Diane Klein 12.31.25MIAMI BEACH
BOARD AND COMMITTEE CHECKLIST
APPOINTEE:Diane Klein------------------DATE OF APPOINTMENT.8/28/24--------
BOARD/COMMITTEE:Miami Beach Comission For Wo Appointed by:Comissioner Kristen Rosen Ge
FOR SCANNER
Scan o
Scan o
Scan o
Scan o
Scan o
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 8/28/2024 )
o Resume/Curriculum Vitae
o Diversity Statistics Reporting (Completed on 8/29/24
o Oath
TERM END:12/31/2025 rRM LuMr.\2\at(3]yrts\l\¥
RECEIVED
$EP 03 2024
cry OF MAMB8EN!'OFFICE OF THE CITY CLERK
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
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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
EE 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 ofremoval.
Received on:_81_2_91_24 Signed by x jf_....L-OotL_·_·....,.V""---~----------
Board or Committee Member
Processed on:__q~·--i\.-&_tt-~-~__._By Employee:-~24:"--__,__~_L-----=·------------')ate City Clerk's Office Staff Initials
Date
We are committed to providing excellent public service and salety to all who live,work,and play in our vibrant,tropical,historic community
MIAMI BEACH
City of Miami Beach,I/OO Convonlion Coner Drivo,Miami Boach,Florida 33 139 yywy._miamnibcachll.gov
OFFICE OF THE CITY CLERK,Raf0ol E.Granado,CityClerk
Tel:305.673.7411,Fax.305.673.7254Email:CilyClerk@miamibeachll.gov
August 28,2024
Ms.Diane Klein
765 South Shore Dr
Miami Beach,Fl 33141
RE:Miami Beach Commission For Women
Dear Ms.Diane Klein:
Congratulations!You have been appointed by Commissioner Kristen Rosen Gonzalezto the above-
referenced Board or Committee,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 as they concern your duties,responsibilities,and
requirements as a board or committee member.
Congratulations again and good luck.
Reg7251
Rafa2:anado
City Clerk
cc:Jose Gonzalez,Parking Director
Monica Matteo-Salinas,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,1/OO Convonlion Conler Dive,Miami Boach,Horida 33 139 www._miaribgachllgov
OFFKCE OF THE CITYCLERK,Ratel E.Granado,City Clerk
Tel 305.673.7411,Fax:305.673.7254
Email:City/Clerk@miamibeochll.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO:Ms.Diane Klein
RE:Miami Beach Commission For Women
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.
Ms.Diane Klein
Sworn to and subscribed before me this4'ya@ .zoo4
*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
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
RECEIVED
$EP 03 202
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (check(✓)all that apply):
6 am a resident of the City of Miami Beach for six months or longer.
Home Address:765 South Shore Dr Miami Beach Fl
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:--------------------------
Pg[mes,S,J]]fesS,
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 perjury,I declare that I have read the foregoing document and that the facts
stated in it are true.~05a){lo,sooa-------------Signature Date
Diane Klein
Printed Name
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
DIVERSITY STATISTICS REPORI
Klein
Last Name
Diane
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:
LJMale
[l FemaleDOtherDIprefer not to answer.
Race/Ethnic Categories:
What is your race?D African American/BlackDAsianorPacificIslanderElCaucasian/white0NativeAmerican/American IndianDOther-Print Race:------------t prefer not to answer.
Do you consider yourself to be Spanish,Hispanic,or Latino/a?
Jves
[zJ oD·I prefer not to answer.
Do you consider yourself Physically Disabled?
lvasloDIprefer not to answer this question.
Page 6 of 6F:ICLER\$ALLIREGIBOARD AND COMMITTEE APPLICATIONS FINAL DRAFTSIBOARD AND COMMITTEE APPLICATION REG FINAL.docxUpdated:June 2020
MIAMI BEACH
City of Miami Beach
l 700 Convention Center DriveMiamiBeach,Florida 33139
www.miamibeachfl.gov
OFFICE OF THE CITY CLERK
Email:BC@miamibeachf].gov
Telephone:305.673.7411
Klein
BOARD &COMMITTEE ACKNOWLEDGEMENT STATEMENTS
Diane
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 FinancialInterests(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.Pc ,
Signature
8/29/24
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 CityClerk.
Page 6 of 6F:\CLER\$ALL\BOARD AND COMMITTEES DATABASE\Board and Committee Application\BOARD AND COMMITTEE APPLICATION JULY 2024.d0cxUpdated:July 2,2024
MIAMl·DADE.ETm 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 1stofeveryyear.
Disclosure for Tax Year Ending
!
Last Name First Name Middle Name/Initial
2023 Klein Diane
Mailing Address -Street Number,Street Name,or P.O.Box
765 South Shore Dr
City,State,Zip
Miami Beach,Fl.33141
If your home address is your mailing address,and your home address is exempt from public records pursuant to Fla.Stat.$119.07,read
instructions on the following page and check here.D
Filing as an Employee (check one)
[]county D Public Health Trust []Municipal:(Municipality)
Department
Position or Title Employee ID Number
Work address I Work telephone Employment began on/ended on
Filing as a Board Member (check one)
[]county []Municipal:(Municipality)
Board where serving
Miami Beach Commission For Womens Committee
Alternate address (if home address is exempt)
!
Work telephone
I
Term began on/ended on
(305)905-2241 8-28-2023-12-31-2025
List below every source of income you received,along with the address and the principal activity of each source.Include your public salary.Place the sources ofincomeindescendingorder,with the largest source first.Examples of sources of income include:compensation for services,income from business,gains frompropertydealings,interest,rents,dividends,pensions,IRA distributions,and social security payments.Also,include any source of income received by anotherpersonforyourbenefit.However,the income of your spouse or any business partner need not be disclosed.If continued on a separate sheet,check here.[]
Name of Source of Income Address Description of the Principal Business Activity
Nova Southeastern University 3301 College Ave Davie,Fl.Director of Partnerships,
33314 Engagement and Promotions
I hereby swear (or affirm)that the information above is a true and correct statement.
760»KOSignatureofPersonDisclosing
3/21/1«
Date signed
RECEIVED BY ELECTIONS DEPARTMENT:are/ECEIVED
D Electronic Copy$£03 2024
CITY OF MIAMI BEACH
OFFICE Or TE CITY CLERK
OFFICE USE ONLY Accepted:Y /N Deficiency.Processed Date/initials.Scanned Date/initials.
138 SP.14 COE 2016
MIAMI BEACHCityofMiamiBeach,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 aPARKING
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:8/29/2024
Applicant Name:Diane Klein
Board/Committee Name:Miami Beach Commission For Womens Committee
Address:765 South Shore Dr Miami Beach Fl 33141
E-Mail Address:kdiane@nova.edu
Work Phone:954-262-2171 Home Phone:
Cell Phone:305-905-2241 Preferred Contact Method:email
Please Choose One 1 0 tion:
Citywide Parking Permit/G7 Access Card Citi Bike/Deco Bike Membership
Vehicle Information (For Citywide Parking Permit/Access Card Only)
Tag:KXAV55 Color:White
State:Florida Year:2024
Make:Lexus Model:RX350
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 Si4nature:es
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 subiect:BOARD &COMMITTEE PARKING APPLICATION --APPLICANT NAME
f:\ping\$man\rar\forms\cw boards&committees parkinqtorm.doc form updated 1/18/2024