Sidney Goldin 12.31.26MI E
B O A R D A N D C O M M ITT E E C H E C K L IS T
FOR SCANNER
Scan o
APPOJNTEE: f;'//J.N E Y Q0L ~[~~( DATE OF APPOINTMENT: -z/ I /13
soArov cowrreEe Ka7.TL Lael$6"1.ca». (d4 oms4 fen
TERM No: 2(31)2¢
Scan o
Scan o
Scan o
Scan o
RECEIVED
8 7023 FEB
FOR CLERK STAFF
o Letter of Appointment
o Letter of Reappointment "-$}3 $3" ot AomoenvRearomtoont e-mates
o o ar@ ar@ committee Application (completed on_t0 [4/lb6
o R~sum~/Curriculum Vitae ]
o Diversity Statistics Reporting (Completed on if 3
o Oath
TERM uMrr: 1J)TL
to Committee Liaison on
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
✓City Code Ordinance Section applicable to the agency, board or committee
✓City Code Sections 2-21, 2-22, 2-23, 2-24, 2-25, 2-26, 2-458 and 2-459
✓County Code Section 2-11.1- Conflict of Interest and Code of Ethics Ordinance (as
amended through December 2010 )
✓Amendments to the Code of Ethics Ordinance (September 2009 through July 2012)
✓Highlights of the Miami-Dade County Ethics Code
✓Sunshine Law and Public Records - Frequently Asked Questions
✓Memorandum - Solicitation by City Board and Committee Members
Scan o
Scan o
O Citywide Permit Application (Parking Department Form)
o Booklet - Guide to Sunshine Amendment & Code of Ethics for Public Officers and Employees
o Source of Income Statement
o Acknowledgment of Financial Disclosure Requirement
Received on:
Processed on:
Scanned on:
o Board and Committees Liaison Responsibilities
2£, s. g8. s • , s sf$, «2.
O DIVERSITY STATISTICS REPORTING Keep ~QPy in file and ORIGINAL for Annual Report.
",&/aoa%.£ t 1 Date l ~mittee Member
2/4/3 ymtovee ['L
Date City Clerk'~e Staff Initials
__ v_l<IJ_{ _ia By Employee:-----------------
Date City Clerk's Office Staff Initials
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 safe ty to all who live, work, and play in our vibrant, topical, historic community.
City o f Mi a m i B e a c h , L/0O Convanlion Conlar Drivo, Miami Bosh, Horida 33139 yy_1iamilygachf]_gov
OFFICE OF THE CITY CIERK, Ralaal E. Granado, C y Clark
1ol: 305.673.711, Fax: 305.873.7254
Email: CityClotktiamibwech#l.gov
February 03, 2023
M r. Sidney Goldin
5415 Collins Avenue
Miami Beach, Florida 33140
SUBJECT: Health Facilities Authority Board
Dear Mr. Sidney Goldin:
Congratulations! You have been reappointed by the City Commission to the above referenced board
or committee, for a term ending: 12/3 1/2026.
If you are unable to accept this appointment or have any questions, please call the Office of the City Clerk
at305.673.7411.
Please read the enclosed materials carefully. Congratulations and good luck.
R~lly,
..ls ..
City Clerk
cc: Monica Beltran, Parking Director
Allison Williams, 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
C ity of Miami Beach, I/OO Convontion Canter Drive, Miami Poach, Florida 3.3 139 yywy_miaIIhgachll_gov
OFFICE OF THE CITY CIERK, Ralosl E. Granado, Cy Cdork
Tl: 305.673.7411, Fax. 305.673.7254
Email: Ci#yClerk:@mi amibeachfl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Mr. Sidney Goldin
RE: Health Facilities Authority Board
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: 12/31/2026.
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.
keg.kas
Sworn to and subscribed before me this day « {lo ,2023
K eila£
Deputy Clerk
*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 IAM I
City of Miami Beach
1700 Convention Center Drive
Miami Beoch, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673 7411
r)
RECEIVED
FEB 8 2023
CITY OF MIAMI BEACH
OFFICE OE THE CITY CLERK
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
ST ATE OF FLORI DA
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):
- I am a resident of the City of Miami Beach for six months or longer.
