Lauren Cohen 12.31.25MI AM I ~EA CH
Scan o
Scan o
BOARD AND COMMITTEE CHECKLIST
APPowTEE:_Lay@n (_poler DATE OF APPOINTMEeNr. 2[2 0
oARDcowrrees llu ral /tadl A oite a yr..Aha ommoQ£
FOR SCANNER FOR CLERK STAFF ) , J
scan o o Letter ot Appointment TERM END: _Bl& l 2I_ TERMLIMrr:. 2]1'2 ,
Scan o o Letter of Reappointment
o_opy, Pf, letter of 'Appointment/Reappointment e-mailed to Committee Liaison on
2]24,2s 1 )
o Board and Committee Application (Completed on,[]2122>
o R~sum~/Curriculum Vitae } I
o Diversity Statistics Reporting (Completed on _]_ y 3
o Oath Scan o
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, 2-2 4, 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 Jul y 2012)
✓Highlights of the Miami-Dade County Ethics Code
C IT Y O F M IA M I B E A C H ✓Sunshine Law and Public Records- Frequently Asked Questions
OFFICE OF T H E CITY CLERK V Memorandum - Solicitation by City Board and Committee Members
RECEIVED
MAR 1 2023
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
o Board and Committees Liaison Responsibilities
O DIVERSITY STATISTICS REPORTING Keep COPY In file and ORIGINAL for Annual Report.
2h i4ls .serer»K aas2o
Date Board or Committee Member
ors or. hi) roses [1
Date City Clerk's Office Staff Initials
l )? err Ke
Date City Clerk's Office Staff Initials
Received on:
Scanned on:
CONCLUDED & RESIGNATION LETTERS
Term Expired Letter Date Processed Initials » t Scan o
Resignation Letter Date Processed Initials Scan o
Removal Letter due to absences Date processed Initials Scan o
1.o'
\ ««.,,r e
i ·· • ·..4 t,,+
F:CLER\BOARD AND COMMIT TIES DATABASE\CHECKLIST- MASTER\B&C Checklist 2015 MASTER.docx
l
i , t ,
We ore committed to providing excelent public service ond solely td oll who live, work, and ploy in our vibrant, topical, historic community.
City of Miami Beach, I/OO Convention Cantor Drive, Miami Beach, Florida 33139 yys_miIIibaachllgo
OFFICE OF THE CITY CLERK, Rafaal E. Granado, Cy Clerk
Tel: 305.673.711, Fax 305.673.7254
Email: Cit/Clerk@miamibeoch fl.gov
February 24, 2023
Ms. Lauren Cohen
880 Lakeview Drive
Miami Beach, FL 33140
RE: Cultural Arts Council
Dear Ms. Lauren Cohen:
Congratulations! You have been appointed by the City Commission to the agency, board or committee
named above for a term ending: 12/31/2025.
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 as they concern your duties, responsibilities, and
requirements as a board or committee member.
Congratulations again and good luck.
7
Ra,~ranado
City Clerk
cc: Monica Beltran, Parking Director
Brandi Reddick, 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
MI A MI B E A CH
City of Miami Beach, I700 Conv a •lion Cantor Drivo, Miami Boach, Florida 33 139 Nu.miamhcachll.go!
OHKE OF TE CITY CIERK, Rafool E. Gran ado, Cy dork
Tl : 305.673.7411, Fax: 305.673.72.54
Emal: CIt/Clord @mlamtbaachll.gov
Oath of Offico
Oath of Civility
and
Acknowledgem en ts
TO: Ms. Lauren Cohen
RE: Cultural Arts Council
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 en ding: 12/31/2026.
To my colleagues and to all of those l 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 bf 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.
Ms. Lauren Cohen
Sworn to and subscribed before me this ?& day 1-k_,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.
··•· I
MIAMIBEACH RECEIVED
Ci ty of Miami Beach
1700 Con vention Center Drive
Miami Beach , Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeach1.gov
Telephone: 305.673.7411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
MAR 1 20723
CITY O F M IAMI BEACH
O FFICE O F THE CITY CL.ERK
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
·) a-that apply):
✓I am a resident of the City of Miami Beach for six months or longer.
wore ar es . 380 Lake9ieo De, Har, Real L 33/k 0 ,
□I have an ownership interest (for a minimum of six months) in a business established in the City of
Miami Beach (for a mi nim um of six months).
[qr]e f 1I[[@S3
[[S[[eS,S, (SJ[eS5
a 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).
[qr]9 (f H3JS[fgSS-
[1[S,[[SS, J(]Sf@S.
"O wn ers hip In terest" m eans th e own ership of ten percen t (10%) or more (including the ownership of
10% or m ore of the outstanding capital stock) in a business.
"B usin ess" m eans any sole proprietorship, spon sorship, corpora tion, limited liability company, or other
en tity or business association .
