Laura Leyva 12/31/2009i~~ ii- ~r ,
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.aov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel: (305) 673-741 1, Fax: (305) 673--7254
10-20-2008
Laura Leyva
SUBJECT:>>`` Health Advisory Committee
Congratulations! You have been appointed by the City Commission to the agency,
board or committee named above for a term ending: 12/31/2009.
Pursuant to Ordinance No. 2006-3543, commencing with terms beginning on or after
January 1st, 2007, the term of board members who are directly appointed by a member of
the City Commission shall automatically expire on December 31 of the year the appointing
elected official leaves office.
If you are unable to accept this appointment or have any questions, please call the City
Clerk's Office at 305-673-7411. Please read the enclosed materials carefully.
Congratulations again and good luck.
Sincerely,
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Cliff Leonard
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 Employee
We are commiried to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community.
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City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.aov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel: (305) 673-7411, Fax: (305j 673-7254
TO Laura Leyva
RE: Health Advisory Committee
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: 12/31/2009.
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 theF/orida Commission on Ethics Guide to the Sunshine
Amendment and Code of Ethics for Public Dicers and Employees, and understand that as a member
of a City of Miami Beach Board and/or Committee, I must comply with the financial disclosure* require-
ments 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 calendgyreat on which I av served.
Sworn to and subscribed
day of ~
*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.
We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community.
Silvia Prie
Deputy Clerk
m !'~~Il~,PJtI BEACH
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L/asst NQame t Q ` First Name Middle Initial , ~
HOME ADDRESS: `r ~ 0 ~ C7Gt~i~ I~.A~~ ~NFi ~• ~.S ~~- '.;' 7 7'
No. Street City State Zip Code
PHONE: ~J'YSO ~/• L ~ i~~• Orb ~ LJ~~ ~~~OZ~~~y~
ome Work Fax Email
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Business Name:~uS~tQn~ W>rlSu~~"~ST ~NL Position:
Address: ~ OW w ~ T S ~ ~ lI ~ ~4 (l ~ ~ /-G. 33 0/
No.
Street
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State Zip Code
Professional License (describe) Expires: LlttawJt a copg! o the ticensen
Pursuant to City Code section 2-22(4) a and b: Members of agencies, boards, and committees shall be affiliated with the city; this
requirement shall be fulfilled in the following ways: a) an individual shall have been a resident of the city for a minimum of six
months; or b) an individual shall demonstrate ownership/interest for a minimum of six months in a business established in the city.
• Resident of Miami Beach for a minimum of six (6) months: Yes ^ or No C~
• Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six (6) months: Yes ^ or No
• Are you a registered voter in Miami Beach: Yes ^ or No
. (Please circle one): I am now a resident of: North Beach South Beach Middle Beach
• I am applying for an appointment because I have special abilities, knowledge, exp rie ce. Please list below:
~~~~ c~~ ~~~~ ~~~
Please list your preferences in order of ranking [1] first choice [2] second choice, and [3] third choice. Please note that only three f3)
choices will be observed by the City Clerk's Office. (Regular Boards of City)
^ Affordable Housin Adviso Committee ealth Facilities Authorit Board
^ Art in Public Places Committee ^ His anic Affairs Committee
^ Beach Preservation Board ^ Historic Preservation Board*
^ Beautification Committee ^Housin Authorit
^ Board of Ad'ustment' ^ Loan Review Committee"
^ Bud et Adviso Committee ^ Marine Authori
^ Ca ital Im rovements Oversi ht iami Beach Commission for Women
^ Committee on Homeless ^ Miami Beach Cultural Arts Council
^ Committee for Qualit Education,in MB ^ Miami Beach Florida Sister Cities
^ Comrriunit Develo ment Adviso ' ^ No'rltiand Shores Local Gov't Nei h. Im rowement
^ Communi Relations Board ^ Parks and Recreation Facilities Board
^ Convention Center Adviso Board ^ Personnel Board`
^ Cultural Arts Nei hborhood District Overla CANDO ^ Plannin Board
^ Debarment Committee ^ Police Citizens Relations Committee
^ Desi n Review Board" ^ Production Indust Council
^ Disabilit Access Committee ^ Public Safet Adviso Committee
^ Fine Arts Board ^ Safet Committee
^ Ga Business Develo ment Ad Hoc ^ Trans arenc Reliabilit & Accountabilit Committee "TRAC
^ Golf Adviso Committee ^ Trans ortation and Parkin Committee
^ Green Ad Hoc Committee ^ Visitor and Convention Authorit
Health Adviso Committee ^ Youth Center Adviso Board
esoara ttequirea to File State Disclosure form
'AO J
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r:iCLER1"~ALL1B&C ApplicationlB~C Applications Revised 051908.doc
Note: If applying for Youth Advisory Board, please indicate your affiliation with the Scott Rakow Youth Center:
1. Past service on the Youth Center Advisory Board: Yes ^ No L Years of Service:
2. Present participation in Youth Center activities by your children Yes' No ~. If yes, please list the names of your children, their
ages, and which programs. List below:
Child's name: Age: Program:
Child's name: Age: Program:
~• ~ :Have yota1ever' been convicted of a felony: Y s ^ or No ~' If yes, please explain in detail:
• Do you currently. have a violation(s) of City of Miami Beach codes: Yeh ^ or No ~!` If yes, pl~ahse explain in detail:
. Do you currently owe the City of Miami Beach any money: Yes ~ or Not~lf yes, explain in detail
• Are you currently serving on any City Boards or Committees: Yes 5~ or No ^. If yes; which board?
b~ eA.l-~ tFtCXVi So,~a
• What organizations in the City of Miami Beach do you currently hold membership in?
Name:
Name:
• List all properties owned or have an interest in, which are located within the City of Miami Beach:
• I ~m'now'employed by the City'of Miami Beach: Yes ^ or Nod! Which department?
• Pursuant to City Code Section 2-25 (b): Do you have a parent ^, spouse ^, child ^, brother ~, or sister ^ who is employed by the
City of Miami Beach? Check all that apply. Identify the department(s): N~
This section is "not required" but desired: Age: ~ years old Gender: Male ^ Female
Ethnic Origin (Check one)
White ^Rfrican-American/Black Hispanic: ^ Asian or Pacific Islander ^ American Indian or Alaskan Native ^
"1 hereby attest to the accuracy and truthfulness of the application and have received, read and will abide by Chapter 2,
Article VII - of the City de "Standards of Conduct for City Officers, Employees and Agency Members."
~. ~4 _ / /Z /a 3 /200 ~ ~au,~a Q • ~ t/~-
l
Sig
SE PRINT)
Employment Status: Employed ^ Retired ^ Home-maker ^ Other ^
Received in City Clerk's Office by ~/.L! .2'--??/ i~~-~-r/ Date r~ .~' ~~
Name of Deputy Clerk
Document Control Number (Assigned by the City Clerk's Office) Entered By Date
Revised 04118108 LH
Date
Title:
Title:
Name of Applicant (P
attach a c y o your resume to this application
Applications I remain on file for a period of one (1) calendar year.
r :1CLER\SALL.\BF~C Appiioation\B&C Hppiication Revised 05190H.doc 2