Debra Schwartz 12.31.24BOARD AND COMMITTEE CHECKLIST
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BOARD/COMMITTEE: Grasso la e n
FOR SCANNER
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FOR CLERK STAFF
DATE OF APPOINTMENT: (j l (J..tJ oL3
Appointed by.. Fayer 6e(le
reno Beno._p/3l/4 +en unr. 12.[/ o Letter of Appointment
o Letter of Reappointment "74['1'l° " AnointmenvReappointment e-mated to committee
o Board and Committee Application (Completed on_p ] 1
o R~sum~/Curriculum Vitae ,] ,]
o Diversity Statistics Reporting (Completed on 3] [ 'Q
o Oath
Liaison on
RECEIVED
MAR 13 2023
CITY O F 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
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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
Scanned on:
o Board and Committees Liaison Responsibilities p +.Ag,, g_egg22.. q_.__he .coo % $7, ».t e ti 3/ O DIVERSITY STATISTICS REPORTING K nd ORIGINAL for Annual R,er,prt:
/3/93 sore»X
3/8738 Processed on. by Employee. _[s
Drte y Clerks Office Staff Initials
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City Clerk's Office Staff Initials
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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 cormiitd to providing excellent service and safety to all who live, work, and play in our vibrant, tropical, historic community.
MI I IBE
City of Miami Beach, 1/OO Convonlion Canter Drive, Miami Bach, Florida 33 139 ywwy_miamnibaachll go
OFFICE OF THE CITY CLERK, Raf0al E. Granado, Cy Clerk
Tel: 305.673.7411, Fax. 305.673.7254
Email: Ci#Clerk@miamiboochfl.gov
February 21, 2023
Ms. Debra Schwartz
5680 Pinetree Drive
Miami Beach, Florida 33140
SUBJECT: Miami Beach Commission For Women
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 305.673.7 411. Please read the enclosed materials carefully.
Congratulations and good luck.
• City Clerk
cc: Monica Beltran, Parking Director
Monica Matteo-Salinas, 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
City of Miami Beach, 1/OO Convention Conler Drive, Miami Boach, Florida 33 139 yyw._IiariLagchfl_go
OFFICE OF THE CITY CLERK, Rafael E. Gran ado, City Clerk
Tel: 305.673.7411, Fax. 305.673.7254
Email: CityClerk@miamibeoch fl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Ms. Debra Schwartz
RE: Miami Beach Commission For Women
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-m entioned board or com m ittee of the C ity of M iam i Beach to which I have been appointed for a
term ending: 12/31/2024.
To m y 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 m ade by m e as a public servant.
I have been issued a copy of section 2-11.1 of the M iam i-D ade County C ode (C onflict of Interest and
Code of Ethic s Or di n ance), as w ell as Florida Com m ission on Ethics Guide to the Sunshine Amendment
and C ode of Ethics fo r P ublic O ffi cers and understand that as a m em ber of a C ity of M iam i Beach Board
and/or C om m ittee, I m ust com ply w ith the financi al disclosure requi rem ents of Miami-Dade County or the
State of Florida (depending on the board or com m ittee on w hich I serve) on July 1st, fo llow ing the cl osing
of the calendar year on w hich I have serv ed.
Sw orn to and subs cribed before m e tljj
pl ease visit the C ity of M iam i B each w ebsite at w w w .m iam ibeach fl.gov under C ity C lerk/B oard and
C om m ittees fo r additional info rm ation regarding the Financi al D isclosure R equirem ents.
MIAMI
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
RECEIVED
MAR 13 2023
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
C IT Y OF MIAMI B E on ce ii ch»&?}, -. K
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
STATE OF FLORIDA
COUNTY OF MIAMI-DAD E
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4), as (check
( ✓) all that apply):
\ lam a resident of the City of Miami Beach for six months or longer.
or e Aaaress. st&o [helee Dc. /lb3314o
□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).
[]9re (f [[[[eSS
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).
