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Lily Furst 12/31/2011m MIAMiBEACH City of Miami Beach, 1700 Convention Center Drive, Miami OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk Tel: (305) 673-7411, Fax: (305) 673-7254 12/23/2009 Lily Furst 800 Lakeview Drive Miami Beach, Florida 33140 Sustainability Committee Congratulations! You have been reappointed by Co to the above referenced agency, board or committee If you are unable to accept this appointment, please (305) 673-7411. Please read the enclosed material carefully. Again, Sincerely, ~~~~~~f. Robert Parcher City Clerk cc: Saui Frances, Parking Director Fred Beckmann ATTACHMENTS: Letter of Appointment Oath City Code Ordinance section, applicable to agency, board or cc 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 Ethic Employees Florida.33139,1 ~issioner Joriah M. Wolfson a term ending: 1213112011. 'y the City Clerk's Office at ulations an'd good luck. ~ittee Code of Ethics Ordinance for Public Officers and We are committed to providing excellent public service and safety to all who live,l work and play in anur vibrant, tropical, historic community. m MIAMIBEACH City of Miami Beach, 1700 Convention Center Drive, Miami OFFICE OF THE CITY CLERK, Robert Parcher, Ciy Clerk Tel: X305) 673-7411, Fax: (305) 673-7254 TO Lily Furst RE: Sustainability 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 33139, vrww.miamibeach8.aov ernment of the all the duties of 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 vide to the Suns/~ine Amendment and Code of Ethics for Pub/ic ~cers and Emp/ogees, and unc of a City of Miami Beach Board and/or Committee, I must comply with the ments of Miami-Dade County or the State of Florida (depending on the bo I serve) on July 1st, following the closing of the calendar year on which I h '" `~ Lily /2~- Sworn to and subscribed before me this ~ day ~ .=Si *Please visit the City of Miami Beach website at www.miamibeachfl.gov under City for additional information regarding the Financial Disclosure Requirements. :and that as a member ncial disclosure* require- orcommittee on which served. -~ iv ~,~v,~ , 20~. ~ ~+ Prieto Clerk erk/Board and Committees We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community. ;I 1 ~ ;~~;~~~\~t, i 8~~~ ~"~ CITY JF MII~,IJII BEACi-~ - ~ v S ~ BOA GANG COMMfT T EE APPLI ©tON FOP.M NAME: r Last a//mnne i first Name „„~~ Middle Initial NOME ADDRESS: ~ v D L ~ t~'C Ut t W t ~t I IUl ~ k W~~ ~,f G.c.~ ~~- ~ 3 /~{~ A t o. / o se No./Street City (~ 1 State (Zip Code PHONE: ~ D ~ 6 O " ~ ~ 'C r~rST C9~ !~ l ~ C ~ ~'V1 om(e~') c Wo Fax Email address Business Name: v I e rn J~ y e ~0 C~ - Pa ition: ' Address: ~ U U W . ` i ~ ' L I3 I 2~ No. Street City State Zip Code Professional License (descrlGe) ExpireY ~ 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 requiremeni'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 for a/ inimum of six months in a business established in the city. • Resident of Miami Beach for a minimum of six (6) months: Yes Dbr o 0 • Demonstrate an ownershiplinterest in a business m iami Beach for minimum of six (6) months: Yes ^ or No • Are you a registered voter in Miami Beach: Yes D'or No D • (Please circle one): I am now a resident of: North Beach oath Beach Middle each • I am applying for an appointment because I have special abilities, kn wledge and exp~r/ien lease fist below: .Are you presently a registered lobbyist with the City of Miami Beach? Yes D or No I 1 Please list your preferences in order of ranking [1) first choice [Z) secon choice, and (3] i ird choice. Please note that oniv three (31 choices will be observed by lfre City Cleric's Office. (Regular Boanfs City) D Afiordabie Housin Adviso Committee D H usin Autho ' I D Art in Public Pieces Committee 0 an Review Comr fiittse D Beautification Committee D arine Autho I D Board of Ad'usfirent' 0 iami Beach Com mission for Women D Bud Adviso Committee D iami Beach Guttu ral Arts Coundl D C itel im vemerrts cis Oversi frt Committee D iami Beach Sister Cities Pro ram D Committee on the Homeless D N mtand Shores Local G~vemmerrt Nei h. lm rovement ^ Committee for Qual Education in MB D P rks and Recreati on Faciifties Board D Commun Deveia ment Adviso D P rsonnel Board I D Commun Relations Board D P annin Board" D Convention Center Adviso Board D P lioe Citizens Rel ations Committee D Debam-ent Committee D duction lndu ' Council D Desi n Review Board" 0 ubiic S Advis o Committee D Disabil Access Committee ^ a Committee I D Fine Arts Board D in le Famii Resi dential Review Panel D Ga ,Lesbian, Bisexual and Transaender GLBT ustainabii' Com mittee ^ Golf Adviso Committee D ns eren Rslia bil' & Accountabit' Committee 'TRAC" ^ Health Adviso Committee D n ortation and Parkin Committee D Health Facilities Autho ' Board D isitor and Conven tion Autha D His nic Affairs Committee D aterfront Protecti on Committee ^ Historic Preservation Board ^ oath Center Advis o Board I "B and Required to; Flle State Disclosure Form Note: tf applying for Youth Advisory Board, please indicate your affiliatio with the Scott Re kow Youth Center. 