Kay Coulter 12/31/2011m M!AMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami B
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel: (305) 673-741 1, Fax: (305) 673-7254
12/15/2009
Kay Coulter
1768 Daytonia Road
Miami Beach, Florida 33141
Florida 331319, www.miamibeachH.aov
Committee for Quality Education i~h MB
Congratulations! You have been reappointed by Co missioner J
to the above referenced agency, board or committee f r a term end
If you are unable to accept this appointment, please n tify the City
(305) 673-7411.
Please read the enclosed material carefully. Again, cor
Sincerely,
~~~~~=~~/S~
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Leslie Rosenfeld
ATTACHMENTS:
Letter of Appointment
Oath
City Code Ordinance section, applicable to agency, board or ommittee
City Code Section 2-22, 2-23, 2-24, 2-25, 2-26, 2-2458, 2-45
Ordinance 2006-3543 -Amendment to City Code Section 2-
Miami-Dade County Code Section 2-11.1 -Conflict of Interes and Code of
City Wide Permit Application - (Parking Department Form)
Booklet -Guide to the Sunshine Amendment and Code of Et ics for Public
Employees
~ We are committed ro providing excellent public service and safety to al! who liv~, work and play
1~
Libbin
12!31/2011.
Office at
good luck.
Ordinance
and
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 Kay Coulter
RE: Committee for Quality Education in MB
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 pert
a member of the above-mentioned board or committee of the City of Miami
been appointed for a term ending: 12/31/2011.
Florida 33139, www.miamibeachfl.aov
emment 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 ~cers and Emp/ogees, 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 which I/~a a served.
Kay
,va-
Sworn to and subscribed before me this LZ day
Silvi Prieto
lepu Clerk
*Please visit the City of Miami Beach website at www.miamibeachfl.gov under
for additional information regarding the Financial Disclosure Requirements.
~/20~ ~
and Committees
We are committed ro providing excellent public service and safety to all who live, (work and play in our vibrant, tropical, historic community.
NAME:
Las! Name ~ /y
HDME ADDRESS: ~~(_ ~[~"
N
PHONE:
Business Name:
Address:
Fax
City
CfTY Or MI>='.r~li s~ac~
COMMfTTEE ~+.PPLICATION FOP.fJi
Middle Initial
Professional License (describe) Expir is' Attach a copy of the license
Pursuant to City Code section 2-22(4) a and b: Members of agencie ,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 ownership/interest fora inimum of six months in a business established in the city.
• Resident of Miami Beach for a minimum of six (6) months: Yes ^ or o D
• Demonstrate an ownership/interest in a business in Miami Beach for minimum of six (6) months: Yes D or No ^
• Are you a registered voter in Miami Beach: Yes ^ or No ^
. (Please circle one): I am now a resident of: North Beach oath Beach Middle Beach
• I am applying for an appointment because I have special abilities, kn wledge and experience. Please list below:
. Are you presently a registered lobbyist with the City of Miami Beach?IYes D or No D
Please fist your preferencxes in order of ranking 11J first choice [2) sewn choice, and [3) third choice. Please note that oniv three (31
choices will be observed by the City Cleric's Office. (Regular Boards f City) I
D Affordable Housin Adviso Committee D H usin Autho
^ Art in Public Pieces Committee D an Review Com mittee
^ Beaui3fication Committee ^ anne Autho I
0 Board of Ad'ustmerd"` D iami Beach Com m~sion for Women
^ Bud Adviso Committee 0 iami Beach Cultu ral Arts Council
D C ital fm rovemerrts Pro'ects Oversi ht Committee D iami Beach Sister`, Ciifies Pro ram
^ Committee an the Hameiess D N mien Shores Local Government Nei h. !m rovement
D Committee for Qual' Education in MB D P rks and Recreati on Facilities Beard
D Commun Deveio ment Adviso ^ P rsonnel Board I
^ Commun Relafions Board D P annin Board' I
D Gornrention Center Adviso Board D P lice Citizens Reli ~tions Committee
D Debam-ent Committee D P duction lndu ' Council
D Desi n Review Board' D P biic S Advis o Commtttee
0 Disabil' Access Committee D S fe Committee I
^ Fine Arts Board ^ S n !e Famii Resii iential Review Panel
^ Ga ,Lesbian, Bisexual and Transaender GLBT ^ S stalnabfl' Comt ntttee
^ Golf Adviso Committee D T ns aren Relia bll' 8~ Accour>tabii' Committee "TRAC"
^ Health Adviso Committee ^ T n ortation andl Parkin Committee
^ Health Faalities Autho ' Board D itar and Conven tion Autho
D His nic Affairs Committee ^ aterfront Protecti on Committee
D Historic Preservation Beard D oath Cerrter Advis o Board
"B and R®quired tol Flle State Disclosure Fonm
Note: if applying for Youth Advisory Board, please indicate your affiliatio with the Scott Rakow Youth Genter.
