Karen S. Edelstein 12.31.24 M I AMI BEACH
BOARD AND COMMITTEE CHECKLIST
APPOINTEE: Katef1 del* 'i DATE OF APPOINTMENT: Oil
BOARD/COMMITTEE: CNM/0f[ CA f1/e ffTwe(e55 Appointed by: (tCMMISSioner ghatt"
FOR SCANNER FOR CLERK STAFF 1'
Scan o Letter of Appointment TERM END: I1" 3'Il M TERM LIMIT: 114 3 I) 611
Scan o Letter of Reappointment o Copy of Letter of Appointment/Reappointment e-mailed to Committee Liaison on 1'1 I I, ,r
``1"
Scan o Board and Committee Application(Completed on )
Scan - o Resume/Curriculum Vitae ,L . /� ,
o Diversity Statistics Reporting(Completed on (I
Scan , o Oath
IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
✓ 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
RECEIVED ✓ 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)
FEB 2 8 2024 ✓ Highlights of the Miami-Dade County Ethics Code
✓ Sunshine Law and Public Records—Frequently Asked Questions
✓ Memorandum-Solicitation by City Board and Committee Members
CITY OF MIAMI BEACI-
OFFICE OF THE CITY CLEF
Citywide Permit Application(Parking Department Form)
O Booklet—Guide to Sunshine Amendment&Code of Ethics for Public Officers and Employees
Scan 0 0 Source of Income Statement
Scan 0 o Acknowledgment Statement
O Board and Committees Liaison Responsibilities
o Diversity Statistics Reporting
R/ 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.
NOTE:Members of the Land Use Boards will be removed upon failure to attend three of the regularly scheduled
meetings per calendar year: or upon abstaining from voting due to a conflict of interest on four different
applications within a calendar year A member who is removed shall not be reappointed to membership on the
board for at least one year from the date of removal.
Received on: � V Signed by X 12,2�r1 � /r
, Date Board or
Committee Member
Processed on: Z'Z V L� By Employee v" I
Date City Clerk's Office Staff Initials
We ore committed to providing excellent public service and solo, all who Irve,work,and ploy in our nbront,tropical,historic community
OF
MIAMI BEACH
City of Miami Bach, 1700 Convention Canter Give,Miami Beach, Florida 33 139 www.miamibeachfI.gov
OFFICE Of Tl-E CITY CLERK,Rafael E.Grand°,City Clerk
Tel:305.673.741 1, Fax:305.673.7254
Email:CityClerk@miomibeachfl.gov
February 01, 2024
Ms. Karen Edelstein
4955 Cherokee Ave
Miami Beach, Florida 33140
RE: Committee on the Homeless
Dear Ms. Karen Edelstein:
Congratulations!You have been appointed by Commissioner Tanya Bhatt to the above-referenced
Board or Committee, for a term ending: 12/31/2024.
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.
Regards,
?if
Rafae Granado
City Clerk
cc: Monica Beltran, Parking Director
Janay Guerrero, 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
MIAMI BEACH
City of Miami Beach, I/00 C.onvoNlon Cantor Dom,Miorni Hooch,l lorklo 331 39 www.rriiamitxrKhll 114+
011K1Of II(CITY Cif RK,Raloalt C+modo,CryClark
Ini 305 673 741 I,lax 305.673 7254
[moil C1tyanrkHmiamiboaxhfl gov
Oath of Office
i Oath of Civility
1 and
Acknowledgements
r
i
1
1
TO-Ms. Karen Edelstein
1
RE Committee on the Homeless
i 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; 12/31/2024.
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. �<
Ms. Karen Edelstein
'Sworn to and subscribed before me this (-1 ' day of F 24
f�
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
MIAMI BEACH RECEIVED
City of Miami Beach FEB 2 8 2024
1700 Convention Center Drive C'TM
Miami Beach, Florida 33139
OFFICEO�MIENII E3C�gE H
OFFICE OF THE CITY CLERK Rk
Email:BCCcilmiamibeachfl aov
Telephone 305 673.741 1
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(I) all that apply):
1 I am a resident of the City of Miami Beach for six months or longer.
Home Address: 7.2.Z yl'� _V1s'r7/
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:
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.
Under penalties of perjury, I declare that I have read the foregoing document and that the facts
stated in it are true. 7
Signature -
Date
KCW(r) Ed e I S-k l$1
Printed Name
r
MIAMI BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfl,gov
OFFICE OF THE CITY CLERK
Email: BC( miamibeachf qov
Telephone' 305.673.741 1
DIVERSITY STATISTICS REPORT
KAve-
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:
❑ Male
EZI Female
Q Other
Q I prefer not to answer.
