Ami Glottmann 12.31.25MIAMI BEACH
BOARD AND COMMITTEE CHECKLIST
Ami Glottmann APPOINTEE: _ DATE OF APPOINTMENr. "[22/23
Culturial Arts Council Dan Gelber - (J A f) BOARD/COMMITTEE: Appointed by:' !'Q-0pi&, LO )
TE RM END:I2 [3 ) h rR M urr:. _p2/31/2o FOR SCANNER
Scan o
Scan o
Scan o
Scan o
Scan o
RECEIVED
1 2023 MAR
CI T Y OF MIAM I BEA CH
OFFICE OF THE CITY CLERK
o Citywide Permit Application (Parking Department Form)
Scan o
Scan o
FOR CLERK STAFF
o Letter of Appointment
o Letter of Reappointment
o Copy @fetter of Appointment/Reappointment e-mailed to
2,Jj4)23 y
o Board and 'Committee Application (Completed on LL Lg[2 2 _)
o R~sum~/curriculum Vitae J J
o Diversity Statistics Reporting (Completed on ,] 23
o Oath
Committee Liaison on
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
o Booklet - Guide to Sunshine Amendment & Code of Ethics for Public Officers and Employees
o Source of Income Statement
Received on:
o Acknowledgment of Financial Disclosure Requirement
o Board and Committees Liaison Responsibilities
O DIVERSITY STATISTICS REPORTING Keep COPYi
28 February, 2023 Am i Glottmann
]][]2] [y J bl fl'l
B rd Date
28 February, 2023
Processed on:ByEmployee./,l,,
Date City, irk's fice Staff Initials
28 February, 2023 ~
an[ed Of.' Ly Erp/0/@€. Flt l
Date City Clerk's Officetaff 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
WVe are committed to providing excellent public service and safety to all who live, work, and play in our vibrant, tropical, historic community.
City of Miami Beach, I/OO Convention Canter Drive, Miami Boach, Florida 33 139 yyw:._Iiamibaachllao
OFFICE OF THE CITY CL ER K , Ralaal E. Granado, Ch y Clerk
Tel: 305.673.741I, Fax: 305.673.7254
Email: Cit/Clerk@miamiboochfl.gov
February 24, 2023
Ms. Ami Glottmann
560 Lakeview Drive
Miami Beach, FL 33140
RE: Cultural Arts Council
Dear Ms. Ami Glottmann:
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.
"R& -..
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
MIAMI BEACH
City of Miami Beach, I/OO Convention Coner Drive, Miami Boach, Florida 33139 yywy.Iiamiboachf.gov
OFFICE OF THE CITY CLERK, Rafaol E. Granado, Ciy Clerk
Tel: 305.673.7411, Fax. 305.673.7254
Email: CiNyClerk.@miamibeachll.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Ms. Ami Glottmann
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 ending: 12/31/2025.
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 ~n July 1st, following the closing
of the calendar year on which I have served. Jli ~-
Ms. Ami Glottmann
Sworn to and subscribed before me 1
o / - fer
*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 BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
RECEIVED
MAR 1 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):
El I am a resident of the City of Miami Beach for six months or longer.
560 Lakeview Drive Home Address _
□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).
Name of Business _
Business Address _
□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).
][of] (of [1IS][Sj
P1JS][S,S, (]f@Si
"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
are true. '
Ami Glottmann (U ,
hat I have read the foregoing document and that the facts stated in it
28 February, 2023
Signature
Ami Glottmann
Date
Printed Name
N O T AR Y ,
Sworn to (or affirmed) and subscribed before me, by means o~sical presence or□online notarization, . P .Per ? lilottau
V
(City of Miami Beach Board/Committee Member).
