Shari Gurkin 12.31.24t
i
B O ARD AN D C O M M IT T E E C H E CKLIS T
S h ari G urkin
APPOINTEE: -----------------
6/28/23
DATE OF APPOINTMENT: -------
G .O . O ve rsight C om m ittee M ayor D an G elber
BOARD/COMMITTEE: Appointed by: _
FOR SCANNER
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FOR CLERK STAFF 12/31/24 J
o Letter of Appointment TERM END: TERM LIrr; (2/31'2
o Letter of Reappointment
o Copy of Letter of Appointment/Reappointment e-mailed to Committee Liaison on
3L11> - o Boar@ and committee Application (completed on _el> l?
o R~sum~/Curriculum Vitae M
o Diversity Statistics Reporting (Completed on 3l12]8
o Oath
RE CE I VE D
AUG 14 2023
CI OF 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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Received on:
Processed on:
Scanned 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 STATI STI CS REPORTING Keep COPY in file and ORIGINAL for An nual Report.
7 /12/23 . . X S hari G urkin ~-· · . .· 1, .~ .
Si gned by Lie+)4fZ.
Date Board or Committee M . ber
\4\3 yr»oyee f/] sf. "7ass
\y l[Pl)/?},
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
F:\CLER\BO A RD AN D CO M M ITT IES DATA BASE\CHEC KLI ST M ASTER\B&C Checklist 2015 M ASTER docx
We are committed to pro viding excellent public service ond safety to all who live, work, and ploy in our vibrant, tropical, historic community.
I
City of Miami Beach, /O0 Convontion Cantor Drivo, Miami Boch, Florida 33139 yyw._iaIihaachllgov
OFFICE OF THE CITY CLERK, Raf0al E. Granado, City Clerk
Tel: 305.673.741, Fax. 305.673.7254
Email: Ci#yClerk@miamiboochfl.gov
June 30, 2023
Ms. Shari Gurkin
6801 Collins Avenue #214
Miami Beach, FL 33141
RE: General Obligation (G.0.) Bond Oversight Committee
Dear Ms. Shari Gurkin:
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 305.673.7411.
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
Raft;-;:;r:ado
City Clerk
cc: Monica Beltran, Parking Director
Maria Hernandez, 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
1 1 !-
City of Miami Beach, /00 Connlon Coner Dive, Miami Bach, Florida 33 139 yyAs_miamibgachll.go
OFFICE OF THE CTY CL ERK, Ralaol E. Granado, Cnty Clerk
Tel 305.673.7411, Fax. 305.673.7254
Email: CiyClerk@mlamibeachfl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Ms. Shari Gurkin
RE: General Obligation (G.O.) Bond Oversight Committee
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: 12/31/2024.
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 0f 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 serve) on July 1st, following the closing
of the calendar year on which I have served.
Sh ari Gurkin
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.
1 A A/] /\A/\l
City of Miami Beach
17 00 Convention Cenler Drive
Miami Beach, Florida 33139
RECEIVED
AUG 14 2023
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
OF FIC E O F TH E C ITY C LERK
Em ail: BC@m iamibeachfl.gov
Telep hon e: 305.673.7 4 11
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (check (/) all that apply):
lE 1am a resident of the City of Miami Beach for six months or longer.
A 6801 Collins Avenue, 214, M iam i Beach, FL, 33141 l [[ ]][3,»
D 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).
[Jam]¢ (T P g [P S S ,
PI[fess JJ][es3,
D 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% (f [1J[[%S3,-
[,[[es,, (Fe,
"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.
Shari G urkin ~ ... •:/IJU, ~ • . <4ls>
Signature
Shari G urkin
7/12/23
Date
Printed Name
City o f M iam i Beach
1700 Convention Center Drive
Miami Beach, Flo rida 33139
www.miamibeach[l.gov
O FFIC E O F THE CITY C LERK
Email: BC@miamibeachfl.qov
Telephone: 305.673.7411
DIVERSITY STATISTICS REPORT
Gurkin Shari A
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:
Lhate
El Female
Lother
0 I prefer not to answer.
Race/Ethnic Categories:
What is your race?
