Miriam Haskell 6.30.24MIA IB
BOARD AND COMMITTEE CHECKLIST
APPOINTEE:
ti
July 2023
DATE OF APPOINTMENT:
iii
Quality Education South Pointe Elementary
BOARD/COMMITTEE: ppointed by. _.
Miriam Haskell
FOR SCANNER
Scan o
Scan
Scan o
Scan o
Scan
FOR CLERK STAFF
o Letter of Appointment
o Letter of Reappointment
c .. Cop[ of Letter of Appointment/Reappointment e-mailed
3 13 I ] o Board a@ committee Application (completed on S_ [,23
R~sum~/Curriculum Vitae ),,J
o Diversity Statistics Reporting (Completed on -/»)l3
Oath
rRM o: Q[30/z4 reRw tour. - l0)y
to Committee Liaison on
IMP ORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
City Code Ordinance Section applicable to the agency, board or committee
RECEIVED Y 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)
JUL_ -6 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 Y Sunshine Law and Public Records - Frequently Asked Questions
OFFICE OF THE CITY CLERk Memorandum - Solicitation by City Board and Committee Members
Scan O
Scan O
Received on
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.
10ly 6, 2023 _ X
• }j[]} )\ gs lb«-
Date Board or Committee Member
July 6, 2023 /)
Processed on By Employee: l_v'_L-
Date City Clerk's Office Staff Initials
Joly 6, 2023 {/\
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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
FCLERIBOARD AND COMMIT TIES DATABASE\CHECKLIST MASTER\B&C Checkl ist 2015 MASTER docx
MIAMI BEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139 www .miamibeachfl.gov
OFFICE OF THE CITY CLERK, Rafael E. Granado, City Clerk
Tel: 305.673.7 411, Fax: 305.673.7254
Email: CityClerk@miamibeachfl.gov
July 5, 2023
Miriam Haskell
800 Lenox Avenue Apt. 4
Miami Beach, FL 33139
RE: Committee for Quality Education in Miami Beach
Dear Ms. Haskell,
Congratulations! You have been appointed to the above-referenced Board or Committee as a
representative for the South Pointe Elementary School PTA, for a term ending on 06/30/2024.
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.
Regards,
Rallado
City Clerk
cc: Monica Beltran, Parking Director
Dr. Leslie Rosenfeld, City Liaison
ENCLOSURES:
Oath of Office/Oath of Civility/Acknowledgements
City Code/Ordinance section applicable to agency, board or committee
City Code Sections 2-22, 2-23, 2-24, 2-25, 2-26, 2-458 and 2-459
Ordinance No. 2006-3543 - Am en dment 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
We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community.
OFFICE OW IHE CITY CIERK, Rolool £. Gronodo, Cay Cloud
1al. 305.673.7411, fox. 305.673.725a
Emal: CiyClark. @miamtbeochfl. go
Oath of Office
Oath ot Civility
and
Acknowledgements
TO: Ms. Miriam Haskell
RE: Committee for Quality Education in Miami Beach
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: 06/30/2024,
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 Gulde 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.
Haskell
o° Swor to and subscribed before me this _"
'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
City of Miami Beach
1700 Convention Center Drive
Miami Florida 33139
RECEIVED
JUL -6 2023
CITY OF MIAMI BEACH
OF FICE OF THE CITY CLERK
OFFICE OF THE CITY CLERK
Em ail: BC@miamibeachfl. gov
Telep h on e: 30 5.6 73.7 4 11
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH AND THE COMMITTEE
FOR QUALITY EDUCATION IN MIAMI BEACH
As a voting member of the Committee for Quality Education in Miami Beach, I am in
compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4) and
2-190.137 as.
[] tam a City of Miami Beach resident for six months or longer.
800 Lenox Avenue, Apt. 4, Miami Beach FL 33139
Home Address.
oooooooooooooooooooooooooooooo~
23-24
fly 1am the parent/guardian of a student attending a Miami Beach school for the school
year.
South Pointe Elementary School
School:---------------~------------
Under penalties of perjury, I declare that I have read the foregoing document and that the facts
st in it are true.
