Karen Edelstein 12/31/221A1 AMIB
BOARD AND COMMITTEE CHECKLIST
APPONTEE:_Karen EdelSlcin
O AR D /C OM M I T T EE : CM. on he Ho el$$
FOR SCANNER
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DATE OF APPOINTMENT: l±'A -2012
Appointed by. MMy_ DA L E
12/31/22 12/31/29 TERI EN D:_TERM LIMIT:
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F O R C LE R K S T A FF
o Letter of Appointment
o Letter of Reappointment
o CPP}/7$3'5etter of Appointment/Reappointment e-mailed
12/2 1/2 1
o Board and Committee Application (Completed on
o Résumé/Curriculum Vitae 1/4/2022
o Diversity Statistics Reporting (Completed on»
o Oath
to Committee Liaison on
IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
V City Code Ordinance Section applicable to the agency, board or committee
R eceived Jan u ary 7, 20 22 City Code Sections 2-21, 2-22, 2-23, 2-24, 2-25, 2-26, 2-458 and 2-459
O ffice of the C ity Cl erk' 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
t Memorandum - Solicitation by City Board and Committee Members
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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
Received on.
Scanned on:
o Acknowledgment of Financial Disclosure Requirement
O DIVERSITY STATISTICS REPORTING Keep QPy in tile and ORIGINAL for Annual Report.
1-»22 soso X ±¿a, do-l,
Date ~d/ or C~mmittee Member
1/7/2022 Clasea DO'get [reSSed On.....[}y [rp[0y€€, .....
Date Gjly Çlerk's,Office Staft_Initials
1/7/2022 Claaloa D'Kt goat L} Erp]9ye@%, ...
Date City Clerk's Office Staff Initials
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.ACLER\BOARD AND COMMIT TIES DATABASE\CHECKLIST MASTER\BC Checklist 2015 MASTER docx
M IAMI BEACH
City of Miami Beach, 1ZOO Convonlion Conter Drive, Miami Boach, Horida 33139 ywy_miamiboachfl_go
OFFKCE OF THE CITY CIERK, Rafaol E. Granado, City Clerk
Tol: 305.673.7411, Fax. 305.673.7254
Email: CilyClerk@miamibeachll.gov
January 04, 2022
Ms. Karen Edelstein
4955 Cherokee Ave
Miami Beach, Florida 33140
RE: Committee on the Homeless
Dear Ms. Karen Edelstein:
Congratulations! You have been appointed by Mayor Dan Gelberto the above-referenced Board or
Committee, for a term ending: 12/31/2022.
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.
Rafael Granado
City Clerk
cc: Monica Beltran, Parking Director
Janay Guerrero, 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
MIA,MIBE CH
C ity of M iam i Beach, I/0O Convonfion Conter Divo, Miami Boach, florida 33139 we¿y _migm ubeachll gai
OFHKCE O IHE CITY CIFRK, Rafoal E. Granodo, City Clork
1ol. 305.6737411, fox 305 673.72 54
Eral: CINCl ouk@ml amtbooch fl.gov
Oath of Offico
Oath of Civility
and
Acknowlodgements
TO: Ms. Karen Edelstein
RE: Committee on the Homeless
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: 12/31/2022.
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 1st, following the closing
of the calendar year on which I have served.
} Ms. Karen Edelstein
Sworn to and subscribed before me this__/¿__ day of 'JMf., 2022
Caz?gee
chañfos bAaeüG
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.
MIAMI BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beoch, Florido 33139
www,miamibeachfl,goy
OFFICE OF THE CITY CLERK
Email: BC@miamibeachf]_goy
Telephone: 305.673.7411
DIVERSITY STATISTICS REPOR I
£DS f/ 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:
Cl at e
f reem ae
O Other
O I prefer not to answer.
Race/Ethnic Categories:
What is your race?
El African American/Black
[,l Asian or Pacific Islander
Kcaucasian/wite
[]Native American/American Indian
[Other - Print Race. -
L}I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latinola?
l ves
Ao
Llt prefer not to answer.
Do you consider yourself Physically Disabled?
O ve»
êJ ~:refer not to answer this question.
Page 6 of 6
F ACLERSALLRE GOARD AND COMMITTEE AP PLICATION S FINAL DRAF TS\BOARD AND COMMITTEE APPLICATION REG FINAL docx
Updated June 2020
MIAMI BEACH
City of Miami Beach
1700 Convention Center Drive
Mi a mi Beach, Fl orid a 33 13 9
O FFIC E O F THE CI TY C LERK
Email: BC@miamibeachfl gov
Tele ph on e: 30 5 .6 7 3 .7 4 11
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
S T A T E O F F LO R ID A
C O U N TY O F M IA M I-D A D E
l am in comp lian c e wi th th e affi lia tio n requi rem e nt of Miami B each Ci ty Co de S e ctio ns 2-22 (4 ), as (ch eck
(/) al l th at appl y):
/ la m a resid en t of th e C ity of Miami B each for si x m on th s or lon ger.
ores «are.. 312 .47" st±, Míaii tac 33/0
I have an ow ne rsh ip interest (for a m inimu m of six m on th s) in a business est a blis hed in th e Ci ty of
Mi a m i B each (for a mi n im um of six m on th s).
