Ayala Mendlowitz 6.30.25MIAMI BEACH
BOA R D A N D CO MMITTEE CHECK LIST
BOARD/COMMITTEE:[Lu_±.[lul u
FOR SCANNER
DATE OF APPOINTMENT:_Jug.I ALU
Appointed by:_rug [lergot,_hc]
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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 _,
o Resume/Curriculum Vitae
o Diversity Statistics Reporting (Completed on _,
o Oath
rRw No:•_Q []2 reRu»wr.Q_[0/2s
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RECEIVED 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 2-459JAN162025✓County Code Section 2-11.1 -Conflict of Interest and Code of Ethics Ordinance (as
amended through December 2010)CITY OF M 1AM I BEACH ✓Amendments to the Code of Ethics Ordinance (September 2009 through July 2012)
✓Highlights of the Miami-Dade County Ethics CodeOFFICEOFTHECITYCLERK✓Sunshine Law and Public Records-Frequently Asked Questions
✓Memorandum -Solicitation by City Board and Committee Members
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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.
1ql2,stones oy }_ya.d]nut.g,
Date Board or Committee Member
Processed on:__l_/'--i_i_f _z,r By Employee:------~--------------
Date City Clerk's Office Staff Initials
Received on:
WVe are com mitted to proding ex cellent public service and sa fety to all wh o live,work,and play in ou r vibrant,tropica l,historic community.
M IAM 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:305.673.74 l l,Fax:305.673.7254
Email:CityClerk@miamibeachfl.gov
January 9,2025
Ayala Mendlowitz
4111 Pine Tree Dr.
Miami Beach,FL 33140
RE:Committee for Quality Education in Miami Beach
Dear Ms.Mendlowitz,
Congratulations!You have been appointed to the above-referenced Board or Committee as a
representative for the Yeshiva Elementary School PTA,for a term ending on 06/30/2025.
If you are unable to accept this appointment or have any questions,please call the Office of the
City Clerk at 305.673.7 411.
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.
Regards,
cc:Jose Gonzalez,Parking Director
Dr.Leslie Rosenfeld,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
We are com m itted to providing excellent public serv ice and safety to all who live,work and play in our vibrant,tropical,historic community.
MIA.MA[BEACH
City of Miami Beach,!/OO Convention Center Drive,Miami Bach,Hlorda 33139 ygyyy_miamrib_oct]]_gay
OFFKCE OF THE CITY CLERK,Ralool E.Granado,Chy Clerk
Tel.305.673.7411,Fa.305.673.7254
Email:Ci»yClerk@miomibeachfl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO:Ms.Ayala Mendlowitz
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.Ayala Mendlowitz
Sworn to and subscribed before me this (_day of _Lico_cs 2025.t-Ice ava o
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.
MI/AM/BEACH
City of Miami Beach
l 700 Convention Center Drive
Miami Beach,Florida 33139
OFFICE OF THE CITY CLERK
Email:BC@miamibeachfl.gov
Telephone:305.673.7411
JAN 16 2025
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
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:
IB I am a City of Miami Beach resident for six months or longer.
Home Address:jy po [__pc pg_[y3__[j_Er_Ly_LL_2AL+
[]lam the parent/guardian of a student attending a Miami Beach school for the _)Ly__A_r_school
year.
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 facts
stated in it are true.
Signature Date
Printed Name
MIAMI BEACH
City of M iami Beach
1700 Convention Center Drive
Miami Beach,Florida 33139
www.miamibeach[]._gov
OFFICE OF THE CITY CLERK
Email:BC@miamibeachfl.gov
Telephone:305.673.7411
DIVERSITY STATISTICS REPORT
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.
G ender:
[JaeElremaleloner0Iprefer not to answer.
Race/Ethnic Categories:
W hat is your race?D African American/BlackDAsianorPacificIslanderElcaucastan/white0NativeAmerican/American Indian0Other-Print Race:-------------□I prefer not to answer.
Do you consider yourself to be Spanish,Hispanic,or Latino/a?
JvesJi0Iprefer not to answer.
Do you consider yourself Physically Disabled?
E?voe
zI No
D I prefer not to answer this question.
Page 6 of6
F:\C LE R \$A LL\R E G IB O AR O A N D C O M M ITT E E A P P LI C A T IO N S FIN A L D RA FT SIB O A R D A N D C O M M ITT EE A PPLI C A TIO N R EG FIN A L.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@miamibeachf].gov
Telephone:305.673.7411
Liu_Lio,,t,
Last Name
BOARD &COMMITTEE ACKNOWLEDGEMENT STATEMENTS
Firstfame 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.
Signat're v Date
1 Members of the Planning Board and Board of Adjustment will be notified directly by the State of Florida,
pursuant to F.S.S112.3145(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:\C LE R \$A LL\B O A R D A N D C O M M ITT E ES DA TAB A SE\Boa rd and Co m m ittee A pplica tion\BO AR D A ND CO M M ITT EE APPLI C ATIO N JU LY 2024.d0cx
U pdated:July 2,2024
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
2024 oalot t\o
Mailing Address -Street Number,Street Name,or P.O.Box ...,
IO\Pv·w Tc Ove \+\)
City,State,Zip
Piao Ret Fld.1,44
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.Dl
Fling as an Employee (check one)
[county D Public Health Trust D 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)
O County
Board where serving
Q0
at lress at lress exempt
[J Municipal:
Work telephone
(Municipality)
Term 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 another
person for your benefit.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
ab lane4ta Sr I3300 [wool Ht,Me»Lal l.\q .\{uH-
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I hereby swear (or affirm)that the information above is a true and correct statement.
Signature of Person Disclosing
Date signed
RcEv sYy9»s9R-pJHar«co ~E ,LIVE
)aero6 "9}+7072
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
O FF IC E U S E O N LY Accepted:Y /N Deficiency:Processed Date/initials:Scanned Date/initials:
138_SP-14 COE 2016
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
BOA RD &CO M M ITTEES
PA RKING APPLIC ATIO N 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,gr a
discounted MDC Monthly Transit Pass throughout your term.
Board M em ber Info rm ation
Date of Application:l«a
Applicant Name:al a Mdtoi
Board/Committee Name:Gkuaht «u «h o +co»P e«ts\''\
Address:-
\IO 96 f-
E-Mail Address:(al«gdlao2al no
Work Phone:~Home Phone:
Cell Phone:21-363,-\-(Preferred Contact Method:el o@
Citywide Parking Permit/G7 Access Card Citi Bike/Deco Bike Membership
Vehicle Info rmation (For Cityw ide Parki ng Permit/Access Card Only)
Tag:GQ/93 5 Color:0a 6ce
State:Year:~
Forde 3\A
Make:v6 -Model:?
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.
IM PO RTANT NO TE: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.
AC KNO W LEDG EM ENT:I acknowledge that should m y access card be lost,stolen or damage,I will be
responsible to pay a $10.00 replacem ent fee.
Applicant Signature:es /4L hunt,
Please provide signed form to the Parking Department located at 1755 Meridian Avenue,2°floor.
Working hours are 8:30 to 5:00 p.m.or email to:PgrkingR eception@mn igmibegchfl.gov
e-m ail subject:BOARD &COM M ITT EE PARKING APPLICATION-APPLICANT NAME
f;\ping\$man\var\forms\cw boards&committees parkingtorm.doc torm updated 1/18/2024