[[are [ [[Jg[neSS
[[S[[es \]]FOSS
"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
are true. 94 ~g} ], ] a 3/3 303
Signature Date 1
D ao.a E_ 5ll«o b2_
Printed Name
NOTARY
Swonso ( oc affirmed) and subscribed befor e me, by means o/;..:;;i,ys;c~I l)'esence or online notarization,
.lava H _Ai, Deluca Shat2
x
(City of Miami Beach Board/C°Jmittee Member). f
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Produced f Lie@ Ce -e ff:;_ $, rcownssro mu nssnos
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Form of Identification "## ontea mni ii~ia4,"$""·202s
Known ay1 :Underwriters
(NOT ARY SEAL)
Signatu
Name of Notary, Typed, Printed, or Stamped
M IA /\/\1 B EA H
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
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 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 to file one of these forms, pursuant to the Miami-Dade County Code, may subject the person to a fine
of no more than $500, 60 days in jail, or both.
d. LL Add.at
sion@re 5 Date L '
1 Members of the Planning Board and Board of Adjustment will be notified directly by the State of Florida,
pursuant to F.S. §112.3145(1 )(a), to file a Statement of Financial Interests (Form 1) with the Miami-Dade County
Supervisor of Elections by 12:00 noon, July 1. Planning Board and Board of Adjustment members who file their
Form 1 with the County Supervisor of Elections automatically satisfy the County's financial disclosure
requirement as a Miami Beach City Board/Committee member and need not file an additional form with the Office
of the City Clerk. However, compliance with the County disclosure requirement does not satisfy the State
requirement.
Page 5 of 6
F:ICLER\$ALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
M IA /V\I B E A C H
C ity of M ia m i Be a ch
1700 Convention Center Drive
Miami Beach, Florida 33139
www .miamibe ach~l.gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
DIVER SITY STATI STICS REP ORI
HA
Last Name First Name Middle Initial
The following information is voluntary and has no bearing on your consideration for appointment. It is being
asked. to comply with City diversity reporting requirements.
G e n d e r:
(J Male
U renale
L oner
D I prefer not to answer.
R a c e /Eth n ic C a te g o ri e s:
W h a t is y o ur ra c e ?
[l African Am erican/Black
Q Asian or Pacific Islander
[Cl Caucasian/white
Ll Native Am erican/Am erican Indian 0 Other- Print Race: _
0 I prefer not to answer.
D o y o u c o n sid er y o urs e lf to be S p a n ish , H ispa n ic, or, Latino/a?
v es
Eo
D I prefer not to answer.
D o y o u c on sid er y o u rs e lf Ph y si cal ly Di s ab le d ?
v» l o
D I prefer not to answer this question.
•
Page 6 of 6
F:CLERI$ALLIREGBOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
MIAMD EE 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
202 20
Last Name
S v
First Name
De ro
Middle Name/initial
Mailing Address - Street Number, Street Name, or P.O. Box
5 .
V@
City, State, Zip
'
or a 33to
lf 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 Work telephone Employment began on/ended on
Filing as a Board Member (check on e)
[] county J woninat: city a£ Md ti_ ea A
(Municipality)
Board where serving
Hai Bach
Alternate address (if home address is exempt) Work telephone Term began on/ended on
0
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 incom e include: compensation for services, income from business, gains from
property dealings, interest, rents, dividends, pensions, IRA distribution s, and social security paym ents. Also, incl ude any source of incom e 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 incom e Address Description of the Principal Business Activity
S.Govt.
Rap.ow«d «we.s
«d Bevva-HGr
I hereby swear (or affirm) that the information above is a true and correct statement.
Signature of Person Disclosing
Date sign l
RECEIVED BY ELECTIONS DEPARTMENT:
[] Hardcopy
[] Electronic Copy
OFFICE USE ONLY Accepted: Y / N Deficiency. Processed Date/initials: Scanned Date/initials:
138_SP-14 COE 2016
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