Debra Scholl 12/31/2010~~
m M,!,AM!~~AC~!
City of Miami Beach, 1700 ConvenKon Center Drive, Miami Beach, Florida:33139, www.miamibeachfl.aov
OFFICE OF THE CITY CLERK, Robert Parcher, Ciry Clerk
Tel: (3051673-741 ], Fax: 13051673-7254
1 /14/2010
Debra Scholl
803 East Dilido Drive
Miami Beach, Florida 33139
Convention Center Advisory Board
Congratulations! You have been reappointed by Commissioner Jorge Exposito
to the above referenced agency, board or committee for a term ending: 12/31/2010.
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
Jianina Velazquez
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 ro providing excellent public service and safety to all who live, work and play in our vibrant, tropical, hisroric community.
m MIAMI BEACH
City of Miami Beach, 1700 ConvenKon Center Drive, Miami Beach, Florida 33139, vnww.miamiheachfl.aov
OFFICE OF THE CITY CLERK, Robert Parchar, Ciry Clerk
Tel: 13051673.7411, Fax: (305) 673.7254
TO Debra Scholl
RE: Convention Center Advisory Board
I do solemnly swear or affirm to bear Vue 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: 12/31/2010.
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/aide Commission on EUricsGuide to Ure Sunshine
Amendment and Code of Ethics hx Pub/ic r2/ficers 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 1 served.
Debt
7w -•~
Sworn to and subscribed before me this ~9 day of dMTI u , 20B ~d
~~
-Silvia Prieto
Deputy Clerk
*Please visit the Gty of Miami Beach wetaite at www.miamibearhFl.gov under Gty Gerk/BOard and Gxnmittees
for additional Information regarding the Fnanaal Disdostrre Requirements.
We era committed ro providing excellent public service and safety ro all who live, work and play in our vibrant, Tropical, hisroric community.
m ~,%~ I ;!,r,~i;, BCACH
NAME:
HOM=_ ADDRESS:
PHONE:
First
r ,n
Business Name- Position:
CITY OF MIAMI BEACH
RG AND COMMITTEE APPLICL,TION rOP.M
Address
No. Street City State Zip Code
Professional License (tlesalbe)
6rpires' Attach a ropy of the license
Pursuant to Clty Code section 2-ZZ(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 residem of the dty for a minimum of six
momhs; or b) an individual shall demonstrate ownershiplirtterest for a minimum of six months in a business established in the city.
• Resident of Miami Beach for a minimum of soc (6) months: Yes r No D
• Demonstrate an ownership/irrterest in a business in mi Beach for a minimum of six (6) months: Yes D or No pi-
•Are you a registered voter in Miami Beach: Yea r No 0
• (Please circle one): I am now a resident of North Beach South Beach Middle Beach
• I em applying for en eppointmem because I have special ebillties, kno experien/ce. Please list below: ~g/ni?~-t
• Are you presemly a registered lobbyist with fhe City of Miami Beach? Yes D or No p/ ~ d~~,t-Opp JJ~
Please list your preferences in order of renking (1] first choice [Zj second choice, and [3J third choice. Please note that onN throe f3)
cholcec will be observed by the CIN ClerMc Office. (Regular Boards m City)
^ Affordable Houain Adviso Committee ^ Houain Aufho
^ Art in Public Places Commlbee D Loan Review Committee
^ Beatttlficetion Committee D Medne Autho
^ Board of 'rtatrrtarrC D Miami Beach Comm®slon for Women
0 8 Cammltlee ^ Miami Beach Guttural Arta Coundl
D C hel 1 moms Pro'eets Oversi m Commtgse D Mtaml Baer Sister Cities Pro m
^ Cammlttae on the Homeless D Norman Shores L.o®I Oovemmerd Nei h. tm m
^ Committee for dual Education in MB D Par16 and Recreation Facilities Board
D Commun Devalo merit Adviso ^ Personnel Board
^ C n Relations Board D Plannin Board'
onverdion Comer Adviso Board D Police Citizens Relations Commibee
^ Debartnem CtrmmtGee D Production Ind Council
D Desi n Review Board' D Public Sa Adviso Committee
0 Dtsebil Acoass Committee D S Commltiee
D Fine Arts Board D Sin le Fami Residential Review Panel
^ Ga ,Lesbian, Bisexual and Trenstlender GLBT ^ Susteinabil' CommlCae
^ Goli Adviso Commltiee D Tre aren Reliabll' & Account13bi1 Committee 'TRAC'
^ Health Advso Cbmmidae ^Tre ortation and Perkin Committee
D Health Facilities Ruth Board D Visitor and Convemion Autho '
D His nic Affairs Commltme ^ Waterirom Protection Committee
^ Historic P2sarvation Beard ^ Youth Cartier Adviso Board
'Board Required 1A Flle State Disclosure Form
Note. If applying for Youth Advisory Boartl, please indicate your affiliation with the Scott Rakow Youth Cerrter
~ .Pest service on the Youth Center Advisory Board. Yes C No p Years of Service.
