Faye Goldin Application PackageGoldin Faye
Last Name First Name Middle Initial
5415 Collins Collins Ave Miami Beach
Home Address City
FL 331340
State Zip Code
305-866-2066
HomeWork
ellsid@atlanticbb.com
Email Address
305-332-8878
Cellular
Business Address City State Zip Code
Nike
Occupation:Business Name:
Please list your preferences in order of ranking [1] first choice [2] second choice, and [3] third choice. Please note
that only three (3) choices will be observed by the City Clerk’s Office. (Regular Boards of City)
Choice 1:
Choice 2:
Choice 3:
Visitor and Convention Authority
BOARD AND COMMITTEE
APPLICATION FORM
Note:If applying for the At-Large position of the Historic Preservation Board, please answer the below
questions:
Have you ever resided in one of the City's Historic Districts for at least one year?No
No Address in City Historic District submitted.
Professional License
No Professional Licenses Submitted.
Note:If you are seeking appointment to a professional seat (e.g. attorney, architect, etc.), you must attach a copy of
your currently effective corresponding professional license.
Pursuant to City Code section 2-22(4) a, b and c: Members of Agencies, Boards, and Committees shall be
affiliated with the city. This requirement shall be fulfilled in the following ways:
YesResident of the City for a minimum of six (6) months:
Demonstrate an ownership interest in a business established in the City for a minimum of six (6) months:No
AFFILIATION WITH THE CITY OF MIAMI BEACH
a.
● I am resident of:Middle Beach
Or
b.
"Ownership Interest" shall mean the ownership of ten percent (10%) or more (including the ownership of 10%
or more of the outstanding capital stock) in a business.
"Business" shall mean any sole proprietorship, sponsorship, corporation, limited liability company, or other
entity or business association.
c.Full-time employee of such 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):No
Notwithstanding the requirements set forth herein, the qualified full-time employee of a business must be
approved by a 4/7th vote of the Mayor and City Commission.
NOTE: Members of Agencies, Boards, and Committees shall be required to demonstrate compliance with the City
affiliation requirements of section 2-22 (4) a and b of the Miami Beach City Code by executing an affidavit,
stipulating that they have met either (or both) of said affiliation requirements. The original affidavit shall be filled
with the Office of the City Clerk prior to being sworn in as a member.
Or
No● Have you ever been convicted of a felony:If yes, please explain in detail:
● Do you currently have a violation(s) of City of Miami Beach codes:No If yes, please explain in detail:
● Do you currently owe the City of Miami Beach any money:No If yes, please explain in detail:
● Are you currently serving on any City Boards or Committees:No If yes, which board?
Commission for Women
● Are you presently a registered lobbyist with the City of Miami Beach?No
● I am applying for an appointment because I have special abilities, knowledge and experience. Please list below:
NOTE: IF APPOINTED, YOU WILL BE REQUIRED TO FOLLOW CERTAIN LAWS THAT APPLY TO CITY
BOARD/COMMITTEE MEMBERS. THESE LAWS INCLUDE, BUT ARE NOT LIMITED TO:
o Prohibition from directly or indirectly lobbying city personnel (Miami Beach City Code section 2-459).
o Prohibition from contracting with the city (Miami-Dade County Code section 2-11.1).
o Prohibition from lobbying before board/committee you have served on for period of one year after leaving office
(Miami Beach Code section 2-26)
o Requirement to disclose certain financial interests and gifts (Miami-Dade County Code section 2-11.1).
o Sunshine Law - Florida's Government-in-the-Sunshine Law was enacted in 1967. Today, the Sunshine Law
regarding open government can be found in Chapter 286 of the Florida Statutes. These statutes establish a basic
right of access to most meetings of Boards, Commissions, and other governing bodies of state and local
governmental agencies or authorities.
o Voting conflict - Form 8B is for use by any person serving at the county, city, or other local level of government on
an appointed or elected Board, Council, Commission, Authority, or Committee. It applies equality to members of
advisory and non-advisory bodies who are presented with a voting conflict of interest under Section 112.3143.
Florida Statutes.
● In what organization(s) in the City of Miami Beach do you currently hold membership in?
No Organization Information Submitted.
● List the address of all properties owned or in which you have an interest within the City of Miami Beach:
Property
5415 Collins Avenue
If so, which department and title?No● Are you now employed by the City of Miami Beach:
● Pursuant to City Code Section 2-25 (b):
Do you have a parent, spouse, child, brother, or sister who is employed by the City of Miami Beach?No
If "Yes", identify person(s) and department(s):
No relative's information submitted.
BOARD & COMMITTEE FINANCIAL ACKNOWLEDGEMENT STATEMENT
Acknowledgement of fines/suspension for Board/Committee Members for failure to comply with
Miami-Dade County Financial Disclosure Code Section 2-11.1(i)(2)
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 filled 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 than $500, 60 days in jail, or both.
