Laurie Kaye Davis 12.31.25B O A RD AN D C O M MI T TE E CHE C KL I S T
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Appointed oy. 0om nry /g ut
FOR SCANNER
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FOR CLERK STAFF
o Letter of Appointment
o Letter of Reappointment
o Copy of Letter of Appointment/Reappointment e-mailed to Committee Liaison on
o Board and Committee Application (Completed on - )
o R~sum~/Curriculum Vitae
o Diversity Statistics Reporting (Completed on [Jg/E
o Oath
IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOO
City Code Ordinance Section applicable to the agency, board or committee
Y City Code Sections 2-21, 2-22, 2-23, 2-24, 2-25, 2-26, 2-458 and 2-459
Y County Code Section 2-11.1 -- Conflict of Interest and Code of Ethics Ordinance (as
amended through December 2010)
Amendments to the Code of Ethics Ordinance (September 2009 through July 2012)
Y Highlights of the Miami-Dade County Ethics Code
t Sunshine Law and Public Records -- Frequently Asked Questions
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.
la4 rag Se£ t
Received on: 12 Signed by X 2,rco
Date Board or commie in,
Processed on: 2/g/2± By Employee:
City Clerk~ Staff Initials Date
1/8/- e
Scanned on: By Employee:
Date City Clerk's Office Staff Initials
We are ccmmited to roding excellent public sarvce cnd so~eiy to all who live work, and play in u vibrant, topical, histo:ic community
M IA M I BEACH
C ity of M ia m i B e a ch , 1/0O Conven tion Center Dri ve, Miami Boach , Florida 33 139 yNyw_miamnibeachfl_gov
OFF ICE OF THE CI TY CL ERK, Rafael E. Granado, City Clerk
Tel: 305.673.7411, Fax 305.673.7254
Email: CiyClerk @miamibeachfl.gov
December 28, 2023
Ms. Laurie Kaye Davis
5965 Alton Rd
Miami Beach, Florida 33140
RE: Committee for Quality Education in Miami Beach
Dear Ms. Laurie Kaye Davis:
Congratulations! You have been appointed by Commissioner Tanya Bhatt 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 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 305.673.7411.
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.
Reg~
Rafa2,anado
City Clerk
cc: Monica Beltran, Parking Director
Dr. Leslie Rosenfeld, 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 - Amendment 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
M IAMI BEACH
City of Mi ami Beach, 1ZOO Convention Conter Drive, Miami Boach, Horida 33 139 yww_miaInibcachll_gov
OF FICE OF THE CITY CLERK, Rafael E. Granado, City Clerk
Tel: 305.673.7411, Fax 305.673.7254
Email: Ci/Clerk@miamibeachll.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Ms. Laurie Kaye Davis
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.
au Kg_«vo
Ms. Laurie Kaye Davis
*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.
Cisy of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.goy
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.
Home Address.g15 A(H (Ck _egLA,F- 33/40
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).
[are f PI1re8S,
[JS]fess {feS,
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).
[[are f [3JS[feSS,
[31[[eSS, ([(d[@S,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.
"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
«
Printed Name
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www._miamibegchf],_gov
OFFICE OF THE CITY CLERK
Em ail: BC@miamibeachf].gov
Telephone: 305.673.7411
DIVERSIIY STATISTICS REPORT
k
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:
Luae
[iremale
Ll oher
D I prefer not to answer.
Race/Ethnic Categories:
What is your race?
D African American/Black
ENsian or Pacific Islander
[J Caucasian/white
D Nave American/American Indian
0 Other -- Print Race: _
0 I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latinola?
Dre»
A No
0 I prefer not to answer.
Do you consider yourself Physically Disabled?
s
No
, prefer not to answer this question.
