Mary Keinath 12.31.25MIAMI BEACH
B OA R D A ND COM M ITTEE CHECK LIST
APPOINTEE:___.....,_;...,._;,_-,lf---'--'--e_-'-1~•--.---
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DATE OF APPOINTM ENr:.[[-[f
BOARD/COMMITTEE:--~&-"-'-"'---'-"-'-1'--....a,,:;."""""...,_.;...ppointed by L .Q»,._,,,o
o R scaN R FoRc R ksTarr [[1l,[3th5scanooLetterotAppointmentTERMEND:[%l31,90)rRM LuMrr:_"e'
Scan o o Letter of Reappointment j I
o Copy of Letter of Appointment/Reappointment e-mailed_to Committee Liaison on I!'\2{
o Board and Committee Application (Completed on)
o Resume/Curriculum Vitae
o Diversity Statistics Reporting (Completed on _,
o OathScano
REC EIVE D
JAN 06
CITY OF LAMY BEACH
OFFIOE OF'HG 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 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.
[ll?']soneasy%utr""
Date
Processed on:_....,.....{_r_vl__).._!"By Employee:----~----------------
Date City Clerk's Office Staff Initials
Received on:
We are committed to providing excellent public service and safety to all who live,work,and play in our vibrant,tropical,historic community.
MIAMI BEACH
City of Miami Beach,1ZOO Convention Center Drive,Miami Booch,Hlorida 33 139 yywy_miamibcachll_go
OFFICE OF THE CITY CLERK,Rafael E.Granado,City Clerk
Tel:305.673.7411,Fax.305.673.7254
Email:CiNyClerk@miamibeachfl.gov
November 19,2024
Ms.Mary Keinath
1800 Sunset Harbor DR #707
Miami Beach,FL 33139
S U B JE C T :Com m itt ee for Q uality Education in M iam i Beach
Congratulations!You have been reappointed by Co m m issio ner Laura Dom inguez to 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.
Congratulations and good luck.
Regards,
Ratti.do
City Clerk
cc:Jose Gonzalez,Parking Director
Leslie Rosenfeld,City Liaison
A TT A C H M E NT S :
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 of Miami Beach,1/OO Co nvention Ce nter Drive,Mia mi Boch,Horida 33 139 gyy _miamiba chll_gay
OFFICE OF THE CITY CIERK,Rafool E.Granado,City Clerk
Tel:305.673.7411,Fax 305.673.7254
Email:CiNyClerk@miamibeachfl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO:Ms.Mary Keinath
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: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 requireme ts of.al ii-1 ade C unty or the
State of Florida (depending on the board or committee on which I serve)/on Jdly it,followintIthe closing
of the calendar year on which I have served.
Sworn to and subscribed before me this/{_day «0/4324/2
Alice Lavado
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.
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 Educa tion in Miami Beach,I am in com pliance
witht he affiliation requirement of Miam i Beach City Code Sections 2-22 (4)and 2-190.137 as:
.:%Taoatheparent/guardian of a student attending a Miami Beach school for the school
year.
s.Mt,l,ME
[]M y paren t/legal guardian requirement has been waived by the City Commission.
Un •I declare that I have read the foregoing document and that the facts
stat
Sig1 Date-Printed Nam
MIAMI BEA C H
City of Miami Beach
1700 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 REPORT
Last Name ..lee%D
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:
L»aeLKFemalelonerDIprefer not to answer.
Race/Ethnic Categories:
What is your race?D African American/Black0AsianorPacificIslanderDCaucasian/White
[l Native American/American ndian ,
[Z1 other --Print Race:12put,cgDIprefernottoanswer.
Do you consider yourself to be Spanish,Hispanic,or Latino/a?
Ga.
(J o0Iprefer not to answer.
Do you consider yourself Physically Disabled?aNoDIprefer not to answer this question.
Page 6 of6
F:ICLER\$ALL\REGIBOARD AND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated:June 2020
MIAMI BEACH
City of Miami Beach
1 700 Convention Center Drive
Miami Beach,Florida 33139
ywyywy_migmibegchfl.gov
OFFICE OF THE CITY CLERK
Email:BC@miamibeachfl.gov
Telephone:305.673.7411
BOARD &COMMITTEE ACKNOWLEDGEMENT STATEMENTS
Last NJ~lilJidi -Fi-rs_t_N_,affia.....m_e__.:;.,.(;....~--------DMiddle 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 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 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 b dee e ~'ten1er of resignation from the City agency,board,or committee
L.-{1al-al
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 COMMIT TEES DATABASE\Board and Committee Application\BOARD AND COMMITTEE APPLICATION FEB 2024.docx
Updated:February 22,2024
MIAMI-.EI SOURCE OF INCOME STATEMENT
Clear From Print Form
Sec tion 2-11.1(@)of th e County Ethics Cod e req uire s th at certain em ployees an d public offi cials file a financial disclosure Statement on a yearl y bas is by July 1st
of every year .
