Danielle Klahr 12/31/23B OARD AM AMITTEE CHECKLIST j
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RECEIVED
JAN 2 6 200
CITY OF MI AM I BEACl
or#ICE OF THE CITY CL ER
FOR CLERK STAFF
o Letter of Appointment
o Letter f Reappointment
o ¡9y 94, 1ele{ $PP8%)enReappointment e-mailed to commit«tee
o art a co mi 4 6id on (completed on. , )
o Resumercaroom vae f0/0/, )3 )/
o Diversity Statistics Reporting (Completed on d---= - /) ç;rl.../ ~
o Oath T 7
Liaison on
Scan O
IMPORTANT INF O R M A TI O N FOR BOARD AND C O MI MA IT T E E MEMIBERS BOOK
✓City Code Ordinance Section applicable to the agency, board or committee
t 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
o Source of Income Statement
Scan O O Acknowledgment of Financial Disclosure Requirement !') f D:RP,lîY STATISTICS REPORT/ G K ep O In file and ORIGINA L for Annual Report.
Received o:_]± /y_/0l a„a oy Sf--=
-...ß%Cs.-- y L/ale 'y-y..y
so I2///202„o» [)ata by
CONCLUDED & RESIGNATION LETTE RS
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 COMMIT TIES DATABASE\CHECKLIST MASTER\B&C Checklist 2015 MASTER.dock
Wee are committed to prodiug excellent pubic service and saiey to al wha live, wark, and play In out vibrant, tropicol, historic community.
C ity of Miami poach, 1ZOO Convention Contar Drvo, Miami Booch, Florida 33 139 www.mlam.hoochll,go
OFFCE OF THE CITY CLERK, Raloal E. Granado, Cay Clark
Tel: 305.673.7411, Fax: 305.673.7254
Email: CyCdarle@mtamlbaachfl.gov
November 09, 2021
Ms. Danielle Klahr
9102 W. Bay Harbor Drive
Bay Harbor Islands, FL 33154
SUBJEC T: Disa bility Aocos s Committoo
Congratulations! You have been reappointed by C om m issioner R icky A rriola to the above referenced,
board or committee named above, 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 appointmenUelection 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. 7 411. Please read the enclosed materials carefully.
Congratulations and good luck.
Regards,
Rafael Granado
City Clerk
cc: Monica Beltran, Parking Director
Valeria Mejia, City Liaison
A TT A C H M E N T S :
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
MI A MI BEA CH
City of Miami each, /OO Convention Colar DOIo, Miami Boach, Florido 3213? www.miamniboachfiggy
OFCE OF THE CITY CLERK, Rafael E. Granado, Cy Clerk
Tel: 305.673.7411, Fax 305.673.7254
Email: Ca#yCdarle@mt amtbeachl.go
Oath of Offico
Oath of Civility
and
Acknowl odgomonts
TO: Ms. Danielle Klahr
RE: Disability Access Committee
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 apoointed 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 thiJ;;-f~ay of/) eÇ-2021
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.
M IA M I BE ACH
City of Mi am i ea ch
1700 Convention Center Drive
Miami Beach, Florida 33139
O FFIC E O F TH E C ITY C LERK
Em ail: BC@m iam i be ach fl g ov
Telephone: 305.673.7411
AEEIDAVII OE AEEIL.IATION ITH THE CITY OE MAMIL BEACH
STATE OF FLORIDA \ _
COUNTY OF M\,a_Dado
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.
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).
Q(' 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).
"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" e true.
Date
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of iX;ysical presence or [J online
otorca«on. 221_a o/o/es 4•
Jg//? (_ _(Ci ty of Miami Beach Board/Committee M em b er ).
k/ere /_rose
Name of Notary, Typed, Printed, or Stamped
(NOTARY SEAL)
gs#iii¿., CHARLES J. DAGOSTIN $? ?? wrcoussoN + HH 16s7o s
j$,9di$ ExPRES: Decem ber 14, 2025 "zig" Bonded mru Notary Public Underwrit ers
M IA M I·• E&SAI + SOURCE OF INCOME STATEMENT
Section 2-11 1(i) of the County Ethics Code requires tat certain employees and public officials file a financial disclosure Statement on a yearly basis by July 1st
of every year.
- -------------~-----------------------------------, Disclosure for Tax Year En ding Last Name First Name Middle Name/initial
, me Kla r Dael II
'ailing Address - Street Number , Street Name, or P.0. Bx
• oà o), ay lle»o D r•
City. State, Zi p [
Ip tteof 3l91
If your hom e address'is your mailing address, and your hom e address is exempt from public records pursuant to Fla. Stat. $119.07, read
inst ru ction s on th e followi ng page an d cho ck Hel o.
