Dale Gratz 12/31/2011m MIPJV~BEACN
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
1 /12/2010
Dale Gratz
215 E. San Marino Dr
Miami Beach, Florida 33139
S~~'BJE~GT ~~ Committee on the Homeless
Congratulations! You have been reappointed by Ma
to the above referenced agency, board or committee
If you are unable to accept this appointment, please i
(305) 673-74.11.
Please read the enclosed material carefully. Again, c
Sincerely,
~~f ~~~-~~~56°
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Ingrid Usaga
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
Matti Herrer Bower
~ term endin ~: 12/31/2011.
y the City Clerk's Office at
ulations an'd good luck.
1 ittee
Code of Ethics Ordinance
for Public Officers and
We are committed ro providing excellent public service and safety to oll who live work and play in ~ur 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: (305 673-7411, Fax: (305 673-7254
TO Dale Gratz
RE: Committee on the Homeless
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.
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 t~cers and Employees, and unde
of a City 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 year on which I ha
Dale
Sworn to and subscribed before me this ~~ y
._... Si
*Please visit the City of Miami Beach website at www.miamibeachfl.gov under
for additional information regarding the Financial Disclosure Requirements.
Florida 33139, www.miamibeachN.aov
emment of the
all the duties of
;h to which I ktave
(Conflict of Interest
side to the Sunsihine
end that as a member
uncial disclosurq* require-
or committee oh which
served.
f ~M~1 v 20f~0
..
_ _ ~__
i Prieto
y Cierk
Gerk/Board and Cgmmittees
We are committed to providing excellent public service and safety to all who live, {,vork and play in o~yr vibrant, tropical, historic community.
i
~';,~ ! ~ ;°-`;l '~~! ! ~~~~ I-i ~ CtTY of f~Ift;Ml 3Ekcr
BOARG AN CONIMfTTEE kPPLIC,~;TIOh FOP.N
NAME: ~ / ~ ~
Last Name First Name _M/iddie Initial
HOME ADDRESS: ~S ~Q I"`' ~ ~ C' ~'! ~/3 9
Apt No. House No./Street City State Zip Code
PHONE: .3 ~~' ° ~ ~.Z ~7~7'~'.
Home .Work Fax Email address
Business Name: P sition:
Address: ~
No. Street City State Zip .Code
Professional License (describe) Expir s: Attach a copy of the license
Pursuant to City Code section 2-22(4) a and b: Members of agenci s, boards, and mmfttees shall be affiliated with the city; this
requirement shall be fulfilled in the following ways: a) an individual shall 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 m nths in a business established in the city.
• Resident of Miami Beach for a minimum of six (6) months: Yes~r o 0 I
• Demonstrate an ownership/interest in a business in Miami Beach fo a minimum of si I (6) months: Yes ^ ibr No
• Are you a registered voter in Miami Beach: Yes ~r No ^ ______.~
• (Please circle one): I am now a resident of. North Beach oath Beach Middle Beach - ~en ~-~IQ /1
• I am applying for an appointment because I have special abilities, kn wfedge and exp rience. ease ist below a ~ S~¢~2~
• Are you presently a registered lobbyist with the City of Miami Beach . Yes ^ or No
I
Please fist your preferences in order of ranking (1] first choice [2J secon choice, and [3] ird choice. Please note that oniv three f3)
choices will be observed by the City CIeMc's Office.-(Regular Hoards f City) ~
C~ Affortdeble Housin Advtso Committee 0 ousin Autho
^ Art in Public Places Committee ^ an Review Com(r~tittee
^
^ Desi n Review Board" 0 ubiic 5 Advf o Committee
D Disabil' Access Committee ^ afe Committee
^ Fine Arts Board ^ in le Famii Res derrtfal Review Panel
^ Ga ,Lesbian, Bisexual and Trans ender GLBT ^ ustainabii' Co mitiee
^ Gott Adviso Committee ^ rans ren Rsli' bil' & Accountabil Committee "TRAC"
^ Health Adviso Committee ^ can ortation an Parkin Committise
D Health Faalities Autho ' Board ^ isitor and Conve 'on Autho
D His anic Affairs Committee ^ rfront Prote on Committee
^ Historic Preservation Board ^ oath Center Advisory Board
Fite State .Disclosure Form
u
Note: ff applying for Youth Advisory Board, please indicate your afBfiatio with the Scott i~kow Youth Center.
