Calvin Kohli 12/31/2010m MIAMIBEACH
City of Miami Beach, 1700 Convention
Drive, Miami Beach, Florida.33~.199, vvww.miamibeachN.aov
OFFICE OF THE CITY CLERK, Robert Parcher, City
Tel: (305) 673-7411, Fax: (305) 673-7254
10-27-2009
Calvin Kohli
6039 Collins Ave. #929
Miami Beach, Florida 33140
Committee
Congratulations! You have been appointed by Commissioner Jerry Libbin
to the agency, board or committee named above for a term ending: 12/31/2010.
Pursuant to Ordinance No. 2006-3543, t
January 1st, 2007, the term of board me
the City Commission shall automatically
elected official leaves office.
ncing with terms beginning on or after
who are directly appointed by a member of
on December 31 of the year the appointing
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,
a ~~X ~r=~~~ Sly
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 Depa i ment Form)
Booklet -Guide to the Sunshine Amendment and Code of Ethics for Public Officers and Employee
We are commi»ed to providing excellent public service and safety 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, www.miamibeachfl.aov
OFFICE OF THE CITY CLERK, Robert Parcher, Ciy Clerk
Tel: (305) 673-7411, Fax: (305) 673-7254
TO Calvin Kohli
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: 12/31/2010.
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 Enlnp/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 (depending on the board or committee on which
I serve) on July 1st, following the closing of the calendar rear which I have served.
~~~
a ~r•
~:-
Caly'
Sworn to and subscribed bef A ~ this~~ ~~y of , 2r)0
A
Deputy Clerk [~~~(Yr ~a.rn! nd eL
*Please visit the City of Miami Beach website at www.miamibeachfl.gov under City CIerWBoard and Committees
for additional information regarding the Financial Disclosure Requirements.
We are commit-ed ro providing excellent public service and safey to all who live, work and play in our vibrant, tropical, historic community.
m MIAMIBEACH
NAME:
Last Name
HOME ADDRESS: 6 ° ~~
Apt No.
PHONE: ~S " ~~{ S' c
Home
Business Name: ~~~-~.1.~
Address:
Cam
House No..
~ ~~s
Work
S ~12.~ I CEs
(~ A~.a .
Professional License (describe)
Pursuant to City Code section 2-22(4) a and b: MembE
requirement shall be fulfilled in the following ways: a)
months; or b) an individual shall demonstrate ownershipfi
• Resident of Miami Beach for a minimum of six (ti) mont
• Demonstrate an ownership/interest in a business in is
• Are you a registered voter in Miami Beach: Yes &'or N~
• (Please circle one): I am now a resident of: North
• I am applying for an appointment because I have specie
• Are you presently a registered lobbyist with the City of P
Please list your preferences in order of ranking [1j first
choices will be observed by the City Clerk's Office.
CITY OF MIAMI BEACH
BOARD AND COMMITTEE APPLICATION FORM
~v c s-1
First Name -~ Middle Initial
City State Zip Code
_6~,~ 3~S 1 <a d4o
Fax p Email address V't
_ Position: 11QLS 1~ ~J..~~-
~~ 4rireUll. ~ _ 3(81
City State Zip Code
_ Expires: Attach a copy of the license
> of agencies, boards, and committees shall be affiliated with the city; this
individual shall have been a resident of the aty for a minimum of six
Brest for a minimum of six months in a business established in the city.
:: Yes i~r No ^
ii Beach for a minimum of six (ti) months: Yes ^ or No ^
leach South Beach fiddle Beac
abilities, knowledge and experience. ease fist below:
ami Beach? Yes ^ or No
[2] second choice, and [3) third choice. Please note that only three t3)
it Boards of City)
^ Affordable Housin Adviso Committee ^Housin Autho '
^ Art in Public Places Committee I ^ Loan Review Committee
^ Beautfication Committee I ^ Marine Autho '
^ Board of Ad'ustment* I ^ mi Beach Commission for Women
^ Bud et Adviso Committee iami Beach Cultural Arts Council Z
^ Ca ital Im rovements Pro'ects Oversi ht Committee ^ Miami Beach Sister Cities P ram
^ Committee on the Homeless ^ Norman Shores Local Government Nei h. Im rovement
^ Committee for Quali Education in MB ^ Parks and Recreation Facilities Board
^ Commun' Develo ment Adviso I D Personnel Board
^ Communi Relations Board ^ Plannin Board*
onvention Center Adviso Board ^ Police Citizens Relations Committee
^ Debarment Committee ^ Production Indust Councl
^ Desi n Review Board* ^ P blic Safe Adviso Committee
^ Disabil' Access Committee afe Committee 1
^ Fine Arts Board I ^ Sin le Famil Residential Review Panel
^ Ga ,Lesbian, Bisexual and Trans ender GLB I ^ Sustainabili Committee
^ Golf Adviso Committee ^ Trans renc Reliabili & Acxountabil' Committee °TRAC"
^ Health Adviso Committee ^ Trans ortation and Parkin Committee
^ Health Facilities Authori Board ^ visitor and Convention Authori
0 His anic Affairs Committee ^ Waterfront Protection Committee
^ Historic Preservation Board I ^ Youth Center Adviso Board
*Board Required to FPIe State Disclosure Form
Note: If applying for Youth Advisory Board, please indicate your aLffiliation with the Scott Rakow Youth Center:
1. Past service on the Youth Center Advisory Board: Yes ^ No Mears of Service:~~
2. Present participation in Youth Center activities by your children Yes^ No fD~T yes, please list the names of your children, their
ages, and which programs. List below: ..
