Eric Agazim 12/31/2010m ~P,IAP~~IBEACH
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
01 /16/2009
Erik Agazim
1800 Sunset Harbour Dr. Suite 1010
Miami Beach, Florida 33139
Y .~F '6t' Y ~~
~P~.~ ~G7,~~:, Capital Improvements Projects Oversight
Congratulations! You have been reappointed by the City Commission to the above
referenced agency, board or committee for a term ending: 12131/2010.
If you are unable to accept this appointment, please notify the City Clerk's Office at
(305) 673-7411.
Please read the enclosed material carefully. Again, congratulations and good luck.
Sincerely,
~~c-~~~~
obert Parcher
City Clerk
cc: Saul Frances, Parking Director
Jorge Chartrand
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, 2-2458, 2-459
Ordinance 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
We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community.
` ,~
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
TO Erik Agazim
RE: Capital Improvements Projects Oversight
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: 12/31/2010.
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 Pub/ic OfFcers 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 calendar year on which I have served.
.~
r
Erik Agazim
Sworn to and subscribed before me this~_ day of , 200
1,
Kerry Hernandez
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.
We are commi»ed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community.
I~
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Middle Initial
HOME ADDRESS: ~ $d0 SV,ySET N AR' t/IZ DQ. SU I TG 1'0~ ~ l~Il,~t/I ~''~~1.~ ~l_ 33138
No. Street City State Zip Code
PHONE: (3os) S3z- (o y y8 ~~sCol ~'~Co ' l o ~ 0 oG EArvir ~k'.u~I~TS~ Y,o~ro,
Fax Email address
Business Name: O~•L~4a,/G ~de(.~PMC~tl1 ~ Position: I~AuA~6/u ~~If'~CTIU~?*
Address: I S00 SuNS6.r N~A'KDWK. D~ j Ley, Te ~ of a ~,/},,~y/( l~2~h ,~'L 3313
No. Stmt Ciiy State Zip Code
Professional License (describe)
Expires: -
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 mi ' um of six months in a business established in the city.
.Resident of Miami Beach for a minimum of six (ti) months: No ^
• Demonstrate an ownershiplinterest in a business ' Miami Beach for a minimum of six (6) months: Ye~ No ^
• Are you a registered voter in Miami Beach: No ^
. (Please check one}: I am now a resident of: North Bea~uth Beach ^ Middle Beach ^
• I am applying for an appointment because I have special abilities, knowledge, experience. Please list below:
Please list your prefererx~s in osier of ranking {1J first choice [2] second dioice, and [3] third d~oice. Please Hole that onhr itree (31
choices vritt be observed by the Ciiiv Clerk's Office. (Regular Boards of City)
^ Art. in Public Places. Committee
^ Beach Preservation Board
^ Beautification Committee
^ Board of Adjustment*
d Budget Advisory Committee
^ Committee on Homeless
~ommittee for Quality Education in MB
Community Development Advisory*
^.Community Relations.Board
^ Convention Center Advisory Board
^ Debarment Committee
^ Design Review Board*
^ Disability Access Committee
^ Fine Arts Board
^ Golf Advisory Committee
^ Health Advisory Committee
^ Health .Facilities Authority Board
^ Hispanic Affairs Committee
^ Historic Preservation Board*
*Board Required to File State Disclosure form
^ Housing Authority*
^ Loan Review Committee*
^ Marine Authority*
^ Miami Beach Cultural Arts Council
^ Miami Beach Commission for Women
^ Miami Beach Florida Sister Cities
^ Normandy Shores Local Gov't Neigh. Improvement
^. Oversight. Committee for. General. Obligation Bond
^ Parks and Recreation Facilities Board
^ Personnel Board*
^ Planning Board*
0 Police Citizens Relations Committee
^ Production Industry Council ~
^ Public Safety Advisory Committee -~
^ Safety Committee '~
^ Transportation and Parking Committee r=
^ Visitor and Convention Authority* ~
^ Youth Center Advisory Board
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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 ^ 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 you ever been convicted of a felony: Yes ^ or No ~s, please explain in detail:
. Do you currently have a violation(s) of City of Miami Beach codes: Yes ^ or N y~lf yes, please explain in detail:
. Do you currently owe the City of Miami Beach any money: Yes ^ or Nd~~f yes, explain in detail
• Are you currently serving on any City Boards or Committees: Yes ^ or Nd~yes; which board?
• What organizations in the City of Miami Beach do you currently hold membership in?
Name: Title:
Name: T~1e=
•rList all propeqrties-lown(e~d or have an interest in, which are located within the City of Miami Beach:
1~ 7 ~ t`~ t \J~tair.~Z. ~ ~ w:.a~in.-~ ~w-.C.~. ~~ ~ 3 3 4
• I am now employed by the City of Miami Beach: Yes ^ or No^. Which department?
•. Pursuant to City. Code Section 2=?,5 (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): ~~
This section is "not required" but desired: Age: ~_ years old Gender: Male Female ^
Ethnic lgln (Check one)
Whit-frican-American/Blac Hispanic: ^ Asian or Pacific Islander ^ American Indian or Alaskan Native ^
Employment Status: Employeetired ^ Home-maker ^ Other ^
"1 hereby attest to the accuracy and truthfulness of the application and have received, read and will abide by Chapter 2,
Article Vly- of the City~o~le "Standards of Conduct for City Officers, Employees and Agency Members."
Name of App~nt (PLEASE PRINT)
Please att~h a copy of your resume to this application
NOTE: Applications will remain on file for a period of one (7) calendar year.
Received in City Clerk's Office by Date
Name of Deputy Clerk
~~ Document Control Number (Assigned by the City Clerk's Office) Entered By Date
ReviseO 10@912007 L. Halfiel0