Beverly Heller 12/31/23MI A MI BE
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BOARD AND COMMITTEE CHECKLIST
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scan o o Letter of Appointment TERM END:'> //__ERM Luu<.: /< /
Scan o o Letter of Reappoin ment 7
o opy of ttery of, Appointment/Reappointment e-mailed to Committee Liaison on PO
o ioarc and 'or (mittee Application (Completed on )
o Resume/cçoarcutoum vtae y) ) / o
o Diversity statistics Reporting (Completed on, > (o _)Jo)
o Oath Scan o
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 201 O)
✓Amendments to the Code of Ethics Ordinance (September 2009 through July 2012)
✓Highlights of the Miami-Dade County Ethics Code
CITY OF MIAMI BEACH ✓Sunshine Law and Public Records - Frequently Asked Questions
OFFICE (OF THE CITY CLERK / Memorandum - Solicitation by City Board and Committee Members
RECEIVED
JAN 26 2022
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Received on:
Processed on:
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 Ann ual Report.
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Date Boar Mer b I 0-::; d"Ô~y Employee: --+-~,.(;,£.---,---,..L-:__.....,,¿.:__ _ y )-o 20a;pento»yee: i t l
ate
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 MASTERdocx
M IB
City of Miami Beach, I/OO Convention Center Drive, Miami Booch, Honda 33 139 ya¿yy_Iiaribgachf]_go
OFFICE OF THE CITY CLERK, Rofool E. Granado, Ciy Clerk
Tel: 305.673.7411, F0x. 305.673.7254
Email: CityClerk@miamiboachfl.gov
January 25, 2022
Ms. Beverly Heller
5916 LaGorce Dr
Miami Beach, Florida 33140
SUBJECT: Committee for Quality Education in Miami Beach
Congratulations! You have been reappointed by Commissioner Steven Meiner 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 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. 7 411. Please read the enclosed materials carefully.
Congratulations and good luck.
Regards,
!,~- ~-·-·· 3.
Rafa'ff!f£
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 - Am endment 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
MIAMI B
City of Miami Beach, ZOO Convention Cenlar Drive, Miami Boach, Honda 33139 y¿ywy_miamniLggchf_go
OFFICE OF THE CITY CLERK, Raf0ol E. Granado, City Clerk
Tel: 305.673.7411, Fax. 305.673.7254
Email: CiyClerk@miamibeochfl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Ms. Beverly Heller
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: 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.
rissh !±!yu
•Beverly Heller
Sworn to and subscribed before me this ·
*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.
MIAMIBE 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
RECEIVED
JAN 26 2022
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
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):
V I am a resident of the City of Miami Beach for six months or longer.
Home Address. SLL La éos Dre
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 ne E [ oye_S'y \le_( tr2y2
Signature T -- Date
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means o·~sical presence or o online notarization,
this day of , 20 by _
(City of Miami Beach Board/Committee Member). @messes og gijöç., CHARLES 4. DAGosTN
¿$ À" "? wcoussoN # HH 16s7os
j,J9,¿j sens: Donor 14,202s
""};¡á" ponded Tu Notary Public Underwriters ti4
Produced ID
·,/ ~ Form of Identification - sora«con otay±acot e (NOTARY SEAL)
Name of Notary, Typed, Printed, or Stamped
MIAMl·DADE-
EII 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 Vear Ending Last Nam e
2021
First Nam e
3ve
M iddle Nam e/Initial
M ailing Address - Str eet Num ber, Street Nam e, or P.O. Box
5/, Pe
City, State, Zip
N [ tu
If your hom e address is your m ailing addre ss, and your hom e address is exem pt fro m public records pursuant to Fla. Stat. §119.07, read
instructions on the follow ing page and check here. D
Filing as an Employee (check one)
[] county □Public Health Trust [] Municipal:
(M unici p ality)
Departm ent
Position or Title Em ployee ID Num ber
W ork address I W ork telephone Em ploym ent began on/ended on
Filing as a Board Member (check one)
[] count y [XX M unicipal: TA o E (haos aae
í (M un icip ality)
Board w here serving
CQUoLt4 EDUAT0»
Altern ate addre ss (if hom e addre ss i s exem pt) I W ork telephone I Term ~an on/ended on /V0o2
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 separa te sheet, ch eck her e.[]
Nam e of Source of Incom e Addre ss Description of the Principal Business Activity
2tc le D --t·-· £ >.
I here by sw ear (or affi rm ) that the inform ation above is a tru e and corre ct statem ent.
Si gn ature of Person Discl&sing
Date signed
RECEIVED BY ELECTI ON S DEPARTMENT: □Hardcopy Ht:Lit:IVED
[] Electronic Copy
JAN 26 2022
CITY OF M IAM I BEACH
OFFICF OE TJE IT CLERK
OFFICE USE ONLY Accepted: Y / N Deficiency: Pro cessed Date/Initials: Scanned Date/Initials: _
138_SP-14 COE 2016
/V\IA M IB
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfl,goy
OFFICE OF THE CITY CLERK
Emoil: BC@miamibeachfl.gov
Telephone: 305. 673 .7 411
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)
/Et&re-
Last Name First Name
B,gage)
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 )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. ±est4 Hlesn-
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:IC LER \$A LL\RE G \B O A RD A ND CO M M ITT E E A P P LI C A TIO N S FIN A L D RA FTS\BO A RD A ND C O M M ITT E E A P P LI C A TIO N RE G FI NAL .d ocx
Updated: June 2020
MIAMIBE H
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 331 39
www_miamibeach[]_gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
DIVERSITY STATISTICS REPORT
Last 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:
LlMale
Xl remale
Ll oner
O I prefer not to answer.
Race/Ethnic Categories:
What is your race?
O African American/Black
O Asian or Pacific Islander D 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?
Tves
E4No
O I prefer not to answer.
Do you consider yourself Physically Disabled?
lves
h o
tl ¡ refer not to answer this question.
Page 6 of 6
F:\CLER\$ALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.dccx
Updated: June 2020
/\/\IA/V\I CITYW IDE (CW) BOARD & COMMITTEES
City of Miami Beach, PARKING DEPARTMENT PARKING APPLICATION
1755 Meridian Avenue, Suite 200/Miami Beach, FL 33139/Ph: (305) 6737505 or (305) 673-7000 ex4. 6200
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 enlorcement 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: 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: +
d\ 2->
Applicant Nam e: Batel
Board/Committee Name: Cocho
Address: <°
E.Mail Address:
Work Phone:
' ILoo ,C or
Hom e Phone3 SL41S 3
cell Phone·aos, 21(l, Preferred Contact Metheg;( <(
Vehicle Information
Tag: Ht€( Color: a s uve,
State: Lo\ Year: 9 2o 13
Make: Nu«A Model: ¡/S54
Applicant Sianature: e
Please provide signed form to the Parking Department located at 1755 Meridian Avenue, 2d floor. Working
hours are 8:30 to 5:00 p.m. or email to: ParkingReception@miamibeachfl.gov
e-mail subject: BOARD & COMMITTEE PARKING APPLICATION - APPLICANT NAME
p, ·d D ar Ina epartment ection
PERMIT SYSTEM GARAGE ACCESS
Expiration Date: ID Card Serial #:
Issued By Print Name: Print Name:
Signature: € Signature:
Date Issued: Date Completed:
s
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