Barbara Gillman.`'`"
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City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 331 39, www.miamibeachfl.aov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk ~
Tel: (305) 673-741 1, Fax: (305) 673-7254
01 /14/2009
Barbara Gillman
16 Island Avenue
Miami Beach, Florida 33139 -
~U~G~~ Safety Committee
Congratulations! You have been reappointed by Commissioner Jonah M. Wolfson
to the above referenced agency, board or committee for a term ending: 12/31/2010.
If you are unable to accept this appointment, please notify the City Cterk's Office at
(305) 673-7411.
Please read the enclosed material carefully. Again, congratulations and good luck.
Sincerely
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Clifford 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, 2-2458, 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.
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City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel: (305) 673-741 1, Fax: (305) 673-7254
TO Barbara Gillman
RE: Safety 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: 12/31/2010.
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 Public ricers 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.` ,~
Y Barbara Gillman [~
Sworn to and subscribed before me this ~ day of ~9~Jvr~ , 200 J
1 dc_.---~L.J L---'
~z .Silvia Prieto
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 committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community.
~_ ~~ I ~! `~ \ I ~ ~~~ ~ Ci T l' OF MIAMI BEACH
(///''j '/~ BOARD AND COMMIT T EE APPLICATION FORM
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NAME: 111 "JJ
/L/ast Name ~y, ( First Name - fiddle Initial/
HOME ADDRESS: / V t ~~"` I'"~ ~' ~ A ~ ~l
No. reet City ,~,~ ~I~~/,~~State Zip Code
PHONE: _ ~r~~ ~~ ~~~~ ~ ~ ~~~~~ 7t(~ ~~~]~7`-~-?'t!`J~°~~
onie Work
Fax
Email addre~~~~
Business Nam~:~~
Address: ~
Professional License (describe)
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 ownershipitnterest for a minimu~of six months in a business established in the city.
• Resident of Miami Beach for a minimum of six 6 months: Yesl.P~or No ^
()
• Demonstrate an ownership/interest in a business in M' mi Beach for a minimum of six (6) months: Yes or No ^
• Are you a registered voter in Miami Beach: Ye 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, experience. se li
Please list your preferences in order of ranking [1] first choice [2] second choice, and [3] third choice. Please note that oniv three (3)
choices will be observed by the City Clerk's Office. (Regular Boards of City)
D Affordable Housin Adviso Committee ^ Historic Preservation Board*
D Art in Public Places Committee ^Housin Authori *
D Beach Preservation Board ^ Loan Review Committee*
0 Beautycation Committee ^ Marine Authorit *
^ Board of Ad'ustment* ^ Miami Beach Commission for Women
^ Bud et Adviso Committee D Miami Beach Cultural Arts Council
^ Ca ital Im rovements Oversi ht ^ Miami Beach Florida Sister Cities
0 Committee on Homeless ^ Normand Shores Local Gov't Nei h. Im rovement
0 Committee for Qualit Education in MB Parks and Recreation Facilities Board
^ Communit Develo ment Adviso ^ Personnel Board*
D Communi Relations Board D Plannin Board
^ Convention Center Adviso Board ^ Police Citizens Relations Committee
^ Cultural Arts Nei hborhood District Overla (CANDO D Pr uction Indust Council
D Debarment Committee ^ bfic Safet Adviso Committee
^ Desi n Review Board* Safet Committee
^ Disabilit Access Committee D Sin le Famil Residential Review Panel
D Fine Arts Board ^ Sustainabili Committee
^ Ga Business Develo ment Ad Hoc D Trans arenc Reliabilit & Accountabilit Committee "TRAC"
^ Golf Adviso Committee ^ Trans ortation and Parkin Committee
^ Health Adviso Committee ^ Visitor and Convention Authorit *
^ Health Facilities Authorit Board D Youth Center Adviso Board
^ His anic Affairs Committee
* Board Required to File State Disclosure torm
~,:LcR\ShL~\Boarcv ~om~rntr~=s\58.C. Anpiicauon\o&: ~+,pnl~::aiior: P,evi~l=c ' : ~~Oc.duc
No. '' Street - ~ ~ City State Zip Code
Expires: Attach a copy of the license
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 ~(f yes, please explain in detail:
• Do you currently have a violation(s) of City of Miami Beach codes: Yes ~^ or No ~ If yes, please explain in detail:
• Do you currently owe the City of Miami Beach any money: Yes ^ or No ~' If yes, explain in detail
• Are you currently serving on any ty Bo ds or Com ittees: Yes or No ~. If yes; which board?
~~~~ ,~-~,~Q~"~.. J
• What organizations in the City of
Name:
Name:
Beach do ybu currently hold membership in?
Title:
Title:
• List all properties owned or have an interest in: whi are located wl In the City of Miami Beach:
• I am now employed by the City of Miami Beach: Yes ^ or No?~'f Which department?
• Pursuant to City Code Section 2-25 (b): Do you have a parent C, spouse ~, child ~, brother ~, or sister ~ who is employed by the
City of Miami Beach? Check all that apply. Identify the department(s): Q
/V' .,, ~ ,
This sectio is "not required" but desired: Age: years old Gender: Male ^ Fer~alyt3
Ethnic gin (Check one}
Whit African-American/Black ^ Hispanic: ^ Asian or Pacific Islander ^ American Indian or Alaskan Native ^
"I hereby st to the accuracy and truthfulness of the application and have received, re and will abide by Chapter 2,
Article V - f the City Code "Standards of Conduct for City Officers, Employees and Age Members."
P
Signature
Date
Plea`§e attach a copy of your resume to this application
NOTE: Applications will remain on file for a period of one (1) calendar year.
of
Employment Status: Employed ^ Retired ^ Home-maker ^ Uther ^
Received in City Clerk's Office by Date
Name of Deputy Clerk
a ~ ~~
Document Control Number (Assigned by the City Clerk's Office) ~ Entered By ~~ F ~ Date
i keJlsetl 09/02/08 LH ;