Marc Edelstein 12/31/23B OA RD AN D C O M M ITTEE C HECKLIST
APPOINTEE: Marc Edelstein DATE OF APPOINTMENT: 01/26/22 ----'---"--"-~~----'-~----------
BOARD/COMMITTEE: Transportation/Parking/Bicycle Appointed by: David Richardson
FOR SCANNER
Scan
Scan c
Scan o
Scan
Scan e
FOR CLERK STAFF
o Letter of Appointment
o Letter of Reappointment
o o Y, f t · rj;{'ppointment/Reappointment :.mailed to Committee
'ord an Committee Application (Completed on )
o Résumé/Curriculum Vitae LL ·'ì ¡·
o Diversity Statistics Reporting (Completed on ct:,Jf: r );}- ;;)._.
- O at h
eso e /2/3b >res /2//h2
Liaison on
RECEIVED
JAN 28 2022
CITY O F MIAMI BEACH
OFFICE OF THE CITY CLERK
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
✓Sunshine Law and Public Records - Frequently Asked Questions
✓Memorandum - Solicitation by City Board and Committee Members
Scan O
Scan o
o Citywide Permit Application (Parking Department Form)
o o0klet - 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
01/28/22 Signed by X
[ )] 29 ,,,....,
Processed on: __ -,- __ / By Employee: ----:::-t--:;¡¡,~-:71-77:~~~--::;~,----------
/ #la0- / ) syemotoyee o
Received on:
Scanned on:
Date
CONCLUDED & RESIGNATION LETTERS
- - - -·----~------
Term Expired Letter Date Processed Initials Scan O
Resignation Letter Dato Processed Initials Scan o
----- -- Leuglald-el@r.due- tas:ab@sa Date processed Initials Scan O
f e.+»'«os. „"".. % · . ..» ¿
° a h - .. » « ,
City of Miam i Beach
1700 Convention Center Dive
Miami each, florid0 3313
www_migmibegcht]_gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
DIVERSITY STATISTICS REPORT
Edelstein Marc 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.
r
I Gender:
0 Mate
I
D Female
J ohe
D I prefer not to answer.
Race/Ethnic Categories:
W hat is your race?
D African American/Black
O. Asian or Pacific Islander
] Caucasian/white
D Native American/American Indian
D Other - Print Race: ------------- º I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
O Yes
sJ No
D I prefer not to answer.
Do you consider yourself Physically Disabled?
O Yes
0 o
D I prefer not to answer this question.
Page 6 of 6
F\CLER\SALL\REG BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\OARD AND COMMITTEE APPLICATION REG FINAL.dcx
Updated. June 2020
City o f Mi a m i B e a ch , ?x,:atn Clet Di. ami E«xn, Hlr«du 3!139 g_y_1_ig___L.__cg__]t'y_e
FFKCE OF THE CITY CIERK Rafal E. Cranado, Ciy Cle:k
Isl 305 6737411, Fax 305 673.7254
Email. Cit/Clerk@miomibeachfl.go»
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Mr. Marc Edelstein
RE: Transportation, Parking and Bicycle-Pedestrian Facilities 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 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 hase served. ~
Mr. arc Edelstein
Sworn to and subscribed before me thi~ay of ~022
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-DADE.
EIm SOURCE OF INCOME STATEMENT
Section 2-11.1(i) 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 Last Name
2021 Edelstein
First Name
Marc
Middle Name/Initial
s
Mailing Address - Street Number, Street Name, or P.O. Box
722 W 49 Street
City, State, Zip
I Miami Beach, FL 33140
lí your home address is your mailing address, and your home address is exemp t from public records pursuant to Fla. Stat. $119.07. read
instructions on the following page and check here. []
Filing as an Employee (check one)
[] county D Public Health Trust [] Municipal:
(Municipality)
Department
Position or Title Employee ID Number
Work address I Work telephone Employment began on/ended on
Filing as a Board Member (check one)
[] county E] Municipal: Miami Beach
(Municipality)
Board where serving
Transportation, Bicycle, Pedestrian
Alternate address (if home address is exempt) I Work telephone I Term began on/ended on
(305) 318-2409 01/01/22 12/31/23
ist 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 trom
property dealings. interest. rents. dividends. pensions. IRA distributions. and social security payments. Also. include any source of income received by another
person for your beneíit. However. the income of your spouse or any business partner need not be disclosed. ff continued on a separate sheet, check here.O
Name of Source of Income Address Description of the Principat Business Activity
Island Associates 36 Island Ave #56 Property Management
Miami Beach 33139
Air Age Consulting Services 722 W 49 Street Property Management
Miami Beach 33140
01/28/22
Date signed
RECEIVED BY ELECTIONS DEPARTMENT:
w ar«co RECEIVED =- Electronic Copy
JAN 2 8 2022
CITY OF MIAM I BEA CH
OF FICE OE THE CITY CLER K
OFFICE USE ONLY Acceptd: Y N Deficiency. Processed Date/Initials. Scanned Date/initials
133_S -14 COE 20'€
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florido 33139
OFFICE OF THE CITY CLERK
Email. C @miam.beachfl_gov
Teleph on e: 305.673.7 411
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):
x: I am a resident of the City of Miami Beach for six months or longer.
