Sabrina Cohen 12/31/23M IA M I BEACH
BOARD AND COMMITTEE CHECKLIST
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scan o o Letter of Appointment TE RM END://í'/, rRM LuMIr: 'eh l
Scan o o Letter of Reappointment [7)9)$%5 $' -$y%oowrensont, yates, o corones oso o
Scan o o lß.rd and Committee Application (Completed on ~ /;;;-:). )
Scan o o Résumé/Curriculum Vitae 3 J
o Diversity statistics Reporting (Completed on.- L i 3) )
Scan o o Oath
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
RECEIVED amended through December 2010)
✓Amendments to the Code of Ethics Ordinance (September 2009 through July 2012)
✓Highlights of the Miami-Dade County Ethics Code
MAR 14 2022 Sunshine Law and Public Records - Frequently Asked Questions
✓Memorandum - Solicitation by City Board and Committee Members
CITY OF MIAMI BEACH
OFFICE (OF THE CITY CLERK O Citywide Permit Application (Parking Department Form)
o Booklet - Guide to Sunshine Amendment & Code of Ethics for Public Officers and Employees
Scan o
Scan o
Received on:
o Source of Income Statement
O Acknowledgment of Financial Disclosure Requirement
'7 ¡ O DZERSITY STATISTICS REPORTING Keep COPY in file and ORIGINAL to, Annual Report.
í /, 29) .X Á/A • y t' U_Signed by • _3> __
Scanned on:
/77
Processed on: Jv( :)ó'~ By Employee: ---+-7"-~---,ff--.,,e.-~~,::::;_ _ ¿ Date
3 [[/202%e» [ [to _
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 MASTER.docx
We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, histonc community.
M IAM I BEACH
City of Miami Beach, I/0O Con vention Conter Drivo, Miami Boach, Horida 33139 yNw.miamibca chllgov
OFFICE OF THE CITY CLERK, Rof0ol E. Granado, City Clerk
Tol: 305.673.7411, Fax. 305.673.7254
Email: CilyClerk@miamibeachll.gov
January 27, 2022
Ms. Sabrina Cohen
1800 Purdy Ave
Miami Beach, Florida 33139
SUBJECT: Disability Access Committee
Congratulations! You have been reappointed by Commissioner David Richardson 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. 7411. Please read the enclosed materials carefully.
Congratulations and good luck.
ReÄV
Rafael Granado
City Clerk
cc: Monica Beltran, Parking Director
Valeria Mejia, 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 - 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
M IAM I BEACH
City of Miami Beach, 1/OO Convention Cantor Drive, Miami Boach, Horida 33 139 yyw._miamibca chll_go
OFFICE OF THE CITY CLERK, Rofaol E. Gran ado, City Clerk
Tol: 305.673.7411, Fax. 305.673.7254
Emai l: CilyCl erk@mi amibeach ll.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Ms. Sabrina Cohen
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 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. ¢
ii 'od 7T is.Sabrina Cohen
Sworn to and subscribed before me this /'-/ day ot.~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 BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305 .673 .7 411
RECEIVED
MAR 14 z022
CITY OF MIAMI BEA CH
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):
, lam a resident of the City of 'iami Beach for six months or longer.
Home Address 44 , tp,tu
□I have an ownership interest (for a minirhum of six months) in a business established in the City of
Miami Beach (for a minimum of six months).
[[are [ [us[r@SS
[3ys[fess (]]resS
□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 ------------------------
3[s[fes,S [(]]f@SS
"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.
Unden penalties of perjury, I declare that l have read the foregoing document and the : the facts stated in it
aowe C „ /4 2o22
i
Signature Date o
rinted ame
NOTARY
Sworn to (or affirmed) and subscribed before me, by means o~sical presence or o online notarization,
L0%%( _2s, _Solfa ohe.
_________ (City of Miami Beach Board/Committee Member).
Produced ID
Form of Identification
T' CIIARLES J. DAGOSTIN ¿? ? MY COMMISSION # HH 165705
i3; x3 EXPIRES: Dcember 14, 2025
ij5é" ponded Tru Notary Public Underwriters
(NOTARY SEAL)
MIAMl·DADE-
EII 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
First Name > > \
Middle Name/Initial
I I
If your hom e 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 here. D
Filing as an Employee (check one}
[] Municipal:
Department
Position or Title
Work address
Filing as a Board Member (check one}
D County Municipal:
Board where serving
Alternate address (if home address is exempt)
Hess
Work telephone Term beg on/ended on
2022
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.[]
Name of Source of Income Address Description of the Principal Business Activity
D,»»la) LA co €
.
zer:b swear (or af firm ) that the informa=bove is a true and correct statement.
Signature of Person Disclosing
3/// o2 r ,
Date signed
RECEIVED BY ELECTIONS DEPARTMENT:
Xíaraco» RECEIVED □Electro nic C opy
MAR 14 2022
CITY OF MI AMI BEACH
OFFICE (OE TL E I T V rIrov
OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/Initials: Scanned Date/Initials:
138_SP-14 COE 2016
MIAM I BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeach[l.gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305. 673 .7 41 l
DIVERSITY STATISTICS REPORI
Coheu
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:
Male
Female
Other
O I prefer not to answer.
Race/Ethnic Categories:
What is your race?
O African American/Black
L,)Asian or Pacific Islander
LC_l Caucasian/white
O Native American/American Indian
O Other - Print Race: ------------- □I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
g?ge
?cane ans»er
Dor: consider yourself Physically Disabled?
EE:
O I prefer not to answer this question.
Page 6 of 6
F:ICLER\$ALLIREG\BOARD AND COMMITT EE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITT EE APPLICATION REG FINAL.docx
Updated: June 2020
MIAMI BEACH
City of Miami Beach
l 700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachll.gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachf.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 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 )1;" or
3. A Copy of your latest Federal Income Tax Return.
Fail~~~º file one of these forms, pursuant to the Miami-Dade County Code, may subject the person to a fine
"7%/"er« 3////222
Sigi ture 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
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Updated: June 2020
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