Mark Hayes 12/31/2011m- MIAMI BEACH
CItY Of Miami BeOCflr 1700 Convenfion Center Driva, Miami Beoch, Florida 33139, www.miamibeachfl.aov
OFFICE OF THE CITY CLERK, Robert Parcher, Ciry Clerk
Tel:'(305i 673-7411, Fax: (305( 673-7254
1 /12/2010
Mark Hayes
3001 Prairie Ave.
Miami Beach, Florida 33140
T- ~ Community Development Advisory Commit
Congratulations! You have been reappointed by Commissioner Jonah M. Wolfson
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,
~~~~~~5~
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 Eihics for Public Officers and
Employees
We are commined ro providing excellent public service and safety ro all who live, work and play in our vibrant, tropical, historic community.
m MIAMI BEACH
City of Miami Beaeh, 1700 Convention Center Drive, Miami Beach, Florida 33139, www-miamibeachA aov
OFFICE OF THE CITY CLERK, Robert Parcher, Ciry Clerk
Tel: 1305) 673-7411, Fax: (305) 673-7254
TO Mark Hayes
RE: Community Development 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 tens 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 Cade of Ethics for Public Officers and Employees, and derstand that as a member
of a City of Miami Beach Board and/or Committee, I must comply wi h financial disclosure' require-
ments of Miami-Dade County or the State of Florida (dependi a and ~mittee on which
I serve) on July 1st, following the closing of the calendar ye i hay~e~ied.
Sworn to and subscribed before me this 2- ~ day of~4Cy, 20~Q
ilvia-PrietB - ~--~--
Deputy Clerk
*Please visit the Gty of Miami Bearh welsite at www.miamibeadlfl.gov under Gty Gerk/BOard and Committees
for additional information regarding the Finandal Disclosure Requirements.
We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community.
m
NAME: lJ~E1 ~6 ,~ 1 ' Ik1I~ IC
~I Lca~st Name ~Jp _ n First Name
HOME ADDRESS: _3 GO ~ J f.Etl f~ (~6 /`t V
Apt No. House No./Street
vv1
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 Miami Beach for a minimum of six (6) months: Yes ~Cor No
• Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six (6) months: YesLror No
• Are you a registered voter in Miami Beach: Yes p. or No
• (Please circle one): I am now a resident of: North Beach South Beach Middle Beac
• I am applying for an appointment because I have special abilities, knowledge and experience. Pease is below:
• Are you presently a registered lobbyist with the City of Miami Beach? Yes or No(~
Please list your preferences in order of ranking [1] first choice [2] second choice, and [3] third choice. Please note that only three 131
choices will be observed by the CiN Clerk's Office. (Regular Boards of City)
Affordable Housin Adviso Committee 0 Housin Authorit
^ Art in Public Places Committee ^ Loan Review Committee
^ Beautifcation Committee ^ Marine Authorit
^ Board of Ad~ustment` ^ Miami Beach Commission for Women
^ Bud et Adviso Committee ^ Miami Beach Cultural Arts Council
^ Ca ital Im rovements Pro eIXs Oversi ht Committee ^ Miami Beach Sister Cities Pro ram
^ Committee on the Homeless ^ Normand Shores Local Government Nei h. Im rovement
^ Committee for Qualit Education in MB ^ Parks and Recreation Facilities Board
ommunit Develo ment Adviso ^ Personnel Board
^ Communit Relations Board ^ Plannin Board`
^ Convention Center Adviso Board ^ Police Citizens Relations Committee
^ Debarment Committee ^ Production Indust Council
^ Desi n Review Board` ^ Public Safet Adviso Committee
^ Disabilit Access Committee ^ Safet Committee
^ Fine Arts Board ^ Sin le Famil Residential Review Panel
^ Ga ,Lesbian, Bisexual and Trans ender GLBT ^ Sustainabilit Committee
^ Golf Adviso Committee ^ Tans arenc Reliabilit & Accountabilit Committee "TRAC"
^ Health Adviso Committee ^ Trans ortation and Parkin Committee
^ Health Facilities Authorit Board ^ Visitor and Convention Authorit
^ His anic Affairs Committee ^ Waterfront Protection Committee
^ Historic Preservation Board ^ Youth Center Adviso Board
'Board Required to File State Disclosure Forrn
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:
N~
Professional License (describe) Expires:
-Have you ever been convicted of a felony: Yes _. or NoaP If yes, please explain in detail:
• Do you currently have a violation(s) of City of Miami Beach codes: Yes = or NoQt If yes, please explain in detail:
• Do you currently owe the City of Miami Beach any money: Yes = or Nry(~. If yes, explain in detail
• Are you currently serving on any City Boards or Committees: Yes = or NoD~. If yes; which board?
