Rina Bass 12.31.25B O AR D AND COMMITTEE CHECKLIST
APoreEe:_Ki)0_ b0$ Ar or ArPorr._'['(24
eoARocoMrree. (&utlity duct hon_ Anoint«ea» I-is#en oan Surat
ror SCANNER For cLeRksTArr o [ ] )24
sca totter ot Anointment TERM Eno._{[3l[25 rErRMunr. l),21
Scan LeHer of Reappointment • I a. ' "' , I)
Copy of Letter of ppointment/Reappointment e-mailed to Committee Liaison on l] U,I
Scan o Board and Committee pplication (Completed on )
• Resume/curriculum Vitae )f3]
• Diversity statistics Reporting (Completed on h, lb) ),]_
o Oath
Scan
Scan
IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
RECEIVE[! ,,,. 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 2-111 -- Conflict of Interest and Code of Ethics Ordinance (as
amended through December 2010) J/NV ]8 2)74 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
CITY O F M IA\MI BEACH Memorandum - S oh ci tat ion ty City Board an d Committee Members
OFFICE OF THE CITY CLERK
O Citywide Permit Application (Parking Department Form)
O Booklet - Guide to Sunshine Amendment & Code of Ethics for Public Officers and Employees
Scan O
Scan O
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 removed
from my board/committee upon failure to attend 33% of the regularly scheduled meetings.
Sec. 2-22(9) lf any member of an agen cy 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.
Received on: ~J 1.L• +-I t.:::.•..,'1~---- Signed by X._-M-,,.c..:>L::""-
Date
Processed on --1 . l 1/l- / t,'-r By Employee: ----::--'f:JV\---c:---------,-----------
Date City Clerk's Office Staff Initials
1\2%/f oars f//1...
City Clerk's Office Stat~ Initials
Scanne d on
Date
M IA M I BEACH
City of Miami Beach, 1ZOO Convention Co ntor Drivo, Miami Boach, Florida 33139 yyyy_miamnibea chll.go
OFFICE OF THE CITY CLERK, Rafaol E. Granado, Ciy Clerk
Tel: 305.6 73.74 11, Fax: 305.673.7 25 4
Emai l: CityCl erk @mi am ibeoch fl.go v
D e cem be r 28 , 20 2 3
M s. R ina Bass
635 W 51 st Stree t
M ia m i Beach, F L 3314 0
S U B JE CT : Com mi ttee for Quality Educati on in Miam i Beach
C o ng ratulations! Y ou have been reappointed by Commissioner Kristen Rosen Gonzalezto the above
referenced, bo ard or com m itt ee nam ed above, fo r a term ending: 12/31/2025.
Pu rsuant to C ity of M iam i Beach C ode S ection 2-22 (5) a, "Notw ithstanding any other pro vision of the
C ity C o de or of any resolution, com m encing w ith term s beginning on or after Jan uary 1, 2007, the term of
every boa rd m em ber w ho is directly appointed by a m em ber of the City C om m ission shall autom atically
expire up on the la tter of: D ecemb er 31 of the year the appointing City C om m issioner leaves offi ce or
upo n the appo intm e nt/election of the successor C ity Com m ission m em ber."
If you are un ab le to accept this appointm ent, or have any questions, please call the O ffi ce of the City
C le rk at 30 5 .6 73 .7411. Please read the enclosed m aterials carefully.
C ong ratulatio ns and good luck.
Rega~
R afa el G ranado
C ity C le rk
cc: M o nica Beltra n, Parking Di rector
D r. Le slie R ose nfeld, C ity Li aison
ATTACHMENTS:
Lett er of A ppointm e nt
O ath
C ity C ode/O rdinance section applicable to agency, board or com m ittee
C ity C o de S ectio n 2-22, 2-23, 2-24, 2-25, 2-26, 2-458 and 2-459
O rdina nce N o. 20 06-3543 - Am endmen t to C ity C ode Section 2-22
M iam i-D a de C o unty C ode Section 2-11.1 -C on flict of Intere st and C ode of Ethics O rdinance
C ity W ide Pe rm it Ap plic ation - (Pa rkin g D epartm ent Form )
Book l e t - G uid e to the S unshine A m endm ent and C ode of Ethics fo r Public Officers and Em ployees
Of/KI O IHA CAY CALRK . Ro!olL. Granado, City de+l
It 305.73 7Al, 1ax 305.673724
rl. Cilek olvambeach! gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Ms. Rina Bass
RE: Committee for Quality Education in Miami Beach
I do solemnly swear or affirm to bear true faith, loyalty and allegianc e 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 ] have been appointed for a
term ending: 12/31/2025.
