Faiza Liban 6.30.24A N D C OMMI TT
p e ILA LI il lll
SCAN NER
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.+', a ·pointment/Reappointment e-mailed to Committee Liaison on
Application (complent \[2th
tae I] [23 2porting pleted on 0 > )
RECEIVED
SEP 26 2023
CITY OF MIAMI BEACH "
OFFICE OF THE CITY CLERK
✓
f
IMPORTANT IATION FOR BOARD ANI EE MIEMBERS BOOK
v City Jinance Section applicable y,board or committee
City , 2'1 2 2- 5,2.458 and 2-459
V Coun flic and Code of Ethics Ordinance (as a
Ar linance (September 2009 through July 2012)
thics Code
requently Asked Questions
rd and Committee Members
Scan O
Scan O
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 Acknowle inc 'equirement
O Board and Lia ilities
O DIVERSIT TSTICS REPOF"" _-, "nd o1GAL tor Annual Report.
9g 3_ Signed By r
er
4ll< y wove .. .'.. ..... .a.= By Employee. _ _.,,,_.,,.7..., __ _;_,_-=--="'---- S ca nn ed on:
Date
NC
MI MIBE
City of Miami Beach, 1700 Convention Center Drive, Mi ami Beach, Florido 33139 wwww_miamibeach~l.gov
OFFICE OF THE CITY CLERK, Rafael E. Granado, City Clerk
Tel: 305.673.7411, Fox. 305.673.7254
Email: CiiyClerk@m iamibeachfl.gov
August 22, 2023
Faiza Liban
521 W 46th St.
Miami Beach, FL 33140
RE: Committee for Quality Education in Miami Beach
Dear Ms. Liban,
Congratulations! You have been appointed to the above-referenced Board or Committee as a
representative for the Miami Beach Senior High 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. 7 411.
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.
RegrJ
Rafael 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.
M1IA,;J, M1''; IREACH 4"" \lDL••
City of Miami Beach, 1700 Convention Coner Drtvo, Miami Beach, Florida 331 39 wyw.Iiamilaachll goy
OFFICE OF THE CITY CIERK, Rafool E. Granado, CIiy Clerk
1el: 305.673.711, Fae 36.673.7254 '
Email:. Ci#yClark.t@niamtbe@ch/l.gov
TO: Ms. Faiza Liban
RE: Committee for Quality Education in Miami Beach
tob fiance to " iov the' ted
dth erform dut 2mt the
mm. ch to whit v ·oin ra
ue j] @ erve, qe fairness, integrity and civility, in all
nc ti publi int.
te
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un
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swomi subsorted before me + f0 ' Vk,2o2a
a
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the City of Mi 9ach website w beachfl.gov under City Clerk/Board and
r additional in on regarding closure Requirements.
City of Mimi fNeccv
1700 Convention Center Drive
Miami Beach. Florida 33139
OFFICE OF THE CITY CLERK
Email:
Telephone: 305.673.7411
RECEIVED
sEP 26 2023
cry oE Aw BE2Ng;}
OFFICE OF THE CITY G-
AFFIDAVIT OF AFFILIATION WI TH ND THE COMMITT EE
FOR QUALI f+' ·l]
t
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.
Home Aaaress:. 521 _l4"" 1._ 1, , 22i40
L+Tam the parent/guardian of a student attending a Miami Beach school for the 2lz{ school
year.
Schoo: _D1AL EH St. @H 6-t±
Under perjut re that l have read the foregoing document and that the facts
stated
Signa Date
Printed Name
City of Miami Beach
1700 Convention Center Drive
Miami Beach. Florida 33139
OFFICE OF THE CITY CLERK
Email:
Telephone: 305.673.7411
BOARD & COMMITTEE FINANCIAL ACKNOWLEDGEMENT STATEMENT
Acknowledgement of fines/suspeno n fc B T ·+ Dade Count : " 19ion for Board/Committee Members for failure to comply with Miami
ty Financial Disclosure Code Provision Code Section 2-11.1(i) (2)'
IAN)
Last Name
Fe]2A
First Name Middle Initial
understand that no later than July1 ofe; h ill ea. ii@rino inose of a on 9 "j,2' 3",,","pp3,g'oaras an4cgamttees ore cy sari
Disclosure Requirements. >, re requirec to comply with Miami-Dade County Financial
One of the following form s must be filed with the City Clerk of Miami Beach, 1700 C ti Ce "
Miami Beach , Florida, no later than 12:00 noon of July 1, of each year:' Convention enter Drive,
1. A "Source of Income Statement;" or 1
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
of no more than $500, 60 days in jail, or both.
Signature Date
1 Members of the Planni ng Board and Board of Adjustment will be notified directly by the State of Florida,
pursuant to F.S. $112.3145(1)(a), to file a Statement of Financial Interests (Form 1) with the Miami-Dade County
Supervisor of El e ct ion s by 12:00 noon, July 1. Pl a nn ing Board and Board of Adjustment members who file their
Form 1 with the County Supervisor of Elections automatically satisfy the County's financial dis cl o sure
re q ui reme n t a s a Miami B e a ch City Board/Committee member an d need not file an additional form with th e Office
of the City Clerk. However, compliance with the County di scl o sur e requirement do e s not satisfy the State
requirement.