6/28/23
Signature
Miriam Haskell
Date
Printed Name
I
City of M iami Beach
1700 Convention Center Drive
Miami Beach, Florido 33139
www.miamibeachtl,goy
OFFICE OF THE CITY CLERK
Emai l: BC@miamibeachf gov
Telephone: 305.673.7411
DIVERSITY STATISTICS REPORT
Haskell Miriam
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:
LCJae
[J remate
.Joe
El prefer not to answer.
Race/Ethnic Categories:
What is your race?
[]Attican Am erican/Black
DJ Asian or Pacific Islander
DJ Caucasian/white
0 Native American/American ~ian _v:1,. ·
[]other --Print Race: Uhir_y/AL.tttt 6r-
EM prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
[Ive
ho
L prefer not to answer.
Do you consider yourself Physically Disabled?
ave
Ga o
Ll prefer not to answer this question.
Page 6 of6
F CLER!SALL'REG BOARD AND COMMIT TEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.d0cX
Updated. June 2020
MI A/l
City of Miami Beach
1700 Convention Center Drive
Mi ami Beach, Florida 33139
www.mi amibeachfl.gov
OFFICE OF THE CITY CLERK
Email: BC@miamubeachf.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)
Haskell Miriam
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)';" 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 7 ~. m;e t .. h.· an.$ .. 50~.~60 days in jail, or both.
d a]tu/
Signature Date
' 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 of6
F CLERISALL\REG BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS:BOARD AND COMMIT TEE APPLICATION REG FINAL dOcx
Updated: Jun e 2020
SOURCE OF INCOME STATEMENT
Section 2-11.1(i) 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 Haskell Miriam
Mailing Address - Street Number, Street tame, or P.0. Box
800 Lenox Avenue Ap t 4
City, State, Zip
Miami Beach FL 33139
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)
[7 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 Memb er (check one)
[J county E] Municipal: City of Miami Beach
(Municipality)
Board where serving
Quality Education Committee
Alternate address (it home address is exempt) [ Work telephone I T,'.:rm began on/ended on
I fl, 203
t
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 ot sources ot 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.L_J
Name of Source ot Income Address Description of the Principal Business Activity
Community Justice Project 3000 Biscayne Blvd, Suite 106 Legal non-profit (staff attorney)
Miami FL 33137
I hereby swear (or affirm) that the information above is a true and correct statement.
I (siGr ierson isclosio
Date signed
cw sY 44Ry!ENT
[] Hardcopy
tectonic f(9p -6 2023
CITY OF MIAMI BEACH
OFFI CE OF THE CITY CLERK
REMEMBER TO PRINT, SIGN, AND SUBMIT TO OFFICE OF THE CITY CLERK VIA EMAIL OR HARDCOPY.
!··. n .. · .... · .. ·.··•.r.-.·.· . IH} IL..
City of Miami Beach, PARKING DEPARTMENT
CITYWI DE (CW) BOARD & COMMITTEES
PARKING APPLICATION
1755 Meridian Avenue, Suite 200/Miami Beach, FL 33139/Ph. (305) 6737505 or (305) 673-7000 et. 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 (GZ) access.
IMPORTANT NOTE: Your vehicle license plate serves as your "parking permit". In order to avoid
any unnecessary enforcemen t 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 ot 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 en sure you hold the entire surface of the card against the reader
until the gate opens.
ACKNOWL EDGEMENT: 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: July 6, 2023
Applicant Name: Miriam Haskell
Board/Committee Name: Quality Education
Address: 800 Lenox Avenue Apt 4 Miami Beach FL 33139
E-Mail Address: miriamhaskell@gmail.com
Work Phone: 9127134942 Home Phone 9127134942
Cell Phone: 9127134942 Preferred Contact Method: phone
Vehicle Information
Tag: IQFEH9? Color: Grey
State: Florida Year: 2013
Make: Toyota Model: Prius
Applicant sea r. /
Please provide signed form to the Parking Department located at 1755 Meridian Avenue, 2" floor. Working
hours are 8:30 to 5.00 p.m. or email to: ParkingReception@miamibeachfl.gov
e-mail subject: BOARD & COMMITTEE PARKING APPLICATION - APPLICANT NAME
Fgrking bepar?rent section•
PERMIT SYSTEM GARAGE ACCESS
Expiration Date: IDCard Serial #:
Issued By Print Name: Print Name:
Signature: Signature:
Date Issued: Dote Completed: