Beverly Heller 12.31.25M IA MAIBE A CH
BOARD AND COMMITTEE CHECKLIST
APPOINTEE: Beverly Heller
BOARD/COMMITTEE: Committee for Quality Ed
DATE OF APPOINTMENT: I[P]
A ppoi nted by: Commissioner Bhatt
FOR SCANNER
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FOR CLERK STAFF I I I
o Letter of Appointment TERM END. l[3142S TERMLIMIT: 12y3l 21
o Letter of Reappointment
o Copy of Letter of Appointment/Reappointment e-mailed to Committee Liaison on L[Q/-4
o Board and Committee Application (Completed on _,
Resume/curriculum vitae _[_ _[
o Diversity Statistics Reporting (Completed on l j )4
o Oath
IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
RECEIVED
✓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 2-11.1- Conflict of Interest and Code of Ethics Ordinance (as
JAN 172024 amended through December 2010)
✓Amendments to the Code of Ethics Ordinance (September 2009 through July 2012)
✓Highlights of the Miami-Dade County Ethics Code
CITY OF MIAMI BEACH ✓Sunshine Law and Public Records - Frequently Asked Questions
OFFICE OF TE ~ITV C!ERK Memorandum - Solicitation by City Board and Committee Members
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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 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) 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.
ill9 ses,Xfoe', tetLo-
Date Board or Committee Member
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}. " sans Q/224
Date
Received on:
By Employee: __,f0_A.__ _
City Clerk's Office Staff Initials
By Employee: _,0 _
City Clerk's Office Staff Initials
City of Miami Beach, LOO Convnlion Con ler Di ve, Mia mi Bach, Florida 33139 ya_miamibagchf]_ga
OFFICE OF THE CITY CLERK, Raf0al E. Gran ado, Chy Clerk
Tel: 305.6737411, Fax 305.673.7254
Email: Ci#yClerk@miamibsochfl.gov
January 17, 2024
Ms. Beverly Heller
5916 LaGorce Dr
Miami Beach, Florida 33140
SUBJECT: Committee for Quality Education in Miami Beach
Congratulations! You have been reappointed by Commissioner Tanya Bhatt to the above referenced,
board or committee named above, 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 January 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 appointment/election 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. 7 411. Please read the enclosed materials carefully.
Congratulations and good luck.
Regards,
Rafael Granado
City Clerk
cc: Monica Beltran, Parking Director
Dr. Leslie Rosenfeld, City Liaison
ATTACHMENTS:
Letter of Appointment
Oath
City Code/Ordinance section applicable to agency, board or committee
City Code Section 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 Ordinance
City Wide Permit Application - (Parking Department Form)
Booklet - Guide to the Sunshine Amendment and Code of Ethics for Public Officers and Employees
//4 AA/PF[ I uf V\ DLF 14 1
City of Miami Beach, !/0O Convention Conler Drive, Mami Bach, Florida 33139 y_miamibeach[]_go
OFFICE OF THE CITY CLERK, Rafoal E. Granado, Chy Clerk
Tel 305.673.711, Fax: 305.673.7254
Email: Ci#Clerk@miamibeochfl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Ms. Beverly Heller
RE: Committee for Quality Education in Miami Beach
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) on July 1st, following the closing
of the calendar year on which I have served.
ph Hg.ts is. ~very Heller
swom to and subscribed before me u, J3 a rd(]_, 2024
.4-
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.
MIAM I BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
RECEIVED
JAN 17 2024
CITY OF MIAMI BEACH
OFFICE O 4E CITY CLERK
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7 411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH AND THE COMMITTEE
FOR QUALITY EDUCATION IN MIAMI BEACH
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:
~ am a City of Miami Beach resident for six months or longer.
Home Address: 6QI L_Aco r2 D y@, DBH EL 33/o
I
D I am the parent/guardian of a student attending a Miami Beach school for the school
year.
School: ----------------------------
Under penalties of perjury, I declare that I have read the foregoing document and that the facts
stated in it are true.
Date
Beverly Heller
Printed Name
MIA\MIBEACH
City of Miami Beach
l 700 Convention Center Drive
Miami Beach, Florida 33139
www_miamibeach!]. gov
OFFICE OF THE CITY CL ERK
Email: BC@miamibeachfl_gov
Telephone: 305.673.7411
DIVERSITY STATISTICS REPORT
Heller Beverly
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:
LJ ete
LI Female
0 Other
El refer not to answer.
Race/Ethnic Categories:
What is your race?
[African American/Black L Asian or Pacific Islander
L'] Caucasian/White
OJ Native American/American Indian
D Other - Print Race: ------------- □I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
lves
Hi
0 I prefer not to answer.
Do you consider yourself Physically Disabled?
Ears
' No D I prefer not to answer this question.
Page 6 of 6
F:\C LE R\$A LL\RE G \B O A R D A N D C O M M ITT E E A P P LIC A T IO N S FIN A L D RA FT S \BO A RD A ND C O M M ITT E E A P P LI C A TIO N REG FINA L.docx
Updated: June 2020
M IA M I BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www_miam ibeach[l_gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl_gov
Telephone: 305.673.7411
Heller
BOARD & COMMITTEE ACKNOWLEDGEMENT STATEMENTS
Beverly
Last Name First Name 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 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 than $500, 60 days in jail, or both.
Acknowledgment to Comply with Miami Beach Code of Ordinances Division 1 Sec. 2-22 (23)
I understand that commencing with terms beginning on or after January 1, 2024, and as a condition of applying
for appointment to a City agency, board, or committee, I voluntarily agree that in the event I file with the City
Clerk a Statement of Candidate formally announcing candidacy for City elective office, such filing with the City
Clerk shall be deemed a tender of resignation from the City agency, board, or committee
Signature T Date
1 Members of the Planning Board and Board of Adjustment will be notified directly by the State of Florida,
pursuant to F.S. §112.3145(1)(a), to file a Statement of Financial Interests (Form 1) with the Miami-Dade County
Supervisor of Elections by 12:00 noon, July 1. Planning Board and Board of Adjustment members who file their
Form 1 with the County Supervisor of Elections automatically satisfy the County's financial disclosure
requirement as a Miami Beach City Board/Committee member and need not file an additional form with the Office
of the City Clerk. However, compliance with the County disclosure requirement does not satisfy the State
requirement.
Page 6 of 6
F:ICLERl$ALL\BOARD AND COMMITT EES DATABASE\Board and Committee Application\BOARD AND COMMITT EE APPLICATION OCT 2023.docx
Updated: January 9, 2023
MIAMI-DADE-
EIII SOURCE OF INCOME STATEMENT
Section 2-11.1(@) of the County Ethics Code requires that certain employees and public officials file a financial disclosure Statement on a yearly basis by July 1st
of every year.
Disclosure for Tax Year Ending I Last Name First Name Middle Name/Initial
2023 Heller Beverly
Mailing Address - Street Number, Street Name, or P.O. Box
5qt6 L/4Go2 D2we
City, State, Zip
\t' BCA4 TL 33t4 3
t
If 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.[]
Filing 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
Filing as a Board Member (check one)
[] county [] Municipal: Miami Beach
(Municipality)
Board where serving
Committee for Quality Education
Alternate address (if home address is exempt) I Work telephone I 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, 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
[2ten €5o.Se
I hereby swear (or affirm) that the information above is a true and correct statement.
it. Hett
signature ot Person isclosing
Date signed
RECEIVED BY ELECTIONS DEPARTMENT:
[] Hardcopy RECEIVED
[] Electronic Copy
JAN 1 7 2024
CITY OF MIAMI BEACH
OFFICE Or TE CITY CLERK
OFFICE USE ONLY Accepted: Y I N Deficiency: Processed Date/initials: Scanned Bate/initials.
138_SP-14 COE 2016
/\/A/\/ BEACH Cw«DE (cw OARD & corers g .g
City of Miami Beach, PARKING DEPARTMENT PARKING APPLICATION ldll
1755 M eridi an Avenue, Suite 200/Miami Be ch, FL 33139/Ph: (305) 673-7505 6r (305) 673-7000 e4. 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 (G7) 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
info rmation 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 car d. Please ensure you hold the entire surface of the card against the reader
until the gate 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 M ember Info rmation
Dote of Application:
Applicant Name: Beverly Heller
Board/Committee Name:
Address:
E-Mail Address:
Work Phone: Horne Phone
Cell Phone: Preferred Contact Method:
Vehicle Information
Tog: San 0n0 fl Color:
State: Year:
Make: Model:
Applicant sianatore. F_at (le @
Please provide signed form to the"Parking Department located at 1755 Meridian Avenue, 2d floor. Working
hours are 8:30 to 5:00 p.m. or email to: ParkingReception@miamibeachfl.gov
e-mail subject: BOARD & COMMITTEE PARKING APPLICATION - APPLICANT NAME
P, ·ki D ar Ina epartment ection
PERMIT SYSTEM GARAGE ACCESS
Expiration Date: ID Card Serial #:
Issued By Print Name: Print Name:
Signature: e Signature: e
Date Issued: Date Completed:
s
: pmng man rar\worms cw oats commmtees par mgorm.aoc