2. Presarr, participation in Youth Center activities by your children Yes.' No =. If yes, please list the names of your children, their
ages, end which programs. List below:
Child's name- Age: Program:
Cnild's name: Age. Program
F'~_L_P.',SAL' \a`JRM$\B7ARG ANC :rOMMnTES\BC AooliwvuonOG2609 N°_N'.doc
.nave yb~ eve' deer. ~onvi~ter' ~` c retonv Yes o No I' vas pleas= eXpi2ln in detaiP.
• Do you currently have a vlolation(sj d? City of Miami Beach cotles. Yes . o~No~, If yes, olease erptam in detai!:
• Do you currently owe the City of Miami Beach any money: Yes . or Nom yes. explain Ir. detail
• Aro you currently serving or any Cit}' Boards or Committees. Yes " or Noes. whlci ooard?
• What organizations in the Ciiy of Miami Beach do you currently hold membership ln?
Name: Title:
Name Title:
• List all propertie ow ed 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 D or NoC--V~Ihich department?
• Pursuant to City Code Seefion 2-25 (b): Do you have a parent ^, spouse D, child C, brother D, 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 neither pert of your applfeaGOn nor has any bearing on your conaideredon for appointment. It Is
oaing asked to eompfy with federal equal opportunity reportlng requlremema.
Gender: 0 Male emale
cmntc urrgirt: t;heck one only (1)
him (Not of Hispanic Origin): AV persons having origins in any of the original peoples of Europe, North Afica or the Middle East.
^ African-AmerieatJBtaek (Not of Hispanic Ortgln): All persons having origins in any of the Black rectal groups of Afrt®.
^ Hiapente: All persons of Mexican. Puerto Rkan, Cuban, Cemrai or Sputh American, or other Spanish culture or odgln, regardless of race
Aaffln or Paetfic kfander: All persons having origins in any of the original peoples of the Far cast, SaWheasl Asia, the IMtan Suhcontinent. or
the Padfic Islands. TMs area indlWes, for example, China, India, Japan, Korea, the Philippine islands and Samoa.
^ Anredpen Indian or Ala6kan Native: All pereorts having origins in any of the original peoples of North Anredea, and vhio maintain
CWkirel idantffusfion through trtbel afNgafton ar mrttrruinfty recognlaon.
Physically Cftatfenoed: Yes ~ or NoD.
Employment Status: Employed ^ Retired t~ Homemaker ^ Other p
NOTE: If appointed, you will be required to follow certain kaws which apply to city boardleommFttee members.
These taws ineiude, but are not limihed to, the following:
o Prohibition from directly or indirectly lobbying cAy personnel (Miami Beach City Code section 2-459).
o Prohibtion from contracting with the dty (Miami-Dade County Cotle sedion 2-11.1).
o Prohibition from lobbying before boardlcommtttee you have served on for period of one year after leaving office (Mlam~
Beach City Code sedion 2-26).
o Requirement to disdose certain finandel interests and gifts (Miami-Dade County Code sedion 2-11.1).
(re: CMB Communty Developmarrt Advisory Commiftee). prohibition, during tenure and for one year after leaving office
from having any inrterest in or receiving any benefit from Community Development Blodc Grant funds for either yoursel`
or those with whom you have bueineas or immediate family ties (CFR 57D.611).
Upon request, copies of these laws may be obtained from the City CierY,.
"I hereby attest accuracy and truthfulness of the application and have received, read and will abide by Chapter 2. i
Article VII - of Code " odaWs_of Conduct for City Officers, Employees and Agency Ma ere.'
Applteam's na at Name of Apoltcanl (PLEASE oRINTI j
Please ritmeh a copy of your resume to tnls application
NOTE: Appiicflnons will remain on flee for a period of one (11 calenoar year.
RBCCNBC In the ^.Ity ,^,IefK'S DfflCe DJ' ~ ~}r 1lLr IC~(1 BI ~'~
Dare ..pntrpl No Dele noQ
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