1. Past service on the Youth Canter Advisory Board: Yes C No ^ Years f Service
2. Present participation in h C r activities by your children Yes ~ No 'r.
ages, and which program is` bel w
Child's name: qge: P
Child's name. Ade: < P
F:\: LEF`.SAL' \a~JRMS\BJARG ANC : OMMnT~~~\BC Applicption062t549 N N.`.doc
If yes, please list the names of your children, their
rogram:
rocram:
.`-lave yon ever DeeG ~OnVICte~ O' 8 TelOn~~ YeS O O I` VBS. IeaSe eXplatn I~N detail:
--
• Do you currently have a violation(sj of City of Miami Brach cod s. Yes =~No I If yes, please erplarn in detail:
• Do you currently owe the City of Miami Beach any money: Yes or o -; If ye ~. explain in detail
• Ara you currently serving or any ~ y ards or Committees. Y s " No -. If des; whic~ board?
~,
• What organizations in the City of Miami Beach do you currently old membersh ~ m?
Name: Titl p
R
Name: Titi
• List all properties owned or a an interest in, which are locate I in the ity o€ Miami Beach:
• I am now employed by the City of Miami Beach: Yes Cdr NoG~. hich de rtme pnt?
• Pursuant to City Code 5eetion 2-25 (b): Do you have a parent D, sp use ~~, child C, b r C, or sister 0 who is employed by the
City of Miami Beach? Check all that apply. Identify the department(s): i
The following information is voluntary and is neither part of your apptieatlon
nor has any bearir 11
Fg on your consideration for a
ointment
It i
being asked to comply with federal equal opportunity reporting requfreme pp
.
s
Gender: D Male D emale
Ethnic Origin: Check one only (1)
~Whtte (Not of Hispanic Origin}: All persons having origins in any of the origi al peoples of Europ i ,North Africa or the Middle East.
/ U African-AmerieanlBiack (Not of Hlepanic Origin): All persons having origin in any of the Btack ~ racial rou s of Africa.
8 P
Hispanic: All persons of Mexican, Puerto Rican, Cuban; Central or South A erican, or other Sp anish culture or origin, regard~ss of race.
Asian or Pacific !slander: All persons having origins in any of the original p pies of the gar mas t, Southeast Asia, the Indian Subcontinent
or
the Pacific islands. This area irududes, for example, China, India, Japan, Ko a, the Philippine ls~ .
ands and Somoa.
^ American indlian or Alaskan fMaties: All persons having origins in any of th original peoples of North America, and vfio ntairttain
CWtural iderttiftcaflon through tribal affliiafion or community recognition.
Physically Challenged: Yes 0 or Nod.
Employment Status: Employed Retired D Homemaker D Other D I
M
NOTE: If appoiiMoed, you will be required tie follow certain law which apply to city boardicommittae members.
These laws include, but are not limited to, the following:
o Prohibition from directly or indirectly lobbying city personnel ( iami Seach City erode section 2-459).
c Prohibition from contrading with the dty (Miami-Dade County ode section 2-1 ~ .1).
o Prohibition from lobbying before baardJcommittee you have erved on for period of one year after leaving office (Miami
Basch City Code sedton 2-26).
o Requirement to disdose certain finandal irrterests and gifts ( iami-Dade County Code sedion 2-11.1).
(re: CMB Community Development Advisory Committee): p hibition, during tenure and for one year after leaving office
from having any irtbarest in or receiving any benefit from Co munity Development Block Grant funds for either yourself .
or those with whom you have business or immediate family ti (CFR 57D.611).
Upon request, copies of these laws may be obtained from the City CIerY..
"I hereby attest tote curacy and truthfulness of the applrcati n and have rei
Article VII - of the C to rds o Conduct for City Offfc s, Empi a Ci
Applicant's Signature Uate r Name of Apo is
Please attach a copy of y ur r ume to this appltcation
NOTE: Applications w remain on file for period of one (1)
-/ 2~ /G
Receroed in the City Clerk's Office o)' ate _ / 09 ,
Name of Ueouty Cleri;
I, rasa and will abide by Chapter ~.
ge cy Members."
.EASE pR ~
iar year.
No Uate _ _;20D6