Anthony Broad 12/31/2010m MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeochfl.aov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel: (305) 673-741 1, Fax: (305) 673-7254
08-28-2009
Anthony Broad
~_ .__ ~ Debarment Committee
Congratulations! You have been appointed by Commissioner Ed Tobin
to the agency, board or committee named above for a term ending: 12/31/2010.
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,
6 ~~Z/s~
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Gus Lopez
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 iv11AMdBEA~H
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.aov
OFFICE OF THE CITY CLERK, Robert Parcher, Ciy Clerk
Tel: (305) 673-7411, Fox: (305) 673-7254
TO Anthony Broad
RE: Debarment 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: 12/31/2010.
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 Ethics Guide to the Sunshine
Amendment and Code of Ethics for Pub/ic 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 ve served.
thony Broad
S a~
Sworn to and subscribed before me this ~tday of ~!-~ !./s , 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 commi»ed to providing excellent public service and safety to all who live, work and ploy in our vibrant, tropical, historic community.
(`~/ ~~, ~ ~,~~'~~~ ~ ~t ~~~ ~ CfTY OF MIAMI BEACH
_ By~OARD AND COMIVIfTTEE APPLICATION FORM
NAME: ~" ~~ ~ "'r"'O~ ~G-f/GS
Last Name r-~ Firs Name Mtddle Initial
HOME ADDRESS: l / ~~ G1 ~5~ 2~ srl£~ ~~~ ~ 3 3 ~ ~~
Apt No. House No./Street City State Zip Cpode
PHONE: 30~ G7'l ~ Qr`(( ~ ~(~-Zc~Fl- (1 3f`' /~j ~p ~-oQ~ ~ ~•C~I S~vE'h. K12 i
Home .1~k ~c ft.- Fax Ematl ad ress
Business Name: D~IDN E Position:
Address:
No. ~ (p Street City State Zip Code
Professional License (describe) 1 ~ ~l'r Expires: Attach a copy 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 of six months in a business established in the city.
• Resident of Miami Beach for a minimum of six (6) months: Yer No ^
• Demonstrate an ownershiplinterest in a business in Miami Beac for a minimum of six (6) months: Yes ^ or No®
• Are you a registered voter in Miami Beach: Yes/3~c~r No ^
• (Please circle one): I am now a resident of: l orth Beach South Beach fiddle
• I am applying for an appointment because I have special abilities, knowledge and experience. Please list below:
• Are you presently a registered lobbyist with the City of Miami Beach? Yes ^ or Ncy~
Please list your preferences in order of ranking ~1] first choice [2] second choice, and (3] third choice. Please note that oniv three (3)
choices will be observed by the City Clerk's Office. (Regular Boards of City)
^ Affordable Housin Adviso Committee ^Housin Authorit
^ Art in Public Places Committee ^ Loan Review Committee
^ Beautifit:ation Committee ^ Marine Autho
^ Board of Ad'ustment" ^ Miami Beach Commission for Women
^ Bud et Adviso Committee 0 Miami Beach Cultural Arts Council
^ Ca ital Im rovements Pro'ects 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 Facilities Board
^ Commun' Develo ment Adviso ^ Personnel Board
^ Commun' Relations Board ^ Plannin Board*
^ Convention Center Adviso Board ^ Police Citizens Relations Committee
ebarment Committee ^ Production Indu Council
^ Desi n Review Board* ^ Public Sa Adviso Committee
^ Disabil' Access Committee ^ Safe Committee
^ Fine Arts Baard ^ Sin le Famii Residential Review Panel
^ Ga ,Lesbian, Bisexual and Trans ender GLBT ^ Sustainabil' Committee
^ Golf Adviso Committee ^ Trans aren Reliabili & Accountabil' Committee "TRAC"
^ Health Adviso Committee ^ Trans ortation and Parkin Committee
^ Health Facilities Autho ' Board ^ Visitor and Convention Autho
^ His anic Affairs Committee ^ Waterfront Protection Committee
^ Historic Preservation Board ^ Youth Center Adviso Board
"Board Required to File State Disclosure Form
Note: If applying for Youth Advi~ory Board, please indicate your affiliation with the Scott Rakow Youth Center:
1. Past service on the Youth Center Advisory Board: Yes L N~ Years of Serve
2. Present participation in Youth Center activities by your children YesO No~lf 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:
F \CLEP.\$ALL\aFORMS\BOARD AND COMMITTEES\BC Application062b09 NEW.doc /
~~((/
•Have you ever been convicted of ~ .eiony: Yes _ o~f Yes, please explain ~„ ~etail:
• Do you currently have a violation(s) of City of Miami Beach codes: Yes = or Ni~~w if yes, Please explain in detail:
• Do you currently owe the City of Miami Beach any money: Yes C or N~i If yes, explain in detail
• Are you currently serving on any City Beards or Committees: Yes : or NIf yes; which board?
• What organizations in the City of Miami Beach do you currently hold membership in?
Name:
Name:
• List all
dUOr,~/
Title:
Title:
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 0 or "1~'~ir Which department?
• Pursuant to City Code Section 2-25 (b): Do you have a parent D, spouse ^, child G, brother D, or sister ~ who is employed by the
City of Miami Beach? Check all that apply. Identify the department(s): N
The following information is voluntary and is nekher part of your application nor has any bearing on your consideration for appointment. It is
being asked to comply with federal squat opportunity reporting requirements.
Male ^ Female
Ethnic Origin: Check one only (1}
^ Whlte (Not of Hispanic Origin): All persons having origins in any of the original peoples of Europe, North Africa or the Middle East.
^ African-American/Black (Not of Hispanic Origin): All persons having origins in any of the Black racial groups of Africa.
~dtspanic: All perr>ons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race.
^ Asian or Pacific tstander: All persons having origins in any of the original peoples of the Far East, Southeast Asia, the Indian Subcontinent, on
the Pacific Islands. This area includes, 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 mairrtain
Cultural iderdtBcation through tribal affi~~~iayytion or community recognition.
Physically Challenged: Yes ^ or Nio~
Employment Status: Employed ^ Retired ^ Homemaker ^ Oth~~ U •Ip ~M~(~~r'e~
NOTE: If appointed, you will be required to follow certain taws which apply to city boardlcommittee members.
These taws include, but are not limited to, the following:
o Prohibition from directly or indirectly lobbying city personnel (Miami Beach City Code section 2-459).
o Prohibition from contracting with the city (Miami-Dade County Code section 2-11.1).
o Prohibition from lobbying before boardJcommittee you have served on for period of one year after leaving office (Miami
Beach City Code section 2-26).
o Requirement to disclose certain financial 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 Block. Grant funds for either yourself ,
or those with whom you have business or immediate family ties (CFR 570.611).
Upon request, copies of these taws may be obtained from the City Clerk.
"I reby att st to the a uracy and truthfulness of the application and have received, read and will abide by Chapter 2,
~i II - o he Ci de "Standards of C nndu for City Officers, E loyees and A ncyM~~e~~mbers."
Applican s ignature ~ ate ! Name of Applican (PLEASE PR~IN )
Please attach a copy of your resume to this application
NOTE: Applications wfll remair~on file for a period of one (1) calendar year.
Received in the City Clerk's Office by : ,~~"i y/~~(~/ Date _/ !2009 Control NS~~ Date: _!_/2009 g/~//~p
-dame of Deputy erk G ~ /