Charlotte Libov 12.31.25MIAMI BEACH
BOARD AND COMMITTEE CHECKLIST
arPoree. _DChoy_lot _Lyoov re or APorer. t_Hoh4
BOARD/COMMITTEE:MW (pnSSa {of \Wyn Appointed by: Comm1ur a-re
FOR SCANNER
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RECEIVE
JAN 12 ."24
CITY CC MIAMI BEACH
OFFICE OF THE CITY CLERK
FOR CLERK STAFF I I
• Letter of Appoi ntm ent TER MEND . nll 3 TER MuMrt.2, 2l/%
• Letter of Reappoi ntment J ]
o Copy of Letter of Appointment/R eappointment e-mailed to Commi ttee Liaison on l {
o Board and Committee Application (Com pleted on )
R~sum 6/Curriculum Vi tae J
o Diversity Statistics Reporting (Completed on t t, fl
o Oath
IMPORT ANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
✓City Code Ordinance Section applicable to the agency, board or committee
City Code Section s 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 Decemb er 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
✓Mem orandum - Solicitation by City Board and Committee Members
Scan o
Scan o
O Cityw ide 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 Statement
o Board and Committees Liaison Responsibilities
O Diversity Statistics Reporting
I acknowledge that pursuant to Sec. 2-22(9) of the Miami Beach Code of Ordinances, I wlll be removed
from my board/committee upon failure to attend 33% of the regularly scheduled meetings.
Sec. 2-229) If any member of an agency, board or committee fails to attend 33 percent of the regularly scheduled
meetings per calendar year, such member shall be automatically removed. To calculate the number of absences
under the 33 percent formula, .4 or less rounds down to the next whole number and .5 or more rounds up to the
next whole number.
I/2/20a/ son«aoyk ta a Board or Committee Member
Processed on: 'le l-'1 y Employee: K/
Date City Clerk's Office Staff Initials
/ 1el24 [/ [mp[9/@},
Date City Clerk's Office Staff Initials
Received on:
Scanned on:
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M IA M I BEACH
City of Miami Beach, 1/00 Convonlion Conlor Drivo, Miami Boach, Florida 33 139 yyayy_miamnibgachf]_go
OFFICE OF THE CITY CLERK, Rolaol E. Gr an ad o, City Clerk
Tl: 305.673.7411, Fax: 305.673.7254
Email: CilyClerk@miamiboachfl.gov
Ja nu a ry 11, 2024
M s. C harlo tte Li bo v
800 W est A venue
M ia m i Beach, Fl orida 3313 9
R E : M iam i B ea ch C om m issi on Fo r W om en
D e ar M s. C ha rlo tt e Li bov:
C o ngratula tions! Y o u ha ve be e n ap p o inte d by C om m iss io ner Jo seph M agazine to the above-
referenced Bo ard or C om m itt ee, fo r a term ending: 12/31/2025.
Pursuant to C ity of M iam i Beach C ode Section 2-22 (5)a:
N o tw ithstand ing any other pro vision of the C ity C ode or of any R esolution, com m encing with
term s beginn ing on or aft er Jan uary 1, 2007, th e term of every board m em ber w ho is directly
appointed by a m em ber of the C ity C om m ission shall autom atically expire upon the latter of:
D ecem be r 31 of the year the appointing C ity C om m issioner leaves office or upon the
appo intm e nt/election of the successor C ity C om m ission m em ber.
If yo u are un able to accept this appointm ent, or have any questions, please call the Offi ce of the City
C le rk at 30 5 .673.7 4 11.
P le ase re ad th e e nc lo sed m ateria ls carefully as they concern your duties, responsibilities, and
requirem e nts as a board or com m itt ee m em ber.
C ongratula tio ns aga in and good luck.
