Liz Atlan 06/30/2010• •
m MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachFl.gov
OFFICE OF THE CITY CLERK, Robert Parcher, Ciy Clerk
Tel: (305) 673-7411, Fax: (305) 673-7254
October 20, 2009
Liz Atlan
SUBJECT: COMMITTEE FOR QUALITY EDUCATION IN MIAMI BEACH
Dear Ms. Atlan:
Congratulations! You have been appointed as a Representative for South Pointe Elementary School to
the above-referenced agency, board or committee for a term ending, 6/30/2010.
If you are unable to accept this appointment, please notify the City Clerk's Office at (305)
673-741 1.
Sincerely,
M~~~~~~
Robert Parcher
City Clerk
«: Saul Frances, Parking Director
Leslie Rosenfeld, Liaisorn
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 committed to providing excellent public service and say to 911 ryho live, work and play in our vibrant, tr~pical, historic community.
V1%e ore cemmi,,ed to pr'oti•:diny ezceitern auor'c servce and so aty toe wno iive, work, and ptey ;n our vibrant; trcp+ce , historic community.
• •
m MIAMBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, vaww.miamibeachfl.gov
CITY CLERK'S OFFICE
Tef: 305-673-741 1 ,Fax: 305-673-7254
TO: Liz Atian
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: 06/30/2010.
1 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 F/orida Commission on Ethics Guide to the
SunshineAmendmentand Code ofEthics forPublic Olfcers and understand that as a member of
a City of Miami Beach Board and/or Committee, I must comply with the financial disclosure*
requirements 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.
'Ciz Atlan
Zq~ e v~
Sworn to and subscribed before me this day of ~ ~ 200
. ~~
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 arr: cornmiltetl to providing axcelle>nt public sc:°rvica and safety to all who live;; work; and play in our vibrant, tropical, historic r.,vrnrnunity.
m MIAMIBEpCH
.... RT~te~ ~I i
CITY OF MIAMI BEACH
~AN OMMITTEE APPLICATION FORM,
Last NlameG n /~ //~~ /~.~~n First Name
HOME ADDRESS: ~~ 5 ~ l ~~ ~ 1 t~ r 1 V tip
/ r 'Apt No. '7 H No./Street
PHONE: 10 "1 ~ '" Z ~ L~ ~~ S ~ Z
City
Home Work
Business Name:
Address:
Middle Initial
P~.(~ Fl-- 3 313 °~
State Zip Code
~~iny~[ y~~0Y1/-
Email address
No.
Professional License (describe) _
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; orb) an
individual shall demonstrate
ownershipfinterest for a
minimum of six months in a
Street City State Zip Code
Expires: Attach a copy of the license
Please list your preferences in order of ranking [1] first choice [2] second choice, and [3] third
choice. Please note that only three /31 choices will. be_ observed by the Citv Clerk's Office.
(Regular Boards of City)
Q Affordable Housing Advisory Committee Q Housing Authority
Q Art in Public Places Committee Q Loan Review Committee
Q Beautification Committee Q Marine Authority
Q Board of Adjustment* Q Miami Beach Commission for Women
Q Budget Adviso Committee Q Miami Beach Cultural Arts Council
Q Capital Improvements Projects Oversight Committee Q Miami Beach Sister Cities Program
Q Committee on the Homeless Q Normandy Shores Local Government Neigh. Improvement
Committee for Quality Education in MB Q Parks and Recreation Facilities Board
Q Communiiy Development Advisory Q Personnel Board
Q Community Relations Board Q Planning Board*
Q Convention Center Advisory Board Q Police Citizens Relations Committee
Q Debarment Committee Q Production Industry Council
Q Design Review Board* Q Public Safety Adviso Committee
Q Disability Access Committee Q Safety Committee
Q Fine Arts Board Q Single Family Residential Review Panel
Q Gay, Lesbian, Bisexual and Transgender (GLBT) Q Sustainability Committee
Q Golf Advisory Committee
Q Health Advisory Committee Q Transparency Reliability & Accountability Committee "TRAC"
Q Transportation and Parking Committee
Q Health Facilities Authority Board Q Visitor and Convention Authority
Q Hispanic Affairs Committee Q Watertront Protection Committee
Q Historic Preservation Board Q Youth Center Advisory Board
*Board Required to File State 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 p No p Years of Service:
2. Present participation in Youth Center activities by your children Yesp 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:
Fax
Position:
F:\CLER\SALL\aFORIylS\BOARD AND COlNMITiEES\BC Application062609 NEW.doc
.Have you ever been convicted o~lony: Yes p or No~lf yes, please expl~ detail:
• Do you currently have a violation(s) of City of Miami Beach codes: Yes p or No~lf yes, please explain in detail:
• Do you currently owe the City of Miami Beach any money: Yes p or No'~ If yes, explain in detail
• Are you currently serving on any City Boards or Committees: Yes p or No ~D 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 p or N~ Which department?
• Pursuant to City Code Section 2-25 (b): Do you have a parent p, spouse p, child p, brother Q, or sister p 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 ~emale
nic Ortgtn: Check one only (1)
hits (Not of Hispanic Origin): All persons having origins in any of the original peoples of Europe, North Africa or the Middle East.
Q African-AmericaNBlack (Not of Hispanic Origin): All persons having origins in any of the Black racial groups of Africa.
0 Hispanic: All persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish cuRure or origin, regardless of race.
Q 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 Somoa.
Q American Indian or Alaskan Native: All persons having origins in any of the original peoples of North America, and who maintain
Cultural ident~cation through tribal affiliation or community recognition.
Challenged: Yes p or Nop.
Employment Status: Employed Q Retired p Homemaker Other ~
NOTE: If appointed, you will ~Fequired to follow certain laws which apply'4'~ity board/committee members.
These laws include, but are not limited to, the following:
o Prohibition from directly or indirectly lobbying city personnel (Miami Beach City Code section 259).
o Prohibition from contracting with the city (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 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 n;ceiving 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 hereb attest the curacy and truthfulness of the application and have received, read and will abide by Chapter 2,
Article I of e d "Standards of Cohn uct for CD Officers, E ~~ yees ~ d Agency ~Ilembeis."
l r/1t r(,~,N
Applican s Signature Date Name of Applicant (PLEASE PRINT)
Please attach a copy of your resume to this application_
NOTE: Applications wrll remain on file for a period_of one (1) calendar_year:
Received in the City Clerk's Office by
Clerk
Dat : / ~O9 Cornrol No. Date: / /,2~Q,Q