_____________________________
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.
DIVERSITY STATISTICS REPORT
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.
WhiteRace/Ethnic Categories
What is your race?
No details providedOther Description:
Gender:Female
Are you Spanish/Hispanic/ Latino? Mark the "No" box if not Spanish / Hispanic / Latino.No
Physically Challenged:No
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING APPLICATION AND
THAT THE FACTS STATED IN IT ARE TRUE. ADDITIONALLY, I AGREE AND ACKNOWLEDGE THAT ANY
FALSE STATEMENTS OR FALSE INFORMATION SUBMITTED AS PART OF THIS APPLICATION SHALL BE A
BASIS FOR MY REMOVAL FROM A CITY BOARD OR COMMITTEE. I HAVE RECEIVED, READ, AND WILL
ABIDE BY CHAPTER 2, ARTICLE VII, OF THE MIAMI BEACH CITY CODE, ENTITLED “STANDARDS OF
CONDUCT FOR CITY OFFICERS, EMPLOYEES AND AGENCY MEMBERS” AND ALL OTHER APPLICABLE
CITY, COUNTY, AND/OR STATE LAWS AND STATUTES ACCORDINGLY.
I Faye Goldin agreed to the following terms on
Received in the City Clerk's Office by:
Name of Deputy Clerk Control No. Date
Board and Committee Application Checklist: Please ensure you have provided all information before applying or
reapplying to any Board and Committee.
YES
YES
YES
YES
I have answered all questions fully.
I have uploaded a current resume, photograph, and a copy of any applicable professional license.
I have completed and attached the Board & Committee Financial Acknowledgment Statement.
I have completed and attached the Diversity Statistics Report.
If you have any questions, please contact the Office of the City Clerk via email: BC@miamibeachfl.gov or
telephone: 305.673.7411
Note: Florida Statutes 119.071: The role of the Office of the City Clerk is to receive and maintain forms filed as
public records. If your home address, telephone numbers, and/or photograph are exempt from disclosure and you
do not wish your home address, telephone numbers, and/or photograph to be made public, please:
1) Use your office or other address for your mailing address;
2) Use your office or other telephone number for your contact number; and
3) Do not attach a photograph.
MIA /BEA C H B3OARD AND COMMITTEE APPLICATION
""co@r First Name
PY€
Middle Initial
Home Address
5/1 » City
0.
State
ri-
Zip Code
331/0
Cellular Telephone Work Telephone
30- 3324634
Home Telephone
3057 L-2dz
Business NamN ~ Occupation
Business Add rel ~ R, ~ City ~ Zip Code
P)« Ft 333//6
Please list your preferences in order of ranking: [1] first choice, [2] second choice, and [3] third choice. Please note that
only three (3)choices will be observed by the Office of the City Clerk.
Email address
Ad Hoc Anti-Bullying Task Force Health Advisory Committee Normandy Shores Local Government
Neighborhood Improvement District
Advisory Council
Affordable Housing Advisory Health Facilities Authority Board Parks and Recreational Facilities
Committee Board
Animal Welfare Committee Hispanic Affairs Committee Personnel Board
Art in Public Places Committee Historic Preservation Board * Planning Board
Audit Committee Housing Authority Police/Citizens Relations Committee
Board of Adjustment Human Rights Committee Production Industry Council
Budget Advisory Committee LGBTQ Advisory Committee Program for Public Information
Committee
Committee for Quality Education in Marine & Waterfront Protection Senior Affairs Committee
Miami Beach Authority
Committee on the Homeless Mayor's 41 st Street Committee Sustainability Committee
Convention Center Advisory Board Mayor's General Obligation Bond Transportation, Parking, and Bicycle-
Oversight Committee Pedestrian Facilities Committee
Cultural Arts Council Mayor's Panel on Ocean Drive Visitor and Convention Authority 1
Design Review Board Miami Beach Commission for Women Youth Commission
Disability Access Committee Next Generation Council
+._/sty ond onutha_Puh to} .
2.
3.
Professional License
Type of Professional License License Number
State of Issuance License Issuance Date License Expiration Date
Note: If you are seeking appointment to a professional seat (e.g. attorney, architect, etc.), you must attach a copy of your
currently effective corresponding professional license.
Page 1 of 6
F:ICLER\$ALL\REGIBOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
A F F ILI A T IO N W IT H T H E C IT Y O F M IA M I B E A C H
P u r s u a n t to C ity C o d e s e c ti on 2 -2 2(4 ) a , b , a n d c : M em bers of Agenci es, Boards, and Com m ittees shall be affiliated
w ith the City. This requirem ent shall be fulfilled in the fo llow ing w ays:
a. R esident of the C ity fo r a m inim um of six m onths: Yes O JONo
• I am a resident of: South Beach D Middle Beach North Beach D
O r
b. Dem on stra tes an own ers hip inter e st (for a m inim um of six month s) in a busine ss est ablish ed in the City (for a mi nim um
of six m on th s): Yes l orlhNo
"Ownership Interest" shall mean the ownership of ten percent (10%) or more (including the ownership of 10% or more
of the outstanding capital stock) in a business.
