Alfredo Rey 12/31/2010Im MIAMI BEACH
City of Miami Beach, 1700 Convenfion Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.aov
OFFICE OF THE CITY CLERK, Robert Percher, Ciry Clerk
Tel: (305) 673-7411, Fax: (305( 673-7254
01-20-2010
Alfredo Rey
610 S. Shore Drive
Miami Beach, Florida 33141
_-. Safety Committee
Congratulations! You have been appointed by Commissioner Deede Weithorn
to the agency, board or committee named above for a term ending: 12/31/2010.
Pursuant to Ordinance No. 2006-3543, commencing with terms beginning on or after
January 1st, 2007, the term of board members who are directly appointed by a member of
the City Commission shall automatically expire on December 31 of the year the appointing
elected official leaves office.
If you are unable to accept this appointment or have any questions, please call the City
Clerk's Office at 305-673-7411. Please read the endosed materials carefully.
Congratulations again and good luck.
Sincerely,
~M~,/S~
Robert Percher
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, 2-458 and 2-459
Ordinance No. 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 Employee
We are committed ro providing excellent public service and safety ro all who live, work and ploy in our vibrant, tropical, hisroric community.
m MIAMI BEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachA.aov
OFFICE OF THE CITY CLERK, Robert Parcher, Ciry Clerk
Tel: (305) 673-7411, Fax: (305) 673-7254
TO Alfredo Rey
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: 12/31/2010.
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/arida Commission on Ethics Guide to the Sunshine
Amendment and Cade of Ethics for Public Officers 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.
Alfredo Rey
Sworn to and subscribed before me this ~ da7y~of~~~~l 20~Q
~~~~'yi' "''" „~~
G~ cSilvia Pr tee o
Deputy Clerk
*please visit the City of Miamr Beach website at www.miamibeadiFl.gov under City Clerlc/Board antl Committees
for additional information regarding the Financial Disclosure Requirements.
We are committed ro providing excellent public service and safety fo oll who live, work and play in our vibronl, Tropical, hisroric communiy.
l~:!? is ~ ;~y~i~; ~~/"~~~ C(TY OF MIAM13cACr
2 BOARG~ ND C~P.IIVIMITT=E APPLICt-,TICN FD?N
NAME: ~ i G~O
ame / C~ /yes Nam/e s~ Mlpole Initial
HDME ADDRESS: ~~l] S'~1~~~~`(.~"~-f. V'~ %Y~~i`~/~~~'-~{~~ ~ "3~{~
A/p: No. / .9ouse No.lSrreet Chy S Zip Code
PHONE: ~2Zf -G-,~-O/.ICJ 5G~ 3 t~/- ~ ~{~ ~~/ 3F3 ~ ~~• °~r/k,
Home Work Fax Email address
Business Name. ~c /~'y'L ` PDShion: ~/Lo~Gc'sL
Address: l3~~/G~/f'<lbly Lt/~ /l~.f.~~i~'/~!//~E~Ek /'C 3 3/ ('~
Nc. Tj Street Ciry State Zip.Cotle
Professional License (tlescrrbe) («~~/~ l ~ Expires: ~~l / Atraeh a copy o1 L1e li: ense
Pursuant to Ctty Code section 2-22(4) a and h: Members of agencies, boards, and commfttees shell be affiliated with the chy; this
requirement shall be fulfilled in the following ways: a) an individual shall have been a resident of the dty for a minimum of six
months; or b) an individual shall demonstrate ownership/Irrterest for a minimum of six months in a business established in the chy.
