Amy Rabin 12.31.25Al .M1BEACH
BOARD AND COMMITTEE CHECKLIST
APPoreEe. _hro, k6loin_ AT or APPonwrEeNr: 3_/1]2oz4
soARco»wwmree. RR(ho Aroitea y. (inn)s o@r byoA
FOR SCANNER
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R E CEI VE D
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 h ]J
o Diversity Statistics Reporting (Completed on &l \Q/)
o Oath
TERM ENo: l31)2s TR LuMwrr. _[2/21\2a
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MAR 12 2024
CITY OF MIAM I BEACH
OFFiCE OF THE CITY CLERK
IMPORTANT INFORMA TION FOR BOARD AND COMMITT EE MEMBERS BOOK
✓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
✓County Code Section 2-11.1 -- Confict of Interest and Code of Ethics Ordinance (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
Scan o
Scan o
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.
N O TE : Members of the Land Use Boards will be removed upon failure to attend th ree 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: ~j/-+-+-t-l\ /~2fl-Signed byx._~_.._.,.___ _ ,T .a-ca.aa.cc .c
Processed on: __ 3_}_1_~_.._, _-z..._4 __ By Employee: J<_/\/\_--=--------------
Date City Clerk's Office Staff Initials
Wo are committed to provdng excellent pubc servce and solely to all who le, wok, and play in our vbrant tropcol, histouc community
M IA M I BEACH
City of Miami Beach, 1ZOO Convention Center Drive, Miami Boach, Florida 33 139 yyw_miamibeachll_go
OFFICE OF THE CITY CLERK, Rafael E. Granado, Cy Clerk
Tel: 305.673.7411, Fax: 305.673.7254
Email: CiNyClerk@miamibeachfl.gov
February 29, 2024
Ms. Amy Rabin
331 West 28th St
Miami Beach, Florida 33140
SUBJECT: Transpor tation, Parking and Bicycle-Pedest rian Facilities Committee
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. 7411. Please read the enclosed materials carefully.
Congratulations and good luck.
Regards,
Rafa~o
City Clerk
cc: Monica Beltran, Parking Director
Monica Beltran, 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
City o f Mi a m i B ea ch , I/0O Convention Cent er Drive, Mamt Boach, Horida 33 139 wyyw_.miamibcachll.gov
OF FICE OF THE CITY CLERK, Rafael E. Granado, Cy Clerk
Tl: 305.673.741, Fax 305.673.7254
Email: Ci#Clerk@miamibeachfl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Ms. Amy Rabin
RE: Transportation, Parking and Bicycle-Pedestrian Facilities 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) on July 1st, following the closing
of the calendar year on which I have served.
r • a Ran
Sworn to and subscribed before me th;, ~4
Keila'M er Cac~res
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 BEACH
City of Miami Beach
l 700 Convention Center Drive
Miami Beach, Florido 33139
RECEIVED
MAR 12 2024
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEA CH
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (ch eck (/) all that apply):
~I am a resident of the City of Miami Beach for six months or longer.
or...» 33) 0. 28g1,Maj {ea ? 331o
l 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).
[qmne (f Hy]mes,S,
P[JS[mes,S (](rs,S,
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 loca tion of the business that is physica lly located in Miami Beach (for a
minimum of six months).
[are f Py1mesS,-
b1JS/mg8S (]]feSS,
"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.
Sign~
Printed Name
Date
MIAM I BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachl.gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
DIVERSITY STATISTICS REPORT
Last Name ..dry L .
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:
Lwae
L&female
Lloher
D I prefer not to answer.
Race/Ethnic Categories:
What is your race?
[Am ica American/Black
0 Asian or Pacific Islander
LC~ucasan/w e
D Native American/American Indian D Other - Print Race: _
D I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
Des L No
D I prefer not to answer.
Do you consider yourself Physically Disabled?
E&
Ll t refer not to answer this question.
Page 6 of 6
F:\CLER\$ALLIREGIBOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
M IA M I BE A C H
City of Miami Beach
1700 Convention Center Drive
M iam i Beach, Florida 33139
www .m iam ibeachfl.gov
O FFIC E O F THE CIT Y CLERK
Email: BC @mia mi be achf _gov
Telephone: 305.673.7 411
BOARD & COMMITTEE ACKNOWLEDGEMENT STATEMENTS
Last Nam e First Nam e M iddle 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 m em bers of Boards and Com m ittees of the City of M iam i
Beach, including those of a purely advisory nature, are required to com ply w ith M iam i-Dade County Financial
Di sclosure R equirem ents.
