Darin Feldman 12.31.25B O A R D A N D C O M M IT T E E C H E C K L IS T
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o ARD rcoMMrr re:D La bl]pH\(cSS An oi nted by ±I I2I' di ui0<al, T" t < FOR SCANNER
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TERM No: (/3j\S +RM LuMmr: woo
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FOR CLERK STAFF
o Letter of Appointment
o Letter of Reappointment
o Copy of Letter of Appointment/Reappointment e-mailed {0 Opmmittee Liaison on_- '' u,
o Board and Committee Application (Completed on - • )
o R~sum~/Curriculum Vitae 1p.4
o Diversity Statistics Reporting (Completed on [_[uh{
o Oath
RECEIVED
JAN 22 Z024
CITY OF MIAM I BE A CH
OFFICE OF THE CITY CLERK
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IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
✓City Code Ordinance Section applicable to the agency, board or committee
C ity 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 Ordinanci (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
O Citywide Permit Application (Parking Department Form)
o Booklet - Guide to Sunshine Amendment & Code of Ethics for Public Officers and Emplo es
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 will be remloved
from my board/committee upon failure to attend 33% of the regularly scheduled meetings.
Sec. 2-22(9) lf 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 tt number of absences
under the 33 percent formula, .4 or less rounds down to the nextwhole number and .5 op/more rounds up to the
next whole number.
Received on: 1/19/821 ¢ &
Processed on: -----'-f _/_1,_1,,~{'----"\,-'i By Employee: (.IV\ _
1#7 _________ By Employee: -0\./1 _ Scanned on:
Date
City Clerk's Office Staff Initials
City Clerk's Office Staff Initials
MIAMI BEACH
City of Miami Beach, 1/OO Convention Center Drive, Miami Beach, Florida 33 139 yyyw_miamibeachllgo
OFF ICE OF THE C ITY CLERK, Rafool E. Gran ado, Cay Clerk
Tel: 305.673.7411, Fax. 305.673.7254
Email: CiNyClerk@miamibeachfl.gov
Jan uary 17, 2024
Mr. Darin Feldman
1662 Lincoln Court #404
Miami Beach, Florida 33139
RE: Disability Acc ess Com mi ttee
Dear Mr. Darin Feldman:
Congratulations! You have been appointed by Commissioner Kristen Rosen Gonzalez to the above-
referenced Board or Committee, for a term ending: 12/31/2025.
Pursuant to City of Miami Beach Code Section 2-22 (5)a:
Notwithstanding any other provision of the City Code or of any Resolution, commencing with
terms beginning on or after Jan uary 1, 2007, the term of every board member who is directly
appointed by a member of the City Commission shall automatically expire upon the latter of:
December 31 of the year the appointing City Commissioner leaves office or upon the
appointmenUelection of the successor City Commission member.
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.
cc: Monica Beltran, Parking Director
Valeria Mejia, 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 - Am en dment 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
City of Miami Beach, !700 Ccnvnlcn Canter Drive, Miami Eoach, Ilorda 33 139 guys_miamibcachllgav
OF FICE OF THE CITY CIERK, Ralaal E. Gran ado, Cy Cerk
Tel: 305.673.7411, Fax. 305.673.7254
Emai l: CityCl erk@miamibeach f.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Mr. Darin Feldman
RE: Disability Access Committee
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. 12/31/2025.
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 Florida (depending on the board or committee on which I serve) or ly 1st, followin sing
of the calendar year on which I have served. L.
C~---f'--,~--
a
Sworn to and subscribed before me this / . d 4
*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.
RECEIVED
JAN 222024
City of Miami Beach
l 700 Convention Center Drive
Miami Beach, Florida 33139
CITY OF M,AMI BEACH
OFF!CE
OFFICE OF THE CITY CLERK
Email: C@miamibeachfl.go
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 Sections 2-22 (4),
as (check (/) all that apply):
~ I am a resident of the City of Miami Beach for six months or longer.
er- sores. 1eea- LPxl (CE hi, £)D ,Tl 334±4
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).
