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Willis "Chip" Arndt, Jr.m MIAMJBEACH City of Miami Beach, 1700 Convention Center Drive, Miami OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk Tel: (305i 673-7411, Fox: (305i 673-7254 11/17/2009 Willis "Chip" Arndt Jr. 4767 Alton Road Miami Beach, Florida 33139 Gay, Lesbian, Bisexual and Florida 33139, www.miamibeachfl.aov ider Congratulations! You have been reappointed by Commissioner Ed Tobin 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, ~~~ ,e ~- ~ ~ Robert Parcher City Cierk cc: Saul Frances, Parking Director Rebecca Wakefield 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 committed 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 Beacth, Florida 331.39, veww.miamibeachH.aov OFFICE OF THE CITY CLERK, Robert Parcher, Ciry Clerk Tel: (305) 673-7411, Fax: (305) 673-7254 , TO Willis "Chip" Arndt Jr. RE: Gay, Lesbian, Bisexual and Transgender (GLBT) 1 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 Public Ollic~rs and Emp/oyees, 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 have served. .A Willis "Chip" Ar t Sworn to and subscribed before me this ~ day of , 20b ~ v ~ •~Silvia Prieto Deputy Clerk *Please visit the Oty of Miami Beach website at www.miamibeachfl.gov under City Clerk/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 vibran-, -ropical, historic community. NAME ~~~ Last Name ,~~J S crTY OF nnl~,r~ll BEkc~ RG AtJD COMMrTTEE ,4PPLICk.TIOh FOP.tY first Name Middle Initial /~ll~)~3e..f~rZ ~ .~ 3/ ~/c City State Zip Code HOME ADDRESS: % /.~ / /7 /~~" i~rr~ Apt No. House No./Street PHONE: _ .313 ~~D ~ ZO ~ .3aS ~y~ ~Y(~ Home Work '~ L.L Business Name: ~ ~ mm / G P Address: /D g0O ~~~'~~~ -~~ 4~ ~~ No. Street Professional License (describe) Pursuant to City Code section 2-22(4) a .and b: Members of agencie requirement shall be fulfilled in the following ways: a) an individual months; or b) an individual shall demonstrate ownership/interest for air • Resident of Miami Beach for a minimum of six (6) months: Yes 4Y6r I • Demonstrate an ownership/interest in a business in iami Beach for • Are you a registered voter in Miami Beach: Yes ~6r No ^ • (Please circle one): I am now a resident of North Beach C • I am applying for an appointment because I have special abilities, kni • Are you presently a registered lobbyist with the City of Miami Beach? Fax ~ Email addrf~s `_ /u1•~" ~- __ 316/ Ciry State Zip Expires: Attach s copy of the license boards, and committees shall be affiliated with the city; this call have' been a resident of the city for a minimum of six nimum of six months in a business established in the city. ~D / minimum of six (6) months: Yes D or No e' ~ ea Middle Beach Ige and experience. Please fist below: / D or No Q/ /lt~s.C.~ 'f" ~ ~~f y ~.r Please fist your preferences in order of ranking [7J first choice [2J second choice, and [3) third choice. Please note that oniv three !31 choices will be o~erved by the City Clerk's Office. (Regular Boards of City) D Affordable Housin Advtso Committee D Housin Autho D Art in Public Pieces Commtttee D Loan Review Committee D Beautification Commitee D Marine Autho D Board of Ad'ustment'' D Miami Beach Commission for Women D B Adviso Committee 0 AAiami Beach Guttural Arts Council D C ital im rovemerrts Pro'ects O~rers' M Committee D Miami Beach Sister Cities Pro ram ^ Committee on the Homeless D Normand Shores Local Gvvemmerrt Nei h. im rovement ^ Committee for Quai Education in MB D Parity and Recreation Facilities Board ^ Commun Deveio ment Adviso ^ Personnel Board D Commun Relations Board D Plannin Board' ^ Conrvention CerrterAdviso Beard D Police Citizzens Relations Committee D Debam-ent Committee ^ Pivduction indu Council ^ Desi n Review Beard" D Public 5 Adviso Committee D Disabii' Access Committee D Sa Committee D Fin Arts Board D Sin le Famii Residential Review Panel a ,Lesbian, Bisexual and Tcansaender G1.ST D S;ustainabii' Committee ^ Golf Adviso Committee D Trans aren Reliabil' & Accountabil' Committee "TRAC" D Health Adviso Committee ^ Tran ortation and Parkin Committee D Health Faaiities Autho ' Board D Visitor and Convention Arrtho ' ^ His nic Affairs Committee ^ Waterfront Protection Committee ^ Historic Preservation Beard D Youth Center Adviso Board I "Board Required to Flle State Disclosure Form Note: tf applying for Youth Advisory Board, please indicate your 7 . Past service on the Youth Center Advisory Board: Yes D No =~ Years 2. Present participation in Youth Center activities by your children Ye ages, and which programs. List below: Child's name: _ _ _ ~je: Child's name: Aoe with the Scott Rakow Youth Center. Service No ~. If yes, please fist the names of your children, their Program: Program: `.~LEP.`,SAL'\a~~RMS\B~ARD ANC ~OMMnT~~\B~ ADPlicationOG2609 N:v~`.dD: •; ~avF you ever beer; convicte~ c~ s relon\' Yes ~ F ves. please explain in detail. • Do you currently have a violation(s) of city of Miami Beach codes. Yes :. ~t~o ~es. please erplam in detail: • Do you currently owe the City of Miami Beach any money: Yes = ~ f yes.. explain it detail • Are you currently serving or: any City Boards or Committees: Yes " o No ~ ves. wnic~ board GL8 -T '-~l.C.r.V ~~ • What organizations in the City o? Miami Beach do you currently hold membership in? Name: Title: Name: 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 ~~ or No~a!Which department? • Pursuant to City Code Section 2-25 (b): Do you have a parent ^, spouse B, child G, brother C, or sister D who is employed by the City of Miami Beach? Check all that apply. Identify the department(s): _ No The following information is voluntary and is neither part of your application nor has any bearing on your considerefton for appointment. tt is being asked to co~mp~y with federal equal opportunity reporting requiremerrts. Gender: L9~Ntafe D Female ~Fnm rtgtrt: Check one only (~) tte (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 Hlepanic Odgin): All persons having origins in any of the Black racial groups of Africa. ^ fiiapanic: All persons of Mexi~n, Puerto Rican, Cuban, Cermal or South American, or other Spanish culture or origin, regarrliess of race, D Asian or Pacfftc islander: All persons having origins in any of the original peoples of the gar East, Southeast Asia, the Indian Subcarttinent. or the Paclfrc islands. Thb area inafuties, for example, China, India, Japan, Korea, the Philippine islands and Somoa. D American Indian or Alaskan Native: All persons having origins in any of the original peoples of North America, and who maintain Cultural identlfii~tfion ttiiough tribal affiliation or co tty recognition. Physically Citalienged: Yes D or Nor9 Employment Status: Employed ~ Retired 0 Homemaker D Other 0 NOTE: If appointed, you w[II be required to follow certain laws which apply to city baardicommMloee members. These caws include, but are not limited f:o, the following: o Prohibition from directly or indirectly lobbying city personnel (Miami Beach City Code section 2-459). I o Prohibition from contracting with the aty (Miami-Dade Count y Code section 2-11.1). o Prohibition from lobbying before baardlcommittee you have served on for period of one year after leaving office (M~am~ 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 hereby attest to the accuracy and truthfulness of the application and have received, read and will abide by Chapter ~. Art' ie VII - the Clty C e 'Stand of Cond ct for City Officers, Employees and Agency Members." Applicant's Signature Ga a Name of Applicant (?! =ASE pRINT~ ?lease attach a copy of your resume his application NOTc: Applications will remain on file for a period of one (1) caienaar year, Recewed rn the amity Uierk's Dff~ce by Gate _' /2009 ;;ontrol Nu Date _;20D9 Name of Deputy clerk