Samuel Rabin 12.31.24BO A R D A N D C O M M IT T E E C H E C K LIS T
APPOINTEE: Samuel J. Rabin, Jr.
BOARDICOMMIT TEE. Police/Ci tizen s Relation s OTB Appointed by. Mayor Dan Gelber
FOR SCANNER
Scan o
Scan o
to Committee Liaison on
Scan o
Scan o
Scan o
DATE OF APPOINTMENT. 1/31/2023
FOR CLERK STAFF
o Letter of Appointment
o Letter of Reappointment ",f?'y/ 3° " Aomoownanoment ·onto4
o Board and Committee Application (Completed on I
o Resume/curriculum Vitae .] [
o Diversity Statistics Reporting (Completed on Z 2 G
o Oath
re eo. n/3/)24 resow uonr.12/3¥/2o
IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
City Code Ordinance Section applicable to the agency, board or committee RECEIVED • ciy code Sections 2-21, 2-22, 2-23, 2-24,2-25, 2-20, 2-458 and 2-4659
/ County Code Section 2-11.1 -- Conflict of Interest and Code of Ethics Ordinance (as
amended through December 2010) FEB 2,2023 Amendments to the Code of Ethics Ordinance (September 2009 through July 2012)
/ Highlights of the Miami-Dade County Ethics Code
I T OF MIAMI BEACH ' Sunshine Law and Public Records - Frequently Asked Questions
OFFICE OE THE CITY CLERK " 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
Scan o
Scan o
Received on:
Scanned on:
o Source of Income Statement
o Acknowledgment of Financial Disclosure Requirement
o Board and Committe · · · · - ·
W,O,·.'s'··'· ·•··•.·,•.·.· .. ,• .. ·.·.·.· ... ·.·.·.·.·.·.·,··.·.·r>:·/'·''cH•( ,,
O DIVE RSI T Y STATIS
2/2/2 0 2 3
Date
Processed on. 2/2/2023
o,,,,,,,too
Date
O R IGI N AL for An n ual Report.
ember
City Clerk's fice Staff Initials
l?CO? By Employee:'
City Clerk's Office Staff Initials Date
C O N CL U D E D & RE S IG N A TI ON LE T TE R S
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:CL ER\B O ARD AN D COMMITTIES DATABASE\CHECKLIST MASTER\B&C Che ck list 2015 MASTER.docx
MIA IBE
City of Miami Beach, I/OO Convention Cantor Drive, Miami Beach, Florida 33 139 yywy_miamibaachll.gov
OFFICE OF THE CITY CIERK, Raf0al E. Granado, Cy Clerk
Tel: 305.673.7411, Fax. 305.673.7254
Email: Cit/Clerk@miamibeochfl.gov
January 31, 2023
Mr. Samuel Rabin
9 Island Avenue, Apt. 2101
Miami Beach, Florida 33139
SUBJECT;: Police/Citizens Relations Committee
Congratulations! You have been reappointed by Mayor Dan Gelberto the above referenced, board or
committee named above, for a term ending: 12/31/2024.
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.
cc: Monica Beltran, Parking Director
Chief Rick Clements, 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
MI
City of Miami 8each, 7O0 Corn#icon Cantor Drive, Miam i Boah, +lonida 33139 yyw.miamhbeach~i.go:
OFFKE OF IHE CITY CIERK, Rofool E. Granado, Cay dor k
Tl: 305.673.7411, Fax. 305.673.7254
Email: Ci#y/lark, @ioriboschll.gos
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Mr. Samuel Rabin
RE: Police/Citizens Relations 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: 12/31/2024.
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, f · the closing
of the calendar year on which I have served.
Sworn to and subscribed before me this _4_ day 2023
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.
Ml MIB H
City of Miami Beach
17)) Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF TH E CITY CLERK
Email: BC@miamnibeachf].goy
Telephone: 305.673.7411
RECEIVED
FEB 2 2023
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}:
121 I am a resident of the City of Miami Beach for six months or longer.
Home Address Island Avenue, #2101, Miami Beach, FL 33139
□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).
[par9 tf 1 [me8Sr
Hy[[?es J([f@So
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).
[Jam7]e pf J S[m@S5
Hy]m9, (]]for
"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.
care that I have read the foregoing document and that the facts stated in it
2/2/2023
Date
Samuel J. Rabin, Jr.