[y am7 e f Py,1f@on
J 1ms,-, J(Sf@ii
lam a full-t im e empl o ye e of a busine ss (for a mi n im um of six m on th s) an d I am base d in an offi ce or
ot her locatio n of th e busi ness that is ph ysi cal ly lo cated in M iami B each (for a mi nimu m of six m on th s).
[[qfe tf [1[[So+
Pys[f, J(St]f@Si»
"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.
U nder penal ti e s of perj ury , I decl a re th at I have read th e for e goin g docum ent and that th e facts state d in it "EZgí. lla Mao2-
Si g nat ú r • Date
Karn {4elk mn
P rinted Na m e
N O TA R Y
S w orn to (o r affi rm ed ) and sub scr ibe d be for e m e, by m ean s of }ph ysic al pre sen c e or o on line nota rization ,
a th aa a Jan u ar y 20 2 2 y _haren Edelstein
(C ity of Miami B ea ch B o a rd/C omm i ttee Member)eeeeseemeeeeeetee .jg., CHARLES J. DAGOSTIN
FL Dr ive rs_Li cen se [j"? wcowussioN # HH 16s7os
Form of id en tificat ion [èi;,{2la.¿is EXPIRES: Decem ber 14, 2025 232;2"A,et @2e a..aoc as
(N O TAR Y SE AL )
Sig na tur e of,N o tary Pub lic
C h ar le s J. D 'A g o stin
X P roduced ID
N am e of N o ta ry , Typ ed , Printed , or Stam ped
1/1 \4$1BEA CH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florido 33139
www.miomibeachfl,gov
OFFICE OF THE CITY CLERK
moil BC@miamibeachfl goy
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)
Ss
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)';" 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. @ é lis Date
' 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
S upervi sor of Elections by 12:00 noon, July 1. Planning Board and Board of Adjustment m emb er s who file their
Form 1 with the County Supervisor of Elections autom at ical ly 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 dis cl osure requirement does not satisfy the State
requirement
Page 5 of 6
F ACLE RSALLREGBOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL. docx
Updated June 2020
SOURCE OF INCOME STATEMENT
Section 2-11 1() of the County Ethics Code requires that certain employees and publc officials fle a financial disclosure Statement on a yearly basis by July 1st
of every year
Olsclosure tor Tax Year Ending Last Name
2020
Flts! Name
N
Mlddle Name/Initial
¢, WAITZ-
Mailing Address - Street Number, Street Name, or P,0. Box
. 44 Ska
City, State, Zlp
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 tle.
Filing as an Employee (check one)
El county [] Public Health Trust E] Municipal:
(Munlcipallty)
Department
Posltlon or Title Employee ID Number
Work address I Work telephone Employment began on/ended on
Filing as a Board Member (check one)
[J county };( Municipal:
(Municipality)
Board where serving
Mirr ML65
Alternate address (lf homo address ls exempt)
MIAMI WACH
Lust below every source of income you received, along with the address and the principal activity of each source. Include your publc 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 It continued on a separate sheet, check here. []
Name of Source of Incomo Address Descriptlon ot the Principal Business Actlvity
MAR¢ D¢Lt I 1 w.44 4. 40 33/40 $Po0 $¢
6LA«p Po1rs ";t, 1L4wd Ave. ± t5,
tr AMT M1 0,2134
(nod Sw5 neshnls 2333 ne de Lon l,
I Ve hwerl +coonf #k too C.4L 3234
I hereby swea,(or affirm) that the information above is a true and correct statement. 7. lli, i.G...oso
Date slgned
RECEIVED BY ELECTIONS DEPARTMENT:
[ Hardcopy
X Electronic Copy
Received January 6, 2022
Office of the City Clerk
REMEMBER TO PRINT. SIGN, AND SUBMIT TO THE OFFICE OF THE CITY CLERK VIA EMAIL OR HARDCOPY
I
//\//4\/N\/\/BE, ']CIYWDE (CW) BOARD COMMITTEES
cw9y cot tent see+, PARKING EPARrMNr PARKING PP[[CATION .. nus
1755 Meridion Avenue, Soito 200/Mi0mi Beach, FL 33139/Ph. (305) 6737505 or (305) 6737000 1 6200 PARKING
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 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 rellect 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.
ACKNOWL EDGEMENT: I ackn owledge 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: K Ye S. del
Board/Committee Name:
Address:
E-Mail Address:
Work Phone:
Cell Phone:
Home Phone
Preferred Contact Method:
Vehicle Information
Tag: N
State:
Make:
Color:
Year:
Model: VAN
Applicont S+nature:
Please provide signed form bo the Parking Department located ot )755 Meridian Avenue, 2d floor. Working
hours are 8:30 1o 5:00 p.m. or email to: ParkingReception@miamibeachfl, gov
e-mail subiet: BOARD & COMMITTEE PARKING APPLICATION -- APPLICANT NAME
p, ·d D rt ar 1na epa men ec ron
PERMIT SYSTEM GARAGE ACCESS
Expiration Dale: ID Card Serial #:
Issued By Print Name. Print Name:
Signature. Signature:
Date Issued. Dote Completed:
tS Ai