Name of Business: _
Business Address: _
D 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
minimum of six months).
Name of Business: ---------------------------
Business Address: _
"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.
der Z that l have read the foregoing document and that the facts .c'- 4/a»
Te.a, Flha
Printed Name
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 331 39
ww w_miamibegchth,gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305. 673.74I1
DIVERSITY STATISTICS REPORT
,
DB
Last Name First Name Middle Initial
The following information is voluntary and has no bearing on your consideration for appointment. It is deing
asked to comply with City diversity reporting requirements.
Gender:
tao tienee
loner
El1prefer not to answer.
Race/Ethnic Categories:
What is your race?
D African American/Black
[]Asian or Pacific Islander
[d Caucasian/white
1J ave American/American Indian 0 Other - Print Race: _
0 I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
9ve=
lo
Ll 1pr ef er not to answer.
Do you consider yourself Physically Disabled?
[Jes
~ ~;refer not to answer this question.
Page 6 of 6
F:CLER\SALL!REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\OARD AND COMMITTEE APPLICATION REG FINAL.dox
Updated: June 2020
C ity of Miami Beach
17 00 C on vention C enter D rive
Miami Beach, Florida 33 13 9
www.miamibeachfl.gov
O FFI C E O F TH E C ITY C LERK
Em ai l: BC @mi ami be a chfl.g ov
Telephone: 30 5.6 7 3 .7 4 11
BOARD & COMMITTEE ACKNOWLEDGEMENT STATEMENTS
dopa au
L a st N a m e First N am e M iddle lni· ial
Acknowledgment of fines/suspension for Board/Committee Members for failure to comply with Mi mi-
Dade County Financial Disclosure Code Provision Code Section 2-11.1(i) (2)
I un d e rsta nd tha t no la te r th an July 1, of each year all m em bers of B oards and C om m ittees of the City of I iam i
Be a ch, in c lud in g tho se of a pure ly ad visory nature, are required to com p ly w ith M iam i-D ade C ounty Finlnci al
Di sclo sure R e q u ire m ents.
One of the fo llo w ing fo rm s must be filed w ith the C ity C lerk of M iam i Beach, 17 00 C o nvention Center rive,
M ia m i B e a ch , Flo rid a , no la ter th a n 12 :00 noon of July 1, of each year:
1. A "S o u rce of In co m e Statem ent;" or
2. A "S tate m e n t of Fina nci al Interests (F orm 1)1;" or
3. A C o py of yo u r la test Fe d era l In co m e T a x R eturn .
Failure to file on e of th e se fo rm s, pu rsu a nt to the M iam i-D ade C o unty C ode, m ay subje ct the person to fine
of no m o re th a n $500, 60 da ys in jail, or bo th.
Acknowledgment to Comply with Miami Beach Code of Ordinances Division 1 Sec. 2-22 (23)
I und e rsta nd th a t co m m encin g w ith term s be ginning on or aft er Jan uar y 1, 2024, and as a condition of app ying
fo r ap po intm e nt to a C ity ag e ncy, bo ard, a com m itt ee , I voluntarily agre e that in the event I file w ith the City
Cl e rk a Statem e 1t of C andi date form ally,an noun ci ng can dida cy for City el ective offi ce, such filing wi th the/City
Clerk shall be d e er d a ten d er i resi~ atio n from th e Ci ty agen cy, board , or comm i tt ee
/ / 1/147202
D ate
1 M e m b e rs of th e P lan n ing B oa rd an d B oa rd of A djustm ent will be notified directly by the State of Flo ida,
pursua nt to F .S . §112 .3 14 5 (1 )(a ), to file a S tatem ent of Fina ncial Interests (F orm 1) w ith the M iam i-D ade C o nty
S u pe rv iso r of E le ctio ns by 12 :00 noo n, Jul y 1. Planning Bo ard and Board of A djustm ent m em bers w ho file heir
F o rm 1 wi th th e C oun ty S u p erv iso r of E lections autom atically satisfy the C o unty's financial dis clos u re
req u irem e nt as a M ia m i Be a ch C ity Board/C om m ittee m em ber and need not fil e an additio nal fo rm w ith the Office
of th e C ity C le rk. H o w eve r, co m pliance w ith the C ounty discl osure requirem ent does not satisfy the 'tate
req u irem e nt.