Child's name: _ ~~ -~ Age: Program:
Child's name: 1J\lPt I Age: Program:
F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC Application0 2609 NEW.doc `"
.Have you ever been convicted of a felony: Yes ^ or
• Do you currently have a violation(s) of City of Miami
• Do you currently owe the City of Miami Beach any rr
• Are you currently serving on any City Boards or Cori
1~e S~ arl~ ~~ 2
• What organizatio in the City of Miami Beac do y
Name: ~ ~
Name:
• List all properties owned or have an interest in, whic
• I am now employed by the City of Miami Beach: Yes ^ or Noi~JdVhich department?
• Pursuant to City Code Section 2-25 (b): Do you have al parent ^, spouse ^, child ^, brother ^, or sister ^ who is employed by the
City of Miami Beach? Chedc all that apply. Identify the dep Irtrnent(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 w federal equal opportunity reporting requirements.
Gender: ale D Female
ethnic origin: cnecK one only ('1)
^ tMrite (Not of Hispanic Origin): All persons having origins in any of the original peoples of Europe, North Africa or the Middle East.
^ African-AmericaNBlack (Not of Hispanic Origin): All pers~
^ Hi nic: All persons of Mexican, Puerto Rican, Cuban, Ce
ian or Pacific Islander: All persons having origins in any
the Pacific Islands. This area inGudes, for example, China, I
^ American Indian or Alaskan Native: All persons having or
Cultural identiflca6on through tribal affiliation or community i
piff yes, please explain in detail:
codes: Yes ^ or Nod. If yes, please explain in detail:
Yes ^ or No t-!If yes, explain in detail
Yes ^ or No ^. If yes;
currently hold membership in? ~_
~~~Fitle: ~2~cRJ'
Title:
located within the City of Miami Beach:
~CQn ~ L ~~~~1~
having origins in any of the Bladc racial groups of Africa.
'al or South American, or other Spanish cukure or origin, regardless of race.
the original peoples of the Far East, Southeast Asia, the Indian Subcontinent, on
lia, Japan, Korea, the Philippine Islands and Somoa.
in any of the original peoples of North America, and who maintain
Physically Challenged: Yes ^ or No^. ~
Employment Status: Employed Retired ^ Homemaker ^ Other o
NOTE: If appointed, you will be required to fo
These laws include, but are not limited to, the
o Prohibition from directly or indirectly lobbying
o Prohibition from contracting with the city (Miai
o Prohibition from lobbying before board/comn
Beach City Code section 2-26).
o Requirement to disclose certain financial inter
(re: CMB Community Development Advisory
from having any interest in or receiving any
or those with whom you have business or imn
Upon request, copies of these laws may be ob1
certain laws which apply to city board/committee members.
personnel (Miami Beach City Code section 2-459).
jade County Code section 2-11.1).
e you have served on for period of one year after leaving office (Miami
and gifts (Miami-Dade County Code section 2-11.1).
imittee): prohibition, during tenure and for one year after leaving office,
'fit from Community Development Block Grant funds for either yourself ,
ite family ties (CFR 570.611).
from the City Clerk.
"I here attest to the accuracy and truthfulness of the application and have received, read and will abide by Chapter 2,
A e VII of a City Code "S ndards of Conduct for Ci Officers, Employe and Agency Mem "
Q ~ 2..-l ~`~ v' lei fl ~~-,r~T
App can s Signature to Name of Applicant (PLEASE PRINT)
Please y of your resume to this application
NOTE: Applicatlons will remal on file fora period of one (1) calendar year. ,/
Received in the City Clerk's Office by : " ~ ~ I Date: / _~ ~ q /
/2009 Control No ~O Dat . ~ / / 9 / r/
_. Name of Deputy i lerk