppt the information above is a true and correct statement.
Signature_9f Person Disclosing
"//Z/
DWAigned
RECEIVED BY ELECTIONS DEPARTMENT:
❑ Hardcopy -", j � -
❑ Electronic Copy
J 2
REMEMBER TO PRINT, SIGN, AND SUBFIAIT TO THE OFFICE OF THE CITY CLERK VIA EMAIL € R HARDCOPY.
Name of Source of Income
Address
Description of the Principal Business Activity
A/6#
I
hereby §VeaAor aff� jrm)ppt the information above is a true and correct statement.
Signature_9f Person Disclosing
"//Z/
DWAigned
RECEIVED BY ELECTIONS DEPARTMENT:
❑ Hardcopy -", j � -
❑ Electronic Copy
J 2
REMEMBER TO PRINT, SIGN, AND SUBFIAIT TO THE OFFICE OF THE CITY CLERK VIA EMAIL € R HARDCOPY.
}.�B EAC H CITYWIDE (CW) BOARD & COMMITTEES
City of Miami Beach, PARKING DEPARTMENT PARKING APPLICATION
1755 Meridian Avenue, Suite 200/Miami Beach, FL 33139/Ph: (305) 673.7505 or (305) 673-7000 ext. 6200
A citywide (CW) parking permit is honored at metered parking spaces and restricted residential zones
parking spaces. A CW parking permit 15 NOT honored in prohibited areas. An Access Card will be
provided to you for City Hall Garage (G7) access.
IMPORTANT NOTE: Your vehicle license plate serves as your "parking permit". In order to avoid
any unnecessary enforcement actions, it is important that our records reflect the most current and
accurate information regarding your vehicle license plate. Inaccurate and/or outdated vehicle
information may lead to the issuance of parking citation(s) and/or the towing of your vehicle.
Please note that this new access card CANNOT be hole -punched or perforated in any manner. To use
the new card please hold the card at close proximity to the reader until the gate opens. You may need
to try the other side of the card. Please ensure you hold the entire surface of the card against the reader
until the gate opens.
ACKNOWLEDGEMENT: 1 acknowledge that should my access card be lost, stolen or
damage, I will be responsible to pay a $10.00 �replacement fee.
Qranrel Maanal.or I.e�nrmnFir,n l-� (0 1n / l/`// t ��
Date of Application: EZ-/ Z
GARAGE ACCESS
Applicant Name: �
ID Card Serial #:
Board/Committee Name:
Print Name:
Address:
Z/
E -Mail Address:40, G( V -n S �to /- CUXt
Work Phone:
Home Phone�-
Cell Phone: r 7—
Preferred Contact Method:
Vmh;elm Infnrmrn#inn
Tag: I T 1_3
/✓3
GARAGE ACCESS
Color:
ID Card Serial #:
State: /
L_
Print Name:
Year:
Z/
Make:
(GL
Date Completed:
Model:
Applicant Signature: -K �6 A Ilf MttZfZ/q,6
Please provide signed form to the Parking Department
located at 1755 Meridian Avenue, 2nd floor. Working
hours are 8:30 to 5:00 p.m. or email to:.ParkingReceDtion@miumibeachfi.gov
e-mail subject: BOARD & COMMITTEE
PARKING APPLICATION — APPLICANT NAME
Pnrkinn n&nnrtmP_nt Srsrtinn
PERMIT SYSTEM
GARAGE ACCESS
Expiration Date:
ID Card Serial #:
Issued By Print Name:
Print Name:
Signature: xt
Signature: -e
Date Issued:
Date Completed:
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