Race/Ethnic Categories:
What is your race?
El African American/Black
Q Asian or Pacific Islander
al Caucasian/White
❑ Native American/American Indian
Q Other—Print Race
Q I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
Q Yes
21 No
Li I prefer not to answer.
Do you consider yourself Physically Disabled?
Yes
O No
I prefer not to answer this question.
Page 6 of 6
F\CLER\SALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL docx
Updated June 2020
MIAMIBEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibgachfl.gov
OFFICE OF THE CITY CLERK
Email: BC(amlamlbeachfl qov
Telephone: 305.673.7411
BOARD &COMMITTEE ACKNOWLEDGEMENT STATEMENTS
Lft. Ks+ E S
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)':"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
' 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 ICLERSALL\BOARD AND COMMITTEES DATABASEIBoard and Committee Appl,cabon\BOARD AND COMMITTEE APPLICATION OCT 2023 docx
Updated January 9,2023
- r
Clear From Print Form
MIAMFDADE COUNTY SOURCE OF INCOME STATEMENT
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 First Name Middle Name/Initial
2023 r G=t `i T t 1/-) KA-(LP N 5
Mailing Address-Street Number,Street Name,or P.D.Box
122 W yCI*4' 9- (eel-
City,State,Zip
\� P(MI Gf A-04 3/11 0
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 Work telephone Employment began or/ended on
Filing as a Board Member(check one)
❑ County El Municipal: M i AM <\<i-t
(Municipality)
Board where serving
COti'Mrr-rf4 (c h ' 4-6 MELf5S
Alternate address(if home address is exempt) Wart telephone Term began on/ended on
305-q ' -8o01 07 -
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
7/2 or yytM 51,
k2t EOtL-4,1f/N MF3 , FL 33140 oU 5E-
• ,3/o ssuand Me 51„ inrvlt_y owr.EO PrzcpEiz_rt.,\
ru ,G 33/3°1 �T. 13uSu'4E55
TSLA'ND HSSOC I+a'tTcS g t-
MOND Thom S
? 33 41 recteL.eov Swot-
$'SOi; Per9cr%al 'in JtSilKe^f i-
rt4V4yrM4Nr pre e_r C t c .f-t.- 33/34 ';AuuN6s .occou'lar
I hereby swear(or affirm)that the Information above is a true and correct statement. RECEIVED BY ELECTIONS DEPARTMENT:
Hardcopy F(SEIVED
aA •
l�P /� /. Electronic Copy
Signature of Person Disclosing fit\ b tb 2 8 2024
71a� CITY OF MIAMI BEACH
Dam ,JF-
'- 'Lt-. Lit- i L-11-- (:t IY r l r PK _
REMEMBER TO PRINT,SIGN,AND SUBMIT TO THE OFFICE OF THE CITY CLERK VIA EMAIL OR HARDCOPY.
M AM( BEACH CITYWIDE (CW) BOARD & COMMITTEES
City of Miami Beach,PARKING DEPARTMENT PARKING APPLICATION ".:, •r
1755 Meridian Avenue,Suite 200/Miami Beach, Ft 33 139/Ph (305)673 7505 or(305)673-7000 exi 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
information 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 card. 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 Member Information
Date of Application:
a -/- ay
Applicant Name: k<ti2EN EDEI.Srf/
Board/Committee Name: CeMk&Tfitfti ON Tttf 1-1-0PA€€L4.,S5
Address: ZZ w q,N s-hz_EE r, Yu �n,-+M t Bet cf , c L 33)4
E-Mail Address: KeaddS4Ctn LQjmatl, COM
Work Phone: 3 Home Phone
05- U1-8001 305-8 ,5-06 e3
Cell Phone: Preferred Contact Method:
3o S• 98� g 0 o ct C-ELL rNa►vE
Vehicle Information
Tag: 33 Dim 5 Color: $ILV�CR.
State: Vt. Year: 202_0
Make: Model: ODYSSEY M l ry l VA Q
Applicant Signature: ,d
Please provide signed form to the Parking Department located at 1755 Meridian Avenue, 2nd 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
Parkin De artment Section GARAGE ACCESS
PERMIT SYSTEM
Expiration Date: ID Card Serial #:
Issued By Print Name: Print Name:
Signature: d Signature:
zr
Date Issued: Dale Completed:
Mil r mi