"Business" shall mean any sole proprietorship, sponsorship, corporation, limited liability company, or other entity or
business association.
O r
c. Full-time em pl oyee of such a business (for a mi nim um of six mont hs); and l am based in an offi ce or other location of
th e busin ess th at is ph ysically locate d in M iami Beach (for a minim um of six month s): Yes Ll or llNo
Notwithstanding the requirements set forth herein, the qualified full-time employee of a business must be approved by
a 417th vote of the Mayor and City Commission.
NOTE: Members of Agencies, Boards, and Committees shall be required to demonstrate compliance with the City affiliation
requirements of sections 2-22 (4) a and b of the Miami Beach City Code by executing an affidavit, stipulating that they
have met either (or both) of said affiliation requirements. The original affidavit shall be filed with the Office of the City Clerk
prior to being sworn in as a member.
• I am applying fo r an appointm ent because I have special abilities, know ledge, and experience. Please list below:
Page 2 of 6
F:\CLER\$ALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
U p d at e d:; Jun e 20 2 0
• Are you a registere d active lobbyist w ith the City of Miam i Beach? Yes Dor No@'
• Have you ever been convicted of a felony? vesor No CE('lf yes, please explain in detail:
• Do you currently have a violation(s) of City of Miami Beach Code? Yes Dor No If yes, please explain in detail:
• Do you currently owe the City of Miami Beach money? Yes Dor No ~If yes, please explain in detail:
• Are you currently serving on any ity Board or Committee? Yes ~No ~~oard/Committee?
• In what organization(s) in the City of Miami Beach do you currently hold membership?
Name Position
Name Position
• List the address of all pro · · have an interest within the City of Miami Beach:
• Are you now employed by the City of Miami Beach? Yes Dor No~ so, which department and title?
• Pursuant to city code Section 2-25 (b): Do you have a parent I, spouse l }, cha l brother Ll or sister LI
who is employed by the City of Mi am i Beach? Yes Llor No I
If "Yes," identify person(s) and department(s): _
* Note: If applying for the At-Large position of the Historic Preservation Board, please answer the below questions:
• Have you ever resided in one of the City's Historic Districts for at least one year? ves or o
If you answered "Yes," please indicate:
From: To
Address Dates
From: To
Address Dates
Page 3 of 6
F:\CLER\$ALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
N O T E : IF A P P O IN T E D , Y O U W IL L B E R E Q U IR E D T O FO L L O W C E R T A IN LA W S T H A T A P P LY TO CITY
B O A R D /C O M M IT T E E M E M B E R S . T H E S E LA W S IN C L U D E , B U T A R E N O T LI M IT E D T O :
o Prohibition from directly or indirectly lobbying City personnel. (Miami Beach City Code Section 2-459)
o Prohibition from contracting with the City. (Miami-Dade County Code Section 2-11.1)
o Prohibition from lobbying before the Board/Committee you have served on for period of one year after leaving office.
(Miami Beach City Code Section 2-26)
o Requirement to disclose certain financial interests and gifts. (Miami-Dade County Code section 2-11.1)
o Sunshine Law - Florida's Government-in-the-Sunshine Law was enacted in 19 67. Today, the Sunshine Law regarding
open government can be found in Chapter 28 6 of the Florida Statutes. These statutes establish a basic right of access to
most meetings of Boards, Commissions, and other governing bodies of state and local governmental agencies or
authorities.
o Voting conflict - Form 88 is for use by any person serving at the county, city, or other local level of government on an
appointed or elected Board, Council, Commission, Authority, or Committee. It applies equally to members of advisory and
non-advisory bodies who are presented with a voting conflict of interest under Section 112.3 14 3, Florida Statutes.
I H E R E B Y A T T E S T T O T H E A C C U RA C Y A N D T R U T H F U L N E S S O F T H E A P P LI C A T IO N ; A N D I HA V E R E C E IV E D ,
R E A D A N D W IL L A B ID E B Y CH A P T E R 2, AR TI CL E V II , O F T H E M IA M I B E A C H C IT Y C O D E , E N TITL E D "S T A ND A R D S
O F C O N D U C T FO R C IT Y O F F IC E R S , E M P L O Y E E S A N D A G E N C Y M E M B E R S A N D A L L O THE R A P P LI C A B L E
C O U N T Y AN DI S T A TE LA W S A N D T U TE S A C C O RD IN G L Y."