R egards,
Ra;Z2i ado
C ity C le rk
cc: M o nica Be ltran , Parking D irector
M onica M att eo -S alinas, C ity Li aison
EN C L O S U R E S :
O ath of O ffi ce/O ath of C ivility/A cknow ledgem ents
C ity C o de /O rdina nce section applicable to agency, board or com m ittee
C ity C o de S ections 2-22, 2-23, 2-24 , 2-25, 2-26, 2-458 and 2-4 59
O rdina nce N o . 2006 -3543 - Am en d m en t to C ity Code Section 2-22
M ia m i-D ade C o unty C ode Section 2-11.1 - C on fl ict of Interest and C ode of Ethics
C ity W ide Pe rm it Ap plic ation - (Pa rkin g D epartm ent Form )
Book l et - G uid e to the S unshine A m endm ent and C ode of Ethics fo r P ublic Officers and Em ployees
M IA M I BEACH •
City of Miami Beach, I/OO Corvontion Conlot DOwo, Mami Hooch, Fonda 33139 www.miamthoochll.ace
OH IC O TH CITY CIFRK, Ralol E Granado, Cay Clod
16l 305 673 7411, Fox 305.673.7254
Emel CH/Cler l omlomtbochll gov
Oath ot Offico
Oath oft Civility
and
Acknowlodgomonts
TO Ms Charlotte Libov
, ·s Beach Commission For Women RE. Miam
1 do solemnly swear or affirm to bear true faith, loyalty and allegiance to the Government of the Uni
States, the State of Florida, and the City of Miami Beach, and to perform all the duties of a member
above-mentioned board or committee of the City of Miami Beach to which I have been appointed for a
term ending. 12/31/2025.
To my colleagues and to all of those I represent and serve, I pledge fairness, integrity and civility
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 t
State of Florida (depending on the board or committee on which I serve) on July 1st, following the cl
of the calendar year on which I have served.
Ms. Charlotte Libov
Sworn to and subscribed before me this -1.t.t_ day of
Keila Mena Caceres
Deputy Clerk
·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 IA M I BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
RECEIVED
JAN 12 2024
CITY OF MIAMI BE oic or ~cir2pg! LERK
OFFICE OF THE CITY CLERK
Email. 8C@miamibeachfl.gov
Telephone. 305.673.7411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
I am in compliance with the affiliation requirement of Miami Beach City Code Section s 2-22 (4),
as (check(✓) all that apply):
[l] I am a resident of the City of Miami Beach for six months or longer.
Hom e Address:_6 2·14 @uc, @pl. fl Daoa, Sea4 5_
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).
[/3mm9 (f [1JS]meSS,
[[JS]mes,, J(]]feSS,
0 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
m in im u m of six m on ths).
[[am7e ([ JS][@SS,
Hy[[9SS, ((]feSS,
"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.
Signature f w
Date
Printed Name
M IA M I BEACH
City of Miami Beach
17 00 C onven ti on C en ter Dr ive
Mi a m i Bea ch , Flor ida 33 13 9
www.m i amibea ch(l gov
OFFICE OF THE CITY CLERK
Email: BC@mambeach!I.gov
Tel eph on e: 305.673.741I
DIVERSITY STATISTICS REPORT
-,o
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.
G ender:
[Jae
[ktemale
0 Other
0 I prefer not to answer.
R ace/E thnic C ategories:
Wh at is yo ur race?
0 African American/Black
0 Asian or Pacific Islander
L@Caucasian/white
N ave American/American Indian 0 Other -- Print Race: _
0 I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latinola?
ves
Rio
Ll t prefer not to answer.
Do you consider yourself Physically Disabled?
&z
LJ tprefer not to answer this question.
Page 6 0l 6
F CLER SALL RE G BOARD ANDO COMMIT TEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL doc
Updated June 2020
MIAMI BEACH
C ity of M ia m i B e a ch
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachll.gov
OFFICE OF THE CITY CLERK
Emil: C@mamibeachfl gov
Telephone: 305.673.7411
BOARD & COMMITTEE ACKNOWLEDGEMENT STATEMENTS
74
Last Name First Middle Initial
Acknowledgment 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)
I understand th at no later th an July 1,_of each year all members of Boards and Committees of the Ci ty of Mi ami
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 St atem ent," or
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.
