Moni Cohen 12.31.24BOARD AND COMMITTEE CHECKLIST
APPOINTEE: Moni Cohen ------------------
BO ARD/COMMITTEE: Sister Cities --------------
DATE OF APPOINTMENT: 3/27/24 --------
Appointed by: Commissioner Dominguez
FOR SCANNER
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FOR CLERK STAFF 1/2
o Letter of Appointment TE RM END. 12/3 4 TERM LIMIT. 12/31/31
o Letter of Reappointment
o Copy of Letter of Appointment/Reappointment e-mailed to Committee Liaison on 3/27 /24
o Board and Committee Application (Completed on _- _,
o R~sum~/Curriculum Vitae
o Diversity Statistics Reporting (Completed on A/1/A
o Oath
S ca n o
S ca n o
IM P O R T A N T IN F O R M ATION FOR BOARD AND COMMITT EE 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
., 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 ackn o w led g e that p u rsu a n t to S ec. 2-22(9) o f th e M ia m i B each C o d e of O rd ina n ces , I w ill b e rem o ved
fro m m y bo ard /c o m m itt ee up o n failu re to a tt en d 33 % of the reg u la rly s ch ed u led m eeti n g s .
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.
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Processed on: 1/----'--f_:,,__]z_lJ By Employee: -,,.'---'---------------
Date
Received on:
City Clerk's Office Staff Initials
We committed to provdmng excellent pubhc servce and safely to all who lve work, and play mn our vbran, hropcal, hvsto community
City of Miami Beach, Zou Canvonlion Cott Diva, Ma i Florida 33 139 ww.miaribeach#i.go
OFFKCE OF THE CITY CLERK, Rafael E. Granado, Ci#y Clerk
Tel: 305.673.7411, fox€ 305.673.7254
Email: City.Clerk@iamibeochll.go
Oath of Office
Oath of Civility
and
Acknowledgements
TO : M s. M oni C ohen
R E : S ister C ities Program
I do solem nly sw ear or affi rm to bear true faith, loyalty and allegiance to the Government of the United
S tates, the S tate 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 M iam i-Dade C ounty Code (Conflict of Interest and
C ode of Ethics O rdinance), as w ell as Florida C om mission on Ethics Guide to the Sunshine Amendment
and C ode of Ethics fo r P ublic O ffi cers and understand that as a member of a City of Miami Beach Board
and/or Committee, I must comply with the financial disclosure requirem ents 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. Moni Cohen
Sworn to and subscribed before me this i day of ~2024
D L Keila fena Caceres
Deputy Clerk
p lease visi t the C ity of M iam i B each w ebsite at w ww.miamibeachfl.gov under City Clerk/Board and
C om m ittees fo r additional info rm ation regarding the Financial D iscl osure R equirem ents.
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 3313 9
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 30 5.6 73.7 4 11
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):
ISZJ I am a resident of the City of Miami Beach for six months or longer.
or-woes» ~o Laleie2 Bro • 33//2
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).
Name of Business:. _
Business Address:, _
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).
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 perjcLry, I eclare that I have read the foregoing document and that the facts
stated in it are true. du /-1-24
Signature
Mani Cohen
Date
Printed Name
City o f M ia m i B e a c h
l 700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfl.gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
DIVERSITY STATISTICS REPORT
Cohen Moni
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:
Late
D~F emale
0 Other
D I prefer not to answer.
Race/Ethnic Categories:
What is your race?
[ Amican American/Black
Ll Asian or Pacific Islander
[5K Caucasian/white
0 Native American/American Indian 0 Other- Print Race: _
0 I prefer not to answer.
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
Ee
0 I prefer not to answer.
Do you consider yourself Physically Disabled?
Ls
A~N o
D I prefer not to answer this question.