To my colleagues and to all of those I represent and serve, l 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) on July 1st, following the closing
of the calendar year on which have served.
Ms. Rina Bass
sworn to and subscribed before me this _l] day ot J01_. 2023
£s
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.
'
l # ma I senna» a ease s tar mew neat
Ci ty of Miami Beach
I70 Convention Ceater Dive
Miami eh Hori&s 33139
RECEIVED
JAN 18 2024
CITY OF MIAMI BEACH
OFFICE r Ir CIT ctrk
OFFICE OF THE CIY CIERK
Email C(@miamibeachf gov
Telephone. 305.673.7411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
I am in compliance with the affiliation requirem ent of Miami each 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.
Home Address._(03S «4_S1" Mari Bzod 3319o
E [1have 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).
[Jam)9 ({ Pp],]f@,,
p[[,If@,S, k(}[r s,,---
[]1am 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).
pp1 f t9 (9[ p/1,[[,,
P{1,HP%S,, f\([(Hf@,S,_.....----
"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.
"B usiness" m eans any sole proprietorship, sponsorship, corporation, limited lia bility com p any,
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. ge Mau site
/+7[24
Date
Printed Name
of Miami Beach
Convention Center hive
Mi0mi 8eoch, ftondo 33139
OF+Ct OF 1Ht CI CLERK
Ema BC@miamubeach.gov
Telephone 305 673.7411
DIVERSITY STATISTICS REPORT
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:
LJuae
LT remale
LJ oner
DH prefer not to answer.
Race/Ethnic Categories:
What is your race?
[]African American/Black
El Asian or Pacific Islander
] Caucasian/white
E]Native Am erican/Am erican Indian
[] Other - Print Race. -
El prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latinola?
Yves
[J o
El prefer not to answer.
Do you consider yourself Physically Disabled?
tee n
L ht refer not to answer this question.
Page 6 of6
FCA.ER\SALL REGABOARD AND COMMITTEE APPLICATIONS FINAL DRAF TS(GOARD ANO COMMIT TEE APPLICATION REG FINAL. doc
Updated June 2020
Ci t y o f Mia m i Beach
1700 C o nv ent io n Center Drive
Mi »i Beach , Hord 33 139
OFFI CE OF THE CIY CI R K
OARD & COMMITTEE ACKNOWLEDGEMENT STATEMENTS
a
First Name
A ckn o wle dgm e n t o f fines/suspension f or Bo ard/C o mmitte e Members for failure to comply with Miari-
Dade County Financial Disclosure Code Provision Code Section 2-11.1(i) (2)
I understand that no later than July 1, of each_year all member s 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 Con vention 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)';" 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 $500, 60 days in jail, or both.
Acknowledgment to Com ply with Miami Beach Code of Ordinances Division 1 Sec. 2-22 (23)
I understand that commencing with terms beginning on or after January 1, 2024, and as a condition of applying
for appointment to a City agency, board, or committee, I voluntarily agree that in the event I file with the City
Clerk a Statement of Candidate fo rm a lly announcing candidacy for City elective office, such filin g with the City
Clerk shall be deemed a tender of resignation from the City agency, board, or committee
.± 1 \11/24
Date
Middle Initial
' Members of the Planning Board and Board of Adjustment will be notified directly by the State of Florida,
pursuant to F .S . 112.3145(1)(a), to file a Statem ent of Financial Interests (Form 1) with the Miami-Dade County
Supervisor of Elections by 12:00 noon, July 1. Planning Board and Board of Adjustment members who file their
Form 1 with the County Supervisor of Elections automatically satisfy the County's financial disclosure
requirement as a Miami Beach City Board/Committee member and need not file an additional form with the Office
of the City Clerk. However, compliance with the County disclosure requirement does not satisfy the State
requirement.