Home Address 722 W 49 Street -
x 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 Island Associates
Business Address 36 Island Ave Miami Beach 33139
-
X I am a full-time employee oí 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 Island Associates
Business Address 36 Island Ave Miami Beach 33139 ------------
"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.
lare that I have read the foregoing document and that the facts stated in it
01/28/22
Signature
Marc Edelstein
Date
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of6hysical presence or : online notarization,
n s 2 a y ot _haooew/ .202 2 y dl I ---------------------
(City of Mi am i Beach Board/Committee Member).
Produced ID
Form of Identification
ii·. LARRY GONZALEZ f<5$$& woo ñoi«-sow« i nor 3jli5 comm»son + cc sos» e3f wycm. ioires os 18, 1013
onded through Nation al Notary Ms.
· 'ure of Notary Pub lic / ta, codal
(NOTARY SEAL)
Name of Nota y, Typed, Printed, or Stamped
C WI DE (CW) BOARD & COM MI TTEES I.7
co» ·tors er«as Aske oeaero+ PARKING APPLICATION I#ma#
PARKING 755 Meridian Avenue Sue 200/Miami eh, F 33139/P+: {305] 6737505 a7 (305) 573-7000 ¢. 6200
A citywide (CW) parking permit is honored at metered parking spaces and restricted residential zones
parking spaces. A CW parking permit IS N O T honored in prohibited areas. An Access Card will be
provided to you for City Holl Garage (G7) access.
IM PO RTA N T N O TE: 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 piote. 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 CA N N O T 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.
A CK N O W LED G EM EN T: I ack now ledge that should m y access card be lost, stolen or
dam a g e, I will be respo nsib le to pay o $10.00 replacem ent fee.
B o a rd M e m b e r In fo rm a tio n
Date of Application: 01/28/22
Applicant Nome.
- - --
Marc Edelstein
Board/Committee Name:
Transoortation Bicvcle Pedestrian
Address:
- 722 W 49 Street Miami Beach, FL 33140 -
E-Mail Address: medelste@hotmail.com
Work Phone: Home Phone
305-318-2409 305-865-0683
Cell Phone: Preferred Contact Method: u/ok - -
V e h icl e In fo rm a tio n
Ta g : GXJN57 Color:
Silver
State: Year. 2021 FL
Make:
Toyota
Model:
Camr
Applicant Sf+nature:. a
Pl e a se p ro vi d e sig ne d fc e Parki ng D ep o rtm ent lo cated oat l755 M er idi a n Avenue, 2° floo r. Working
hours are 8:30 to 5:00 p.m. or email to: P a rk in g R ecep tion @ m ia m ib ea ch fl.g o y
e -m a il su b je ct : B O AR D & C O M MI TTE E P A R K IN G A P P LIC A TIO N - A P P LI C A N T N A M E
p. ·ki D ar Ina epartment Section
PERMIT SYSTEM GA&AGE ACCESS
Expira tion Date: ID Card Serial #:
lssued By Print Name: Print Name:
Signature:. e Signature: E
Date Issued: Date Completed:
tom updated CA tu
City of Miami Beach
170O Convention Center Drive
Miami Beach, Florido 33139
www_miamibeacht]_gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone. 305.673.7411
BOARD & CQNMIIIEE 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)
Edelstein Marc s
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 Orive,
Miami Beach, Florida, no later than 12:00 noon of July 1, of each year:
1. ASource 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 tl u,1I0 days in jail, or both.
01/28/22
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
FCLERISALLIREGOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.dccx
updated: Jun e 2020