Robyn Malek 12/31/23M/AMIBEACH
FOR SCANNER
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BOARD AND COMMITTEE CHECKLIST
APPOINTEE: 'F'---olo--r MCt le)c DATEOFAPPOINTMENT: / /1 / v,'::i,-
BoARDrcOMMrrrE: _Mia_La. a±ili _'A66i ea by. {_aciargr /}ex [u ao%«-
ser os/2 ///23a 02 /37 l27
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FOR CLERK STAFF
o Letter of Appointment
o Lett r of R appointment
°[ypy/0f 1e%3"{8PP8%menueaoomment
o Board'and Comni#Ge 'íiication (Completed on/4/1 <
o Résumé/Curriculum Vitae
o Diversity Statistics Reporting (Completed on _g A '' Ct
o Oath
ittee
2
Liaison on
RECEIVED
JAN -6 2022
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
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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
v 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
✓Memorandum - Solicitation by City Board and Committee Members
o Citywide Permit Application (Parking Department Form)
o Booklet - Guide to Sunshine Am endmen t & Code of Ethics for Public Offi cers and Employees
o Source of Income Statement
Scanned on:
o Acknowledgment of Financial Disclosure Requirement
I O DIVERSITY STATISTICS REPOR
Received on: / ~ Zoz, -z-- Signed by X Tf l a]. a,5a7,„...,
Processed on./, /kl9 e oyee: al
922 /20- Employee. (z,2..y
Date -
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nad RIGINAL for Annual Report.
CONCLUDED & RESIGNATION LETTERS
Term Exp ired Letter Date Processed Initials Sca n o
Resignation Letter Date Processed Initials Scan o
Removal Letter due to absences Date processed Initials Scan o
F:\CLER\BOARD AND COMMIT TIES DATABASEICHECKLIST MASTERB&C Checklist 2015 MASTER.docx
M IA MIBEACH
City of Riari Beach, 1700 Convontion Conlr Drive. Wvami Booch, Tlorida 33 139 www.mimutyeochhi,goy
OFFICE OF THE CITY CI ER:X, Rafool E. Gronodo, C.y Clerk
1el: 305.673.7A1I, Fac 305.673.72 54
Emai l. CH Cle rk@ml alboch l.gr
January 04, 2022
Ms. Robyn Malek
1701 sunset harbor drive apt 303
Miami Beach , Florida 33139
RE: Miami Beach Commission For Women
Dear Ms. Robyn Malek :
Congratulations!You have been appointed by Commissioner Alex Fernandez to the above-referenced
Board or Committee, for a term ending: 12/31/2023.
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.
RegaÌJÍ
Raloranado
City Clerk
cc: Monica Beltran, Parking Director
Monica Matteo-Salinas, 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, 2-2 4, 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
MIAMIBEACH
City of Wimmai %each, )700 Corvan#ion Con#or Dive, Miami Boo.h, Florida 33 139 www.miarlbach ll.g o
OFFICE OF TH CITY CIERI, Rafaol E. Granado, Cy Clo
tl: 305.673.7A11, Fa 305.673.7254
Enouil : CH/Cdon l femionlboochfl.go
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Ms. Robyn Malek
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: 12/31/2023.
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.
Sworn to and subscribed before me tt,;n day of 'J..,,~_2 __
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.
MIAMI BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florido 33139
OFFICE OF THE CITY CLERK
Email. BC@miamibeachf 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):
o I am a resident of the City of Miami Beach for six months or longer.
ore aoess 170[Sus± Huh pre hp! }3 ro,r5
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. _
lam 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.
penaltie s of perjury, I declare that I have read the foregoing do
~
Signat 'e
-ac =Ml
NOTARY
Sworn to {or affirmed) and subscribed before m~ me~s ol:,(physical presence or online notarization,
»'1 ,Joys 4a 2.3. Kl /09_LK_
(City of Mia~ Beach Board/Cozittee Member).
X oooceao //he» ce C
¡en ot Identification
lly Known
Si
jg., CHARLES J.D ff1:······ .. \, MY COMMISSION
t ·.: i, ¿is¿ EXPIRES: Docen
i3jj%" Bonded Tru Notary Pe .2 I,a ?aea#ggeese er
¿?A"? wtcous li'i«fis'
È¿j, J,i&é xeres: ecm»r 14, 2025 "jg Bonded mu Notary Public underwriters
Name of Notary, Typed, Printed, or Stamped
MIAMI-. EE
Clear From Print Form
SOURCE OF INCOME STATEMENT
Section 2-11.1(@) 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
2020
Last Name
W\ Le E: Middle Name/initial
Lr'-
Mailing Address - Street Number, Street Name, or P.4. Box
I o 8osl lo Dice
City, State, Zip
13
If your home address is our 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 tl@le .
