Jonathan Rothman 6.30.24MI A\I B
B O A R D A N D C O M M IT T EE C H EC K L IST
AP P o r ee. Jonah@_&h t@- DA TE or A P o r ter, 9]4[03
BOARD/COMMITTEE. _Qfy Appointed by. Soy inlEtvyw
TERM No: o [30 l24 FOR SCANNER
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aECENVED
uG 21 2023
FOR CLERK STAFF
o Letter of Appointment
o Letter of Reappointment
o Cop of Letter of Appointment/Reappointment e-mailed
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o Board and committee Application (completed on_'Q(bl)
o R~sum~/curriculum Vitae } ]
o Diversity Statistics Reporting (Completed on @)/ 21)3
o Oath
reno tuwr. 'Qlh4
to 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 4IAMI BEACH ctr Of 4 cir cERK
OFFICE OF '
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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
O Board and Committees Liaison Responsibilities
O DIVERSITY STATISTICS REPORTING Keep COPY in file and ORIGINAL for Annual Report.
)\\4)23 sioneay
Date Board or Committee Member
Processed on: _~ __ }_?-_l_}_2,,_3 By Employee: l_<Nl ~------
Date City Clerk's Office Staff Initials
9l21/5 re s ee o
Received on:
Scanned on:
Date City Clerk's Office Staff Initials
CO NCLUDED & 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:\C LERIBO ARD AN D COM M ITT IES DATABASEICHECKLI ST MASTERIB&C Checklist 2015 MASTER.docx
W e care committed ts providing excellent public service and salty to all who live, work, and ploy in our vibrant, tropical, historic community.
MIAMI BE
City of Miami Beach, 1700 Convention Center Dive, Miami each, florid0 33139 yguy_y___Arilygac_hf__gov
OFFICE OF THE CITY CLERK, Rafael E. Granado, City Clerk
Tel: 305.673.7411, Fox. 305.673.7254
Email: Ci!yClerk@miamibeachtl.gov
August 21, 2023
Jonathan Rothman
RE: Committee for Quality Education in Miami Beach
Dear Mr. Rothman,
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,
Rafl?A o
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 safely to all who live, work and play i our vibrant. tropical, historic community.
City o f M ia m i B e a ch , tO) Convnlion Contes Dive, Miami Bach, Florida 33 139 yzy._riauilgaechll_gov
OFFICE OF IHE CITY CLERK, Ralaal E. Granado, Ciy Clork
Tl: 305.673.7411, Fox 305.673.7254
Email: Cit/Cdork@miamileochfl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Mr. Jonathan Rothman
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 Guide to the Sunshine Amendment
and Code of Ethics for Public Officers and understand that as a member of a it {Miami Beach. Board
and/or Committee, I must comply with the financial disclosure requirements of a i-Dade Co ty or the
State of Florida (depending on the board or committee on which I serve) on Ju 1st f low· g the closing
of the calendar year on which I have served.
Sworn to and subscribed before me this 21 day o/9yst 2023
Keil
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
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
RECEIVED
AUG 1 2023
CITY OF MIAMI BEACH
OFFICE OF TH E CITY CLERK
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
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,
( check (/) all that apply):
~ I am a City of Miami Beach resident for six months or longer.
Home Address: -------------------------- 210 Washington Ave, Miami Beach, FL 33139
[] 1am the parent/guardian of a student attending a Miami Beach school f6, 442023-20244ol
year.
sasoot ·wroic"coo"oo
Under penalties of perjury
stated in it are true.
at I have read the foregoing document and that the facts
8/21/2023
Signature
Jonathan Rothman
Date
Printed Name
M IAM IBE H
City of Miami Beach
1 700 Convention Center Drive
Miami Beach, Florida 33139
www._miamibeacht]. gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
DIVERSITY STATISTICS REPORT
Rothm a n Jonathan
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:
LJ M ate
[l Female
D Other
D I prefer not to answer.
Race/Ethnic Categories:
What is your race?
DI African American/Black
LJ Asta or Pacific Islander
0 Caucasian/White
0 Native American/American Indian
0 Other - Print Race: ------------- □I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
lves
Jo
D I prefer not to answer.