Ll Amican American/Black
0 Asian or Pacific Islander
El Caucasian/white
LO 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?
Yves
l o
D I prefer not to answer.
Do you consider yourself Physically Disabled?
a ve
glo
Ll t prefer not to answer this question.
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F:\CLER1$ALL\REG \BO ARD AND CO M M ITT EE APPLI CATIO NS FINAL DRA FTSIBO ARD AND COMM ITT EE APPLICATION REG FINAL.docx
Updated: June 2020
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City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeach[l.gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
BOARD & COMMIIIEE 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 Mid~ Initial
l 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.
Ong 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,[hap $500, 60 days in jail, or both.
H, la 72r23
Signa~ure W~f-4A~ ,(A~ -D-at_e _
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.
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F:\CLER\$ALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINALdocx
Updated: June 2020
MIAMl·DADE• EI
Clear From Print Form
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 I Last Name First Name Middle Name/initial
2022 Shari Amanda
Mailing Address - Street Number, Street Name, or P.0. Box
7520 SW 59th Place, Unit 1,
City, State, Zip
Miami, FL, 33143
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)
Department
Position or Title Employee ID Number
Work address I Work telephone Employment began on/ended on
Filing as a Board llemb er (check one)
E] county E] Municipal:
(Municipality)
Board where serving
Miami Beach
Alternate address (if home address is exempt) I Work telephone I Term began on/ended on
786-218-5247 6/28/23 - 12/31/24
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.[]
Name of Source of Income Address Description of the Principal Business Activity
Fairstead 250 W 55th St, New York, NY Real Estate
10019
I hereby swear (or affirm) that the information above is a true and correct statement.
Shari Gurkin •~~ ;d. ~ .,,
Signature of Person Dis~ ,___ _
7/12/23
Date signed
c v sY ~@TO %HT
[] Hardcopy
LJ EIectroni4,Ry'14 2023
CITY OF MIAMI BEACH
OFFICE OF THE CI TY CL EP R
REMEMBER TO PHINT, SIGN, AND SUBMIT TO THE OFFICE OF THE CITY CLERK VIA EMAIL OR HARDCOPY.
A A j ,,1 \l;L\ ¥ i
City of Miami Beach, PARKING DEPARTMENT
1755 Meridian Avenue, Suite 200/Miami Bech, FL 33139/Ph: (305) 673-7505 or (305) 673-7000 o4. 6200
CITYWIDE (CW) BOARD & COMMITTEES
PARKING APPLICATION
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 perm it". In order to avoid
any unnecessary enforcement action s, 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 cord. Please ensure you hold the entire surface of the card against the reader
until the gate open s.
ACKNOW LEDGEMENT: I ackn owl edge that should m y access card be lost, stol e n or
dam age, I will be re sp o n sibl e to p a y a $10.00 repl acem ent fee.
Board Mem ber Information
Date of Application:
Applicant Name:
Board/Committee Name:
Address: 6801 Collins Avenue, Unit 214, Miami Beach, FL, 33141
E-Mail Address: shariamanda.gurkin@gmail.com
Work Phone: Home Phone
Cell Phone: 786-218-5247 Preferred Contact Method: Email
Vehicle information
Tag: BM68WZ Color: Black
State: Florida Year: 2024
Make: Mercedes Model: GLE 350
Applicant Sianature: e5
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@miamibechft. gov
e-m ail subiect: B O A RD & C O M MI TTE E PAR K IN G A PPLI CA TIO N - APPLICA N T NAME
p, ·kt D ar mna epartment ection
PERM IT SYSTEM GARAGE ACCESS
Expiration Date: ID Card Serial #:
lssued By Print Name: Print Name:
Signature: Signature:
Date Issued: Date Completed:
s .
or m up !ale