Hope Fuller 12/31/2011
m MIAMIBEACH
•
City of Miami Beach, 1700 Convention Center Drive; Miami;Beach;:Florida 33139, www.miamibeachFl aov
OFFICE OF THE CITY CLERK, Robert Parcher, Ciry Clerk
Tel: (3051673-741 1, Fax: (305) 673-7254 .
12/10/2009
Hope Fuller
925 N Shore Drive
Miami Beach, Florida 33141
15UB~JaE;C~T~~ Police Citizens Relations Committee
Congratulations! You have been reappointed by Commissioner Jerry Libbin
to the above referenced agency, board or committee for a term ending: 12/31/2011.
If you are unable to accept this appointment, please notify the City Clerk's Office at
(305) 673-7411.
Please read the enclosed material carefully. Again, congratulations and good luck.
Sincerely,
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Chief Carlos Noriega
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 2-11.1 -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
Employees
We are commiMed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community.
• •
m MiAMBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.aov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel: (305) 673-7411, Fox: (305) 673-7254
TO Hope Fuller
RE: Police Citizens Rotations Committee
t 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: 12/31/2011.
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 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 (depending on the board or committee on which
I serve) on July 1st, following the closing of the calendar ye r on whic ave served.
Hope Fuller
Sworn to and subscribed before me this ~ day of fl~l,~f3i2, 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 commiNed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community.
~ MIAMIBE/~H
NAME:
• CITY OF MIAMI BEACH
BOARD AND COMMITTEE APP~.I~ATION FORM
Last Name n C,~I FYst Name ~/y~
HOME ADDRESS: ~ ~~ ' " 0 r M ~ l'~ d K- ~ ~ ~ ~ / 1'
Apt No. House No./Street City
PHONE~~~- ~~D`CD~'~g ~ 3~~- ~'3-37io1- 3bS-
Home
Business Name:
~1
Code
Email
Address:
No. Street City State Zip Code
Professional License (describe)
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 aty for a minimum of six
months; or b) an individual shall demonstrate ownershipfinterest fora inimum of six months in a business established in the aty.
• Resident of Miami Beach for a minimum of six (6) months: Yeo ^
• Demonstrate an ownershipfinterest in a business in Miami Beach for a minimum of six (6) months: Yes ^ or No ^
• Are you a registered voter in Miami Beach: Yes s~r No ^
• (Please cirGe one): I am now a resident of. orth Be South Beach Middle Beach
• I am applying for an appointment because I have al abilities, knowledge 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 [7] first choice [2] second choice, and [3] third choice. Please note that only three (3)
choices will be observed by the 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 Authori
^ Board of Ad'ustment' ^ Miami Beach Commission for Women
^ Bud et Adviso Committee ^ Miami Beach Cultural Arts Counal
^ 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 Faalities Board
^ Communi Develo ment Adviso ^ Personnel Board
^ Communi Relations Board ^ Plannin Board*
^ Convention Center Adviso Board fiJ,Police Citizens Relations Committee
^ Debarment Committee ^ Production Indu Counal
^ Desi n Review Board* ^ Public Safe Adviso Committee
^ Disabili Access Committee ^ Safe Committee
^ Fine Arts Board ^ Sin le Famil Residential Review Panel
^ Ga ,Lesbian, Bisexual and Trans ender GLB ^ Sustainabil' Committee
^ Golf Adviso Committee ^ Trans aren Reliabili & Accountabil' Committee "TRAC°
^ Health Adviso Committee ^ Trans rtation and Parkin Committee
^ Health Faalities 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 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 partiapation 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:
Fax
Position:
F:\CLER\$ALL\afORMS\BOARD AND COMMITTEES\BC Application062609 NEW.doc
.~'
.Have you ever been convicted of any: Yes ^ or N If yes, please explain in ail:
• Do you currently have a violation(s) of City of Miami Beach codes: Yes ^ or N . If yes, please explain in detail:
. Do you currently owe the City of Miami Beach any money: Yes ^ or Noes, explain in detail
• Are you currently serving on any City Boards or Committees: Y or No ^. If yes; which board?
. What organizations in the City of Miami Beach do you currently hold membership in?
Name:
Name:
• List all
Title:
Title:
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 N~P!GVhich 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 Beachi1 C~hedc all that apply. Identify the department(s):
The following information is voluntary and fs 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 male
Ethnic Origin: Check one only (1)
site (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 persons having origins in any of the Bladc racial groups of Africa.
^ 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 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
Cultural identification through tribal affiliation or community recognition.
Yes ^ or Not7~
Employment Status: Employeil~ 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 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 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 the City Clerk.
"I hereby st to the ccuracy and truthfulness of the application and have received, read and will abide by Chapter 2,
Article 11 of the Code "Standards of ndu for City Officers, Em ogees and Aged Me bens."
j 5 /D
Appl can 's ignature ate Name f Applicant (PL SE PRINT)
Please attach a copy of your resume to this application ~ (lira-..Q_.
NOTE: AppNcations wlU rerr~ln on file for a period~ot one (1) calendar year. _ _ /
Received in the City Clerk's Office by : ___ ~ .4~-Yi~Vf f~/~/ Datefl/ ` OlS9 Control Noted / Date: