Harvey Burnstein 12/31/2011m fJ~IAPc^,IBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel: (305) 673-741 1, Fax: (305) 673-7254
1/15/2010
Harvey Burstein
1775 Washington Ave PH2
Miami Beach, Florida 33139
Community Development Advisory
Congratulations! You have been reappointed by Com
to the above referenced agency, board or committee fc
If you are unable to accept this appointment, please
(305) 673-7411.
Please read the enclosed material carefully. Again,
Sincerely,
D~~l' ~~1:~~ S~
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Mercedes Rovirosa
ATTACHMENTS:
Letter of Appointment
Oath
City Code Ordinance section, applicable to agency, board or c
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
City Wide Permit Application - (Parking Department Form)
Booklet -Guide to the Sunshine Amendment and Code of Ethi
Employees
Florida.331.39,
mit
~sioner Ed Tobin
term ending: 12/31/2011.
the City Clerk's Office at
ratulations and good luck.
I'
k
I
I:
I'
nmittee
~d Code of Ethics Ordinance
for Public Officers and
We are committed ro providing excellent public service and safety ro oll who live work and play in our vibrant, tropical, historic community.
m MIAMIBEACH
City of Miami Beach, 1700 Convenfion Center Drive, Miami
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel: (305) 673-7411, Fax: (305) 673-7254
TO Harvey Burstein
RE: Community Development Advisory Committee
I do solemnly swear or affirm to bear true faith, loyalty and allegiance to the
United States, the State of Florida, and the City of Miami Beach, and to perF
a member of the above-mentioned board or committee of the City of Miami
been appointed for a term ending: 12/31/2011.
Florida 3$.1.39, ~nvvr.miamibeachN.aov
ernment of the
all the duties of
:h to which I have
I have been issued a copy of Section 2-11.1 of the Miami-Dade County Cod (Conflict of Interest
and Code of Ethics Ordinance), as well as theF/orida Commission on Ethics uide to the Sunshine
Amendment and Code of Ethics for Pub/ic Oflrcers and Employees, and unde nd that as a member
of a City of Miami Beach Board and/or Committee, I must comply with the fi ancial disclosure* require-
ments of Miami-Dade County or the State of Florida (depending on the boar or committee on which
I serve) on July 1st, following the closing of the calendar year on ich I ha a served.
Sworn to and subscribed before me this ~ day
rstein
2~6'D
~- ~~~~
Silvi Prieto
-epu Clerk
*Please visit the City of Miami 13eadt website at www.miamibeachfl.gov under City
for additional information regarding the Financial Disclosure Requirements.
and Committees
We are commiHed ro providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community.
NAME: ~~-r~~~
HDME ADDRESS. ~
pt No.
~..~ ~ '-
PHONE:
Home
Business Name: _~
Address ~ i
Middle Initial
7a~ ~I J /?l ~~~
,city state ziF
~ ILL(. l ~ ~~ 0 ~- ~ C 0
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 agenci s, boards, and committees shall be affiliated with the city; this
requirement shall be fulfilled in the following ways: a) an individual hall have been `a resident of the city for a minimum of six
months; or b) an individual shall demonstrate ownershiplinterest fora inimum of six months in a business established in the city.
• Resident of Miami Beach for a minimum of six (6) months: Ye~pr o D
• Demonstrate an ownershiplinterest in a business in Miami Beach for a minimum of six (6) months: Yes D or Nom
• Are you a registered voter in Miami Beach: Yes~or No ^ .,
• (Please circle one): I am now a .resident of: orth Beach oath Beach Middle Beach
• i am appfyrng for an appointment because I have special abilities, ge and experience. Please fist below:
• Are you presently a registered lobbyist with the City of Miami Beach. Yes ^ or No ^ I
Please list your preferences in order of ranking [7J first choice [2] secon choice, and (3) third choice. Pisase note that only three f31
choices will be observed by the City Clerk's Office. (Regular Boards f City)
^ Affordable Housin Adviso Committee ^ ousin Autho I
^ Art in Public Places Committee ^ an Review Com mittee
^ Beautification Committee ^ arine Autho ' I
D Board of Ad'ustrnent' ^ iami Beach Com mission for Women
D Bud Adviso Committee ^ iami Beach Cultia ral Arts Council
D C ital im rovemerrts P 'acts Oversi ttt Committee ^ iami Beach Sister Cities P ram
D Committee on the Homeless ^ onnand Shores lLowl Government Nei h. im rovement
^ Committee for Qual Education in MB ^ rks and Recreation Facilities Board
ommun' Deveio ment Adviso ^ rsonnel Board I
^ Commun Relations Beard D tannin Board'
D Convention Center Adviso Board ^ olive Citizens Rei"ations Committee
^ Debarment Committee D roduction indu 'Council
^ Desi n Review Board' ^ ubiic S Adviso Committee
D Dtsabif' Access Committee D a Committee I
D Fine Arts Board D in le Fami Residential Review Panel
D Ga ,Lesbian, Bisexual and Transoender GLBT ^ ustainabil~ Comfifttee
^ Golf Adviso Committee D ns aren Reli$bil' 8~ Accountabii' Committee "TRAC"
D Health Adviso Committee ^ ns ortation and Paridn Committee
^ Health Facilities Autho Baarci D isitor and Convention Autho '
D His nic Affairs Committee ^ rfront Protecfton Committee
^ Historic Preservation Beard D oath Center Advisory Board
I
"B rd Required toy Flle State Disclosure Form
.:
c
Note: tf applying for Youth Advisory Board, please indicate your atfiiiatio with the Scott Rakow Youth Center.
