Silvia Ros 12/31/2010•
m MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, wwrw.miamibeochFl.aov
OFFICE OF THE CITY CLERK, Robert Parcher, Ciy Clerk
Tel: 1305) b73-741 1, Fax: (305) 673-7254
10-15-2009
Silvia Ros
Uf3JECT ,.~ ~ Community Development Advisory Committee
Congratulations! You have been appointed by Commissioner Deede Weithorn
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,
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Mercedes Rovirosa
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 safely to all who live, work and play in our vibrant, tropical, historic community.
m MIAMIBEACH
•
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, vaww.miamibeachA.aov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel: (305) 673-7411, Fax: (305) 673-7254
TO Silvia Ros
RE: Community Development Advisory 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 Public t~aers and Emp/ogees, 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 (dependi the board or committee on which
I serve) on July 1st, following the closing of the calendar y r o hich I have served.
Silvia Ros
Sworn to and subscribed before me this `~ day of ~'}_ , 200q
Silvia Prieto
Deputy Clerk
*Please visit the City of Miami Beach website at www.miamibeachfl.gov under City Gerk/Board and Committees
for additional information regarding the Financial Disclosure Requirements.
We are committed to providing excellent public service and safely to all who live, work and play in our vibrant, tropical, historic community.
'~` ~~
Address: 1~] 1~~PrS~11~(rTO~ 1~~~i mItQI'W`~ ~~ ~( ~~~~ I
_ ~,~~, { ~+,~~~~ ~ ~ ~~~ ~ CfTY OF MIAM! BEACH
BOARD AND COMMITTEE APPLICATION FORM
NAME: ~CS ~t l~ll i ~
Last Name _ First Name M~ fiddle Initial
HOME ADDRESS: ~~ ~~[ ~ ~JL~-tom 1~~~ ~`~t^'~` Ici•~~h `I'~ ~ c~3~
Apt o. c~ House No./Street City State Ztp Code
PHONE: ~OS S ~O~G1~y SI(~Vt(h ~StW1a.~OS. ~N
No.
Home Work Fax Email address
Business Name: `~Nri/ tIJDLS<DOJ t~~ Position:
Professional License (describe)
C~
City
State Zip
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 fora minimum of six months in a business established in the city.
• Resident of Miami Beach for a minimum of six (6) months: Yes of or No ^
• Demonstrate an ownership/interest in a business i~'Miami Beach for a minimum of six (6) months: Yes or No ^
• Are you a registered voter in Miami Beach: Yes l~ or No ^ --~~:-~ ~
• (Please circle one): I am now a resident of: North Beach C:~QUw-tseasw Middle Beach
• I am applying for an appointment because 1 have special abilities, knowledge and experience. Please list below:
• Are you presently a registered lobbyist with the City of Miami 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 oniv three (31
choices will be observed by the Citv Clerk's Office. (Regular Boards of City)
0 Affordable Housin Adviso Committee ^Housin Autho '
Art in Public Places Committee D Loan Review Committee
^ Beautification Committee Q Marine Autho '
0 Board of Ad'ustment* 0 Miami Beach Commission for Women
^ Bud et Adviso Committee 0 Miami Beach Cultural A-ts Council
D Ca ital Im rovements Pro ects Oversi ht Committee ^ Miami Beach Sister Cities Pro ram
^ Committee on the Homeless D Normand Shores Local Government Nei h. im rovement
^ Committee for Quali Education in MB 0 Parks and Recreation Facilities Board
ommun' Deveio ment Adviso 0 Personnel Board
^ Commun' Relations Board ^ Plannin Board*
^ Convention Center Adviso Board 0 Police Citizens Relations Committee
D Debarment Committee ^ Production Indus Council
^ Desi n Review Board* ^ Public Safe Adviso Committee
^ Disabil' Access Committee ^ Safe Committee
^ Fine Arts Board 0 Sin le Famil Residential Review Panel
a ,Lesbian, Bisexual and Trans ender GLBT 0 Sustainabil' Committee
^ Golf Adviso Committee ^ Trans aren Reliabil' & Accountabil' Committee "TRAC"
^ Health Adviso Committee p Trans ortation and Parkin Committee
0 Health Facilities Autho ' Baard ^ Visitor and Convention Autho '
^ His anic Affairs Committee D Waterfront Protection Committee
^ Historic Preservation Board ^ Youth Center Adviso Board
*Board Required to Flle State Disclosure Fonm
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 YesO No 0. 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:
F:\CLEP.\$At.l\aFORMS\BOARD AND COMMITTEES\BC Application062609 NEW.doc
.Have you ever been convicted,.,-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 expiain in detail:
• Do you currently owe the City of Miami Beach any money: Yes ^ or No,~' If yes, expiain 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:
Title:
Title:
• List al! 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 Nod. Which department?
• Pursuant to City Code Section 2-25 (b). Do you have a parent ^, spouse C', child G, brother D, or sister 0 who is employed by the
City of Miami Beach? Check all that apply. Identify the department(s):
The following information is voluntary and is neither part of your application nor has any bearing on your consideration for appointment. It is
being asked to comply with federal equal opportunity reporting requirements.
Gender: ^ 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. ~`
^Airican-American/Black (Not of Hispanic Origin): All persons having origins in any of the Black racial groups of Africa.
f~Hispanic: All persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture 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 Indian Subcontinent, on
the Pacific Islands. This area includes, for example, China, India, Japan, Korea, the Philippine Islands and Somaa.
^ American Indian or Alaskan Native: All persons having origins in any of the original peoples of North America, and who maintain
Cufturaf identification through tribal affiliation or community recognition.
Physically Challenged: Yes ^ or NoD.
Employment Status: Employed .e' Retired ^ Homemaker ^ Other ^
NOTE: If appointed, you will be required to follow certain caws which apply to city board/commlttse members.
These caws include, but are not fimlted to, tihe 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 baardlcommittee 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 laws may be obtained from the City Clerk.
"I here s o the accuracy and truthfulness of the application and have received, read and will abide by Chapter 2,
Artici V - e Clty Co "Standards f Conduct for C Officers, Employees and Age cy embers."
~_ t~ ' 20 I' 1 ~i'_6
Applicant's Sign ~ Date Nam of Applicant (PLEASE PRINT)
Please attach a copy of your resume to this application
NOTE: Appiicatio~s wl~remain,ot~flle for a period of one (1) calendar year.
Received in the City Clerk's Office by : ~ o.~t~/~~~-(///(i6fi(~( Dated V/~~ !2009 Control No