Chana Levin Eisner 06.30.25MIAMI BEACH
BOARD AND COMMITTEE CHECKLIST
APPOINTEE:Chana Levin Eisner DATE OF APPOINTMENT:duly 17 2024
BOARD/COMMITTEE:Quality of Education Committee Appointed by:Yeshiva Elementary School
FOR SCANNER
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FOR CLERK STAFF \\
o Letter ot Appointment TERM END:o[0\2
o Letter of Reappointment
o Copy of Letter of Appointment/Reappointment e-maile
o Board and Committee Application (Completed on )
o Resume/Curriculum Vitae
o Diversity Statistics Reporting (Completed on _,
o Oath
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JUL 17 2024 ✓
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CITY OF MIAMI BEACH ✓
OFFICE OF THE CITY CLERK ✓
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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
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 I I 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:_71_1_71_2_4 Signed by X.Cfi-=_._,.1/l,--_~·---------
Date
ores4•1\24
D te
Board or Committee Member
By Employee:---'A........_,La:;..__'_
City Clerk's Office Staff Initials
WVe are committed to providing excellent public service and salety lo all who live,work,andplay in our vibrant,tropical,historic community.
7/17/2024
MIAMI BEACH
City of Miami Beach,1/OO Convention Conlor Drive,Miami Boach,Florida 33 139 yyywy._miamibcachll.gov
OFFICEOF THE CITY CLERK,Raf0ol E.Granado,CityClerkTol:305.673.7411,Fax.305.673.7254
Emall:CiyClerk@miamibeachll.gov
July 12,2024
Ms.Chana Eisner
4101 Pine Tree Dr ,Apt 804
Miami Beach,FL 33140
SUBJECT:;Committee for Quality Education in Miami Beach
Congratulations!You have been reappointed by to the above referenced,board or committee named
above,for a term ending:06/30/2025.
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.
7RalGranado
City Clerk
cc:Jose Gonzalez,Parking Director
Dr.Leslie Rosenfeld,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
MIAMI BEACH
City of Miami Beach,1ZOO Convonlion Cantor Drive,Miami Boach,Florida 33 139 yww_miaIibgachflgov
OFFICE OF THE CITY CLERK,Rafael E.Granado,CyClerk
Tol:305.673.7411,Fax.305.673.7254
Email:CityClerk@miamibeachfl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO:Ms.Chana Eisner
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:06/30/2025.
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.
Ms.Chana Eisner
swor to and subscribed before me this _l_day duly,2024
2sis±.
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.
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MIAMI BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach,Florida 33139
OFFICE OF THE CITY CLERK
Email:BC@miamibeachfl.gov
Telephone:305.673.7411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI 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:
(21 I am a City of Miami Beach resident for six months or longer.
H Add 4101 Pine Tree Dr,Apt 804,Miami Beach FL 33140/ome ress:
[]1am the parent/guardian of a student attending a Miami Beach school for t#+-school
year.
School:Yeshiva Elementary School
D My parent/legal guardian requirement has been waived by the City Commission.
Under penalties of perjury,I declare that I have read the foregoing document and that the factsstatedinitaretrue.[M/ozorzo«-------------Signature
Chana Levin Eisner
Printed Name
Date
MIAMI BEACH
City of Miami Beach
1 700 Convention Center Drive
Miami Beach,Florida 33139
www.miamibeach[l.gov
OFFICE OF THE CITY CLERK
Email:BC@miamibeachfl.gov
Telephone:305.673.7411
DIVERSITY STATISTICS REPORI
Levin Eisner
Last Name
Chana
First Name
B
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:
LJMaeIZIIFemaleDOtherDIprefer not to answer.
Race/Ethnic Categories:
What is your race?L Amica American/BlackDAsianorPacificIslanderIZIICaucasian/White0NativeAmerican/American Indian0Other-Print Race:-------------□I prefer not to answer.
Do you consider yourself to be Spanish,Hispanic,or Latino/a?
OvesJo0Iprefer not to answer.
Do you consider yourself Physically Disabled?
vshoDIprefer 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
MIAMI BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach,Florida 33139
www.miamibeachfl.gov
OFFICE OF THE CITY CLERK
Email:BC@miamibeachfl.gov
Telephone:305.673.7411
Levin Eisner
Last Name
BOARD &COMMITTEE ACKNOWLEDGEMENT STATEMENTS
Chana
First Name
B
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)"directly 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 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.
Acknowledgment to Comply with Miami Beach Code of Ordinances Sec.2-22 (24)
I understand that if I am engaged to provide services,for compensation,to either (1)a candidate for City elected
office,or (2)a political committee or electioneering communications organization expending funds for or against
candidates for City elected office,such engagement shall be deemed a tender of resignation from the City
agency,board,or committee.
Cf8,
Signature
7/17/24
Date
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:ICLER\$ALL\BOARD AND COMMITTEES DATABASE\Board and Committee Application\BOARD AND COMMITTEE APPLICATION JULY 2024.docx
Updated:July 2,2024
MIAMl·DADE-EI SOURCE OF INCOME STATEMENT
Clear From Print Form
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 1stofeveryyear.
Disclosure for Tax Year Ending
'
Last Name First Name Middle Name/Initial
2023 Levin Eisner Chana B
Mailing Address -Street Number,Street Name,or P.O.Box
4101 Pine Tree Dr.
City,State,Zip
Miami Beach FL 33140
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.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 ]Municipal:Miami Beach
(Municipality)
Board where serving
Quality of Education Committee
Alternate address (if home address is exempt)I Work telephone ITerm began on/ended on
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 ofincomeindescendingorder,with the largest source first.Examples of sources of income include:compensation for services,income from business,gains frompropertydealings,interest,rents,dividends,pensions,IRA distributions,and social security payments.Also,include any source of income received by anotherpersonforyourbenefit.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
Yacholet-lkann Wellness Center Clinical Psychotherapist
Biscayne Associates Interest Income
I hereby swear (or affirm)that the information above is a true and correct statement.Cf,-
Signature of Person Disclosing
6/25/24
Date signed
ocvs 4Ke%97%/59DHardcopy
t1tectonis9'17 2024
CITY OF MIAMI BEACH
OFFICE OE THF CITY CLERK
REMEMBER TO PRINT,SIGN,AND SUBMIT TO THE OFFICE OF THE CITY CLERK VIA EMAIL OR HARDCOPY.
MIAMI BEACHCityofMiamiBeach,PARKING DEPARTMENT
1755 Meridian Avenue,Suite 200 Miami Beach,FL 33139/Ph:(305)673-7505 0r (305)673-7000 ext.6200
aPARKING
BOARD &COMMITTEES
PARKING APPLICATION
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:7/17/24
Applicant Name:Chana Levin-Eisner
Board/Committee Name:Quality of Education Committee
Address:4101 Pine Tree Dr.Miami Beach FL 33140
E-Mail Address:cbleisner@gmail.com
Work Phone:Home Phone:
Cell Phone:786-245-9179 Preferred Contact Method:Cell
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:IVGG32 Color:Black
State:Florida Year:2023
Make:Honda Model:Odyssey
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.
A,licant Siunature:es
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 subiect:BOARD &COMMITTEE PARKING APPLICATION -APPLICANT NAME
f:\ping\$man\var\forms\cw boards&committeesparkingform.doc form updated 1/18/2024