• What organizations in the City of Miami Beach do you currently hold membership in?
Name: Title:
Name: Title:
•//~~List all properties oOwned_ or haveatn interest in, which are located within the City of Miami Beach:
rF/6M 6 .~J ° ~+~IIP r tea' AY.
• I am now employed by the City of Miami Beach: Yes . or Nom' Which department?
• Pursuant to City Code Section 2.26 (b): Do you have aparent -, spouse =, child C, brother =, 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 part of your application nor has any bearing on your consideration for appointment. It is
being asked to comply with fetlerel equal opportunity reporting requlrementa.
Gender:p(Y Male ^ Female
Ethnic Origin: Check one only (1)
D~White (Nat of Hispanic Origin): All persons having origins in any of the original peoples of Europe, North Afdca or the Mitldle East.
^ African-AmericaNBlack (Not of Hispanic Odgin): All persons having odgins in any of the Black racial groups of Afdca.
^ Hispanic: All persons of Mexican, Puerto Ricen, Cuban, Central or South American, or other Spanish culture or origin, regardless of race.
^ Asian or Pacgic Islander: All persons having origins in any of the original peoples of the Far East, Southeast Asia, the Intlian Subcontinent, on
the Pacific Islands. This area includes, for example, China, India, Japan, Korea, the Philippine Islantls and Somoa.
^ American Intlian or Alaskan Nadve: All persons having origins in any of the odginal peoples of North Amedca, and who maintain
Cultural identification through tribal affliction or community recognition.
Physically Challenged:. Yes - or N~
Employment Status: Employed Retired ^ Homemaker ^ Other ^
NOTE: If appointed, you will be required to follow certain laws which apply to city board/committee members.
These laws include, but are not limited to, the following:
o Prohibition from directly or indirecgy lobbying city personnel (Miami Beach City Code section 2459).
o Prohibition from contraIXing 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 offce (Miami
Beach City Code section 2-26).
o Requirement to disGose 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.
and truthfulness of the application and have received, read and will abide by Chapter 2,
ndards of Con~ltct fyr City Officers, Employees and Agency Members."
Please attach a copy of your resume to this
NOTE: Appl
Received in the City Clerk's Office by
will remain on rile for a period of one (1) calendar year.
Date: ~7-/2009 Control Nc. Date: _/_/
lease Print or Typ
Name:
Mailing Address:
City/State/Zip:
m
,S~ o ,~ 'stn c ~ Y
M~ ~/, 3~ l ~/o
Disclosure
For Tax Year
Ending:
Social Security Number: ~~ ~ ~ ~'~ ~~
Filing as a: ® County Employee:
® Municipal Employee of:
Position held or sought:
Board where servin /' ~,,a ~' Term or Employment
~~ Began on:
Department where employed:
Work Address:
If your home atldress is exempt from public records pursuant to
Florida Statutes § 119.07 please checksshere (read instrAructions): ® Work Telephone:.~~~~~y~~
Home Address: ~~ ~ ~~0. l ~ (a- V'+~
Street Addre
~ ~ g~ ~ .~3 i Yc~
City State Zip Cade
Please list below in descending order with the largest source first, the name, address and
principal business activity of every source of your income including public salary you
received or any person received for your benefit or use during the disclosure period. The
income of your spouse or any business partner need not be disclosed. If continued on a
separate sheet, check here:
Name of Source of Income
Address Description of the Principal
Busine Adivi
I hereby swear rm) ~ e aforesaid information is a true and correct statement.
~ 20 ?' D
Signa re of n disdo g D s' ned