I
1. Past service on the Youth Center Advisory Board: Yes ^ No C Years f Service:
2. Present participation 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: Ape: Program:
':'~~LEP`,SAL'\a~~P.MS\B~ARG AND ~OMMITT~c~\B~ Applicpfion062604 N~V~',do:
ctTY OF Mlfi,tdil BEACH
O~+.RG AND, COMMITTEE l+,PPLIC<;TIOC~ FOP.M
" r=ir t Name i
Hous~" o./Street ~''
~~1~ ~V
Work Fax
•i-iave yon eve- peen convictec o' i; felom~ Yes Cyr l`~ t yes. lease explain i " d il:
• Do you currently have a violation(s) of City of Miami Beach code . Yes ~ o ^. It , ,please explain in detail:
• Do you currently owe the City of Miami Beach any money: Yes or No If yes explain in detail
• Are you currently serving or any City Boards or Committees Y or No -. If y'e . w,~~~ard?
. What organizations in the City of Miami Beach do you currently ' old membership In?
Name: Titl ~
Name: Titl pp
• List all properties owned or have an interest in, which are locate within the City of Miami Beach:
I
. I am now employed by the City of Miami Beach: Yes ~~ or Noy. hich department?
e Pursuant to City Code Section 2-25 (b). Do you have a parent ^, sp use G,, chi C
ther G, or sister 0 who is employed by the
City of Miami Beach? Check all that apply. Identify the department(s): ~
The foltowing information is voluntary and is neither part of your application or has any bsarin® on your consideration for appointment. tt Is
being as d to comply with federal equal opportunity reporting requtremerrts
Gender: D ale 0 Female
Eic Origirt: Check one only (1)
hNte (Not of Hispanic Origin): All persons having origins in any of the origin I peoples of Europe
, North Africa or the Middle East.
^ African-AmericantBlack (Not of Hiepenic Origin): All persons having origin !I
in any of the Black~raaal groups of Africa.
Hispanic: All persons of Mexican, Puerto Rican, Cuban, Central or South A erican, or other Spanish culture or origin, regardless of race.
~ Asian or Pacific islander: All persons having origins in any of the original pe pies of the mar Easit, Southeast Asia, the intiian Subcontinent
or
the Pacific Isfartds. This area mdudes, for example, China, India, Japan, Ko .
a, the Philippine Islands and Somoa.
J American Indian or Alaskan Nadva: All having origins in any oft original peoples of North America, and who mairttein
Cultural iderttifrca6on through tribal or comrnurtity recognition.
Physically Ckalfengect: Yes ~ o
Employment Status: Employ 0 Retired D Homemaker D VV
Other p G
!
NOTE: ff appointed, you will be requited b follow certain taw which apply to ~ ih' boardlcommltbae membees.
These taws include, but are not limtloed bo, the following:
o Prohibition from directly or indirectly lobbying city personnel ( iami Beach City bode section 2-459).
c Prohibition from contracting with the city (Miami-Dade County ode section 2-11!.1).
o Prohibition from lobbying before board/committee you have erved on for period of one year after leaving office (Mlam~
Beach City Code section 2-26). R
o Requirement to disclose certairi financial irrter+ests and gifts (M V
ami-Dade County Code section 2-11.1).
(re: CMB Community Development Advisory Commtttee): pr hibition, during tenure and for one year after leaving office
from having any interest in or receiving any benefit from Co munity Development Block Grant funds for either yourself
or these with whom you have business or immediate ,family tie ,
(CFR 5/0.611).
Upon request, copies of these laws may be obtained from the ity Clerk.
Q
"I hereby attest t e accuracy and truthfulness of the applicati n and have received, read and will abide by Chapter ::
A i ie VII - of a City "Standards of Co duct f r City Office ,
s, Hmpfoyees ate` Agency Members."
I
Appfi is ign ur Date Name of polica ilt (PLEASE pRINT~ j
Please attach a copy of your resume to this application
NOTE: Applications will remain on file for a period of one (1) C
w alendar year.
Received in the City ~Ierk's Offrce oy a I
te' _' /ZDQ9 ;; ontrol No Uate. !2008
Name of Deputy clerk I - -