• Resident pf Miami Beach for a minimum of six (6) months: Yes ^ or No ^
• Demonstrate an ownership/interest in a business rn lami Beach for a minimum of six (6) months: Yes ^ or No ^
• Are you a registered voter in Miami Beach: Yes o 0
• (Please drde one): I am now a resident of orfh Beach South Beach Middle Beach
• I am applying for en appointmem because I have special abilities, knowledge a experience. Please list below:
• Are you preserrtly a registered lobbyist with the City of Miami Beach? Yes or No 0
Please list your preferences in order of ranking [1j first choice [2J semnd choice, and [s) thilsi choice. Please note that onN three fsl
chokes will be observed by the Chv ClerMs DRice, (Regular Boards of Ciry)
D Affordable Housin Adviso Committee C Houein Autho
^ Art in Public Places Commitee D Loan Review Committee
D Beautification Commitee D Merme Autho
D Board of Ad'rmtrnerrt' ^ Miami Bseeh Commission for Women
0 Bud Adviso Committee D Miami Beach Cultural Arts Ceundl
D C Itel 1 Ovtsrs Committee D Miami Beach Sirt~r Cities P
D Committee on the Homeless D Nonne Shores tuxal Govemmerrt Ne' h. Improvement
^ Committee for Quat Education in MB ^ Perks and Recreation Facilities Board
D Commun Devalo ant Adviso D Personnel Board
^ Commun Relations Board ^ Plannin Board'
0 Converrtion Carder Advil Board p Police Cft~ns Relations Committee
O Debamrent Committce D Production fnd Council
^ Desion Review Board' D P 'c 5 Adviso Committee
^ Disabli Access Committee a Committee
D Fine Arts Board D Si le Farm Reairterrtiai Review Panel
D Ga ,Lesbian, Bismrual and Trans nder (GLBT D Stuteinabtl Committee
^ Golf Advil Committee D T ran Reliabli' & AcmuntabiliN Comm(dee'TRAC'
^ Heahn Adviso Committee p Tre ortation and Perkin Committee
0 Health Fadtities Au7to Board p Vlsitpr antl Converrtion Atttfto '
D H nic Affehs Committee D Waterfrom Protection Commibee
^ Historic Preservation Board ^ Youth Carrier Adviso Board
'Board Required to File State Disclosure Form
Note: tf applying for Youth Advisory Board, please indicae your affiliation with the Sett Rakow Youth Center
1 . Past service on the Youth Center Ndvisor)~ Board: Yes . ND wears of Service.
2. °resen? panmlpation In Youth Center activities by your children Yes=~ Nc =. Ii yes, please fie? the names of your children, their
egeE, and NmICh programs ! IS? oeIDN'
:hild'S nom=~
Cnitd's nom=_
Age: Progrem:
Ad=- Program
- •.=!?P .SA!'. ~aFJRM.S \B74P,D ?ND ~7MMnTcS\B_ kooimononOG2604 N°_H'.do:
•~avE yo_ =v_.:,_sr CDrv,~teC : ~ i=iur~ "e<_
• Jo you currently nave e vio;atlorns, of C¢y o. IJram.
• Do you currently owe the City of Miam~, Beach env
C9
' vas ole=_se explain rn oe:air
:atlas Yes . o' No _ I` ve<_ oiease ero;a!r ;r ce:ai!
Yes . or No =;. If yes exolam In detail
• Are you currently serv!nc or and alt)' 3oards or ~omm¢tee~ es o' No I` vas whlcr ooardr
• What oryani~ations c. the Cip o' Miami Beach oo you Darr=_ntly nD10 memoersnl,. lr:r
Name
Name
Title
• List all properties owned or have ar. interest in, which are located within the City of Miami Bsach:
• I am now employed by the City of Miami Bsach. Yes ~ or No 1~Vhich department?
• Pursuant to Cfty Code Section 2-25 (b}; Do you have a parent ~, spouse D, chiitl G: brother ~, or sister ~ who is employee oy tne.
City of Miami Beach % Cheek all that apply, Identify the department(s):
The following information Is voluntary and Is neNher pan of your apptieetfon nor has any hearing on your eonsideratlon far appofntmen; 1; i=
oeing asketl tom~comply with federal equal opporWnlty reporting requtremerds.
Gender: C-!'Ntale ~ Female
ctnmc vngln: Check on=_ only (1)
White (Not of Hispanic Jrigin)'. All persons having onglns in any of the original peoples of catrope, North Africa or the Middle East.
