Devorah Zeiger 6.30.24BOARD AND COMMITTEE CHECKLIST
AP PorEe. DUoaL Ar or APPorNr: 3//I/2024
soARD coMM rrree:._quo ls} E duct, Apointed y l/h o /Fl
FOR SCANNER
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RECE IVED
MAR 18 2024
FOR CLERK STAFF f~ J"2./'\) \ 1f
Letter of Appointment TERM END:_~ p-ht TERMLIMIT.
o Letter of Reappointment
o Copy of Letter of Appointment/Reappointment e-mailed to Committee Liaison on
o Board and Committee Application (Completed on ___,
R~sum~/Curriculum Vitae
o Diversity Statistics Reporting (Completed on _,
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
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)
Highlights of the Miami-Dade County Ethics Code
Sunshine Law and Public Records - Frequently Asked Questions
Memorandum - Solicitation by City Board and Committee Members CI T Y O F MI AM I B E A CH
OFFICE OF THE CITY CLERK
o Citywide Permit Application (Parking Department Form)
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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) I 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
ceveson ?)[2 [01 Signed by X D)vorfoL 2&iqU uudd9/ I
Board or Committee Memt, Date
Processed on 3/e h4 By Employee (
Scanned on 3ff# 1a By Employee:
City Clerk's~ Initials
Date City Clerk's Office Staff Initials
1
City of Miami Beach, 1/OO Com ntn (Conto Drwvo, Momu [ooh, Horka 33I39 wy_mambo ht!yo
OH KCF O TH CITY C(ERK. Rafaol E Granado, Coy Cord
Tl 305 673 74l1 fax 305 673 725
E ml. Cidol @miamuboochfl gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO. Ms. Devorah Zeiger
RE Com mittee for Quality Education in Miami Beach
I do solemnly swear or affirm to bear true faith, loyalty and allegian ce to the Government of the United
States, the State ot Florida, and the City of Miam i 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 06/30/2024.
To my colleagues and to all of those I represent an d 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-D ade County Code (Conflict of Interest and
Code of Ethics Ordinan ce), as well as Florida Com mission on Ethics Guide to the Sunshine Amendme nt
and Code of Ethics for Public Officers and understand that as a member of a City of Miami Beach Board
an d/or Committee, I must comply with the finan cial disclosure" requirements of Miami-Dade County or the
State of Flonda (depe nding on the board or committee on wh ich I serve) on July 1st, following the closing
of the calendar year on which I have served.
Ms Devorah Zeiger
Sworn to and subscribed before me this .M!t£ day of , 2024
K
'Please visit the City of Miami Beach website at www.miam ibeachfl gov under City Clerk/Board and
Committees for addition al information regarding the Financial Disclosure Requireme nts.
M IA M I BEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139 www.miamibeachfl.gov
OFFICE OF THE CITY CLERK, Rafael E. Granado, City Clerk
Tel: 305.673.7411, Fax: 305.673.7254
Email: CityClerk@miamibeachfl.gov
M a rch 8, 20 2 4
D e v o rah Ze ig er
4 10 1 P ine T re e D r.
M ia m i B e a ch , FL 33 14 0
RE: Committee for Quality Education in Miami Beach
D e a r M s. Z e ig e r,
C o n g ratula tion s! Y o u ha ve be e n ap pointed to the above-referenced Board or Com m ittee as a
re p re se ntati ve fo r the Hebrew Academy PTA, fo r a term ending on 06/30/2024.
If yo u are un able to acce pt this ap po in tm ent or have any questions, please call the Offi ce of the
C ity C lerk at 30 5.6 73.7 411 .
P le a se re a d the e nclo se d m a teria ls ca refully as the y concern your duties, responsibilities, and
re q u irem e nts a s a bo a rd or co m m ittee m em b e r.
C o n g ratula tion s ag ain an d go o d luck.
