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Marcella Paz Cohen 12/31/2009 City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, wwv`-.miamibeachfl.aov OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk Tel: (305j 673-741 1, Fax: 1305) 673-7254 05-14-2009 Marcella Paz Cohen 90 Alton Road Apt. #2106 Miami Beach, Florida 33139 SUBJECT:. Safety Committee Congratulations! You have been appointed by Commissioner Deede Weithorn to the agency, board or committee named above for a term ending: 12/31/2009. Pursuant to Ordinance No. 2006-3543, commencing with terms beginning on or after January 1st, 2007, the term of board members who are directly appointed by a member of the City Commission shall automatically expire on December 31 of the year the appointing elected official leaves office. If you are unable to accept this appointment or have any questions, please call the City Clerk's Office at 305-673-7411. Please read the enclosed materials carefully. Congratulations again and good luck. Sincerely, - ~ ;~ 5 „% f Robert Parcher City Clerk cc: Saul Frances, Parking Director Clifford Leonard 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, 2-458 and 2-459 Ordinance No. 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 Employee We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community. m 'Ii~11BEACH City of Miami Beatfi, 1700 Convention Center Drive, Miomi Beach, Florida 33139, www.miamibeachfl.aov OFFICE OF THE CITY CLERK, Robert Porcher, City Clerk Tel: X305} 673-7411, Fax: (305} 673-725A TO Marcella Paz Cohen RE: Safety 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 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. .-- ~.- u. ~ -- ~ l_- ~-~_... a ohen Sworn to and subscribed before me this l~ ~ day of ~} 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 infarmation 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. NAME: yy yy M ~~~~~ ~~z ~ i w ~ i~ ~r mu ~~~ ~, -~ ~ ~ (LAC Last Name First Name Middre Initial HOME ADDRESS: ~~~ '~ ~'~ i ~" ~ ~ i Apt No. House No./Street --7 C~ S to Zip Code PHONE: '~jr~~-=~ `~ ~,~1~;.~~ ~3r-~S '-i~~ '"~~~~ ~~'1'~,~~~ t t'1 ~ -~ (N.'~~ ~ ~~2-1. Home W rk Fax Email address ~ <-~ti'1 Business Name: , +~~--~- ~ Gin ~a ~~Z%„~t'~ osition:~~~~~ ~~~~ '~ r--~~(r~~t.~~~_ Address: ~~~ e~~'(~"f R J ~ ~ 1©~-ty~-.a 't` l ~~ ~c:ft -'t' I ~ ~ ) -T~~' No. Professional License (describe) City / State Zip Code Expires: ~Gf~ O r,,~~;f~ c.~ Pursuant to City Code section 2-22(4) a and b: Members of agencies, boards, and committees shall`de 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; orb) 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 ~r No • Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six (6) months: Yes 1/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: • Are you presently a registered lobbyist with the City of Miami Beach? Yes or No ~ Please list your preferences in order of ranking [1J 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) ~l i Affordable Housin Adviso Committee ^ Historic Preservation Board ^ Art in Public Places Committee ^Housin Authorit each Preservation Board ^ Loan Review Committee ^ Beautification Committee l arine Authorit ,~~ ^ Board of Ad'ustment" Miami Beach Commission for Women ^ Bud et Adviso Committee ^ Miami Beach Cultural Arts Council ^ Ca ital Im rovements Pro~ects Oversi ht Committee ^ Miami Beach Sister Cities Pro ram ~ ^ Committee on the Homeless ^ Normand Shores Local Gov't Nei h. Im rovement ^ Committee for Qualit Education in MB ^ Parks and Recreation Facilities Board ~~ _; ^Communit Develo ment Advisor ^ Personnel Board ^ Communit Relations Board ^ Plannin Board" ^ Convention Center Adviso Board ^ Police Citizens Relations Committee ^ Debarment Committee ^ Production Indust Council ^ Desi n Review Board" ublic Safet Adviso Committee ^ Disabilit Access Committee afet Committee .~~,; ^ Fine Arts Board ^ Sin le Famil Residential Revi w Panel _~ ^ Ga Business Develo ment Ad Hoc ^ Sustainabilit Committee ^ Golf Adviso Committee ^ Trans arenc Reliabilit & Accountabilit Committee "TRAC" ^ Health Adviso Committee ^ Trans ortation and Parkin Committee ^ Health Facilities Authorit Board ^ Visitor and Convention Authorit _ ^ His anic Affairs Committee ^ Youth Center Adviso Board " Board Re wired to File State Disclosure form F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC Application 040809.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 '~ NoYears of Service: 2. Present participation in Youth Center activities by your children Yes No i . 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: i' .Have you ever been convicted of a felony: Yes ' or No ~ If yes, please explain in detail: • Do you currently have a violation(s) of City of Miami Beach codes: Yes - or No r/If yes, please explain in detail: • Do you currently owe the City of Miami Beach any money: Yes - or No i>~ If yes, explain in detail • Are you currently serving on any City Boards or Committees: Yes ' or No % If yes; which board? • What organizations in the City of Miami Beach do you currently hold membership in? Name: ~~°~ ~ G~~~' ~ Title: ~ ~~-~-~~ ~~ , ~ z~O.~~l Name:~~<-%`~~~~ Title: ~~"> ~~ r. s= ~~ J n"T ~~ ~- ~ • List all properties owri d or have an interest in, which are located within the City of Miami Beach: , • 1 am now employed by the City of Miami Beach: Yes ' or Noi~Which department? • Pursuant to City Code Section 2-25 (b): Do you have a parent ' ~, spouse ,child '_ , brother r , or sister ° who is employed by the City of Miami Beach? Check all that apply. Identify the department(s): "Yl.~.~ rfl Gender: Male ^ Female [~" Race: White ~ Black ^ Ethnic Origin: Asian or Pacific Islander'._ African-Am/erican/Black ~' American Indian or Alaskan Native __! Hispanic !!~ White -Not Hispanic Physically Challenged: Yes or No!iV. "I hereb est to the acc n truthfulness of the application and have received, read and will abide by Chapter 2, Article Vll - of the City Co a "Standards ~ d r City Officers, Empl yees and Agency Mve~mbers." ~''s: sue`" i Applic ignature ' ~ ate 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- ker ^ O er ^ Received in City Clerk's Office by ate Name of Deputy Clerk // Document Control Number (Assigned by the City Clerk's Office) ~ Entered By ~ Date F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC Application 040809.doc