Thomas Barker 12/31/2011•
m n-vaN~iaEacH
City of Miami Beach, 1700 Convention Center Drive',. Miami
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel: (305) 673-74 i 1, Fax: (305) 673-7254
1 /12/2010
Thomas Barker
1770 Meridian Ave. #209
Miami Beach, Florida 33139
SUBJEC~T~:~~ Gay, Lesbian, Bisexual and Transge
Florida.33;139, www.miamibeachfl.aov
(~[.~7,
Congratulations! You have been reappointed by Commissioner Michael Gongora
to the above referenced agency, board or committee fo i 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,
.~~~ ~P
Robert Parcher
City Clerk
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 nd 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, l work and play in our vibrant, tropical, historic community.
•
m MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami
OFFICE OF THE CITY CLERK, Robert Parcher, Ciry Clerk
Tel: (305) 673-741 1, Fax: (305) 673-7254
TO Thomas Barker
RE: Gay, Lesbian, Bisexual and Transgender (GLBT)
I do solemnly swear or affirm to bear true faith, loyalty and allegiance to the
United States, the State of Florida, and the Ciry of Miami Beach, and to pert
a member of the above-mentioned board or committee of the Ciry of Miami
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 Coc
and Code of Ethics Ordinance), as well as theF/orida Commission on Ethics
Amendment and Code of Ethics for Public OtFicers and Emp/ogees, and unde
of a Ciry of Miami Beach Board and/or Committee, I must comply with the fi
ments of Miami-Dade County or the State of Florida (depending on the boa
I serve) on July 1st, following the closing of the calendar yeargti which I ha
Sworn to and subscribed before me this /~-- day
~~ -
~~
*Please visit the cty of Miami Beach website at www.miamibeachfl.gov under
for additional information regarding the Fnancial Disclosure Requirements.
•
Florida=33.139, www.miamibeachH.aov
emment of the
all the duties of
;h to which I have
(Conflict of Interest
tide to the Sunshine
and that as a member
ncial disclosure* require-
orcommittee on which
served.
Barker
F ,2
i Prieto
V Clerk
Clerk/Board and Committees
We are commiried to providing excellent public service and safely ro a!! who live, fvork and ploy in our vibrani tropical, historic community.
m M'A^J,1B~CH
NAME:
:_7
~ ~~ ~~~
Last Name,/~, ff
HOME ADDRESS: ~ 7 ~~ , ~"~ d~t i
A t No.
PHONE:
Home
Business Name: ~l ~-
Address: ~ S' ~ ~
No.
Professional License (describe) _
House No./Street
- "Z7~
First N me ~ Mi dle Initial
City Sate Zip Code
Work
Email address
,,., _
Street
n'11f~ tMt ~ ~~(
iy State Zip Code
Expires: .~tfa~t~ ~ c€~P3~ €sf fh~ !#cense
Pursuant to City Code section 2-22(4) a and b: Members of agencies, bo rds, and committees shall be affiliated with the city; this
requirement shall be fulfilled in the following ways: a) an individual shall ave been a resident of the city for a minimum of six
months; orb) an individual shall demonstrate ownership/interest for/a minim m of six months iri a business established in the city.
• Resident of Miami Beach for a minimum of six (6) months: Yes fd or No ^
• Demonstrate an ownership/interest in a business i Miami Beach for a min mum of six (6) months: Yes r No ^
• Are you a registered voter in Miami Beach: Yes~or No ^
• (Please circle one): I am now a resident of: North Beach o h Beach Middle Beach
• I am applying for an appointment because I have special abilities, kno e n 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 [i] first choice [2] second choi ,and [3] third choice. Please note that only three f31
choices will be observed by the Citv Clerk's Office. (Regular Boards of City
^ Affordable Housin Adviso Committee ^Housin Authorit
^ Art in Public Places Committee ^ Loan R view Committee ;
^ Beautification Committee ^ Marine uthorit
^ Board of Ad'ustment* ^ Miami each Commission for Women
^ Bud et Adviso Committee ^ Miami each Cultural Arts Council
^ Ca ital Im rovements Pro'ects Oversi ht Committee ^ Miami each Sister Cities Pro ram
^ Committee on the Homeless ^ Norma d Shores Local Government Nei h. Im rovement
^ Committee for Qualit Education in MB ^ Parks a d Recreation Facilities Board
^ Communit Develo ment Adviso ^ Person el Board
^ Communit Relations Board ^ Plannin Board*
^ Convention Center Adviso Board ^ Police itizens Relations Committee
^ Debarment Committee ^ Product on Indust Council
^ Desi n Review Board* ^ Public afet Adviso Committee
^ Disabili Access Committee ^ Safet ommittee
^ Fine Arts Board ^ Sin le anvil Residential Review Panel
^ c ~ ^ Sustain bilit Committee
^ Ga ,Lesbian Bisexual and Trans ender GLBT ^ Trans renc Reliabilit & Accountabilit Committee "TRAC"
^ Golf Adviso Committee ^ Trans rtation and Parkin Committee
^ Health Adviso Committee ^ Visitor nd Convention Authorit
^ Health Facilities Authorit Board ^ Waterfr nt Protection Committee
^ His anic Affairs Committee ^ Youth nter Adviso Board
^ Historic Preservation Board
*Board R quired to File State Disclosure Form
Note: If applying for Youth Advisory Board, please indicate your affiliation with
1. Past service on the Youth Center Advisory Board: Yes ^ No ^ Years of Sen
2. Present participation in Youth Center activities by your children Yes^ No
ages, and which programs. List below:
Child's name: Age:
Child's name: Age:
F.'~. .....'~~'''f.~' C 1~5~ aiu C;:FPIC;`IJCi _.:: ~} .LFLiC
e Scott Rakow Youth Center:
I
:e:
~. If yes, please list the names of your children, their
Program:
Program:
Y
~~
.Have you ever been convicted of 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 explain iri detail:
• Do you currently owe ;he City of I,lliami Beach any money: Yes~or No ^. If yes, explain 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:
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 Nq~'` Which 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 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 reportlng requirements.
Gender: Male ^ Female
Ethnic Origin: Check one only (1)
White (Not of Hispanic Origin): All persons having origins in any of the original peoples of Europe, North Africa or the Middle East.
^ African-AmericanlBlack (Not of Hispanic Origin): All persons having origins in any of the Black 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 includes, 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
Employment Status: Employed 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 Cody 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"Coininunity 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.
acy and truthfulness of the application and have received, read and will abide by Chapter 2,
"Standards of C9nduc~ for City OfFcers, Employees and Agency Members."
Please attach a copy of,yourresume4o this application
NOTE::Applications will. remain on.fife'for a period of.one (1) calandaryear:
Received in the City Clerk's Office by : ~ Date: _/ /2009 Control No,,~ Date' ~ 00 6
Name of Deputy Clerk