Under pena ties of perjury, I declare that I have read the foregoing document and that the facts stated in it
eve pp >/\)2
Sign at ure Date
Laa@en Cl ea
Printed Name
NO TARY
Sworn to (or affirmed) and subscribed before me, by means of o physical presence or o online notarization,
o» E"i prod a@ o. )a. A_ @lg
by
(City of Miami Beach Board/Committee Member).
[ »a.co f6 @vi or-
Form of Identification
Gi. ALEN BETANCOURT
l$}i$$% soi ~»#gqS!Ee ls3~] coin«li}@i88rsE ?$ y comm. tires May 1,2016
MIAMI 'BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.,miami beachl,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)
Colen
Last Name First Name Middle Initial
I understand that no later than Jul1, of each year all mem bers of Boards and Committees of the City of Miami
Beach, including those of a purely advisory nature, are required to com ply with Miami-Da de County Financial
Disclosure Requirements.
One of the following form s 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 Statem ent;" or
2. A "Statemen t of Finan cial Interests (Form 1)"" or
3. A Copy of your latest Federal Income Tax Return.
Failure to file one of these forms, pursuant to the Miami-Da de County Code, may subject the person to a fine
of no m o re tha n $500, 60 days in ja il, or both .
. 2/23/23
S ig nature D ate
1 M em b er s of the P la n ning B o ard and B oa rd of A dju stm e nt w ill be notifie d directly by the S tate of Florida,
pu rsua nt to F .S . $112.3145(1)a), to file a S tatem ent of Fina nci al Interests (F o rm 1) w ith the M iam i-D ade C ounty
S u p e rv iso r of E le ctio ns by 12.0 0 noon , Jul y 1. Pl an ning Bo a rd and B oard of A djustm e nt m e m b ers w ho fil e their
For m 1 with the C oun t y S u pervi sor of El e ctions autom at ically sati sfy the C oun t y's financial discl osure
req u irem e nt as a M iam i Be ach C ity Boar d /C om m ittee m em b er and need not file an add itio nal form w ith the O ffi ce
of the C ity C lerk. H ow ever, com p liance w ith the C o unty disclosure req uirem e nt does not satisfy the State
req uirem e nt.
Page 5 of 6
F:\CLER\$ALL\REGIBOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL. docx
Updated: June 2020
MIAMI BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www,miamibeachfl,gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
DIVERSI TY STATISTICS REPORI
Last Name First Name Middle Initial
The following information is voluntary and has no bearing on your consideration for appointment. It is being
asked to comply with City diversity reporting requirements.
Gender:
[Jae
q remale □Other
0 I prefer not to answer.
Race/Ethnic Categories:
What is your race?
D African American/Black
D Asian or Pacific Islander
Ej Caucasian white
D Native American/American Indian D Other- Print Race: _
D I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
LJ ves
Sa o
D I prefer not to answer.
Do you consider yourself Physically Disabled?
ves
9+
D I prefer not to answer this question.
Page 6 of 6
F:\CLER1$ALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
MIAMI BEA CH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeach fl,goy
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(1) (2)
Colen
Last Name
L Alen first Name Middle Initial
I understand that no later than Jul1, 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.
ls. er5=>
Signature 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.
l Page5of6
.
F:\CLER'SALLIREGIBOARD AND COMMITTEE APPLICATIONS FINAL DRAFTSIBOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
//\/AM\[BEACH CwE (CW1 OAR & co0MwnEes
coy cf ii6ri ea«i, PARK@c Dir~ritNr PARKING PPL[CAT[ON
1755 Meridian Avonve, Soito 200/Mimi Beach, FL 33'39/Ph: (305) 673-7505 or (305) 673-7000 ex4. 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 cord 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
d a m age, I will be resp on si bl e to pay a $10.00 repl acem en t fee.
Board Member Information
pate of Aplication: 2') [23
Applicant Name: L«en (Co
Board/com m ittee Name: (%, ·al {ls Cog cl
Address: 3 ke oes> )i v ins z acd FL 32I O
EMail Address L ao«e 6l e,{ l @ «ad. oa
Work Phone: ( 4, 2o0=7}61 1ome Phone-
Cell Ph one: $@)2oo -7\,7 Preferred Contact Method: ,e (l
Vehicle Information
Tag: \ L Color: $\e
State: TL Year: 2o\
M ake: Les M odel: E S 3 o
Applicant S;@nature: 6
Please provide signed torm to the Parking Department located at 1755 Meridian Avenue, 2" floor. Working
hours are 8:30 to 5:00 p.m. or email to: PgrkingReception@miamibeachfl.gov
o-mail subiect: BOARD & COMMITTEE PARKING APPLICATION -- APPLICANT NAME
p, ·kt D S .· ar ina epartment ection
PERM IT SYSTEM G A RAG E ACCESS
Expiration Date: ID Cord Serial #:
lss ued By Print N am e: Print Name:
Signature: 5 Signature:
Dote Issued: Dote Completed: