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Abraham Lavender, Ph.D. 12/31/2011City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida,33'139, ~v~!vt.miamibeachfl.aov OFFICE OF THE CITY CLERK, Robert Parcher, Ciy Clerk Tel: (305) 673-7411, Fax: (305! 673-7254 12/21 /2009 Abe Lavender 345 Ocean Drive Apt. #401 Miami Beach, Florida 33139 Safety Committee Congratulations! You have been reappointed by Mayor Matti Herrera Bower to the above referenced agency, board or committee for a term ending: 12/3112011. 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, Robert Parcher City Clerk cc: Saul Frances, Parking Director Clifford Leonard 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 and 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 commit-ed to providing excellent public service and safety to all who live, work and play in our vibrant, tropicol, historic community. m MIAMIBEACH City of Miami Beach, 1700 Convenfion Center Drive, Miami Beach, Florida 33139, ~v.miamibeachH.aov OFFICE OF THE CITY CLERK, Robert Parcher, Ciy Clerk Tel: (305) 673-7411, Fax: (305) 673-7254 TO Abe Lavender RE: Safety Committee I do solemnly swear or affirm to bear true faith, loyalty and allegiance to the Government of the United States, the State of Florida, and the City of Miami Beach, and to perform all the duties of a member of the above-mentioned board or committee of the City of Miami Beach to which I have 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 Code (Conflict of Interest and Code of Ethics Ordinance), as well as thef/orida Commission on Ethics Guide to the Sunshine Amendment and Code of Ethics for Public ~cers and Employees, and understand that as a member of a City of Miami Beach Board and/or Committee, I must comply with the financial disclosure* require- ments of Miami-Dade County or the State of Florida (depending on the board or committee on which I serve) on July 1st, following the closing of the calendar year on which I have served. Abe Lavender Sworn to and subscribed before me this~~ day ofd , 200 Silvia Prieto Deputy Clerk *Please visit the City of Miami Beach website at www.miamibeachfl.gov under City Clerk/Board and Committees for additional information regarding the Financial Disclosure Requirements. We are committed to providing excellent public service and safely to all who live, work and play in our vibrant, tropical, historic community. Lam, i`,~~ { r;~~~` 1 t~~~~ ~ CITY Or' MIAMI B=kCH BOARG AND COMtV11TTEE ~+,PPLICATION FOP.M NAME: ~/~ y~~~ti ~71~y~ ~- Last Name First Name Middle Initial HDME ADDRESS: ,~O'~ ~~~~~~''~' ~~lY~ ~/~/7i ~11~- /°~ J~.~/-~9 Apt No. House No./Street City -' State Zip Code PHONE: ~rf'G-•Zrv/-~ ~~9Z .~o.!'=.~f~6'-.Z2~'7 ~~9y~J~~.~•rr Home Work Fax Email address Business Name: ~Lo~~.~ -•~%~~~-~'~ Position: ~,~Of~ps-o~ Address: _ ~La~' .~/1 ,?~-2:8 ~O?/jy~ o~- .n/F.I~: /l/~' fZ .~~/99 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 agencies, boards, and committees 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 for a minimum of six months in a business established in the city. • Resident of Miarni Beach for a minimum of sa (6) months: Yes ~ No ^ • Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six (6) months: Yes ~r No ^ • Are you a registered voter in Miami Beach: Yes ~r No ^ . (Please circle one): I am now a resident of: North Beach B Middle Beach . i am aer,ivina' for an aooointrnent because J have special abilities, know a ge and experience. Please list below: • Are you presently a registered lobbyist with the City of Miami Beach? Yes D or No t0~ Please list your preferences in order of ranking [1] first choice [2] second choice, and [3] third choice. Please note that oniv free t3) choices will be observed by the City Clerk's Office. (Regular Boards of City) D Affordable Housin Adviso Committee 0 Housin Autho ' D Art in Public Places Committee 0 Loan Review Committee D Beautification Committee D Marine Autho D Board of Ad'ustmerrt" D Miami Beach Commission for Women D Bud Adviso Committee D Miami Beach Cultural Arts Council D C itel im rovements Pro ects Oversi ht Committee D Miami Beach Sister