Page 5 of6
p,C LE R \S AL L R E G\B OAR D AND COMMITTEE APPLICATIONS FINAL DRAF T S\B OAR D AND COMMITTEE APPLICATION REG FINAL.d0ox
t a.lbs y mm2moil.lllllilt.ldill-le.owleel well lee"eemailelell ill.ell we llliileilaareno
City of Miami each
170 Convention Center Drive
Miami Beach, Florido 33139
t
OFFICE OF THE CITY CLERK
Email:
Telephone: 305.673.7411
DIVE RSI TY STATI STICS REPORT
01
Last Name First Name Middle Initial
The following information is voluntary and has no bearing on your consideration for appointment. It is being
asked to com·plJ wi~tl Ci~ divelisi~ rreperltlil'ilg reql!lirrememts. I
Gender:
Lee
L Female
Ll oner
El1prefer not to answer.
Race/Ethnic Categories:
What is your race?
[k~nican Am erican/Black
[Asian or Pacific Islander
[] Caucasian/white
[]Native American/American Indian
[] other - Print Race. -
[ll prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
[J Ye
L3
El 1prefer not to answer.
Do you consider yourself Physically Disabled?
' Lly refer not to answer this question.
Page 6 of6 , ION REG FINAL.docx
F;\CLER$ALLREG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION"
Jt([a(9d, J)Pe {) Iiiiii well millweuwwwe
MIAH- En6i
Clear From Print Forn
SOURCE OF INCOME STATEMENT
?"";$;]},},<?<; ,"") of the county Ethics code requires that certain employees and public oficlats fie a financial disclosure statement on a yeary basis by Juy 1st
Disclosure for Tax Year Ending [Last Name
2022 LA,/
First Name Middle Name/initial
Mailing Address - Street Number, Street Name, or PO. Box
21 46t 5T.
City, State, Zip
M A4w t &G
lf your hom e address is yc address is exempt from public records pursuant to Fla. Stat. $119.07, read
instructions on the followir age mntc chec
Filing as an Empl oyee (check one)
[] county [] Public Health Trust [] Municipal:
(Municipality)
Department
Position or Title Employee ID Number
Work address Work telephone
Filing as a Board Member (check one)
Employment began on/ended on
[] county []lynicipal:
(Municipality)
Board where serving
Alternate address (if home address is exempt) Work telephone Term began on/ended on
List belowv income you received, along with the address and the principal activity of each source. Include your public salary. Place the sources of
income it r, with the largest source first. Examples of sources of income include: compensation for services, income gins from
proper rents, dividends, pensions, IRA distributions, and social security payments. Also, include any sot 'another
person' vever, the income ay business partner need not be disclosed. If continued on; 1ere.L_l
Address Description of "vity
652 Jtt ST,
M8 @ 33£o
I hereby swear (or affirm) that the information above is a true and correct statement.
ate signed
RE CEIVED BY ELE CTI ONS DFPARTMENT
I □HardcopftEc;E, vt::l l
[] Electronic Copy
$£P 26 7023
CITY OF MIAMI BEACH
OFFICE OF TE CI CLERK
a CITYWIDE (CW) BOARD & COMMITTEES D
Ci ty of Miami Beach, PARKING DEPARTMENT PARKING APPLICATION a
1755 Meridian Avenue, Suite 200/Miami Beach, FL 33139/Ph:. (305) 673-7505 or (305) 673-7000 ex4. 6200 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 (GZ) access.
IMPORTANT NOTE: Your vehicle license plate serves as your "parking permit". ln 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 veh icle
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: l acknowledge that should my access card be lost, stolen or
] damage, I will be responsible to pay a $10.00 replacement fee.
I
Board Member lnformation
Date of Application: o&]
o% or
Applicant Name : A2 Lt9l
Board/Comm ittee Name: I T o DUCAT«ON) 0o ar (QC)
I Address: 52 W/ (GT sr, Mj .ft.:, 310
E-Mail Address: [02 3)Du4 OJ At- OA -- l' Work Phone: Home Phone
'
Cell Ph on e: 3os 4as 62g2 Preferred Con tact Method: A_ #
I
.
Vehicle Information - Color: HA oe) I Tag: HTNA V24
.. 4
Year: State: 1_ l 202-23 t
Model: Make: fr tu Op I POIS0 €
me
Applicant signature• - , 5a
Working Please provide signed form to the Parking Departm ent located at 1755 Meridian Avenue, 2' floor.
hours are 8:30 to 5:00 p.m. or email to:
] e-mail subject: BOARD & COMMITTEE PARKING APPLICATION -. APPLICANT NAME
Parkinq Department Section
PERMIT SYSTEM rot GARAGE ACCESS _I - ' t · r ID Card Serial t: Expiration Date:
Print Name: I Issued By Print Name: -, ..
-1
1
!
Signature: e6 1 Signature: 1 g; , l m. ·- ' .. -
Date Completed: i
Date Issued: a ..
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