Acknowledgment to Comply with Miami Beach Code of Ordinances Division 1 Sec. 2-22 (23)
I understand that commencing with terms beginning on or after January 1, 2024, and as a condition of applying
for appointment to a City agency, board, or committee, I voluntarily agree that in the event I file with the Cit
Clerk a Statement of Candidate formally announcing candidacy for City elective office, such filing with the Cit
Clerk shall be deemed a tender of resignation from the City agency, board, or committee
Signature Date
' Members of the Planning Board and Board of Adjustment will be notified directly by the State of Florie
pursuant to F.S. $112.3145(1)(a), to file a Statement of Financial Interests (Form 1) with the Miami-Dade Cou
Supervisor of Elections by 12:00 noon, July 1. Planning Board and Board of Adjustment members who file th
Form 1 with the County Supervisor of Elections automatically satisfy the County's financial disclos
requirement as a Miami Beach City Board/Committee member and need not file an additional form with the O f
of the City Clerk. However, compliance with the County disclosure requirement does not satisfy the S
requirement.
Page 6 of 6
F CLER\SALL BOARD AND COMMITTEES DATABASE\Board and Committee ApplicatuonBOARD AND COMMITTEE APPLICATION OCT 2023 docx
Updated January 9, 2023
SO UR CE OF INCO M E STATEM EN T
Section 2-111 () of the County Ethics Code requires that certain employees and public officials file a financial disclosure Statement on a yearly basis by .July 1st
ot every year
Disclosure tor Tax Year Ending Last Name
2023 • boou'
First Name
Chalo -.
Middle Name/Initial
4
Mailing Address - Street Number, Street Name, or P,0. Box
3/31
ll 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.[]
Fil ing 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
Fling as a Board Member (check one)
D County [] Municipal:
(Municipality)
Board where serving
Alternate address (ii home address is exempt) Work telephone Term 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 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, IR A distributions, and social security payments. Also, include any source of income received by anothgr
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
or±,"% kO de! A, ,
ma lc al oleo /-ls
Ul + eooc a}i-
0
I hereby swear (or affirm) that the information above is a true and correct statemen t.
Signature ot Person Disclosing
Date sign@ '
RECEIVED BY EI IS E
[] Hardcopy
) tectonic. toy 12 2074
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
OFFICE USE ONLY Accepted Y / N Deficiency. Processed Date/initials: Scanned Date/initials:
138 SP.14 COE 201
Ml \M /BEAC H CTWDE (Cw) OAR & COM»Es
coy «t iv ·«+, PAo or·rot PARKING APPLICATION
'55 Merdian Avoe. Sue 200/Mm» Borh, H 33139/P0 43054 6737505 « (105) 73.7000 «0 4200 II
A citywide [CW) parking permit is honored a! 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 tor City Hall Garage (G) 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 ol 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 cord at close proximity to the reader until the gate opens. You may need
to try the other side oh the card. Please ensure you hold the entire surface of the card against the reader
until the gale 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 Ap~licotion: '----
--:-/- -/-a..,/,.;u,.t.\J----------------------1 Applicant lame. =t
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8oard/comes N9"%, C
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Address:
l. dOo u/Sr Arr, )l ( T l I
E Mail Address: De thy lplo l,
Work Phone: Home Phone
Cell Phone: ntact Method.
Vehicl
Tog:
State. F=[
Color:
Year.
d
20 a-.
Make: Model.
--~-~~--- ._ __ _,__..._,_ -1
Alco saowoe. Collect_)
Please provide signed form to the Parking Department located at 1755 Meridian Avenue, 2 floor. Working
hours are 8.30 1o 5.00 p.m. or email to: ParkingReception@miamibeachfl.gov
e-mail subject: BOARD & COMMITTEE PARKING APPLICATION - APPLICANT NAME
··---------------- Expiration Dote
sued By Print tome
1gn0lure.
Dote lsood
ing Department Section
Ptssit GRAGE ACCESS
io cad soil ma id
Signature.
,oi» Colored