f [co o_do se
Form of IdentificatlO' ,aeeeneeeeeeeeeemeeee=p
}] giii.., CHARLES J. DAGOSTIN s8" " MY COMMISSION # HH 165705 !> k}i?keg}AS}as EXPIRES: December 14, 2025 [OTARY SEAL)
"j@i Bonded Tru Notary Public Underwriters
Produced ID
Name of Notary, Typed, Printed, or Stamped
M IAMI BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www .miamibeach fl.gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305. 673 .7411
BOARD & COMMITTEE FINANCIAL ACKNOWLEDGEMENT STATEMENT
A c k n o w le d g e m e n t o f fi nes/suspension for Board/Committee Members for failure to comply with Miami-
Dade County Financial Disclosure Code Provision Code Section 2-11.1(i) (2)
Glottmann Ami
Last Name First Name Middle Initial
I un derstan d that no later than July1,of each Vear all member s of Boards and Com mittees 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 $50~Q d~s. in jail, or both.
Ami Glottmann (a ht 28 February 2023
a
Signature Date
' Mem bers 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 of6
F:\CLER\$ALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARDAND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
M IAM I BEACH
City of Miami Beach
1 700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeach~l.gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
Glottmann
DIVERSITY STATI STICS REPORT
Ami
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:
Late
El remale
oner
0 I prefer not to answer.
Race/Ethnic Categories:
What is your race?
D African American/Black
0 Asian or Pacific Islander
El Caucasian/white
Nave American/American Indian
D Other - Print Race: ------------ □I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
Tves
lo
El1 prefer not to answer.
Do you consider yourself Physically Disabled?
lves
R o
D I prefer not to answer this question.
Page 6of6
F:\CLER\$ALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
...999 &ijiiii
clear From Print Form
SOURCE OF INCOME STATEMENT
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 Glottmann Ami
Malling Address - Street Number, Street Name, or P.O. Box
560 Lakeview Drive
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.Dl
Fig as an Employee (check oneo)
[] county □Public Health Trust □Municipal:
(Municipality)
Department
Position or Tltl e Em ployee ID Number
Work addres s Wo rk tel ephone Em ploym ent began on/ended on
Filg as a Board Member (check one)
E] county
Board where serving \. [, A \ f Bado \ho\ /Q Cud
Alternate address (if home address Is exempt) Work telephone
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.LJ
Name of Source of Income Address Description of the Prlnclpal Business Activity
A
I hereby swear o,@(f) that the information above is a true and correct statement. k (las-
Signature of Person Disclosing
L lo,h 3003
Date signed
RECEIVED BY ELECTIONS DEPARTMENT:
LJ Haro RECEIVED
[] Electro nic Copy
MAR 12023
CITY OF MIAM I BEACH
OFFICE OF THE CITY CLERK
REMEMBER TO PRINT, SIGN, AND SUBMIT TO THE OFFICE OF THE CITY CLERK VIA EMAIL OR HARDCOPY.
M IA M I BEACH CITYWIDE (CW) BOARD & COMMITTEES Iii City of Miami Beach, PARKING DEPARTMENT PARKING APPLICATION
1755 Meridian Avenue, Suite 20 0/Miami Beach, FL 33139/Ph: (305) 673-7 505 or (305) 673-7000 ext. 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: 28 February, 2023
Applicant Name: Ami Glottmann
Board/Committee Name:Culturial Arts Council
Address: 560 Lakeview Drive Miami Beach, FL33140
E-Mail Address: amiglottmann@gmail.com
Work Phone: Home Phone
Cell Phone: 306-206-0077 Preferred Contact Method:
Vehicle Information
Tag: GAS WHAT Color: silver
State: FL Year: 2020
Make: [Tesla Model: X
Ami Glottmann
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: ParkingRec eption@m iamibeachfl .gov
e-mail subject: BOARD & COMMITTEE PARKING APPLICATIO N - APPLICANT NAME
Parkina Department Section
PERMIT SYSTEM GARAGE ACCESS
Expiration Date: ID Card Serial #:
Issued By Print Name: Print Name:
Signature: A5 Signature: a5
Date Issued: Date Completed:
• ' ran lI?0s [lKl]VU.IO. VU U la?l ?f «t