Page 6 of 6
F:ICLER\$ALL\REG\BOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
City of Miami Beach
1700 Con ven tion Center Drive
Miami Beach, Florida 33139
www.miamibeachfl.gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.74 l l
BOARD & COMMITTEE ACKNOWLEDGEMENT STATEMENTS
Cohen Moni
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 Copy of your latest Federal Income Tax Return.
Members of the Planning Board and the Board of Adjustment must electronically file a "Statement of Financial
Interests (Form 1)" dire ctly with the Florida Commission on Ethics.
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
«-t 2o f
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 electronically file a Statement of Financial Interests (Form 1) with the Florida
Commission on Ethics by 12:00 noon, July 1. Planning Board and Board of Adjustment members who file their
Form 1 with the Florida Commission on Ethics 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.
Page 6 of 6
F:ICLERI\SALL\BOARD AND COM MITTEES DATABASE\Board and Com mittee Application\BOARD AND COM MITTEE APPLICATION FEB 2024.d0cx
Updated: February 22, 2024
MIAMl·DAD E- EI 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 Statem ent on a yearly basis by July 1st
of every year.
Disclosure for Tax Year Ending I Last Name First Name J Middle Name/Initial
2023 Cohen Moni /tln nae>
Mailing Address - Street Number, Street Name, or P.O. Box •• 8o lake7o)
City, State, Zip
M1 3 £- 33/40 I
If your hom e addre ss is your m ailing address, and your hom e addre ss is exem pt fro m public re cords pursuant to Fla. St at. $119.0 7, read
instructions on the follow ing page and check here. D
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 E] Municipal: Miami Beach
(M unici pality)
Board where serving
Sister Cities Program o
Alternate address (if home address is exempt) ~ telephone I Term began on/ended on
5 0 ro e 72 -2 o .6 -/ March 2024
Li st below every source of incom e you received, along w ith the address and the principal activity of each source. Include your public salary. Place the sources of
incom e in descending order, w ith the largest source first. Exam ples of sources of incom e include: com pensation for services, incom e fro m business, gains fro m
pro pert y dealings, interest, rents, dividends, pensions, IRA distributions, and social security paym ents. Also, include any source of incom e re ceived by another
person for your benefit. How ever, the incom e 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 at ATC l/ao us ad¢ 5 e Ke.I s.
I hereby sw ear (or affi rm ) that th e inform ation ab ove is a tru e and corre ct statem ent. M · ?l • 6- CY
Signature of Person Disclosing
Date signed
RECEIVED BY ELECTIONS DEPARTMENT:
[] Hardcopy
"' [] El ectron ic Copy
OF FIC E US E O N LY A ccep t ed: Y / N Defici ency:
138 SP-14 COE 2016
Pro cessed Date/Initials: - Scan ne d Dat e/Ini tial s:
• A/ /\/\IL\/,\ y1 u ,
City of Miami Beach, PARKING DEPARTMENT
BOARD & COMMITTEES
PARKING APPLICATION
1755 Meridian A venue, Suite 200 Miami Beach, FL 33139 /Ph: (305) 673-7505 or (305) 673-7000 ext. 6200
a
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.
Board Member Information
Date of Application: 4/1/24
Applicant Name: Moni Cohen
Board/Committee Name: Sister Cities Program
Address:
I -
E-Mail Address: o n, Cleo 820 ' ma.l co
Work Phone: Home Phone: )/4)
Cell Phone: 18-20o -- / Preferred Contact Method:
Please Choose One 1 0 tion:
Citywide Parking Permit/G7 Access Card O Citi Bike/Deco Bike Membership
Vehicle Information (For Citywide Parking Permit/Access Card Only)
Tag: 12//B Color: /3 CL~
State: tu,eh- > Year: 2022
Make: (a «> Model: <x 3 So
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". 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.
/!
licant Si nature:
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 sub'ect: BOARD & COMMITTEE PARKING APPLICATION -- APPLICANT NAME
f:\ping\$man\rar\forms\cw boards&committees parkingform.doc form updated I /18/2024