Home A @re s, 5157 0 oL {NS y r 33L4 cg
□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).
[]are (f [[neSS_
[[I[Poss J(]foSS
□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).
[]are [ [yg[hes8S
[[S1mess []]reSS
"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
""t«so, hut .. 1/2/40 4 3
Signature T Date l
SgEY GOLDIN
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of~ysical presence or on line notarization,
sf_a.sf ? Se, Colli
_________ (City of Miami Beach Board/Committee Member).
Produced ID
-~ f Fo,m of ldentiflcaflon
-✓-_:~~---------------- s9645te
g3jg. CHAR .Es s. Gosriw
$? d h,? MY co»uuIsso HH 1os7os
2,l!s,is5 ExPRts: December 14, 2025
fjjj? Bon ded Thu Notary Public Underwriters
(NOTARY SEAL)
Name of Notary, Typed, Printed, or Stamped
City of Miami Beach
l 700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfl.gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
DIVERSITY STATISTICS REPORT
Last Name
$/y
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:
sf.
l remate
D Other
El prefer not to answer.
Race/Ethnic Categories:
What is your race?
D African American/Black
Ll Asian or Pacific Islander
ELK Caucasian/white
0 Native American/American Indian
D Other - Print Race: ------------- n prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
[Jves
(9G
t) prefer not to answer.
Do you consider yourself Physically Disabled?
D, al
No
D I prefer 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.docx
Updated: June 2020
M IAM IBE C
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfl.gov
OFFICE OF THE CITY CLERK
Email: 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)
Go LA
Last Name Firs Na 7 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.
ck, #s< sorah' m Date I •
V
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:\CLER\$ALL\REG\BOARD AND COMMITT EE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITT EE APPLICATION REG FINAL.docx
Updated: June 2020
' M IA M l·DA D E.
EIII souncE OF INCOME STATEM.tr
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 Year Ending !Last Name First Name Middle Name/Initial
2022 EG] Goldin Sidney -
Mailing Address - Street Number, Street Name, or P.O. Box
5415 Collins Ave. apt:701
City, State, Zip
Miami Beach Fl. 33140
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.Ll
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 [K tunicipal: ]Wu/ 6eun
(Municipality)
Board where serving
Health Facilities Authority
Alternate address (if home address is exempt) I Work telephone Term began on/ended on
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
Northern Trust Company Deffered Chicago, IL 60680 Banking
Commensation Cccount
Valic Retirement Services Houston, Tx 77253 Retirement Services
Company
I hereby swear (or affirm) that the information above is a true and correct statement.
Signature ot Person Dis;lsi4
..%l a°
RECEIVED BY ELECTIONS DEPARTMENT:
J Har@tcoRECEIVED
[] Electronic Copy
FEB 7 2023
CITY OF MIAMI BEACH
OFFICE+ CITY CLERK
OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/Initials: Scanned Date/initials:
138_SP-14 COE 2016
MIAMI BE C CITYWIDE {CW) BOARD & COMMITTEES
City of Miami Beach, PARKING DEPARTMENT PARKING APPLICATION
1755 Meridian Avenue, Suite 200/Miami Beach, FL 33139/Ph: (305) 673-7505 or (305) 673-7000 e1. 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 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 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:
Applicant Name:
Board/Committee Name:
Address:
E-Mail Address:
Vehicle Inf '
Tag:
State:
Make:
Color:
Year:
Model:
Applicant St+nature: ef
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 & COMMITT EE PARKING APPLICATION - APPLICANT NAME
p, • D ar Ina epartment ection
PERMIT SYSTEM GARAGE ACCESS
Expiration Dote: ID Cord Serial #:
Issued By Print Name: Print Name:
Signature: e Signature:
Date Issued: Date Completed:
5
:«pmng man rar tors cw atdsd&commutees par+g tom.doc