Page 6 of 6
F\CL ER\SALL IBOARD AND COMMIT TEES DATAB ASE\Board and Ccmmittee Ap plication \BOARD AND COMMITTE E AP PLICATION OCT 2023.d0cx
Updated: January 9, 2023
M IA M I-DAD E.
Em SOURCE OF INCOME STATEMENT
Section 2-11.1i) of the County Ethics Code requires that certain employees and public officials file a financial disclosure Statement on a yearly basis by J ly 1st
of every year.
Disclosure for Tax Year Ending
2023
Last Name y
rOIl0a l
Middle Name/Initial ~
M, Street Num
Ci
«ml'f FL
If your home address is your mailing address, and our home address is exempt from public records pursuant to Fla. Stat. $119.07, read
instructions on the following page and check here.[]
Filing as an Employee (check one)
[] county [] Public Health Trust [] Municipal:
(Municipality)
Department
Position or Title Employee ID Number
Work address Work telephone Employment began on/ende on
Filing as a Board Member (check one)
[] County } Mwonicat: I
(Municipality)
cc@$
Work teleph
30$
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 sou tees 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, 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 separate sheet, check here.[]
Name of Source of Income Address Description of the Principal Business Activity
r affirm that the inf r- · d correct statement. ~----- RECEIVED BY ELECTIONS DEPARTMENT:
J or«co»ECEIVED
[] Electronic Copy
JAN 22 2024
CITY OF MIAMI BEACH
OFF~E r IE OIyy p
OFFICE USE ONLY Accepted: Y / N Deficiency. Processed Date/initials. Scanned Date/initials: I
138_SP-14 COE 2016
/\/4/,/\y/PF/A(Ci,CITYWIDE (CW) BOARD & COMMITTEES
co» -two» .«s. +aG oearia PARKING APPLICATION
1755 Meridian Avenue, Suite 200/Miami Beach, FL 33139/P1: (305) 6737505 or (305) 673.7000 ex4. 6200 I
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 wi I be
provided to you for City Hall Garage (G7) access.
IMPORTANT NOTE: Your vehicle license plate serves as your "parking permit". In order to void
any unnecessary entorcement actions, it is important that our records rellect the most current [and
accurate information regarding your vehicle license plate. Inaccurate and/or outdated vehicle
information may lead to the issuance ot parking citation[s) and/or the towing oh your vehicle.
Please note that this new access cord CANNOT be hole-punched or perforated in any manner. T use
the new card please hold the card at close proximity to the reader until the gate opens. You may eed
to try the other side of the card. Please ensure you hold the entire surface of the card against the re der
until the gate opens.
ACKNOW LEDGEMENT: I acknowledge that should my access card be lost, stole or
damage, I will be responsible to pay a $10.00 replacement fee.
Board Member lnfor ·
Date of Applicatio
Applicant Name:
Board/Com mitt
Home Phone,
ontact Method:
Vehicle lnformati
Tag:
State:
Make:
Applicant St+nature: e
Please provide sign cated at 1755 Meridian Avenue, 2" floor. Working
hours are 8:30 to ? p.m. or email 5: ParkingRecepl mn@miamibeachfl.gov
e-mail subiec: BOARD & COMMITTEE PARKING APPLICATION - APPLICANT NAME
Parkin De artment Section
PERMIT SYSTEM GARAGE ACCESS
Expiration Dote: ID Card Serial #:
lssued By Print Name: Print Name:
Signature: e Signature:
Date Issued: Date Completed:
ors mm:tees po ngorm1.o rm upoa a -