Debra Leibowitz 12/31/2011m--- MlAMiE~
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, v"n~w.miamibeachfl.aov
OFFICE OF THE CITY CLERK, Robert Parcher, Ciy Clerk
Tel: (305) 673-7411, Fax: (305) 673-7254
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12/8!2009
Debra Leibowitz
8 W Rivo Alto Dr
Miami Beach, Florida 33139
SU~BJE~T =~;~ Sustainability Committee
Congratulations! You have been reappointed by Commissioner Deede Weithorn
to the above referenced agency, board or committee for a term ending: 12/31/2011.
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.
I
Sincet'rely,
0 `d ~~ ~~
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Fred Beckmann
ATTACHMENTS:
i
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 - Guidei to the Sunshine Amendment and Code of Ethics for Public Officers and
Employees
We are committed ro providing excellent public service and safety to all who live, work and play in our vibrant, tropicol, hisroric community.
m MiAMIBEACH
City of Miami Beach, 1700 Convenfion Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.aov
OFFICE OF THE CITY CLERK, Robert Parcher, Ciy Clerk
Tel: (305) 673-7411, Fax: (305) 673-7254
TO Debra Leibowitz
RE: Sustainability 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 O~ce~s and Emp/ogees, 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.
Debra Leibowitz
Sworn to and subscribed before me this ~/ ~ day of ~Q-h • , 20~ fl
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 ore committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community.
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CfTY OF MllfifJll B=ACrJ
BOARG AND COMMfTT`E /~.PPLIC,r;TION r=OP.N
Last Name First Name Middle Initial
S: i~ ~ ~ I ~o A l ~ DR ~~ ~ 3313
Apt No. House No.lStreet City State •Zip Co e
S 3 - • X1'7 `~ y 3~S- S 3 I - ~ &' ~7 3b S- .f"3l- ~rs~~' ~s~f~.l~G /~
Home
Work
Fax
,~ I Email address,r~~ _~~c.H
Business Name: ~,Q-~S ~ I nL Position: ®T Y) Cl /~~./ yly~'~-
Address: ~v lA.l~ .P
No. Street Crty State Zrp 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 ownershiplinterest for a minimum of six months in a business established in the city.
. Resident of Miami Beach for a minimum of six (6) months: Yes D or No D
• Demonstrate an ownershiplinterest in a business in Miami Beach for a minimum of six (6) months: Yes ^ or No D
• Are you a registered voter in Miami Beach: Yes ^ or No D
• (Please circle one): I am now a resident of: North Bsach South Beach Middle Beach
• I am applying for an appointment because I have special abilities, knowledge and experience. Pfesse fist below:
• An= you presently a registered lobbyist with the City of Miami Beach? Yes D or No D
Please list your preferences in order of ranking [7] first choice [2] second choice, and [3] third choice. Please note that on(v three X31
choices will be observed by the City Clerk's OfPrce. (Regular Boards of City)
D Affordable Housin Adviso Committee D Housin Autho '
D Art in Public Places Committee ^ Loan Review Committee
^ Beautification Committee D Marine Autho
D Board of Ad'usimerrt'' ^ Miami Beach Commission for Women ~
D Bud Adviso Committee D Miami Beach Cultural Arts Coundl
D C ital fm mvemertts Pro etds Oversi ht Commitbae ^ Miami Beach Sister Cities Pro ram
D Committee on the Homeless D Normand Shores Local Gvvemmerrt Nei h. im rovement
D Committee for Qual Education in MB D Parks and Recreation Facilities Board
D Commun' Develo ment Adviso D Personnel Board `
D Commun Relations Board D Plannfn Board"
D Convention Center Adviso Board D Poii~ Citizens Relations Committee
^ Debarment Committee D Production indu Council
D Desi n Review Board'' D Public S Adviso Committee
^ Disabil' Access Committee D Sa Committee
D Fine Arts Board D S' ie Famii Residential Review Panel
D Ga ,Lesbian, Bisexual and Trans ender GLBT ustainabil' Committee
^ Golf Adviso Committee D Tran aren Refiabii' 8 Accountabii' Committee "TRAC"
D Health Adviso Committee D Trans ortation and Parkin Committee
D Health Facilities Autho Board ^ Visitor and Convention Autho '
D Hts anic Affairs Cammittee D Waterfront Protection Committee
D Historic Preservation Board D Youth Center Adviso Board
*Board Required to File State Disclosure Form
Note: ff 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:
Age: Program:
"\: L=P.'.~AL'.\aF~RMS\B~ARD AND ~OMMITT~~S\BC APPII~ottonO6ZdO~ NE~'.ooc
~I-iaVe you eVe' been CbnVICteC ~` 8 felon\' Yes o~ NO .' veS. please explain in detail.