1. Past service on the Youth Center Advisory Board: Yes n No _~ Years 2. Present participation in Youth Center activities by your children Ye ages, and which programs. List below: Child's name: Age: f Service: I _~ No ~. If yes, " Program lease list the names of your children, their I Child's name: Age: Program = \~LEP..SAL'\aF~P.MS\B~ARG AND ~OMMrrT,=..~~\B~ Anali~aiion06260~ N Vv.doc .Have yoz ever been cortVlcte~ c' ~ TelOnv Yes 6~ NO I` vas please Bxp{atn I detail: I • Do you currently have a vloiation(s} of City of Miami Beacr: co I Yes _ or No ; if yes, please erplafr: ir: detail: • Do you currently owe the City of Miami Beach any money: Yes dr No ;. if yes exolain it detail . Are y~ u cur~eanlt~y~ Qiryg ~ r:/ ~ ~Cit~~ Board ~r Commtttee~~ ~ ~ ~ c ~ vh VYl t • What organizations in the.City of Miami Beach do you currently Name: ~ , i Name: Ti • List all grope ies owned or have an interest in, which are locatE 4 a y~. 'e.. ~l (~ (~ L I,Ce y i ~C . I am now employed by the City of Miami Bsach: Yes D or NoG~ • Pursuant to City Code Section 2-25 (b): Do you have a parent 0, sF City of Miami Beach? Check all that apply. Identify the department(s): The following information is vo and is neither part of your application being asked to comply with federal equal opportunity reporting requtremerrtt .;/or No -. If vas. whic~ board B yid membership In? within the City of Miami B ach: hich department fee C~, child C, briotther G, or sister D who is employed b~~ the U I or firs any bsaririg on your consideratlon for appointment. tt Is Gender: D Male D Female I Ethnic Origin: Check one only (1) ^ White (Nat of Hispanic Origin): Atl persons having origins in any of the origi I peoples of Euro ~ ,North Africa or the Middle East. ^ African-American/Black (Not of Hispanic Origin): All persons having origin in any of the Bfar~ rdCial groups of Africa. ^ Htepanie: All persons of Mexican, Puerto Rican, Cuban, Central or South A erican, or other Sp anish culture or origin, regartfless of race. ^ Asian or Pacific lsiandar: All persons having origins in any of the original pe pies of the Far ~a9 t, Southeast Asia, the Indian SubtAnfinent. or the Pacific istancis. This area indttdes, for e~mpie, China, India, Japan, Ko a, the Philippine !sf' ands and Somoa. ^ American indisn or Alaskan Nathre: All persons having origins in any of th original peoples of North America, and who maintain Guttural identfftt~fion through tribal aRitiafion or comnumity recogNfion. Physically Chaliengect: Yes D or NoO. Employment Status: Employed D Retired D Homemaker D Other p l NOTE: If appointed, you will be required to follow certain law which apply to city boardicommltise members. These taws include, but are not: limited to, the following: I o Prohibition from directly or indirectly lobbying city personnel ( iami Beach City r ode section 2-459}. I o 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 peri od of one year after leaving office (Mram~ Bsach City Code section 2-26). I o Requirement to disclose certain financial intetESts and gifts (M I ami-Dade County Code section 2-11.1). (re: CMB Community Development Advisory Committee): p hibition, during te nure and for one year after leaving office from having any interest in or receiving any benefit from Co munity Developm ent Block Grant funds for either yourself . or those with whom you have business or immediate family tie (CFR 570.611). lfpon request, copies of these laws may be obtained from the ity Cierf:. "I her by attest to the accuracy and truthfulness of the appiicati n and have rece ived, read and wilt abide by Chapter ~ ~ Artie VII - the Code "S dards o Conduct for City Office s Employees an d Agency Members " I ~ ~ d , ~~~~, ~IMI . - v rS f' ~, ti nf's Signature Uate Name o. kppfican t (PLcASE °RINT~ Please attach a copy of vour resume to this a pltcation ' NOTE: Applications will remain on file for a period of one (1) C aienoar year. ~ Received In the :ity ~len:'s Gffice by G~te _' /2D09 Name of Deputy clerk No Gate. _'_/20D8