Dakshesh Bhatt 06/30/2009m !/!IP,fs,IBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, vrww.miamibeachfl.gov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel: 1305) 673-741 1, Fax: (305} 673-7254
March 4, 2009
Mr. Dakshesh Bhatt
SUBJECT: COMMITTEE FOR QUALITY EDUCATION IN MIAMI BEACH
Dear Mr. Bhatt:
Congratulations! You have been appointed as the Representative of the PTA of Biscayne Elementary
Community School to the above-referenced agency, board or committee fora term ending,
6/30/2009.
If you are unable to accept this appointment, please notify the City Clerk's Office at (305)
673-741 1.
Sincerely,
a~~~~ s~°
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Leslie Rosenfeld, Liaison
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 2-1 1.1 -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'~t~gt@~{r/~~zrQ~/~+~g:,~t:pu~tlfd;:se~{msearnr# sa~fy!da:6Vll,~ho~fiyetinyr~pdn~p~pla~C~ie,a'~rvf~apt,dhdplGml;: 6iatarric~i~,ommunify.
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City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, vrww.miamibeachfl.aov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel: (305) 673-741 1, Fax: ~305~ 673-7254
TO Dakshesh Bhatt
RE: Committee For Quality Education in Miami Beach
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: 06/30/2009.
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/oiida 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.
~'~X4 e~
Dakshesh Bhatt
Sworn to and subscribed before me this s ~/ 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 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
NAME: QW AT7 ~gl~Sl-I ASH
Last Name First Name Middle Initial
HOME AaDRESS: 20 2 ~-~~ H ~ R ~ (NCB AVM ~r~rhl 8~~~ ~ L 33 ~ ~ 1
Apt No. House No./Street City State Zip Code
PHONE:C305~ ~6uA~q~ ~$6-- 208-2196 ~jf~q~ Q ~ IVL°. C19I`~
Home Work Fax Email address
Business Name: ~ ~ Yl n °L- ~-~-~c9 ~ Position:
Address: ~ ~ /U ~ 1-~ c5~'F~~~ )'ti') ( ~-I7? ~ ~ ~-- - `3 3 ~ 3 ~_
No. Street city State Zip Code
Professional License (describe) 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 fallowing 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 i_; or No
• Are you a registered voter in Miami Beach: Yes ~or Na ~~
. (Please circle one}: i am now a resident of: North Bead South Beach Middle Beach
• I am applying for an appointment because I have special abilities, knowledge, experience. Please list below:
• Are you presently a registered lobbyist with the City of w"iami Beach? Yes '--' or No i
Please list your preferences in order of ranking [1] first choice [2] second choice, and [3] third choice. Please note that only three f3i
choices will be observed by the City Clerk's Office. (Regular Boards of City)
Affordable Housin Advisor Committee _ ~ T Historic Preservation Board ~ -i_
~ i
1
^ Art in Public Places Committee ~ :Housin Authority
_ ____ _
Beach Preservation Board _ _
____
C Loan Review Committee _ _
~
' ^ Beautification C
ommittee ^
Marine Authority ___
~
_
_ _ _
J Board of Adjustment* _ _
_ __
[ ;Miami Beach Commission for Women __ __ _
___~
I ^ Budget Advisory Committee _
~ ~;~ Miami Beach Cultural Arts Council ~
i !~ Capital Improvements Projects Oversight Committee ~ Ci Miami Beach Sister Cities Pro rg am ___
_
!i_ Committee on the Homeless J __ ,___
~_
^ Normandy Shores Local Gov't Neigh. Improvement ~-_
__
^ Committee for Qualit Education in MB ~:=i Parks and Recreation Facilities B
oard
C] Communit Develo ment Adviso _
__
^ Personnel Board_ _
^ Community Relations Board _ i I~ Planning Board*
i u Convention Center Advisory Board
~ __
~l Police Citizens Relations Committee ________
~
____ ~
~
^ Cultural Arts Neighborhood District Overlay (CANDQ j i Production Industry Council ___ __
~^ Debarment Committee t ~ Public Safe~Advisory Commit_tee_______ _
~
~~ Design Review Board" ~ ~~_Safety Committee _ ____ ___
__~
r^ Disability Access Committee _ __ _
~ Single Fam~ilY Residential Review Panel _____
^ Fine Axis Board ~ Ci Sustainability Committee
_
Ci ;Gay Business Devel~ment Ad Hoc ___ __
_ ___ _ __ _
~Trans~aren~Reliability & Accountability Committee "TRA_C_''__~
~
~ Golf Advisory Committee ___ __ ~ !Transportation and Parking Committee_ __ _ _
^ Health Advis~Committee - _______ _ ~, Visitor and Convention Authoriv~ _ 1
-~ Health Facilities Authority Board
----- --
'--- I i~ Ycuth Center Advisor~Board
~~------- --- --------- _ _~
[~ Hispanic Affairs Committee i ~
~ - ----
~ Board rtestuirec~ to Fiie State Disclosure form -_-
i
C:\DOCUME-1\Kids\-OCALS-1\Temp\8C Application 21309.dvc
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:
n n__......a ..._ ....-..a:.... :... ~i_..a~
.Have you ever been convicted of a felony: Yes :~ or No~ If yes, please explain in
detail:
• Do you currently have a violation(sj 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 I-i or No~ If yes,
explain in detail
• Are you currently serving on any City Boards or Committees: Yes L 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 ~- or No~~. 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):
Gender: Male Female ^
Employment Status: Employed ~, Retired ^ Home-maker ^ Other ^
ethnic Origin: --`- ---- --- ----
4sian or Pacific Islander African-AmericanfBlack American Indian or Alaskan Native Hispanic: White -Not Hispanic
physically Challenged: Yes or No
"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 Code "Standards of
Conduct for City Officers,
Employees and Agency
Members."
Received in City Glerk`s Office by
Race: White ^ Black ^
Date ~ S/~ /
Name of Deputy Clerk
Control Number (Assigned by the City Glerk's Office) ~~ Entered 8y
Revised 09/02!08 LH
C:\DOCUME-i\Kids\LOCALS-1\Temp\BC Application L1309.doc