0b 3120a3 #NY G 0 0r U
A p p lic a n t's S i D ate N am e of A p p licant (P LE A S E P R IN T)
B o a rd an d C o m m ittee A p p licatio n C h eck list: Please ensure you have provided all information before applying or
reapplying to any Board and Committee
[ 1 have answered all questions fully.
D I have attached additional sheets, if necessary, to provide required information.
D I have attached a current resume, photograph, and a copy of any applicable professional license.
D I have completed and attached the Board & Committee Financial Acknowledgement Statement.
D I have completed and attached the Diversity Statistics Report.
[] submit complete application package.
Via Email: BC@miamibeachfl.gov
Via U.S. Mail or in Person:
City of Miami Beach
Office of the City Clerk/ Board and Committee Section
17 0 0 Convention Center Drive, 1S Floor
Miami Beach, FL 33 13 9
If you have any questions, please contact the Office of the City Clerk via email: BC@miamibeachfl.gov or telephone:
30 5 .6 7 3 . 7 4 11 .
N o te : F lo rid a S tatute s §11 9 .07 1: The role of the Office of the City Clerk is to receive and maintain forms filed as public
records. If your home address, telephone numbers, and/or photograph are exempt from disclosure and you do not wish
your home address, telephone numbers, and/or photograph to be made public, please: 1) Use your office or other address
for your mailing address; 2) Use your office or other telephone number for your contact number; and 3) Do not attach a
photograph.
Page 4 of 6
F:ICLER\$ALL\REGIBOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
M IA M I BEACH
C ity of M ia m i B e ach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeach[l.gov
OFFICE OF THE CITY CLERK
Emai l: 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)
GoL@rd
Last Name t ame 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 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 an $500, 60 d s in jail, or both.
Date 1
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:\CLER\$ALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
l In d a to d : .H un s 9 0 9 n)
MA N]BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachtl.gov
O FFIC E OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305. 673 7411
DIVERSITY STATISTICS REPORT
Go-pr y
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
Cl Female
D Other
D I prefer not to answer.
Race/Ethnic Categories:
What is your race?
D African American/Black
LAsian or Pacific Islander
Cl Caucasian white
D Native American/American Indian
D Other - Print Race: ------------- □I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
a° No
0 I prefer not to answer.
Do you consider yourself Physically Disabled?
a- No
Ll1 prefer not to answer this question.
Page 6 of 6
F:ICLER\$ALL\REGIBOARD AND COMMITTEE APPLICATIONS FINAL DRAFTSIBOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
N a m e : F a y e G o ld in
A d d r e s s : 5 4 1 5 C o llin s A v e n u e , Ap t .: P H A
M ia m i B e a c h , F lo r id a 3 3 1 4 0
D a t e o f B irt h : A p r il 1 , 1 9 4 1
P la c e o f B irt h : B ro o k ly n , N e w Y o r k
M a r it a l S t a t u s : M a r r ie d
E d u c a t io n :
W o r k
E x p e r ie n c e :
1 9 5 4 - 1 9 5 8 : Y e s h iv a o f F la t b u s h H ig h S c h o o l
B ro o k ly n , N e w Y o r k
1 9 5 8 -1 9 6 2 : B a c h e lo r o f A r t , B ro o k ly n C o ll e g e
B ro o k ly n , N e w Y o r k
1 9 6 2 - 1 9 6 8: T e a c h e r , N e w Y o r k P u b li c S c h o o ls
B r o o k ly n , N e w Y o r k
1 9 7 6 - 1 9 8 6: S a le s A s s o ci a t e , N e im a n M a r c u s
B a l H a r b o u r , F lo r id a
1 9 8 6 - 2 0 1 0: P e r s o n a l S h o p p e r , N e im a n M a r c u s
B a l H a r b o u r , F lo r id a
O r g a n iz a t io n s : 1 9 8 9 - 2 0 1 0: Y o u n g P r e s id e n t s C lu b , M o u n t S in a i M e d ic a l C e n t e r
M ia m i B e a c h , F lo r id a
1 9 9 1 - 2 0 1 0: F o u n d e r s C lu b , M o u n t S in a i M e d ic a l C e n t e r
M ia m i B e a c h , F lo r id a
1 9 9 2 - 2 0 1 0: F o u n d e r s C lu b , M ia m i J e w is h H e a lt h S y s t e m s
M ia m i B e a c h , F lo r id a
C M B
C o m m itt e e s : 1 9 9 0 - 1 9 9 8: F ine A rt s B o a r d
1 9 9 9 - 2 0 0 5: B e a u t ifi c a t io n C o m m itt e e
2 0 0 5 - 2 0 1 0: P ol ic e C it iz e n s R e la t io n s C o m m it t e e
2 0 1 1 -2 0 1 3: M B S is t e r C it ie s C o m m it t e e
2 0 1 6 - Pr e s en t : M B C o m m is s io n fo r W o m e n
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