Filing as an Employee (check one)
□County □Public Health Trust D Municipal:
(Munlelpallty)
Department
Position or Title Employee ID Number
Work address I Work telephone Employment began on/ended on
Filing as a Board Member (check one)
fcounty
(Municipality)
Board where serving
Alternate address (it home address is exempt) 'Work telephone Term began on/ended on
2022- 1»75
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. Ll
Name of Source of Income Address Description of the Principal Business Activity
4o1 B ka 6ad i /0) o-0-1
B, €hua r3# 8
lo ell G
• orcen satos»
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RECEIVED BY ELECTIONS DEPARTMENT:
□Hardcopy RECEIVED □Electronic Copy
JAN -6 2022
CITY OF MIAMI BEACH
OFF ICE OF THE CITY CLERK
"VI 3E, TO PRINT IGN, AND) SUBMIT TO THE OFFICE OF 'HE CITY CLER, VIA EMAIL OR HAR D C O.
M IA M I B EA C H
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfl.gov
OFFICE OF THE CITY CLERK
Email: BC@miamnibeachfl.gov
Telephone: 305.673.7411
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 ti
Middle Initial
I understand that no later than July1, of each vear 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)';" 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 re than $500, 60 days in jail, or both.
Date T /
1 Members of the Planning Board and Board of Adjustment will be notified directly by the State of Florida,
pursuant to F.S. $112.3145(1)(a), to file a Statement of Financial Interests (Form 1) with the Miami-Dade County
Supervisor of Elections by 12:00 noon, July 1. Planning Board and Board of Adjustment members who file their
Form 1 with the County Supervisor of Elections automatically satisfy the County's financial disclosure
requirement as a Miami Beach City Board/Committee member and need not file an additional form with the Office
of the City Clerk. However, compliance with the County disclosure requirement does not satisfy the State
requirement.
Page 5 of 6
F:CL E R\SAL LIRE GIBO AR D AND COMM ITTE E APPLICATIONS FINAL DRAFTSIBOARD AND COMMITTE E APPLICATION REG FINAL.doox
U p da ted : Ju ne 20 20
MIAMI BEACH
City of Miami Bea ch
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfl,gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.goy
Telephone: 305.673.7411
DIVERSITY STATISTICS REPORT
4
Last Name r Nian Middle Initial
The following information is voluntary and has no bearing on your consideration for appointment. It is being
asked to comply with City diversity reporting requirements.
Gender:
Et.
J oner □I prefer not to answer.
Race/Ethnic Categories:
What is your race? □African American/Black
O Asian or Pacific Islander
L} caucasianwite □Native American/American Indian O Other- Print Race: _
O I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
Dyes
LT No
O I prefer not to answer.
Do you consider yourself Physically Disabled?
&:
O I prefer not to answer this question.
Page 6 of6
F:ACLER$ALLREGBOARD AND COMMIT TEE APPLICATIONS FINAL DRAFTS \BOARD AND COMMIT TEE APPLICATION REG FINAL.doc
Updated: June 2020
M IA M I BEACH CITYWIDE (CW) BOARD & COMMITTEES r-111
sr-+««.o r6 sera PARKING APPLICATION l#MA.JI[Il
17 55 Meridion Avenue, Suite 200/Miam i Beach, FL 33139/Ph : (305) 673-7505 or (305) 673-7 000 ex4. 6200 PARKIN
A citywide (CW} parking permit is honored at metered parking spaces and restricted residential zones
parking spaces. A CW parking permit IS NOT honored in prohibited areas. An Access Card will be
provided to you for City Holl 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 cord at close proximity to the reader until the gate opens. You may need
to try the other side of the cord. Please ensure you hold the entire surface of the card against the reader
until the gate opens.
ACKNOWLEDG EMENT: I acknowledge that should my access card be lost, stolen or
damage, I will be responsible to pay a $10.00 replacement fee.
Board Member Information
Date of Application: /
Applicant Name:
Board/Committee Name: Joo
Address: 70I
E Mail Address:
Work Phone:
cell Phone: 305- {16-Y0
Veh
Ta .
State:
Make:
Home Phone 20S->,12-5/237
Preferred Contact Method: Cal]
Color:
Year:
Model:
ol
9
Applicant siaatore: s /la_a
Please provide signed fam to th Parking Department located at 1755 Meridian Avenue, 2d floor. Working
hours are 8:30 to 5:00 p.m. or ema il to: ParkingReception@miamibeachfl.gov
e-m ail subiect: BOARD & COMMITTEE PARKING APPLICATION - APPLICANT NAME
Parkina Department 6 .. -
PERMIT SYSTEM GARAGE ACCESS
Expiration Dote: ID Card Serial #.
Issued By Print Nome: Print Name:
Signature: f Signature: AS
Date lssued: Date Completed:
; wg man rar 1
3 s