• Do you currently havE z vioiation~sj of City of Miam+ Bract; codes: Yes ~ or No =_ f` yes. please explain tr. detail.
• Do you currently owe the City of Miami Beach any money: Yes =: or No _;. If yes. explain in detail
• Are you currently serving on any City Boards or Committees: Yes " or No -. If vas whtcr: board
• What organizations in the City o= Miami Beach de you currently hold membership in?
Name: Title:
Name: Title:
• List all properties owned or have an interest in, which are located within the City of Miami Beach:
• I am now employed by the City of Miami Beach: Yes G or NoD. Which department?
• Pursuant to City Code Section 2-ZS (b): Do you have a parent ^, spouse ~~, child G, brother C, or sister D who is employed b~~ the
City of Miami Seach? Check all that apply. Identify the department(s):
The following information is voluntary and !s neither pert of your eppltcatton nor has any bearing on your consideration for appointment. tt is
being asked to comply with federal equal apportunlty reporting requiremerrts.
Gender: 0 Ntale 0 Female
ct:nntc ~rrgm: neck one orny (~)
^ White (Nat of Hispanic Origin): All persons having origins in any of the original peoples of curope, North Africa or the Middle East.
D African-American/Black (Not of Hispanic Origtn): All persons having origins in any of the Bieck racial groups of Afica.
D Hispanic: A!I persons of Mexican, Puerto Rican, Cuban, Certh'al or South American, or other Spanish culture or origin, regardless of race.
Asian or Paeiflc islander: All persons having origins in any of the original peoples of the mar East, Southeast Asia, the Indian Subcorrtinent, or
the Pacific Islands. Tans area includes, for exartrpte, China, India, Japan, Korea, the Philippine !stands and Somoa.
Arrrerican indtian or Alaskan Native: All persons having origins in any of the original peoples of North America, and who maintain
Culture( identtfrcafion through tribal afttliafion or community recognftion.
Physically Cisalienged: Yes ^ or Noy]
Employment Stratus: employed 0 Refired 0 Homemaker ^ Other 0
NOTE: If appointed, you will be-ntquired to follow certain laves which apply to city boardicommlt6ee members.
These caws include, bun are not limited m, the following:
o Prohibition from directly or indirectly lobbying city personnel (Miami Beach City Code section 2-459}.
o Prohibition from contracting with the dty (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 (Mtam
Beach City Code section 2-28).
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
i from having any interest in or receiving any beneftt from Community Development Block Grant funds for either yourself
or those with whom you have business or immediate family lies (CFR 570.611).
upon request, copies of these laws may be obtained from the City CierY,. 1
"I hereby attest to the accuracy and truthfulness of the application and have received, read and wttl abtde by Chapter Z.
Article VII - of the Clty Code "Standards of Conduct for City Officers. Employees and Agency Members."
Applicant's Signature Uate Name of Applicant (PEASE PRINT)
Please attach a copy of your resume to this appltcation
NOTE: Applications will remain on file for a oeriod of one (1 i calenpar year.
Recewec rn the City Cierlrs Cffrce oy Gate' _ !2005 control No Gate _ 00~
Name of Leputy Cler1: -