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Glassome Wint Group II Rep 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: X305) 673-7254 January 13, 2009 Glassome Wint 2049 SW 120th Ave. Miramar FL 33025 SUBJECT: Personnel Board Congratulations) You have been appointed *by virtue of your being a Representative for Group II to the agency, board or committee named above for a term ending 7/31 /2010. If you are unable to accept this appointment, please notify the City Clerk's Office at (305) 673-741 1. Sincerely, Robert Parcher City Clerk cc: Saul Frances, Parking Director Ramiro Inguanzo 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 200b-3543 -Amendment to City Code Section 2-22 Miami-Dade County Code Section 2-1 1.1 -Conflict of Interest and Code of Ethics Ordinance City Wide Permit Application - (Parking Department Formj Booklet -Guide to the Sunshine Amendment and Code of Ethics for Public Officers and Employees We ark'~ryttfii}Fed~t~rc~t~?vt~fEryg-l~~fssri~R->pu.~l(c~eEVi4t~a~f sa~tyr~ta;thl6~iuh©~h,vaowicpdn~Rdrbpla~e~u~n+oLC,!v~al~rgm~t,c}F,dpitaml; hasterne~tT,ommunity. 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 Glassome Wint RE: Personnel 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: 07/31/2010. 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 Officers 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. - ~ --. - Glassome Wint iC ~ Sworn to and subscribed before me this / day of ~~~ [~ , 200 '~ ~~~ ~_ -'~ ,~.t --- ._ __ _ F ~ --- 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. ~~~~ ~~ -~ C€hy ~f ic~rni ~ebtWtF s_ 1 E~_a~ ~, ~ t ~. ~, ;: z. t-_ .~;ri,. , Pv',i~~rrn t3..c;~t`f i l~r",~=s ~ 4 ~ J'?, dvrxv~r,rn a~,ib~~c ~= y~~ CERTIFICATE CAF ELECT1~3hJ RE~tSt~N~LEL. E~pARD - CR+QUP 2 CITY CAF MIAMI BEACH EMpLC}YEES ~r~i~ip 1; consists of P~li~~ Department, Fire [?epartrnent end B~~ch P~tr~t Dep~rtmentempltar~es Group ~: c~i~sists csf em~atoyees ire cterical and executive positions Group 3: Ccansists ~sf all other empltayees F 1;,"L.E~t'~.~ ~LLt~~ER~~~NNEL ~{F,F2C] EL[~ ;TIQt~J8'~2(?49 ~r~up "2 - re-~lecti~an',c der;°fi~~ka cF E~~ction ~rr~up 2 2~°:~9.do ,.,t ,.,... .x ,-,. ,:,,, ~ ,. STATE CaF ~~,(~R1[?A CC~L9NTY C}F iAPV1I_DA~DE IN WITfVESS 'h1'~1HEREt~F, we have hereurtt~ set t~tar hands end seals at Miami m ,,,,li;^/,IBEACH GI E `'' _'~ rVittirtCli BEACH BUARI~' ANO COMr1~iT t EE APPLiCATIOt~' FORIV! NAME: ~ //~f C~~Ct.S.SFG'i7JC.~ Last Name 9 f ~~.,Flrst Name ~ Mlddle Initial HOME ADDRESS: ~i ~~ ~ -~~"~J!'~ /~~ L~~=C~~?'®'-°" ,..~//i'lij7ly ~~ _ ,S~i~-~ No. Street City State Zip Code PHONE: Work Fax Email address ~ ~,T Business Name: ~ ®~f ///~%~L,r~ ~r`'~iC~ -_P~o-s~ition: ~ ~!-=f. ,~~7!?~,f_ ~._ Address: ,~/~c~ ~'~.5,~L!/l Li ,~/'"~"~ / °~.~/i..-l?e ~~'Q ~L~ f~ ~-~ / ~ ~% No. Street City State Zip ode Professional License (describe) _,!//i~ Expires: Attach a cope of the Ircer~se 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 ~~ • 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, experience. Please list below: Please list your preferences in order of ranking [1] 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) ^ Affordable Housin Adviso Committee ^ Historic Preservation Board' ^ Art in Public Places Committee ^Housin Authorit " 0 Beach Preservation Board ^ Loan Review Committee'` 0 Beautification Committee ^ Marine Authorit "` ^Board of Ad'ustment' ^ Miami Beach Commission for Women ^ Bud et Adviso Committee ^ Miami Beach Cultural Arts Council ^ Capital Im rovements Oversi ht ^ Miami Beach Florida Sister Cities 0 Committee on Homeless ^ Normand Shores Local Gov't Nei h. Im rovement ^ Committee for Qualit Education in MB ^ Parks and Recreation Facilities Board ^ Communit Develo ment Adviso Personnel Board" ^Communit Relations Board ^ Plannin Board ^ Convention Center Adviso Board ^ Police Citizens Relations Committee ^ Cultural Arts Nei hborhood District Overla (CANDO ^ Production Indust Council ^ Debarment Committee ^ Public Safet Adviso Committee ^ Desi n Review Board` ^ Safet Committee ^ Disabilit Access Committee ^ Sin le Famil Residential Review Panel ^ Fine Arts Board ^ Sustainabilit Committee ^ Ga Business Develo ment Ad Hoc ^ 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 ^ Youth Center Adviso Board ^ His anic Affairs Committee * Board Required to File State Disclosure form ,. _~R~'~G,~:_AE3oa«~ c: ~ommitt~~s'~6U~ AoPii~,at~~r~6~~:~ ~~,ppiicano~ Revs 1~d . '~ 3~Jb.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 - 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.~yes, please explain in detail: • Do you currently have a violation(s) of City of Miami Beach codes: Yes ^ or No/ff yes, please explain in detail: • Do you currently owe the City of Miami Beach any money: Yes ~ or No ~'ff yes, explain in detail • Are you currently serving on any City Boards or Committees: Yes a or No.~''If yes; which board? • What organizations in the City of Miami Beach do you currently hold membership in? ,/~/~~ ~_ Name: Name: Title: Title: • List all properties owned or have an interest in, which are located within the City of Miami Beach: • I am now employed by the City of Miami Beach: Yes ~ No^. Which department? ~~lc • Pursuant to City Code Section 2-25 (b): Do you have a parent ~, spouse ~, child ~~, brother ~, or sister C who is employed by the City of Miami Beach? Check all that apply. Identify the department(s): i~~? 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 ^ "I 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 C de "Standards of Conduct for City Officers, Employees and Agency Members." /~ LUG ~ Lr SS E' . • ' -,~ Iica is ignature a Name of Applicant (PLEASE PRINT) Please attach a copy of your resume to this application NOTE: Applications will remain on file for a period of one (1) calendar year. Employment Status: Employed. Retired ^ Home-maker ^ Other Received in City Clerk's Office by ~3-~ : ~? ~ ~ Date ` ~ Name of Deputy Clerk ~~ ~ ` / f Ci' '~ Document Control Number (Assigned by the City Clerk's Office)`.~~ Entered By 7~s ~ ~e-'"~ Date ~ Revisetl 09/02/08 LH ~, ._ ~. _ .. Jc3 i'. _ J~~:-i l ~... .._ ,. ~ ~ - ,~_ . `.hill ~ „_. ~(` JI:2~. J' ..,~.