Page 6 of 6
F\CLER$AL.LORD AND COMMITTEES OK!ABASE Board and Canvntteo ppcato&OAR) AND COMMITTEE APPLICATION OCT 2023 0
Updated January 9, 2023
M IA M I
EE,i SOURCE OF INCOME STATEMENT
Section 2-11 1¥ of the County Ethics Code requires that certain employees and pubc offals fe a financial hstosure Statem ent on a year0y oasis by July 1st
of every eat
"" Year E11dlng i Last £:~.:..> Fi-1--B--t-'-;.~"-n-'m'-'e1r. ---------M--id-rll_e_lJ_a_m_(!/-ln_lt_la_l ~
Mailing Address - Street Number, Street Name, or P.0. Box
6 \{S" Sf. I
City, State, Zip
/Mao (8h , ft $%1/ I
lf your home address is your mailing address, and your home address is exempt trom public records pursuant to fla. S1at. $119.07, read
instructions on the tollowing page and check here. []
Filing as an Em ployee (check one)
[] county [] Public Health Trust [] Municipal:
(M unicipality)
Department
Position or Title Employee ID Numbe r
Work address I Work telephone Employmen t began on/en ded on
Filing as a Board Mem ber (check one)
[] county 1 Monica. Miami ?ah
(Municipality)
Board where serving uati
Work teleph one
7& 2, 13328-
Term began on/en ded on
t 4
Lust below every source of income you received, along with the address and the principal actty of each source. Include your public salary Place the sources of
income in descending order, wath the largest source first Examples of sources of income include: compensation for services, income from business, gains from
prop erty dealings, interest, rents, dividends pensions, IRA di strib utions, and social secunity paym en ts Also, include any source of inc om e received by an otte
person tor your benefit However, the incom e ot your spouse or any business partner need not be disclosed. It continued on a separate sheet, check here.[]
Name of Source of Income Addre ss Description ot the Princ ipal Business Activity
Miam i pod co lkq e dmntw«dab Uy
"'
I hereby swear (or affirm) that the information above is a true and correct statement
Sign~-M&-:-o!..C-c-lo_s_ln_g _
RECEIVE D 8Y ELECTIONS DEPARTMENT:
war@ co HEiGEIV~D
Electronic Copy
JAN 18 2024
CITY OF MI A M I BEA CH
OFFICE_OF THE Or
OFFICE USE ONLY Meted YA N De!ency.-- • Pr ocessed Date/tutals.-. Scanwea Date:trtials. -.
38 .°4 CG£ 20A6
' Bf }/CITYWIDE {CW) BOARD &, COMM»HES
ca y ot i i «es@ P A K o o otaR1wt1 P/ARKIN /PP[IC[IO}/
PAKING
A citywide [CW} parking perm it is honored al metered parking spaces and restricted residential zones
parking spaces. A CW parking permit IS NOT honored in prohibited areas An Access Card ill be
provided to you for City Ha ll Garage (G7) access.
IMPORTANT NOTE: Your vehicle license plate serv es as your "parking peruni!" In order to avoid
any unnecessary enlorc em e nt actions, it is important that our records rellect the m ost current and
accurate information regarding your vehicle license plate. Inaccurate and/or outdated vehicle
informa tion 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 hol e 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. '(ou may need
to try the other side of the card. Please ensure you hol d the entire surface of the card against the reader
until the gate open s.
ACKNOWLEDGEMENT: I acknowledge that should my access card be lost, stolen or
damage, I will be responsible to pay a $10.00 replacement fee.
2dfd fief1bet [f o rm a tion1.--
ate of Ap plication : ,
Applicant Name:
Boord/Committee N am ° ka tihy €olacet4:v--
Address (y35 51% Se} la.m, & ft
c ell Phone: 1fu-240 ·2 3 2- Preferred Contact M ethod: @@//
Vehicle Infor m a ti o n
Tog: ?wX12 Color.
State:
Make:
Year.
Model:
Applican' Signature. es 1[ 1 J5 .... I
'Pl eose provi de sign@ f, i ik e Park ing Deportm ent located or 1755 Meridian A ven ue. 2 ° floor W orkiog /
/hours are 830 1 500 p.m . or email to: ParkingReception@mniamibeachfl.gov
e-mail subject: BOARD & COMMITTEE PARKING APPLICATION -- APPLICANT NAME }
g Dep artme nt Section 1=gap5Gp {rs
II SY(S IEM ID C ard Ser f
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