1. Past service on the Youth Center Advisory Board: Yes ~ No ~ Years of Service:
2. Present participation in Youth Center activities by your children Ys -~ No ~. If yes, 'lease fist the names of your children, their
ages, and which programs. List below:
Child`s name: Age: Program
Child's name: Ape: Program'
\~LEP..~AL'\oF~RMS~B~ARD AND :.OMMITT~C~~BC APOiicotionO626O9 N~V\'.do:
•~ave you ever Dean convi^tec o` s felony Yes ~ o .' vet please explai~ in detain.
• Do you currently havE z vioiation~sj of City of Miami Beact, cotfes: Yes . 3~IVo ~ I` yes, please explalr~ Ir. detail:
i
• Do you currently owe the City of IViiam~ Beach' any money: Ye _` or No ~If yies. explain in detail
• Are you currently serrino on any City Boards or Committees: es ~ o :.. If vas whlci- board
. What organiz/ations in the City o. Miami Beach de you currentl ~ hold members ~ ip in?
Name: ~~~ ( ~r~urlQ~l D ~ ~c°c,(~/s ~ ~~~ .~tle
Name: T,o~-rn.~~ 1~~~h ~G~o la ~ ~ tie:
• List al( properties owned or have an interest in, which are locat d within the Ci ~ of Miami Beach:
o m i/ - a S r~ ~~Arn~` ~ o h• fl
. I am now employed by the City of Miami Beach: Yes C~ or No hich department?
• Pursuant to City Cade Section 2-25 (b): Do you have a parent G, s Ouse ^, child G, Brother G, or sister G who is employed by the
City of Miami Beach? Check all that apply. Identify the department(s): ,~l
The foliowtng information is voluntary and is nettiter part of your applteatio nor has any bear ng on your consideration for appointment. It is
being asked to comply with federel equal opportunity reporting requlreme
Gender: G Niafe t~male
~~E,t/t}f~tic Origirt: Check one only (1) INuI
9!J White (Not of Hispanic Origin): All persons having origins in any of the origi al peoples of Eurode, North Africa or the Middle East.
African-AmericanlBiack (Not of Hispantc Origin). All persons having origi sin any of the Biecky nasal groups of Africa.
Hispanic: All persons of Mexican, Puerto Rican, Cuban. Centrel or Sotrth A erican, or other SpFanish culture or origin, regardless of race.
Asian or Paetffc islander: Ail persons havhg origins in any of the original p ogles of the Far ca t, Southeast Asia, the Indian Subcorrtinen+.. or
the Pacific islands. This area includes, for , China, fruiia, Japan, Kona, the PMfippine l ands and Somoa.
^ American Indian or Alaskan Native: All persona; having origins in any of th original peoples ~ North America, and who mairttain
Cultural tdertttftcafian through tribal aftlfiafton or community recognlfion.
Physically Challenged: Yes ^ or No~
Employment Status: Employed G Retired ~" Homemaker ^ Other 0
NOTE: If appointed, you will be-required to follow certain la which apply to ~ tty baard/commttbae members.
These taws include, but are not limned m, the following:
o Prohibition from directly or indirectly lobbying city personnel ( iami Beach City ode section 2-459).
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 perod of one year attar leaving office (Mlam~
Beach City Code section 2-26).
o Requirement to disGose certain financial interests and gifts (M ami-Dade Count '~ Code section 2-11.1).
(re: CMB Community Development Advisory Committee): pr hibition, during tenure and for one year after leaving Offl^e
from having any interest in or receiving any benefit from Co munity Develop ant Block Grant funds for either yourself
or those with whom you have business or immediate family tie (CFR 570.611).
Upon ;request, copies of these laws may be obtained from the lty Cierl;. ,
"I hereby attest to the accuracy and truthfulness of the applicatidn and have received, read and will abide by Chapter
Article VII - of the Clty Cade "Standards of Conduct or City Office s, Employees aril Agenc Members."
Applicant's Signature Uate Name of Apolican (PLcASE PRItJT)
Please attach a copy of your resume to this appUcation j
N6TE: Applications will remain on fife fora eriotl of one (1 i lender year.
~i
Receroec it the Cite Cierl:'s Office oy D to _ I2 Q5 ~orhtroi No Gate _/~~
Name of Leouty Clerk