Robert Glick 12/31/2010m I,n;~';~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) 673-7411, Fax: (305j 673-7254
01 /20/2009
Robert Glick
4960 Lakeview Drive
Miami Beach, Florida 33140
SUBJECT::. Fine Arts Board
Congratulations! You have been reappointed by Commissioner Victor M. Diaz, Jr.
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, ,,
~~~
~~ ~~~~' ~ ~ s~'
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Gary Farmer
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.
Cil~- of Miami Math, 1700 Convention Center Drive, Miami Beach, Fbrida 33139, www.miamibeachfl.gov
OFFICE OF THE CITY CLERK, Robert Porcher, Ciy Clerk
T1:1: (305) 673-741 1, FAX: (305) 673-7254
TO Robert Glick
RE: Fine Arts 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 Ethia 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 o
I serve) on July 1st, following the closing of the calendar yeafe9 whic ve served.
Sworn to and subscribed before met 's ~ day of ~~ ~ , 20 ~
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 ro providing excellent public service and safely to all who live, work, and play in our vibrant, tropical, historic communiy.
m ,^,~A;'~!, BEACH
NAME: __S1!~
OARG AND
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CIT1' OF MIAM! BEACH
COMMITTEE APPLICATION FORM
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Last NameQ / ~ // CF~irst~Na ~--~,~., / Middle Irytial
HOME ADDRESS: ~ 1 ~ C~ C~-°4 ~L~ ~• ,L`t,,`."' ~ 1--~ `, c V ~ -/l,c ~i ~ L _/S~q~t(i!
No. Street _ City State ~j~~ oyl~
PHONE: ~~ ~ ~ G ~ ~ ~ ~ C3~ g ~~ ~ ~ ~ '~. S K
Home
Business Name:
Address:
Work
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S~a~-~-
Fax mail address
Position:
No. ~ Street City
((~ State Zip Code
Professional License (describe) ~ Expires: Z'-~, " Attach a cop~~ of the license
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 o '" months in a business established in the city.
• Resident of Miami Beach for a minimum of six (6) months: Y or No ^
• Demonstrate an ownership/interest in a business in Miami B ach for a minimum of six (6) months: Yes ^ or No ^
~~
• Are you a registered voter in Miami Beach: Yes ^ o ^
• (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 oniv three !31
choices will be observed by the Citv Clerk's Office. (Regular Boards of City)
^ Affordable Housin Adviso Committee ^ Historic Preservation Board*
^ Art in Public Places Committee ^Housin Authori "
^ Beach Preservation Board ^ Loan Review Com "
^ Beautification Committee ^ Marine Authori
^ Board of Ad'ustment* ^ Miami Beach Com on for Women
^ Bud et Adviso Committee 'z ^ Miami Beach Cultural Arts Council
^ Ca ital Im rovements Oversi ht D Miami Beach Florida Sister Cities
^ Committee on Homeless ^ Normand Shores Local Gov't Nei h. Im rovement
^ Committee for Qualit Education in MB ^ Parks and Recreation Facilities Board
^ Communit Deveio ment Adviso ^ Personnel Board*
^Communit Relations Board ^ Plannin Board
^ Convention Center Adviso Board ^ Police Citizens Relations Committee
^ Cultural Arts Nei hborhood District Overta (CANDO ^ Production Indust Council
^ Debarment Committee ^ Public Safet Adviso Committee
^ Desi n Review Baard* ^ Safet Committee
^ Disabilit Access Co ee ^ Sin le Famil Residential Review Panel
^ Fine Arts Board i ^ 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
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,..~cR\Sti_~1F3carc: ~ ~nmirnh°=s\5UC HPpir:auon\6u:: E~,pnii;;auor. Revf~l°d ? 130:;.ou;
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 belo ~/
Child's name: ~~ ~ ~' CT Age: ~_ Program:
Child's name: Age: Program:
.Have you ever been convicted of a felony: Yes ^ or ~ If 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 City Boards or Committees: Yes ^ or N~ If yes; which board?
• What organizations in tt}e City of Miami Beach do you currently hold membership in?
Name: I,•~/ ~ Title:
Name:
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 ^ or No hich 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 ~N~tat apply. Identify the department(s):
Gender: Mald ^ / Female ^
Race: White ^ Black ^
aian or Pacific Islander ^ African-American/Black ^ American Indian or Alaskan Native ^ Hispanic: ^ White -Not His~giEC
~ysically Challenged: Y o^.
"I hereby atte to the accuracy and truthfulness of the application and have received, read and will abide by Chapter 2,
Article VII ~o t e City Code "Standards of Conduct for City Officers Employees and cy Members."
Applicant's Si n ure Date Name of Applicant LEASE
PRINT)
Please-attach:aica~p~~#f,rout~r ,~,., _is, c i~oyn
Employment Status: Employed ^ R d ^ Home-maker ^ Ot r ^
Received in City Cierk's Office by Date
Name of eputy Clerk >~ ~ .
Document Control Number (Assigned by the City Clerk's Office) _~ C~~!~~ Entered By Date
Revised osro2roe ~r+
F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC Application 21309.doc