Reg]'}
R afae l G ra n a d o
C ity C le rk
cc : M o n ic a B eltra n , P a rking D ire cto r
D r. Le s lie R o senfeld , C ity Li aiso n
E N C L O S U R E S :
O a th of O ff ice /O a th of Ci vi lity /A ckn owl edg em ent s
Ci ty C o de/Or di nan c e se ction ap plicable to ag ency, bo ard or com m ittee
C ity C o de S e ction s 2-2 2 , 2-2 3 , 2-2 4, 2-25, 2-2 6, 2-4 58 and 2-459
O rd in a nce N o . 2006 -3 5 4 3 - Am en dmen t to C ity C ode Section 2-22
M ia m i-D a d e C ou nty C o d e S e ction 2-11.1 - C on flict of Interest and C ode of Ethics
C ity W id e P erm it Ap p lic ation - (Par king D ep a rt m ent Form )
Bo o kl e t - G uid e to the S un sh in e A m e n d m ent and C ode of Ethics fo r Public Offi cers and Em ployees
We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community.
BL .A
City of Miami Beach
1700 Convention Center Drive
M iami Beach, Florida 33139
O FFIC E OF TH E CITY CLER K
Em ail: BC@miamibeacbfL.aoy
Teleph on e: 305.673.7411
AFFIDAVIT OF AFFILIATION WITH THE CITY QF MIAML 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:
f am a City of Miami Beach resident fo r six months or longer.
Home Address: ol ~ihg ±cee
] tam the parent/guardian of a student attending a Miami Beach school for the 3]Jo)-4
sc h o o l year.
Under penalties of perjury, I declare that I have read the foregoing document and that the facts
stated in it are true.
sign ature pate Morch ?d, 30)9
n tea N am e Devora' ordi of (zis)
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
wwwmiomibeoch!l.gov
OFFICE OF THE CITY CLERK
Email BC@miamibeachfl_gov
Telephone: 305.673.7411
{±A Last Na
BOARD & COMMITTEE ACKNOWLEDGEMENT STATEMENTS soy- 2!o • Gal e 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)
l 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 C'erk 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
Sig0ature
' 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.
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F CLER SALL BOARD AND COMMITTEES DATABASE Board and Committee Appvcatvon BOARD AND COMMITTEE APPLICATION OCT 2023 00cx
Updated January 9 2023
B E A CH
City o f M ia m i Be a ch
1700 Con v ention Cen ter Dr ive
Mom Beach, Florido 33139
www..miam nib e achtl. gov
OFFICE OF THE CITY CLERK
Em ai l BC@miambeachf gov
Telephone 305.673.7411
D IVE R SI T Y STATISTICS REPORI
Last Na
De
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:
at e
[O Fem al e
0 Other
0 I prefer not to answer.
Race/Ethnic Categories:
What is your race?
D African American/Black
0 Asian or Pacific Islander
DO Caucasian white
L_I Native American/American Indian
D Other - Print Race: ------------ □I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
Oves
Ono
D I prefer not to answer.
Do you consider yourself Physically Disabled?
es c l_ □- I prefer not to answer this question
_______________________________ ...J
Page 6 of 6
F C L E R S A L L R E G B O A R D AN D C O M MI T TE E AP P LIC A TION S FIN AL D R A F T S B O AR D AN D CO M MI T TE E APP L IC A TIO N RE G FINAL doc
Upd ated Jun e 2020
CITYWI DE (CW) BOAR D & COMMITTE ES g.g
or ·rovers. raw«awe oea«a PAR KING APPLICATION .Ai
PARKING 75$ Me ridi a n Ave ve, Sue 200/Mori Beach, FL 33 13 9 /P h (305) 673.7505 0 (305) 673.7000 et 6200
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 Infor ·
Dote of Application:
Boord/Committee Name·
Address: A lo [
E Moil Address: A
Work Phone:
Cell Phone: Preferred Contact Method:
Vehicl e Information
Tes. T!AO
State
Make:
Color:
Year:
Model:
Applicant Sf+nature.
Please provide signed form to the Parking Departmen t located at 155 Meridian Avenue, 2 floor. W orking
hours are 8.30 to 5.00 p.m. or em oil to: ParkingReception@m iamibeachfl,gov
e-mail subiect: BOARD & COMMITTEE PARKING APPLICATION - APPLICANT NAME
Parking Department ection
PERM IT SYSTEM G AR AGE ACC ESS
[ Eproton Dote ID Card Serial #
Issued By Punt N am e Punt Name
Signature £ Signature - - --- -- Date lssued Date Comp l eted
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