David Smith 12/31/2011m ;~IAMBEACH
City of Miomi Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, ~e~ttv.miamibeachH.aov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel: (305) 673-741 1, Fax: (305) 673-7254
1/12/2010
David Smith
4538 Sheridan Ave
Miami Beach, Florida 33140
~. ~~~~ ~,
~~~~ ~ ~1'' ~~ ,~ Community Development Advisory Commit
Congratulations! You have been reappointed by Commissioner Jerry Libbin
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,
~~'~ /S~°
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Mercedes Rovirosa
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 committed to providing excellent public service and safety to all who five, work and play in our vibrant, tropical, historic community.
m MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.aov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel: (305) 673-7411, Fax: (305) 673-7254
TO David Smith
RE: Community Developmet Advisory 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/oryda Commission on Ethics Guide to the Sunshine
Amendment and Code of Ethics for Pub/ic Officers 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.
avid Smi
Sworn to and subscribed before me this ~ day of , 20~~
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 Fnancial Disclosure Requirements.
We ore committed to providing excellent public service and safely to all who live, work and play in ovr vibrant tropical, historic community.
I I-11 V 11 8.~~/"~i... CITY OF MIAMI BEACH
BOARD AND COMMITTEE APPLICATION FORM
Last Name / !First Name Middle Initial
HOME ADDRESS: ~~ 3 ~ ~~c~tc ~ ~ ~ ~ ~ ~ ~~ ~
No. Street (( ~~ City IState~. Zip Code
PHONE: ~~ ~_ ` ~ ~_~~- ~ ~ ~ ~ ~~---~/ ~ Q ~ l~Y_ ~' A-n t ~ 0.4,ti.M-~-S . C~ M
Home Work Fax
Business Name:
Position:
Address:
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; orb) an individual shall demonstrate ownershipfinterest for a minimum of six months in a business established in the city.
• Resident of Miami Beach for a minimum of six (li) months: Yes f~6r No ^
• Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six (li) months: Yes ~o ^
• Are you a registered voter in Miami Beach: Yes ~6r No ^
r_._..__.....
• (Please circle one): I am now a resident of: North Beach South Beach Middle Beach
• I am applying for an appointment because I have special abilities, knowledge, experience. Please list below:
Please list your preferences in order of ranking [1] first choice [2] second choice, and [3] third choice. Please note that only three (3)
choices will be observed by the Clty Clerk's Office. (Regular Boards of City)
^ Affordable Housin Adviso Committee ^ Historic Preservation Board*
0 Art in Public Places Committee ^Housin Authori
^ Beach Preservation Board ^ Loan Review Committee*
^ Beautification Committee ^ Marine Authori
^ Board of Ad'ustment* ^ Miami Beach Commission for Women
^ Bud et Adviso Committee ^ Miami Beach Cultural Arts Council
^ Ca ital Im rovements Pro'ects Oversi ht Committee ^ Miami Beach Sister Cities Pro ram
^ Committee on the Homeless ^ Normand Shores Local Gov't Nei h. Im rovement
^ Committee for Quali Education in MB ^ Parks and Recreation Facilities Board
f~Ciimmuni Develo ment Adviso * ^ Personnel Board*
^ Communi Relations Board ^ Plannin Board
^ Convention Center Adviso Board ^ Police Citizens Relations Committee
^ Cultural Arts Nei hborhood District Overla CANDO ^ Production Indust Council
^ Debarment Committee ^ Public Safe Adviso Committee
^ Desi n Review Board* ^ Safe Committee
^ Disabili Access Committee ^ Sin le Famil Residential Review Panel
^ Fine Arts Board ^ Sustainabili Committee
^ Ga Business Develo ment Ad Hoc ^ Trans arenc Reliabili & Accountabili Committee °TRAC"
^ Golf Adviso Committee ^ Trans ortation and Parkin Committee
^ Health Adviso Committee ^ Visitor and Convention Authori
^ Health Facilities Authori Board ^ Youth Center Adviso Board
^ His anic Affairs Committee
* Board Required to File State Disclosure form
F:ICLERtSALUBoard & CommitteestB&C ApplicationlB&C Application Revised 111308 2.doc
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: Age: Program:
.Have you ever been convicted of a felony: Yes ^ or No~lf yes, please explain in detail:
• Do you currently have a violation(s) of City of Miami Beach codes: Yes ^ or No ~s, please explain in detail:
• Do you currently owe the City of Miami Beach any money: Yes ^ or No ~ explain in detail
• Are you currently serving on any City Boards or Committees: Yes~B~6r No ^. If yes; which board?
C`~ ~ ~'.
• What organizations in the City of Miami Beach do you currently hold membership in?
Name
Name:
Title:
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 ^ or No[_~Which department?
• Pursuant to City Code Section 2-25 (b): Do you have a parent ^, spouse ^, child ^, brother ^, or sister ^ who is employed by the
City of Miami Beach? Check all that apply. Identify the department(s):
This section is "ng~required" but desired: Age: ~ ~P years old Gender: Male' Female ^
Race: White i~African-American/Black ^ White/Hispanic: ^ Asian or Pacific Islander ^ American Indian or
Alaskan Native ^ Haitian: ^ Origin Ethnic: Hispanic: Yes or No
"1 hereby attest to the accuracy and truthfulness of the application and have received, read and will abide by Chapter 2,
Article VII - of the City Code "Standards of Conduct for City Officers, Employees and Agency Members."
Applicant's Signature Date Name of Applicant (PLEASE
PRINT)
!'lease attach a copy of your resume to this application I
MOTE Applications will remam~on file fora penod of one,(!) calendarsyear;
Employment Status: Employed ^ Retired ^ Home-maker ^ Other ^
Received in City Clerk's Office by Date
Name of Deputy Clerk
Document Control Number (Assigned by the City Clerk's Office) Entered By Date
Revised 09/02/08 LH
F:\CLER1$ALL1Board & CommitteeslB&C Application\B&C Application Revi~d 111308 2.doc