Yair Lapciuc 12/31/2009
Gtr olF Miami Beath, 1700 Convention Center Drive, Miami Beach, Florido 33139, www.miamibeachll.gov
OFFICE OF THE CITY CLERK, Robert Parcher, Ciy Clerk
TEL: (305 673-7411, FAX: (305) 673-725d
01 /26/2009
Yair Lapciuc
4210 Nautilus Drive
Miami Beach, Florida 33140
Public Safety Advisory Committee
Congratulations! You have been reappointed by Commissioner Jerry Libbin
to the above referenced agency, board or committee for a term ending: 12/31/2009.
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,
i
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Chief Noriega
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 commined to providing excellent public service and sofey to all who live, work, and play in our vibrant, tropical, historic community
I1
Gf~I of Miomi B~och, 1700 Convention Center Drive, Miami Beach, Fbrida 33139, www.miomibeachA.gov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
TEt: (305) 673-7411, FAX: (305 673-7254
TO Yair Lapciuc
RE: Public Safety 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 Pub/ic Officers and Emp/ogees, 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 hive served.
IY~~M`apciuc
Sworn to and subscribed before me this / ~ day of /~~L ~ , 200
-~~~. -
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 Requiremenfs.
We are committed to providing excellent public service and safety to all who live, work, and play in our vibrant, tropical, historic community
r~.:'u z^r +.., ,*4 ~.-,..r We ,.a :°zdi ,§l 'I°..; ~i°'. ~A ^'."°_Y'~d7-i S !s'V ':._~r"~ S:
NAME:
Last Name
rst Name
Middle Initial
HOME ADDRESS: _ _ ~11 ~ 0 ~f 1 ~V i D HIV e ~~A~I ~3 ta~V1 FC 33 ~ y/~'
~ No. ~ Street , City State • Zip Code G
PHONE:. ~30~ ~' •3~~y C3of 1 ' ,t'
Home Work
Business Name: ~~~eLrSlv~- ~In
Address: ~-17~ ().(1~ .M i
No. Street
Professional License (describe)
State Zip Code
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 minimum of six months in a business established in the city.
• Resident of Miami Beach for a minimum of six (6) month . Ye or No
• Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six (6) months: Yes
• Are you a registered voter in Miami Beac . Ye or No
• (Please check one): I am now a resident of: North Beach South Beach fiddle 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)
!~ Art in Public Places Committee
Beach Preservation Board
J Beautification Committee
Board of Adjustment"
Budget Advisory Committee
L Committee on Homeless
C Committee for Quality Education in MB
Community Development Advisory*
Community Relations Board
Convention Center Advisory Board
5 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. Im provement
- Oversight Committee for General Obliga tion Bond
_ Parks and Recreation Facilities Board
Personnel Board*
Planning Board
Police Citizens Relations Committee
production Industry Council
Public Safety Advisory Committee
Safety Committee
= Transportation and Parking Committee
Visitor and Convention Authority
Youth Center Advisory Board ~~`-'
~~y
C-` S~
~~~ ~~~
'2 3 C 30~ S91-o~4'1 ~/a~i~~P<<GilMf~4~lA1
Fax Email addr s
Position: "-~PG•-•~~V~
City
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
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 ~ If yes, please explain in detail:
• Do you currently have a violation(s) of City of Miami Beach codes: Yes or~1Ve-~. If yes, please explain in detail:
• Do you currently owe the City of Miami Beach any money: Yes No If yes, explain in detail
• Are you currently serving on any City Boards or Committees: Yes ~ If yes; which board?
• What organizations in the City of Miami Beach do you currently hold membership in?
Name: ~~ti~,~ Sti~'e(,,, ~u Ui~GI ~~~~~,Iti1 ~~~P Title:
Name: Title:
. List alIll pro, Ip-erties owned or have an interest in, which are located within the City of Miami Beach:
~~lL' ! W,~v ~ I~J~~~ I(I'E'
• I am now employed by the City of Miami Beach: Yes oaf IVY, .Which department?
• Pursuant to City Code Section 2-25 (b): Do you have a parent, spo}~se.~hild.~brother , or sister who is employed by the
City of Miami Beach? Check all that apply. Identify the department(s): C ~
This section is "not required" but desired: Age: ~~ years old Gender: Male // Female
Ethnic~igin (Check one)
White African-American/Black _ Hispanic: =Asian or Pacific Islander -American Indian or Alaskan Native
Employment Status: Employed retired ,~,, 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 VII - of the City Code "Standards of Conduct for City Officers, Employees and Agency Members."
~1/ Z~~a ~ ya~~
Applica 's n ure Date me of
Please attach copy of your resume to this application
NOTE: Applications will remain on file for a period of one (1) calendar year.
~~~
nt (PLEASE PRINT)
Received in City Clerk's Office by ~ Date ~~ ` o
Name of Deputy Clerk
Document Control Number (Assigned by the City Clerk's Office) Entered By Date
Revised 10/29/2007 L. Hattield
their