Cities Pro ram D Committee on the Homeless 0 Normand Shores Local Govemmerrt Nei h. im rovemertt D Committee for Qual Education in MB D Parks and Recreation Facilities Board D Commun Develo ment Adviso D Personnel Board D Commun Ratations Board D Plannin Baadd" ' D Convention Center Adviso Boari D Polioe Citizens Relations Committee D Debarment Committee D Production indu Council D Desi n Review Boart!' D Public 5a Adviso Committee D Disabil' Access Committee a Committee D Fine Arts Board D Sin fe Famii Residential Review Panel D Ga ,Lesbian, Bisexual and Trans ender t;LBT D Sustainabil' Committee D Gotf Adviso Committee D Trans aren Reliabil' 8~ Accountabii' Committee "TRAC" D Health Adviso Committee D Trans ortation and Parkin Committee D Health Facilities Autho ' Board D Visitor and Convention Autho D His anic Affairs Committee D Waterfront Protecdion Committee D Historic Preservation Board D Youth Cerrter Adviso Board "Board Required to Flie State Disclosure Form Note: If applying for Youth Advisory Board, please indicate your affiliation with the Scott Rakow 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 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: i Age: Program: F:\: LEP.`,$AL!\aF~RM,S~BOARD AND COMNdTTEES\BC Application062609 NEW.do; .Have you ever been convlctec of a felony, Yes : No I` yes. please explain in detail i • Do you currently have a violation(s) of City of Miami Beach codes: Yes ~. o(CNo ~, If yes, please explain in detail: i . Do you currently owe the City of Miami Beach any money: Yes ._ r No ~ . If yes. explain in detail i • Are you currently serving on any City Boards or Committees~~ or No -.. If yes, which board? .SI~1l~~ ~ cin~i JFT~$ • What organizations in the City of Miami Beach do you currently hold membership in? Name:/( ~• ~~!'J J'7"D.tJe~ ~-~„quya,,~ Title: ~i?~'~~3t~-%'- Name: ~ Title: • List ail properties owned or have an interest in, which are located within the City of Miami Beach; ~f9'- Gc~.l,~,)2. ~?. f~o~' /~3 ryJA.~ ST. A~lr. / : /QTY/R~ .S'r> ~aT. • I am now employed by the City of Miami Beach: Yes D or o~. hich department? • Pursuant to City Code Section 2-25 (b): Do you have a parent D, spouse C', child C, brother C, 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 nekher part of your application nor has any hearing on your consideration for appointment. It !s treing asked to comply with federal equal opportunity reporting requirements. Gender: ~liafe ^ Female ,,E..t/,h~~nic Origin: Check one only (1) Itef'whlte (Not of Hispanic Origin): All persons having origins in any of the original peoples of curape, North Africa or the Middle East. ^ African-AmericanlBlack (Not of Hispanic Origin): All persons having origins in any of the 8iack 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. ^ Aston or Pacific islander: Atl persons having origins in any of the original peoples of the Far East, Southeast Asia, the Indian Subcontinent, on the Pacific tsiands. This area indudes, for example; China, India, Japan, Korea, the Philippine (stands and Somoa. ^ American tndtlan or Alaskan Native: All persons having origins in any of the original peoples of North America, and who maintain Cultural identiftcafion through tribal affiliation or community recognttion. Yes 0 or Employment Status: Employed ~ Retired ^ Homemaker ^ Uther ^ NOTE: If appointed, you tarn[ be required to follow certain caws which apply to city baardicommittee members These caws 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 Code 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 Community 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. "I hereby attest to the accuracy and truthfulness of the application and have received, read and will abide by Chapter 2. article of the Cit a "Standards of Conduct for City Officers, Employees and Agency Members." Applicant's Signature Uate Name of Applicant (PLEASE PRINT) Please attach a copy of your resume to this application NdTE: Applications will remain on file for a period of one (1} calendar year. Received in the City' Clerk's Office by Date _~ /2005 control No Date: ~_I 005 Name of Ueputy Clerk -'