Di sc los ure fo r Tax Yea r End ing
2023
City ,Sta te ,Zip
First Nam efl Middle Name/Initial
bona
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)
D County D Public Health Trust []Municipal:
(Municipality)
Departm ent
Pos itio n or Title Employee ID Number
Wo rk ad dre ss W ork te lep ho ne Employme nt bega n on/ended on
Fling as a Board Member (check one)
D County D Municipal:
(Municipality)
Board w here se rv ing
Alte rna te ad dress (if hom e add ress Is ex em pt )I W ork te lep ho ne I Term beg an on /end ed on
Li st be low every sourc e of incom e you received ,along wi th th e add ress an d th e principal activity of each source.Include yo ur public sal ary.Place the sources of
inco m e in desc ending order,with the larg est source first.Ex am ples of sources of incom e include:co m pe nsation for servi ces ,income from busines s,gains from
pro pe rty dealing s,interes t,rents ,dividends,pensions,IRA distri buti ons,an d soc ial se curity paym ents.Also,Include any source of Income received by another
pe rs on for your be nefit.However,the Incom e of your spouse or any business part ner need not be disclosed .If co ntinued on a separate sheet ,check here.□
Name of So urce of Inco me Add ress Desc ription of the Principal Busines s Acti vity
Da te signed
e is a true and correct statement.RECEIVED BY ELECTIONS DEPARTMENT:
J HardcoyRECEIVED□Electronic Copy
JAN 06
CITY O F M IA M I BEACH
OFFICE Or r9=I CLERK
REMEMBER TO PRINT.SIGN,AND SUBMIT TO THE OFFICE OF THE CITY CLERK VIA EMAIL OR HARDCOPY
MIAMI BEACH
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 LaPARKING
A s a Boar d/C om m itt ee m em b er you ar e entitled to a Cityw ide Par king Perm it,w hich incl udes City Hall
g ar age (G 7)par king ac cess (A ccess Car d),or a com plim entary Ci ti Bike/Deco Bike Membership,or a
d isco un ted M D C M onthly Transit Pas s throughout your term .
Board Member Information
D ate of Ap p lica tion:
A p p lic a n t N a m e:
A dd ress:
E-M ail Ad d re ss:
W or k Ph on e:205-'(3f
C ell Phone:Preferred Contact Method:
Please Choose One 1 0 tion:
Cityw ide Parking Permit/G7 Access Card Citi Bike/Deco Bike Membership
Vehicle Information For Cit ide Parkin Permit/Access Card Onl
Ta g :
State:
M a ke:
C olor :
Year :
M odel:
A ci tyw ide (C W )par king perm it is honor ed at m etered par king spaces and restricted residential zones
parking sp aces.A CW parking perm it IS NOT honored in prohibited ar eas.An Access Car d w ill be
p ro vided to you fo r City Ha ll G ar age (G 7)access.
IMPORTANT NOTE:Your vehicl e license plate serv es as your "par king perm it".To avoid any
un nec essary enfo rcem ent actions,it is im port ant that our recor ds reflect the m ost current and
a c curate in fo rm a tion regar ding your vehicl e license plate.Inaccurate and/or outdated vehicl e
info rm ation m a y lead to the issua nce of par king citation(s)and/or the tow ing of your vehicl e.
Please note th a t this new access car d CANNOT be hole-punched or perforated in any manner.To use
the ne w car d please hold the car d at close pro xim ity to the reader until the gate opens.You may
ne ed to try th e other side of the car d.Pleas e ensure you hold the entire surface of the car d against
the read er until the gate opens.
ACKNOWLEDGEMENT:I acknowledge that s
responsible to pay a $10.00 repl ce ent
y access card be lost,stolen or damage,I will be
A,lic an t Si mn a ture:es
Please pro vid e signed fo rm (o [he 'ark ing Depart m ent located at 1755 Meridian Avenue,2nd floor.
W or kin g hou rs ar e 8:30 to 5:00 p..or em ail to:ParkingReception@miamibeachfl.gov
e-mail subiect:BOARD &COMMITTEE PARKING APPLICATION-APPLICANT NAME
f:in \iman\rar\form s\cw boards&committees orkin form.doc form updated 1/18/2024