Aimee Kamat 12.31.24M IA M I BEACH
BOARD AND COMMITTEE CHECKLIST
APPoTEE.. _P1Mg~ kt1_ Dr or APPorwEeNr.2[1[23
oArDrcowMrrrEE: Hen /Lt. Aoitea y.. _kq om_mm 1Q9
FOR SCANNER
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FOR CLERK STAFF
o Letter of Appointment
o Letter of Reappointment
o Co1y r Letter of Appointment/Reappointment e-mailed
]3[2> hr]
o Board and Committee Application (Completed on \ (J 18
o Resume/curriculum Vitae ] yJ
o Diversity statistics Reporting (completed on Z]Pf}3
o Oath
rRM eNo. v[>/){ rRM Lurr. (l31hQ
to Committee Liaison on
IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
✓City Code Ordinance Section applicable to the agency, board or committee
RECEIVED ✓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)
FEB 22 2023 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
OFF ICE OF THE CITY CLERK ✓Memorandum - Solicitation by City Board and Committee Members
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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
Received on:
Scanned on:
o Acknowledgment of Financial Disclosure Requirement
o Board and Committees Liaison Responsibilities
O DIVERSITY STATISTICS REPORTING Keep copy +· n
1/¥J3 signed by h_(_J4Wu
Date Board or Committee Member
Processed on: _1,1_/_i_i1_v_3 By Employee: KM _
Datef City ClerkKAl1's Offi e Staff Initials v\l ..l lmp\}, l
City Clerk's Office Staff Initials Date
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 salety to all who live, work, and play in our vibrant, tropical, historic community.
City of Miami Beach, I/OO Convonlion Canter Drive, Miami Bach, Florida 33139 yywy_miamibaachflao
OFFICE OF THE CITY CLERK, Rafaal E. Gran ado, Cy Clerk
Tel: 30 5.673.7411, Fox 305.673.7254
Email: Cit/Cl erk@miamibooch fl.gov
February 03, 2023
Ms. Aimee Kamat
1908 NE 118th Rd
North Miami, Florida 33181-3316
RE: Health Advisory Com mittee
Dear Ms. Aimee Kamat:
Congratulations! You have been appointed by the City Commission to the agency, board or committee
named above for a term ending: 12/31/2024.
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 as they concern your duties, responsibilities, and
requirements as a board or committee member.
Congratulations again and good luck.
Rega~
Rafael Granado
City Clerk
cc: Monica Beltran, Parking Director
Marc Chevalier, City Liaison
ENCLOSURES:
Oath of Office/Oath of Civility/Acknowledgements
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
City Wide Permit Application - (Parking Department Form)
Booklet - Guide to the Sunshine Amendment and Code of Ethics for Public Officers and Employees
M IA M I BEACH
City of Miami Beach, 1Z OO C on von lion Conlor Dr ive, Miami Bo ach , Florida 33 139 yyw _miamibcachflgo
OFFICE OF THE CITY CIERK, Rolool E. Gr an ado, Ci ty Clerk
Tel:. 305.673.7411, Fax. 305.673.7254
Emai l: City Clerk@miamibeachfl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO : M s. Aim ee Kamat
RE: H ealth Advisory Com m ittee
I do solem nly sw ear or affirm to bear true faith, loyalty and allegiance to the Govern ment of the United
States, the State of Florida, and the City of Miam i Beach, and to perform all the duties of a member of the
above-m entioned board or com m ittee of the City of Miami Beach to which I have been appointed for a
term en ding: 12/31/2024.
To my colleagues and to all of those I represent and serve, I pledge fairn ess, integrity and civility, in all
actions taken and all com m unications made by me as a public servant.
I have been issued a copy of section 2-11.1 of the Miam i-Dade County Code (Conflict of Interest and
Code of Ethics O rdinance), as well as Florida Com mission on Ethics Guide to the Sunshine Amendment
and Code of Ethics fo r Public O fficers and understand that as a member of a City of Miami Beach Board
and/or Com m ittee, I must com ply with the financial disclosure* requirements of Miami-Dade County or the
State of Florida (depending on the board or com m ittee on which I serve) on July 1st, following the closing
of the calendar year on w hich I have serv ed. oo .kn Ms. ine karat
Sworn to and subscribed before me this Rday Oh1,e, 2023
Keila Mena Caceres
Deputy Clerk
*Please visit the City of Miam i Beach website at ww w.m iam ibeachfl.gov under City Clerk/B oard an d
C om m ittees fo r additional info rmation regarding the Financial Disclosure Requirements.
M IAM I BE A CH
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
FEB 22 2023
CITY OF MIAMI BE A OFFICE r n \CH HE 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
(/) al l that apply):
□I am a resident of the City of Miami Beach for six months or longer.
b[ff] lf}ff,bi
□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).
[Jar] (f 1 ]f@S-
1S,[es,S, (](]feS-
/1am 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 ot Business. \/\TPQv1 A
susmess Aaares (10 Pp4 e Sour l Pf [Mu,/ F- 333 j
"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 pe
are true.
ies of perjury, I decl re that I have read the foregoing document and that the facts stated in it
awe, 02/;2o
Signature
l±in kn+r
Date
Ried Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means of y physical presence or online notarization,
me [/ day or EE 2 0Z fu at
________ (City of Miami Beach Board/Committee Member).
Produced ID ye Form of Identification EA Si~e of ,Notary Pul lic •
U llin ~ushu2
. JILLIAN GUSTIN
Notary Public
·Fis69ef flortda
e/ Commit'HH267200
Expires 5/23/2026
Name of Notary, Typed, Printed, or Stamped
M IAM I BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
wwow.miamibeachfl.gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.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 Nam e First Nam e M iddle Initial
I und er st and th at no lat er than July 1 o f each vear al l m em bers of Board s and Com m ittees of th e Ci ty of Mi am i
Beach, including those of a purely advisory nature, are required to com ply w ith M iam i-Dade County Financial
Di scl osure R equirem ents.