Page 6 of 6
F:\CLER\$ALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTSIBOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeach!].gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.qoy
Telephone: 305.673.7411
BOARD & COMMITTEE ACKNOWLEDGEMENT STATEMENTS
La««
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 Date
//2/
1 Members of the Planning Board and Board of Adjustment will be notified directly by the State of Florida,
pursuant to F.S. S112.3145(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:\CLER\$ALLIBOARD AND COMMIT TE ES DATABASE\Board and Committee Application\BOARD AND COMMITTEE APPLICATION OCT 2023.docx
Updated: January 9, 2023
MIAMl·DAD E- EI SOURCE OF INCOME STATE MENT
Section 2-11.1 (i) 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 Last Name
a0z es
Middle Name/Initial
K €
Mailing Address - Street Number, Street Name, or P.O. Box
\e
City, State, Zip
Mc
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. 0
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 flember (check one)
[] county Municipal:. €_ty_ of Mk,
(Municipality)
Board where serving
@ou t€
Alternate address (if home address is exempt) Work telephone
35.10.40]
Term began on/ended on
Ile03{
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
LkK o(hi o· 5 ft(5 Kd! M)- T
LI-C MR ~ zad, ;40 cos«ltik
n
I hereby swear (or affirm) that the information above is a true and correct statement.
Signature of Person Disclosing
Date signed
RECEIVED BY ELECTIONS DEPARTMENT:
[] Hardcopy
[C Electronic Copy
OFFICE USE ONLY Accepted: Y [ N Deficiency. Processed Date/initials:Scanned Date/initials:
138_SP-14 COE 2016
/\A! 6. t\\/\ '! kl C ,~/\ l~"'U CITYWIDE (CW) BOARD & COMMITTEES DE]
? {{fi f4 j g } ; ta k i . l.hi ask #
ciy of Mi@ri Bea±, PARKING DARTENr PARKING PP[[CA[ON fie@±
17 5 5 M eri di an A ven ue, Suite 20 0 /Mi a mi Be ch, FL 33 13 9 /P h : (3 0 5 ) 6 7 3 -7 5 0 5 or (3 0 5) 67 3-7 0 0 0 ex4. 62 0 0 PARKING
A city w ide (C W ) par king perm it is honored at m etered parking spaces and restricted residential zones
par king spaces. A C W par king perm it IS NOT honored in prohibited areas. An Access Card will be
pro vided to you for C ity H all G ar age (G 7) access.
IMPORTANT NOTE: Y our vehicl e license plate serves as your p ar ki ng permi t". In or der to avoid
any unnecessar y enfo rcem ent act ions, it is im portant that our records reflect the m ost current and
accura te info rm ation regar ding your vehicl e license plate. Inaccura te and/or outdated vehicl e
info rm ation m ay lead to the issuance of parking citat ion (s) and/ or the tow ing of your vehicl e.
Please note that this new access car d CANNOT be hol e-punched or perfo ra ted in any m anner. To use
the new car d please hold the car d at cl ose proxim ity to the re ader until the gate opens. Y ou m ay need
to try the other side of the card. Please ensure you hold the entire surface of the car d 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 re pl a cem en t fee.
B o a rd M e m b e r In fo rm a ti o n
Date of Application: l)a04
Applicant Name: l-ce K_cu cs $
Board/Committee Name:, Glee -( Gld-y dl echo '0n\-
Address: 5 »5 Alo (-oak M i c a d F 3 q l
E-Mail Address: L ay e a 6is O-<\. o
work Phone 305,+10. Le Home Phone 8104 e o-4 305 68
Cell Phone: 3o$. H4o '0- Preferred Contoct Method: e l
V eh icle ln fo rm a tio n
Ta g: I a qt Color: 5(€
State: rlocd4 Year: 0 \q
Make: Aa d Model: $65
Applicant Sianature: ei Stunt- K a , oCe -iA }L _.,
Please provide signed form to the Parking Department/located at 1755 Meridian Avenue, 2" floor. Working
hours are 8:30 to 5:00 p.m . or email to: PgrkingReception@resign ibeachfl.gov
e-mail su b je ct: BO ARD & CO M M ITT EE PA RK IN G APPLICATI O N - AP PLICA N T NAM E
P ·kt D ar ina epartment ection
PERMIT SYSTEM GARAGE ACCESS
Expiration Date: ID Card Serial #:
Issued By Print Name: Print Name:
Signature: e5 Signature: e5
Date Issued: Date Completed:
5
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