One of the follow ing form s must be filed w ith the City Clerk of M iam i Beach, 1700 Convention Center Drive,
M iam i Beach, Florida, no later than 12:00 noon of July 1, of each year:
1. A "S ource of Incom e Statem ent;" or
2. A Copy of your latest Federal Incom e Tax R eturn .
M em bers of the Planning Board and the Board of Adjustm ent m ust elect ronically file a "Statem ent of Financial
Interests (Form 1)" directly w ith the Florida Com m ission on Ethics.
Failure to file one of these form s, pursuant to the M iam i-Dade C ounty C ode, m ay subject the person to a fine
of no m ore 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 com m encing w ith term s beginning on or after January 1, 2024, and as a condition of applying
fo r appointm ent to a City agency, board, or com m ittee, I voluntarily agree that in the event I file with the City
Clerk a Statem ent of Candidate fo rmally announcing candidacy fo r City elective offi ce, such filing with the City
Clerk shall be deem ed a tender of resignation from the City agency, board, or com m ittee
S ignature ~ □ate '3 / l L /4
' M em bers of the Planning Board and Board of Adjustm ent w ill be notified directly by the State of Florida,
pursuant to F.S. S112.3145(1)(a ), to electronically file a Statement of Financial Interests (Form 1) w ith the Florida
C om m ission on Ethics by 12:00 noon, July 1. Planning Board and Board of Adjustment m em bers who file their
Form 1 w ith the Florida Com m ission on Ethics autom atically satisfy the County's financial disclosure requirem ent
as a M iam i Beach City Board/Com m ittee mem ber and need not file an additional fo rm w ith the O ffice of the City
Clerk.
Page 6 of 6
F:CL E RI S AL L B O A RD AN D C O M M ITT E E S D A T A B A S E \B o a rd a n d C o m m itt e e Ap pl ica tio n\B O AR D A N D C O M M ITT E E A P P L IC A T IO N FE B 20 24 .d o cx
Updated: February 22, 2024
M IA //BE 2CL
City of Miami Beach, PARKING DEPARTMENT
1755 Meridian Avenue, Suite 200 Miami Beach. FL 33139/Ph: (305) 673-7505 or (305) 673-7000 ext. 6200
BOARD & COMMITTEES
PARKING APPLICATION La
PARKING
As a Board/Committee member you are entitled to a Citywide Parking Permit, which includes City Hall
garage (G7) parking access (Access Card), or a complimentary Citi Bike/Deco Bike Membership, or a
discounted MDC Monthly Transit Pass throughout your term.
B o a rd M e m b e r In fo rm a tio n
Date of Application:
Applicant Name:
Address:
E-Mail Address'
Work Phone:
Cell Phone:
C h o o se O n e 1
itywide Parking Permi t/G 7 Access Card Citi Bike/Deco Bike Membership
V e h icl e In fo rm a tio n
Tag:
State:
Make:
Pe rm it/ A c c e ss C a rd O n l
Color:
Year:
Model:
1
A citywide (CW) parking permit is honored at metered parking spaces and restricted residential zones
parking spaces. A CW parking permit IS N O T honored in prohibited areas. An Access Card will be
provided to you for City Hall Garage (G7) access.
IM P O R TA N T N O TE: Your vehicle license plate serves as your "parking permit". 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 C A N N O T 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.
A C K N O W LED G EM EN T: I a c k no w le d g e tha t sho u ld m y a c c e ss c a rd be lo st. sto le n o r d a m a g e . I w ill b e
re sp o n sib le to p a y a $10 .0 0 re p la c e m e nt fe e .
A
Please provide signed (6 the Parking Department located at 1755 Meridian Avenue, 2nd floor.
Working hours are 8:30 to 5:00 p.m. or email to: Pa rkin g R e c e p tio n@ m ia m ib e a c hfl.g o v
e -m a il sub i e c t: BO AR D & C O M M ITT EE PA R K IN G A PPLI C A TI O N - A PPLI C A N T N AM E
f:\ping\$man\var\forms\cw boards&committees parkingform.doc form updated 1/18/2024