Simon Nemni 12/31/2010m MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, vdww.miamibeachfl.aov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel: 1305) 673-741 1, Fax: (305) 673-7254
01 /16/2009
Simon Nemni
5151 Collins Ave PH-H
Miami Beach, Florida 33140
SU~,~ECbT,; Historic Preservation Board
Congratulations! You have been reappointed by the City Commission 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 Clerk's Office at
(305) 673-7411.
Please read the enclosed material carefully. Again, congratulations and good luck.
Sincerely,
obert Parc er
City Clerk
cc: Saul Frances, Parking Director
Thomas Mooney
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, v~ww.miamibeachfl.aov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel: (305) 673-741 1, Fax: (305 673-7254
TO Simon Nemni
RE: Historic Preservation Board
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 ~cers 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.
--~,~~
Simon Nemni
Sworn to and subscribed before me this ~ day of 200
~- ,~~.~ ~
Ker Hernandez
ry ~~
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.
m MIAMIBEACH
BOARDS AND COMMITTEE APPLICATION FORM
Pursuant to City Code section 2-22(4) a and 6: Members of agencies, boards, and committees shall be offiliated 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 I?CJ or ;No [ J
Demonstrate an ownership/interest in a business in Miami Beach for a minimum';of six (6) months: Yes ~,or No [ J
I am applying for a Board appointment because I hove special abilities, knowledge, experience: Yes [~
My special abilities, knowledge, or experience is: 1~
Are you a registered voter in Miami Beach: Yes ®or No ^ R e.t?a q ~! T t O~ 'H+ S'rGR i cA t.
NAME: E ~ ~ - ~ - - +
_Last Name
Home ~~~
Address: No. Street
City
Name
c.s' ~ x~ 6-S
Middle: Initial
~ 3140
State Zip Code
Phone: ~52 3y _1.~ 6~".~Q~S~ -_86 ~ -9 QJ ~
Home Work E.t_4SOt~~r N . I t-
Fax Emai address
(Please check one): I am -now a resident of: North Beach ^'South Beach ^ Middie Beach ~
Business Name: ~R F s ~ ~ R aTl At~ ,I~~~~~fJLL~ARP 'cant's Position: 1~1
O V Q C c. w G .. ~T
Address:
No. Street - - City
~I Owner ^ Stockholder/Shareholder ,® Corporate C>fficer ^ Other Explain:
Professional License (describe):
Aitoch a copy of the license listed above.
1. Have you ever been convicted of a felony: Yes ^ or No ~ff yes, please explain in detail:
State
Expires:
Zip Code
2. Do you currently have a violation(s) of City of Miami Beach codes: Yes Q or No ®. If yes, please~explain in detail:
3. Do you currently owe the City of Miami Beach any money: Yes ^ or No ®.
If yes, explain in detail:
4. Are you currently serving on any City Boards or Committees: Yes ^ or No ®.
If yes; which board
G~
What organizations in the City of Miami Beoch do you currently hold: membership in?
Name: ~ 1 A N ; (~j q ~ .,r (r,, ~ s Title:.
~ nM.~ tee.
Name:
Title:
List all properties owned or have an interest in, which are located within the City of Miami Beach:
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~ C D aJ ~ o rt ~ N~ v
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C:\DOCUMENTS AND SETTINGS\CLERHERK\LOCAL SETTINGS\TEMPORARY INTERNET FILES\OLKSD2\BC APPLICATION JAN 2006.DOG
~.
1 am now employed by the City of Miami Beach: Yes ^ or No (,~. ff yes, 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): _ ]
Please list your preferences in order of ranking []]first choice [2] second choice, and [3] third choice. Please note that only
three (3) choices;will be observed by the City Clerk's Office.
Regular Boards of:City]
^ Art m Public Places Committee ~-•
^ Barrier Free Environment Committee
^ Beach Preservation Board
O Beautification Committee
^ Board of Adjustment (Flood Mana em
~ Budget Advisory Committee
^ Committee on the Homeless
^ Committee for Quality of Education in
Q Community Development Advisory Coi
^ Community Relations Board
[~ Convention Center Advisory Board _
^ Debarment Committee
^ Design Review Board
^ Fme Arts Board
^ Golf Advisory Committee
^ Health Advisory CommiHee
^ Health Facilities Authority
l7His nic Affairs Committee
Historic Preservation Board
Committee
OMiami Beach Cultural Arts Council
ClMiami Beach Commission on Status of Women
C1Miami Beach Fbrida Sister Cities
^Normandy Shores Local Gov Nei hborhood In
^North Beach Youth Center Oversi ht Committe
D_Oversight Committee for General Obli anon &
^Parks & Recreational Facilities Board
^ Personnel Board
_^ Planning Board
D Police Citizens Re
Public
~ Transportation & Parking Coi
^ Visitor & Convention Authorit
^ Youth Center Advisory Board
*Board Required to File State Disclosure form
Note: I# applying for Youth Advisory Board, pieose 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:
This section is 'not required' but desired: e: O ~~
A9 Gender Mole Female ^
Ethnic Origin (Check one)
White ~9 African-American/Black ^ Hispanic: ^
Asian or Pacific Islander ^ American Indian or Alaskan Native O
Employment Status: !Employed 1~1 Retired ^ Home-maker ^ Other ^
"1 hereby attest to the accurpcy and truthfulness of the application and have received, read and will abide by Chapter 2,
Article VII - of th ty Code "Standards of Conduct for City Officers, Employees and Agency Members."
App~cont's Signature: Date , Name of Applicant (PLEASE PRINT)
Attachment: ,Please attach a copy of your resume to your application.
NOTE: Applications will remain on file for a period of one (1] calendar year.
Received in City Clerli:'s Office ' I_T~s C) by
Da+e eputy Clerk
Document Control N tuber (Assigned by the City. Clerk's Offic Entered By` Date
F:\CLER\$ALL\ELIZA ET\B&C\B&C Application Jan 2006.do
C:\DOCUMENTS AND SETTINGS\CLERHERK\LOCAL SETTINGS\TEMPORARY INTERNET FILES\OLK5D2\BC APPLICATION JAN 2006.DOC