Filing as an Employee (check one) ,-
[]county [] Public Heath Trust E] Municipal:
(· ·--------------------------------------------------1
1
0,p,rtmeot
(M unic ipality)
Position or Title Employee ID Number
I Work telephone Em plo ym en t began on/end ed on
Filing as a Board Member (che ck on e)
l .-.
:¡ [_J_· __ co:-u-nt_y_-,- Ef_ IVM_u_ni-ci-pa_1·_. _NJ __ Ì q_c(V\ __ , __ ;..,ß~e..:_°"=_c.=_-~::~::::::::::::::::::::::::::~----,1 -- (M unicip al ity)
Board where serving
------,-----------r ::---:-------c ---:--:----·11 Work telephone Term began on/ended on
I
Alternate address (if home address is exempt )
ist below every source of income you received, along with the addre ss and the principal activity of each source. Include your public salary. Place the sources of
income in descendin g order, with the largest source first. Example s of sources of income include: comp ensation for servi ces, income from business, gains from
property dealings, interest, rents, dividends, pen sion s, IRA distributions, and social security paym ents. Also, include an y source of incom e received by aO[]
person for your benefit. However, the income of your souse or any business partner need not be disclosed If continued on a separate sheet, check here.
! Name of Source of Income Address Description of the Principal Business Activity
I4, p d«") \Lo J«Swirl« Ar calo ;
1$' 5us-i s el, E 3381 .
--- -----·- ·- --- --··-----
t --·- ·-·-·--·· -
I hereb y swear (or affirm ) that th e inform ation above is a true and correct stat em e nt.
closing
lo l asa sala I"
RECEIVED B'.ELECTIONS DEPARTMENT:
a ra#CEI VED
El ectronic Copy
JAN 26 2022
9%£!9w .soc
iE I'yr:Du
M E MEE R TO PRINT. SIG. AN D SUM!T TO TI E OFFICE OF THE CIT CLERK VI A EM AI L OR HARDCOPY.
MIA M\I BE A CH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www .mi ami bea chfl,goy
O FFIC E O F TH E C ITY C LERK
Emai l: BC@miamibeachfl.gov
Telephone: 305.673.7411
BOARD & COMMITTEE EINANCIAL 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 First Name Middle Initial
l understand that no later than July1,@f 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.
Qu 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.
éc?t u
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 of6
F:CLERSALLREGBOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL. docx
Updated: June 2020
MIAM/BEACH
City of Miami Beach
1700 Convention Center Drive
Miomi Beach, Flor ida 33139
www.miamibeachll,gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
DIVERSITY STATISTICS REPORT
Last Name
Dael« ,
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:
Lyate
L.3female
.2 oner
O I prefer not to answer.
Race/Ethnic Categories:
What is your race?
O African American/Black
L) Asian or Pacific Islander
LlC aucasian/wh ite
O Native American/American Indian
O Other - Print Race: ------------ □I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latinola?
Lv»
divo
O I prefer not to answer.
Do you consider yourself Physically Disabled?
2 as
d1 o
O I prefer not to answer this question.
Page 6 of6
F:ICLER\$ALL\REG \BO ARD AN D CO M MI TT EE APPLICATI ON S FINAL DRAFTSIBOARD AND COMMITT EE APPLICATION REG FINAL .docx
U pd a ted : June 20 2 0
, ,[\M/ BEA CH!C W E (C I OARD & COMM«TEES a«, ± ici s.as enraie orins PARKING APPLICATION
755 Meridian Avenue, Suite 200/Miami Beoch, FL 33139/0% (305) 6737505 0r (305) 737000 01. 6200
:
PARKING
\ citywide (CW} pa rking per mi t is hon ore d at metered parking spaces and restricted residen tial zone s
parking spaces. A CW parking permit I NT honored in prohibited areas. An Access Card will be
provided to you for City Hall Garage (G Z) access.
IMPORTANT NOTE: Your veh icle licen se pl ale serves as your "parking permit". In order to avoid
any unnecessary enforcement actions, it is imp ortant that our records rellect the most current ancd
accurate information regar di ng your vehicle license plate. Inaccurate and/or outdated vehicl e
information may lead to the issuance oh parking citation(s] and/or the towing ol your vehicle.
Please note that this new access card CANNOT he hole pun ched or perforated in any manner. To use l
'he new card please hold the card al close proximily to the reader until the gale ope ns. 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: l acknowledge that should my access card le lost, stolen or
clamnage, I will be responsible to pay a $10.00 replacement fee.
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Board Member Information 'ii of ep ic@ñ o; A,, 30 lo9]
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'hours are 8:30 to 5:00 p.m. or em ail to: pgrkingRe cept ion @m a icgrib g achfl.go v
H] e-mail subject: BOARD 8 COMMITTEE PARKING APPLICATION - APPLICANT NAME
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