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me. by means of~al presence or o online notarization.
o.la «(buy023s 5@Goel • .a1,7%
(City of Miami Beach Board/Committee Member).
Produced ID
Form ~f l.d 1tification
_- Personally Known = g l sure oil Sary uiie ) uhrc
;ig... JACQUELINE PAYA
~·f~tf\ .. ~_··._ .. \ .. M .. y .. C .. OMM·· 1SS ION #.GG949890 «Mg!21% 3; TAY"Sf ·%#? pondihil,. yudowrtors
44
Name of Notari, Typed, Printed,for Stamped
MI A H
City of Miami Besch
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfl.gov
OFFICE OF THE CITY CLERK
Em ail: BC@miamibeachfl.gov
Telephone: 305.673.7411
DIVER SITY STATISTICS REPORT
Rabin Samuel J
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:
[0Male
[ remat e
J other
0 I prefer not to answer.
Race/Ethnic Categories:
What is your race?
D African American/Black
D Asian or Pacific Islander
[l Caucasian/white
D Native American/American Indian
L Other - Print Race. •
0 I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
Jes
lo
0 I prefer not to answer.
Do you consider yourself Physically Disabled?
ves
zh o
D I prefer not to answer this question.
Page 6 of 6
F:ICLER\$ALLIREG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
M IAM IBEA H
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www .miam ibeachll.g ov
OFFICE OF THE CIY CLERK
Email: BC@miamibeachfl_gov
Telephon e: 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(1) (2)
Rabin Samuel d
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.
Failure ·
of n
a{+ ruse forms, pursuant to the Miami -Dade County Code, may subject the person to a fine
s in jail, or both.
Date r '
' Memb ers 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:\CLER\$ALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
M I ME
EI
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.
SOURCE OF INCOME STATEMENT
Disclosure for Tax Year Ending I Last Name First Name Middle Name/initial
2022 Rabin Samuel J
Mailing Address - Street Number, Street Name, or P.O. Box
9 Island Avenue Apt 2101
City, State, Zip
Miami Beach, FL 33139
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 here.[]
Filing as an Employee (check one)
[] county □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
Police/Citizens Relations Committee
Alternate address (if home address is exempt) I Work telephone I Term began on/ended on
(305) 358-1064 1/31/2023
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.[l
Name of Source of Income Address Description of the Principal Business Activity
Rabin & Lopez, P.A. 1 SE 3rd Avenue, Suite 2600 Attorney
Miami, FL 33131
" )1hat the information above is a true and correct statement.
-7E;-
Date signed
RECEIVED BY ELECTIONS
[] Hardcoy
) Electromte coy FEB 22023
CI( OF MIAMI BEAC
FRIE O THE CITY CLE!]K
OFFICE USE ONLY Accepted: Y / N Deficiency. Processed Date/Initials: - Scanned Date/initials:.-
138_SP-14 GO 2016
MIAMI BE
City of Miami Beach, PARKI NG DEPART MENT
1755 Meridian Avenue, Suite 200/Miami Beach, FL 33139/Ph: (305) 673-7505 or (305) 673-7000 ex1. 6200
CITYWIDE (CW) BOARD & COMMITTEES
PARKING AP PUCA TION
A cityw ide (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 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 th is 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 lnformation
Date of Application: 2/2/2023
Applicant Name: Samuel J. Rabin, Jr.
Board/Committee Name: Police/Citizens Relations Committee
Address: 9 Island Avenue, Apt 2101, Miami Beach, FL 33131
E-Mail Address: sjr@miamilawyer.com
Work Phone: 305-358-1064 Horne Phone
Cell Phone: 305-905-0502 Preferred Contact Method: Cell
Vehicle Information
Tag: MAL 179 Color: Gray
State: Florida Year: 2017
Make: Model: S550
Applicant Si+nature: €f
Please provide sign d#mm o the Parking Department located at 1755 Meridian Avenue, 2d floor. Working
hours are 8:30 5:00 p.m. or email to: ParkingReception@miamibeachfl.gov
e-mail subiect: BOARD 8 COMMITTEE PARKING APPLICATION -- APPLICANT NAME
Parking Department Section ~-----· ,..,,,.,.,_. ___ ,..,.,,
GARAGE ACCESS PERMIT SYSTEM
Expiration Date: ID Card Serial #:
Issued By Print Name: Print Name:
Signature: e Signat ure: f
Dote Issued: Dote Completed:
rm vp009? $4, e'