Do you consider yourself Physically Disabled?
Lvee no t prefer not to answer this question.
Page 6 of 6
F:\CLER\$ALL\REG\BO ARD AND CO M M ITT EE APPLI C ATIO NS FINAL DRAFTS\BOARD AND CO MMITT EE APPLICATION REG FINAL.docx
Updated: June 2020
M IA M IB E H
City of Miami Beach
1700 Convention Center Drive
Miami Beach , Flor ida 33139
ww w.m iami beach fl.gov
OFFICE OF THE CITY CLERK
Em ail: 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)
Rothman Jonathan
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 Feder
Failure to file one of these for
of no more than $500, 60 day9fihj
s nt to the Miami-Dade County Code, may subject the person to a fine
r both.
8/21/2023
Signature Date
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:\C LER \$ALL\REG \BO ARD AND CO M M ITT EE APPLI CATIO NS FINAL DRAFTS\BOARD AND COMMITT EE APPLICATION REG FINAL.docx
Updated: June 2020
M IA M l·DA D E. EIII 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 End ing 'L ast Nam e First Nam e M iddle Nam e/Initial
2022 Rothman, Jonathan
M aili ng Addre ss - Street Nu m ber, Street Nam e, or P.O. Box
210 Washington Ave
City, State, Zip Miami Beach, FL 33139
If your hom e addre ss is your m ailing addre ss, and your hom e addre ss is exem pt from public records pursuant to Fla. Stat. $119.0 7, read
instru ctions on the follow ing page and check here. D
Filing as an Employee (check one)
[] county ] Pubic Health Trust [] Municipal:
(Municipality)
Departm ent
Position or Title Em ployee ID Num ber
W ork addre ss I W ork telephone Em ploym ent began on/ended on
Filing as a Board Member (check one)
[Z] county [X funicipa: Mar Y-tow
(Municipality)
Board where serving Miami Beach South Pointe Elementary, PTA/QEC rep
Alternate address (if home address is exempt) I Work telephone I Term began on/ended on
786.554.5335 2023-2024
List below every source of incom e 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. Exam ples of sources of income include: compensation for services, income from business, gains from
pro perty 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 separa te sheet, check here.□
Nam e of Source of Incom e Address Description of the Principal Business Activity
SJC Real Estate, LLC
20533 Biscayne Blvd. 286
Miami, FL 33180
eal Estate Management, Buying
ove is a true and correct statem ent.
8/21/2023
Date signed
RECEIVED BY ELECTIONS DEPARTMENT:
J ar d »q=.gEIV ED
[ ] El ectronic Copy' "
AUG 21 2023
CITY O F M IAM I BEACH
REMEMBER TO PRINT, SIGN, AND SUBMIT TO THE OFFICE OF THE CITY CLERK VIA EMAIL OR HARDCOPY.
MIAMI BE CITYW IDE (CW ) BOARD & COMMITTEES
City of Miami Beach, PARKING DEPARTMENT PARK! NG APPLICATION
1755 Meridian Avenue, Suite 200/Miami Beach, FL 33139/Ph: (305) 673-7505 or (305) 673-7000 ext. 6200
I?l
PARKING
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
Dote of Application: 8/21/2023
Applicant Name: Jonathan Rothman
Board/Committee Name: Miami Beach Quality Education Committee
Address: 210 Washington Ave, Miami, FL 33139
E-Mail Address: ijrothman@gmail.com
Work Phone: 786.554.5335 Home Phone
Cell Phone: 786.554.5335 Preferred Contact Method: e-mail
Vehicle Information
Tog: DRM C64 Color: Black
State: Florida Year: 2012
Make: Hyundai t. Model: Sonata Hybrid
Applicant Sianature: e % ~
Please provide signed form to'4le%%arking Department located at 1755 Meridian Avenue, 2d 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
p ·ki D rt ar mna epa men ec Ion
PERMIT SYSTEM GARAGE ACCESS
Expiration Date: ID Card Serial #:
Issued By Print Name: Print Name:
Signature: Signature: e
Date Issued: Date Completed:
tS ·ti
pmng man far torms cw oatds committees paringtorm, doc