~~ n-Ameriean161aek (Not of Hlepenic Origin}: All persons having origins m any of the BIaG; racial groups of Africa.
fYFiispanfc: All persons of Maztean. Puerto Rican, Cuban. Central or South Ameri;an, or other Spanish vulture or odgln, ragartlfess of race
J Asian or Paelfic kMnder: Ail persons having origurs M any of Me original peoples of the =ar cast, Southeast Axis, the Indian Subcontinent. or
the Paelfic lstartds. This area irrdtWes, for , China, India, .taoen, ICOrsa, the PNllpptne tslarttls and Samoa.
J Amerfpan Indian or PJaelcarl Native: All parsons having origins in any M the original peoples of North America. and who maasain
CuIWrBI identffteation through tribal aflilietlon/or~ortr reeopMtion.
'i Physically Challenged: Yes D or NoB/ ~~
Employment StatUS: employed I~ Refired D 4omemaker D Other p
NOTE: If appointed, you will be requhed to follow certain Yaws which apply to arty btsardfeommftfse members.
These laws include, but are not iimtted >o, the following:
.. ?rohibition from tlirectly or indirectly lobbying aih' personnel (IJham~ Beacn City ;;ode section 2-459)
., Prohibl5on firm contracting with the dt1' (Miami-Dade County Code section Z-r i.1 ).
o ?rohibition from lobbying before board/committee you have served on for periotl of one year after leaving office (Mien
Beach City Code section 2-26).
c Requirement to disctaae certain financial interests and gifts (Mlam~-Dade County Code section 2-1 i.1}.
(re'. CMB Community Devefopmertt Advisory Commfttae) prohibition, auring tenure and for one year after having office
from having any hrterest in or receiving any berreftt from Communtty Development Block Orant funds for either voursel'
or those with whom you have business or immedfete family lies (CFR 570.611;.
Upon request, copies of these Vows may be obminetl from the City Cterf;.
"! Hereby attest to the accuracy and truthfulness of the application artd have received, read and will abide by Chapte~
Article VII - of th ^Ity Cod 'Standards o` Gon act or Cm, Officers. 5mployeas and~/'A'Oe~ev Msmbers."
_ ~ ~ ~~ (~2CiC/G (Gc
Applie 's Sigpa are ate Name o1 Noohcem. (P! EASE ~ 'I
PI c attach 8 IIppy o' Vour resume [o th15 appltCe ior.
N6TE: Aooheahons will remain oc fire roc a oenotl o: one ft r Wlenoar year
kecewec m the :m ~ien~ s ~Poce nv mate _ ,ZOI)F ;,ontro~ No bate p`pc
Name o` beouty :IerP. --
®~ SOURCE OF INCOME STATEMENT
Please Print or Type First Name raroare rvamci inrc~ai ~.asz. game
Disclosua
~~ _ /v /f C For Tax Year
Name: // LF~ cF ``\ Ending:
MaliingAddress: Caw S• 5~~~/~E ~~ ~ ~G~ -
city/sbte/zip: I ////~i~1/ ~EAC~~i, ~L. 3 /3' / fL/
Social Security Number: D~3 ~~ ~o~0~
Fling as a: ® County Employee:
~ Municipal Employee of;
Position Field or soughti
Board where serving; ~ rte/ ~ ~~ Term or Emp nt
----1/~~ Began on: / ~ / O
Dapartxrfentwhere employed:
Work Address;
Sf your home address fr from poh8c records purmra~rt to
worido s § SSB.G7 phase drank here (read im~trueNousj: ® Work Telephone:
Home Addres:
Street Address
~y
Zip Code
Please fist beiaw in descending osier with the Largest source first, the name, address and
prindpal business activity of every saurt:e of your income including public salary you
received or any parson rewivad for your benefit or use during the disclosure period, The
income of your spouse or airy business partner Head not be disclosed. If continued on a
separate sheet; check hare: ~
Name of Source of Inrnme
Atltlress Description of the Prinapal
Business Activl
~rG ~ _ 3 sJG ~P%i/ /~3
. ~/ilsv/ /~e•? • 3 /
1 hereby swear (or affirm) that the aforesaid information is a true and correct statement.
~a~ Z i /b
Signetu f per ncii -losing Q to s'_ ned