Edison Farrow 12/31/2009m rd,lAl~",!BEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florido 33139, vrww.miamibeachfl.aov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel: (305) 673-741 1, Fax: (305) 673-7254
07-27-2009
Edison Farrow
n lil19 IN ~ n~NeR I
16 ,~ ~; ~~; 'Gay, Lesbian, Bisexual and Transgender (GLBT)
Congratulations! You have been appointed by Commissioner Jerry Libbin
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,
~,~~~ s~°
n
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Rebecca Wakefield
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 sofety to all who live, work and play in our vibrant, tropical, historic community.
[D ~~
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, vaww.miamibeachH.aov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel: (305) 673-7411, Fax: (305j 673-7254
TO Edison Farrow
RE: Gay, Lesbian, Bisexual and Transgender (GLBT)
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 t~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 or committee on which
I serve) on July 1st, following the closing of the calendar year on which I have served.
Edison Farrow
Sworn to and subscribed before me this ~"~ day of , 200.
` ..~%G~iC2'
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 commiried ro providing excellent public service and safety to all who live, work and play in our vibrant, tropical, hisroric community.
NAME• ~ ~~~ ~ t Stlv.
HOME ADDRESS; LasbName ~ ~ ~ try Name ~ A, ~ w ~ Middle Initial
~. fi~`f~ eV~A ('ILA„ ~ 3~~3 ~'
Apt No. ouse No./Street City State Zip Code
PHONE• ~~-535- ~ , 'La'm 6!~(~''Cl~~(C I~b.COn,,
Home ~ Fax ~_ c _1 ~, Em'ad ad ress
Business Name: __ ~~~ 5~~~ a ( C [ J b ~ Position: ~'C~-~~ ~K~.l-
Address: __
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Professional License (descxibe)
City State
_ Expires:
Zip
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Pursuant to Ciiy Code section 2-22(4) a and b: Members of agencies, boards, and committees shall be affiliated with the dty; 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/intere for a minimum of six months in a business established in the aty.
• Resident of Miami Beach for a minimum of six (ti) months:~es ^ or No ^
• Demonstrate an ownership~nterest in a business iryry Miami Beach for a minimum of six (6) months: Yesp'or No ^
• Are you a registered voter in Miami Beach: Yes ~yor No ^
• (Please cirde one): 1 am now a resident oF. North Beach South Beac Middle Beach
• I am applying for an appointment because I have spedal abilities, kno a and 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 [1) first choice {2] second choice, and [3] third choice. Please note that only three (3l
choices will be observed by thg Citv Clerk's Office. (Regular Boards of City)
^ Affordable Housin Adviso Committee ^Housin Autho
^ Art in Public Places Committee ^ Loan Review Committee
^ Beautification Committee ^ Marine Autho '
^ Board of Ad'ustment* ^ Miami Beach Commission for Women
^ Bu et Adviso Committee ^ Miami Beach Cultural Arts Coundl
^ Ca ital Im rovements P 'eds Oversi ht Committee ^ Miami Beach Sister Cities P ram
^ Committee on the Homeless ^ Normand Shores Local Government Nei h. Im rovement
^ Committee for Quali Education in MB ^ Parks and Recreation Fadlities Board
^ Communi Develo ment Adviso ^ Personnel Board
^ Commun' Relations Board ^ Plannin Board''
^ Convention Center Adviso Board ^ Police Cfizens Relations Committee
^ Debarment Committee ^ Production Indust Coundl
^ Des' n Review Board" ^ Public Safe Adviso Committee
^ Disabil' Access Committee ^ Safe Committee
^ Fine Arts Board ^ Sin le Famil Residential Review Panel
Ga ,Lesbian, Bisexual and Tran ender GLBT ^ Sustainabil' Committee
^ Golf Adviso Committee ^ Trans aren Reliabil' 8~ Accountabil' Committee "TRAC"
^ Health Adviso Committee ^ Trans rtation and Parkin Committee
^ Health Fadlities Authori Board ^ visitor and Convention Autho '
^ His anic Affairs Committee ^ Waterfront Protedion Committee
^ Historic Preservation Board ^ Youth Center Adviso Board
=Board Required to File StaiJe Disclosure Form
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 partidpation 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 ~ 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 No ~ If yes; which board?
• What organizations in the City of Miami Beach do you currently hold membership in?
Name:
Name:
• List all
owned or have an interest in
1l~ SSG (`~
Title:
Title:
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):
The following infom~ation is volurrtary and Is neither part of your application nor has any t>~ring on your consideration for appoiMnrerrt. n is
being asked to comply vvlth federal equal opportunity reporting requir+ertrerrts.
Gender: 1~[lMale ^ Female
Check one onty (1)
VYhite (Not of Hispanic Origin): AA persons having origins in any of the original peoples of Europe, North Afica or the Middle East.
African-Amerk:anBlack (Not of Hispanic Origin): All persons having origins in any of the Bladc raaal groups of Afica.
^ Hispanic: All persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish ailture or origin, regardless of race.
^ Asian or Pacific Islander: All persons having origins in any of the original peoples of the Far East, Southeast Asia, the Irxlian Subcontinent, on
the Padfic Islands. This area indudes, for example, China, India, Japan, Korea, the Philippine Islands and Somoa.
^ American Indian or Alaskan Native: All persons having origins in any of the original peoples of North America, and who maintain
CuRural identification through tribal affiliation or community recognition.
~ Physically Challenged: Yes ^ or No^.
Employment Status: Employed ~ Retired ^ Homemaker ^ Other ^
NOTE: If appointed, you will be required to follow certain laws which apply to city board/committee members.
These laws include, but are not limited to, the following:
o Prohibition from directly or indirectly lobbying dty personnel (Miami Beach City Code section 2-459).
o Prohibition ftom contracting with the dty (Miami-Dade County Code section 2-11.1).
o Prohibition from lobbying before board/committee you have served on for period of one year after leaving office (Miami
Beach City Code section 2-26).
o Requirement to disdose certain finandal interests and gifts (Miami-Dade County Code section 2-11.1).
(re: CMB Community Development Advisory Committee): prohibition, during tenure and for one year after leaving office,
from having any interest in or receiving any benefit from Community Development Blodc Grant funds for either yourself ,
or those with whom you have business or immediate family ties (CFR 570.611).
Upon request, copies of these laws may be obtained from fhe City Clerk.
"I hereb attest to the accuracy and truthfulness of the application and have received, read and will abide by Chapter 2,
Anti - of the C' ode "Standards of onduc for City Officers, Employees and Agency Members."
c ~ ~ C~ ~/ ~~.~s t~ ~ ~~
Appli s g re Date Name of Applicant (PLEASE PRINT)
Please attach a copy of your resume to this appNcation
NOTE: Applicatiorrs wiN rer~ptln on TNe for a period of one (1) calendar year. !
Received in the City Clerk's Office by : ~ ~~~c~ri~' "" l~/~i~ Date: _/~ Control N G ~U ~~~
-Name of Depu Clerk Date: /
S~