Barbara Herskowitz 10/31/22MIAMI BEACH
BOARD AND COMMITTEE CH ECKL IST bop, ]Roys coated ] / 3)
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o Letter of Reappointment '
o . ~ of et~ Appointment/Reappointment . e-fiaile7d to Committee Liaison on
o o rd an Committee Application (Completed on, [/, 3 _;i,o1. )
• s e cua on vae J/3/32
o Diversity Statistics Reporting (Completed on -- ,
o Oath
FOR SCANNER
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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
t Sunshine Law and Public Records - Frequently Asked Questions
CR" )F MIAMI BEACH Memorandum - Solicitation by City Board and Committee Members
OFFICE OF THE CITY CLERK
RECEIVED
JAN 4- 2022
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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 COPY in file and ORIGINAL for Annual Report.
Received on: Signed y } ,/(24
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Processed on:_¡_Lt_y By Employee:!
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Date
CONCLUDED & RESIGNATION LETTERS
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
F:\CLER\BOARD AND COMMITTIES DATABASE\CHECKLIST MASTER\B&C Checklist 2015 MASTER.docx
WVe are committed to providing excellent public service and safety to all who live, work, and play in our vibrant, topical, historic community.
M AMIBEACH
City of Miami Beach, 1/OO Convention Center Drive, Miami Boach, Horida 33 139 y¿_y_miamnib_achf]_go
OFFKCE OF THE CITY CLERK, Raf0al E. Granodo, City Clerk
Tel: 305.673.741, Fax. 305.673.7254
Email: CitClerk@miamibeachfl.gov
January 03, 2022
Ms. Barbara Herskowitz
4345 Jefferson Ave.
Miami Beach, Florida 33140
RE: Ad Hoc Neighborhood Resiliency Projects Advisory Committee
Dear Ms. Barbara Herskowitz:
Congratulations! You have been appointed by Commissioner Alex Fernandez to the above-referenced
Board or Committee, for a term ending: 10/31/2022.
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 as they concern your duties, responsibilities, and
requirements as a board or committee member.
Congratulations again and good luck.
%2¥
Rafael Granado
City Clerk
cc: Monica Beltran, Parking Director
Amy Knowles, 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)
Booklet - Guide to the Sunshine Amendment and Code of Ethics for Public Officers and Employees
MIAM(BEACH
City of Miami Beach, !ZOO Conven tion Center Drive, Miami Beach, Florida 33139 yywy_miamibeachllgov
OFFICE OF THE CITY CLERK, Ralool E. Granado, CiNy Clerk
Tel 305.673.7411, Fr. 305.673.7254
Email: CiNyClerk.@miamibeachfl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Ms. Barbara Herskowitz
R E : A d Hoc Neighborhood Resiliency Projects Advisory Committee
I do solemnly swear or affirm to bear true faith, loyalty and allegiance to the Government of the United
S tates, the S tate of Florida, and the C ity of M iam i Beach, and to perform all the duties of a member of the
above-m entioned board or com m ittee of the C ity of M iam i B each to w hich I have been appointed fo r a
term ending: 10/31/2022.
To m y colleagues and to all of those I represent and serve, I pledge fa irn ess, integrity and civility, in all
actions taken and all com m unications m ade by m e as a public serv ant.
I have been issued a copy of section 2-11.1 of the M iam i-D ade C ounty C ode (C onflict of Interest and
C ode of Ethics O rdinance), as w ell as Florida C om m ission on Ethics G uide to the S unshine A m endm ent
and C ode of Ethics fo r Public O fficers and understand that as a m em ber of a C ity of M iam i Beach B oard
and/or C om m ittee, I m ust com ply w ith the financial disclosure * requirem ents of M iam i-Dade C ounty or the
State of Florida (depending on the board or com m ittee on which I serv e) on July 1st, fo llow ing the closing
of the calendar year on which I have serv ed.
Sw orn to and subscribed befo re m e this 3 •
*P lease visit the C ity of M iam i B each w ebsite at ww w .m iam ibeachfl.gov under C ity Clerk/B oard and
Com m ittees fo r additional info rm ation regarding the Financial D iscl osure R equirem ents.
MIAMI B EA C H
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Em ail: BC@miamibeachfl.gov
Telephone: 305.673.7411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
STATE OF FLORIDA
COUNTY OF MIAMI-DADE
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4), as (check
(/) all that apply):
✓I am a resident of the City of Miami Beach for six months or longer.
-.sass 15 refs AU
o I 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).
Name of Business _
Business Address _
o I 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).
Name of Business ------------------------
Business Address _
"Ownership Interest" means the ownership of ten percent (10%) 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 stated in it
are 'fe:Lv00 W\ll ~:1- / _ _? / ;i_ .;i__
Signature Date
hAA'\/MA /tE Stoy
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of o physi al o
0
onlin;;;,:~n, s.3,,Jue.23_,„BA, <
x Produced ID
(City of Miari Beach Board/Committee Member).
/_„hyae s Lee
Form of Identification
Name of Notary, Typed, Printed, or Stamped
... CHARLES J. DAGOSTIN }$"jê w cow«s o»ow sos
¿ji},9.sé ERES: Decamber 14, 2025
@;i?" Bonded Thru Notary Public Underwriters
(NOTARY SEAL}
MIAMI BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeacht].gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl_gov
Telephone: 305.673.7411
DIVERSITY STATISTICS REPORT
HIES KA n2 DA A2A s
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:
M ale
Laf emale
O Other
O I prefer not to answer.
Race/Ethnic Categories:
What is your race?
O African American/Black
O Asian or Pacific Islander
Caucasian/white
O Native American/American Indian
O Other- Print Race: _
O I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
ves
a2í
O I prefer not to answer.
Do you consider yourself Physically Disabled?
2ys
N o
O I prefer not to answer this question.
Page 6 of 6
F :\C LE R \$A LL\R E G IBO A R D A N D C O M M ITT E E A P P LI C A T IO N S FIN A L D R A FTS IBO A R D AN D CO M M ITT EE APP LI C ATIO N REG FIN A L.docx
U p d a te d : Ju ne 202 0
M IA M I BEACH
City of Miami Beach
1 700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeach[l, gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305 .673 7411
BOARD & COMMITTEE FINANCIAL ACKNOWLEDGEMENT STATEMENT
Acknowledgem ent 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)
$
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 m ust be fil ed 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.
A J 8 "0ej,- y signature aie
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.
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Updated: June 2020