One of th e follo wi ng form s must be filed wi th th e Ci ty Cl er k of M iam i Beach , 1700 Conv ention Cen ter Drive,
M iam i Beach, Florida, no later than 12:00 noon of July 1, of each year:
1. A "S ource of Incom e Statem ent;" or
2. A "S tatem ent of Financial Interests (Form 1)1;" or
3. A C opy of your latest Federal Incom e Tax R eturn .
Failure to file one of these f rm s, pursuant to the M iam i-Dade County Code, m ay subject the person to a fine
of no m or an $.500, 60 s in jail, or both.
)1u: )0)
Date
1 M em bers of the P lanning B oard and Board of Adjustm ent w ill be notified directly by the State of Florida,
pursuant to F.S . §112.3145(1)(a), to file a Statem ent of Financial Interests (Form 1) w ith the M iami-Dade County
Superv isor of E lections by 12:00 noon, July 1. Planning Board and Board of A djustm ent m em bers who file their
Form 1 wi th the County Superv isor of Elections autom atically satisfy the County's financial disclosure
requirem ent as a M iam i Beach C ity Board/Com m ittee m em ber and need not file an additional form with the O ffice
of the City Clerk. H ow ever, com pliance w ith the County disclosure requirem ent does not satisfy the State
requirem ent.
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f:\CLER\$ALL\REGIBOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
M IA M I BEACH
City of Miami Beach
17 0 0 C o nventio n C enter D rive
M ia m i Bea ch, Flo rid a 33 13 9
www .miamibeachfl,gov
OFFICE OF THE CITY CLERK
E m a il: B C @ m ia m ib e achfl.g ov
Tele p ho ne : 30 5 .6 7 3 .7 4 11
PIYEBSITY STATISTICS REPORT
HA9a
Last Name Fustian 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:
La» L.Jr6male
l oner □I prefer not to answer.
Race/Ethnic Categories:
What is your race?
0 African American/Black
0 Asian or Pacific Islander
0 Caucasian/White □Native American/American Indian /
EH-ot h er - Print Race: G1ST!Np/au_ Astor
D I prefer not to answer. '
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
Bz
D I prefer not to answer.
Do you consider yourself Physically Disabled?
Bx:
D I prefer not to answer this question.
Page 6 of6
F:\CLER\$ALLIREG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL. docx
Updated: June 2020
.a.HA9egg &iii~i iii» SOURCE OF INCOME STATEMENT
Section 2-11.1(@) of the County Ethics Code requires th at certain employees and public officials file a fin an cial disclosure Statem ent on a yearly basis by July 1st
of every year.
D lsclosure for Tax Year Ending
2022
Last Nam e
<AM1 At
First Nam e
A-Jt-1 ~i;,
M lddle Nam e/lnltlal
M allin g Addre ss - Str eet Num ber, Str eet Nam e or P.O. Box
C ity , State , Zip
h/wt Pt 33&/
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. D
Filing as an Employee (check one)
[] county □Public Health Trust [] Municipal:
(Municipality)
D epartm ent
Po sition or Ti tl e Em ployee ID Numb er
Work addres s Work te lephone Em ploym ent began on/ended on
Filling as a Board Member (chock on e)
E] county I~uneat: M\(0 1) 4 ao
(Mun icipality)
B oard where ser ving rH / k r h AIU , (/w t
Al te rn ate addres s (If hom e addres s Is exem pt) I Work te lephone Term began on/end ed 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 her e.L_I
Nam e of So urce of Incom e Addres s Description of th e Prlnclpal Busines s Acti vity
V10v1A [0 o po4 vt 33139 HD #k 1k 4/w{ 2Lu£
9 Sf - c»0tO
I hereby swear (or affirm) that the Information above Is a true and correct statement. ge.kn
Signature of Person Di sclok ing
Date signed
RECEIVE D BY ELECT IONS DEPARTM ENT:
J Hard» gpCEIVED
[] Electronic Coy
FEB 22 2023
CITY O F MIAM I BEACH
CITY CLERK
REMEMBER TO PRINT, SIGN, AND SUBMIT TO THE OFFICE OF THE CITY CLERK VIA EMAIL OR HARDCOPY.
.±..9£4.2/"«#2%2% L
1755 Meridian Avenue, Suite 200/Miami Beach, FL 33139/Ph: (305) 673-7505 or (305) 673-7000 e4. 6200 PARKING
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 (GZ] 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: F 1»
Applicant Name:
Board/Committee Name:
Address:
E-Mail Address:
Work Phone:
Cell Phone:
Vehicle Information
Home Phone
Preferred Contact Method:
Too: 1 vl Color:
State:
Make:
PL Year:
Model:
2010
659
Applicant Sianature: es
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: PgrkingReception@m iamibeachfl .gov
e-mail subiect: BOAR D 8& COMMITTEE PARK ING APPLICATIO N -- AP PLICANT NAME
P, ·ki D rt ar mna epa men ection
PERMIT SYSTEM GARAGE ACCESS
Expiration Date: ID Cord Serial #:
Issued By Prinf Name: Print Name:
Signature: Signature: 5
Date Issued: Date Completed:
t Si "