Amy Ostroff 6.30.24City of M iam i Beach , 17OO Convention Center Drive, Miami Beach, Florida 33139 ywwwymiamibeachll.gov
OFFICE OF THE CITY CLERK, Rafael E. Granado, City Clerk
Tel: 305.673.7411, Fax: 305.673.7254
Email: CityClerk@miamibeachfl.gov
August 18, 2023
Amy Ostroff
4524 N Michigan Ave
Miami Beach, FL 33140
RE: Committee for Quality Education in Miami Beach
Dear Ms. Ostroff,
Congratulations! You have been appointed to the above-referenced Board or Committee as a
representative for the North Beach Elementary 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,
ael Granado
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 - 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
We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community
MIAMIBEA CH
City of Miami Beach, 1/0O Cov ention Color DNo, Monl oh, Hord, 33 139 ywy,_mlamibochll.1?:
OFHT O TH CITY CIERX, Rafail E. Grarodo, Cay Clod
Tl, 305.673.7411, fer 305.673.7254
fmal: Ceded hriamtbsochll gov
Oath of Office
Oath of CIlllty
and
Acknowledgements
TO: Ms. Amy Ostroff
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 tor a
term ending: 06/3012024.
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 Floflda (depending on the board or committee on which I servo) on July 1st, following the~los1ng
of the calendar year on which I have served
wt !
Sworn to and subscribed before mo this J2_ day of ;n.-"--1.1..,•y~3
'Please visit the City of Miami Beach website at www.miamibeachf\.gov under City Clerk/Board and
Committees for additional information regarding the Financial Disclosure Requirements.
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M IAM I BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florido 33139
OFFICE OF THE CIY CLERK
Email: BC@miamibeach[_go
Telephone: 305.673.7411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH AND THE COMMITT EE
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 requireme nt of Miam i Beach City Code Sections 2-22 (4) and
2-190.137 as:
[B} 1am a City of Miam i Beach resident for six months or longer.
voe.as '45a4 M, [uhuoan ll&nu
d1 am the parent/guardian of a student attending a Miami Beach school for the83~ JY school
year.
-. N Ah Bea ch {lmeat/
U nd er pe n altie s of perju ry , I declare tha t I have read the fo reg o in g d o cument and that the facts
st ·din it are, u
Si Date
Printed Nale
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City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florido 33139
OFFICE OF THE CITY CLERK
Email: 2gr-___.:l
Telephone: 305 673.7411
DIVERSITY. STATISTICS. REPORT
Ostroff Amy C
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:
[Male
El remale
loner
D I prefer not to answer.
Race/Ethnic Categories:
What is your race?
D African American/Black
Asian or Pacific Islander
[) Caucasian/white
D Native American/American Indian oner- Print Race: _
D I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latinola?
ves
Ho
D I prefer not to answer.
Do you consider yourself Physically Disabled?
Oves go
D I prefer not to answer this question.
Page 6 of6
F:CLER SALLIREGBOARD AND COMMITTEE APPLICATIONS FINAL DRAFTSBOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated:. June 2020
I A /I BE A CH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
-w.miomibeochf.go:
OFFICE OF THE CITY CLERK
Email: BC@miamibeach[_g2y
Telephone: 305.673.7411
BOAR D, & COM MIIIEE. FINAN CIAL ACKNOWL EDGEMENT 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)
Ostroff Amy C
Last Name First Name Middle Initial
l understand that no later than Jul1of each ear 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 ' ·in jail, or both.
Si
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:ACLERISALLREGIBOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
r, ()
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 .....
MlddleName/lnltlal Dlsclosure for Tax Year Ending I Last Name FIrst Name
2022 Ostroff Am y C
Malling Address - Street Number, Street Name, or P.0. Box
4524 N. Michigan Ave
CIty, State, zlp
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. 5119.07, read
instructions on the following page and check here. Ll
Fling as an Employee (cbeck one)
[] county □Public Health Trust [] Municipal:
(Munlclpallty)
Department
Position or Title Employee ID Number
Work address -, Work telephone Employment began on/ended on
Fling as a Board Member (cbeck one)
I] county Municipal: Murr« B«cc(
Board where s
(Municipality)
CO0o
Work telephone Tenn began on/ended on
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 n 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
for our benefit. However, the income of your spouse or any business partner need not be disclosed. If continued on a separate sheet, check here.[]
I hereby swear (or affirm) that the [formation above is a true and correct statement
Date signed
RECEIVED BY ELECTIONS 9EPAJMENT:
LJ Haracopy VE:GE:lVED
[] Electronic Copy
MAR 13 2023
CITY OF MIAM I BEACH
OFFICE OF THE CITY CLERK
OFFICE USE ONLY Accepted: Y I N Deficiency.
138_SP-14 COE 2016 -------- Processed Dat /I T I ate/intttals: Scanned Date/initials:
l '- f,, CITYWIDE (CW) BOARD & COMMITTEES •
cw st er »«a. so oisror PARKING APPLICATION x~~G
1755 Mendion Avenue, Soie 200/0i Beach, FL 33139/Ph: (305) 673-7505 or (305) 673.7000 ea. 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 Cily 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 reAect 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: 0la\a% - Applicant Name: Am y Ostroff
Board/Committee Name: Quality Education Committee
Address: 4524 N. Michigan Ave, Miami Beach, FL 33140
E-Mail Address: amala226@aol.com
Work Phone: Home Phone
Cell Phone; 305-785-2655 Preferred Contact Method: cell phone
Vehicle Information
Tag: HAa Color: wtttt IL
State: FL Year: 2
2022
Make: l%# Te\a Model: • # Y I iv
ass... • hJy 0@.,/\ .
Please provide signed form io tkkif DJ5anent located ot 1755 Meridian Avenue, 2 floor. Working
hours ore 8:30 to 5:00 p.m. or email to: ark<ingReception@micmibegchfl.coy
_ o-mail subject: BOARD & COMMITTEE PARKING APPLICATION _ APPLICANT NAME
Parkinq Department Section
PERMIT SYSTEM GARAGE ACCESS
Expiration Date: ID Cord Serial #:
Issued By Print Name: Print Nome:
Signature: Signature: r
Date Issued: Date Completed:
r. a k .b 'Jagifi.d' ii up00ta iotv I'