Jared Plitt 12/31/2011m MIAM BEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl aov
OFFICE OF THE CITY CLERK, Robert Percher, City Clerk
Tel: 1305) 673-7411, Fax: 13051 673-7254
1 /19/2010
Jared Plitt
9721 E. Bay Harbor Drive, #2A
Bay Harbor, Florida 33154
SUBJECaTe•. Police Citizens Relations 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.
Sincerely,
Robert Percher
City Clerk
ee: Saul Franees, Parking Director
Chief Carlos Noriega
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 - Gu+de to the Sunshine Amendment and Code of Ethics for Public Officers and
Employees
We ore committed to providing excellent public service and safety to all who live, work and ploy in our vibrant, tropical, fllstOflC community.
m MIAMI BEACH
City of Miami Beach, 1700 Convention Confer Drive, Miami Beach; Florida 33139, www.m'am'beachfl aov
OFFICE OF THE CITY CLERK, Robert Percher, City Clerk
Tel: 13051 673-7411, Fax: 13051 673-7254
TO Jared Plitt
RE: Police Citizens Relations 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 Ohicers 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 (depend' on the ~ard or committee on which
I serve) on July 1st, following the closing of the calendar ye r n whicla'yhave served.
~~SJa~red Plitt!
Sworn to and subscribed before a this / day of /'~ u , 20(f 0.
~' D ~~~,
Silvia Prieto
Deputy Clerk
*Please visit the City of Miami Beach website at www.miamibearhFl.gov under Ciry gerk/BOard and Committees
for additlonal infortnadon regarding the Finandal Disdosure Requirements.
We are committed ro providing excellent public service and safety ro all who live, work and play in our vibrant, tropical, historic community.
~ MIAMI EH
NAME: _~
HOME ADDRESS:
PHONE: `~°S ~t,
i t'1'
Last
No./Street
CITY (2F MIAE~I BEACH
AND CC)tVl]N]TTEE APPLICATI(3N FORIt~
~">~ ry
State Zip Code
Home Work Fax Emil address
Business Name:22 ~o,Cf~. g~,lY ~~0 P~ A Position: ~UJI.r! ~ ~~QS;(l.~
Address: ~~1 L~IS9 _51". ~~~j_ (fig. I-L-' ~Y_
Professional License (describe)
Expires:~_ Attach a copy of the license
Pursuant to C+ty 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 ,minimum of six
months; or b) an individual shall demonstrate ownership/interest for a minimum of six months in a business e~s~blis$d in16e aty.
--t o NN
• Resident of Miami Beach for a minimum of six (6) months: Yes orr`Jo1 ,/'~ -C v
• Demonstrate an ownership/interest in a business in Miami Beach for minimum of six (6) month9. Yes/ or Na g
• Are you a registered voter in Miami Beach: Yes or~l Ur-,-,, w -~
• (Please circte one): I am now a resident of: North Beach South Beach Middle Beach ~ N
• I am applying for an appointment because I have special abilities, knowledge and experience. Please list belod%: y ~
u' 2 '41
• Are you presently a registered lobbyist with the City of Miami Beach? Yes or® p ~ ~
Please list your preferences in order of ranking [t] first choice [2] second choice, and [3] third choice. Please not~ratvrlly three 131
choices will be observed by the Citv Clerk's Office. (Regular Boards of City)
Affordable Housin Adviso Committee Housin Authori
Art in Public Places Committee Loan Review Committee
Beautification Committee Marine Autho '
Board of Ad'ustment` Miami Beach Commission for Women
'LBUd 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 Government Nei h. Im rovement
Committee for Qualit Education in MB Parks and Recreation Facilities Board
Communit Develo ment Adviso Personnel Board
Commun' Relations Board Plannin Board`
Convention Center Adviso Board Police Citizens Relations Committee
Debarment Committee Production Indust Council
Desi n Review Board` Public Safe Adviso Committee
Disabilit Access Committee Safe Committee
Fine Arts Board Sin le Famil Residential Review Panel
Ga ,Lesbian, Bisexual and Trans ender GLBT Sustainabil' Committee
Golf Adviso Committee Trans aren Reliabii' & Aocoun[abil' Committee "TRAC°
Health Adviso Committee Trans ortation and Parkin Committee
Health Facilities Authori Board Visitor and Convention Authori
His anic Affairs Committee Waterfront Protection Committee
Historic Preservation Board Youth Center Adviso Board
`Board Required to File State Disclosure Form
Note: If applying for Youth Advisory Board, please indicate your affiliation with the Scott Rakow Youth Center:
t. 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:
F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\tiC Applicatian062609 NEW,doc
.Have you ever been convicted of a felony: Yes ol~t If yes, please explain in detail:
vv
• Do you currently have a violation(s) of City of Miami Beach codes: Yes or, loo) . If yes, please explain in detail:
• Do you currently owe the City of Miami Beach any money: Yes~~or~o~ . If yes, explain in detail
• Are you curcently servi on any City Boards or Committees: )yes;' or No If yes; which board?
__ _ ~C ~.c. \~JJ
• What organizations in the City of Miami Beach do you currently hold membership in?
Name: Title:
Name: Title:
• List all propert'es owned or have an interest in, which are located within the City of Miami Beach:
~`~`~ `~~ ~~ S°r ~ ~l0 6 I`~.~, F L ~~ I`l a
• I am now employed by the City of Miami Beach: Yes orrNa .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): ' ~ (
The following Information is voluntary and Is neither paR of your application nor has any bearing on your consideration for appointment It is
being asked to comply with fetlerel equal opportunity reporting requirements.
Gender:
Female
ahntc origin: GheCK one only (1)
r rte Not of His anic Ori in :All ersons havin on ins in an of the on final
( p g ) p g g' y g peoples of Europe, North Africa or the Middle East.
African-AmerlcaNBlack (Not of Hispanic Origin): All persons having origins in any of the Black racial groups of Africa.
Hispanic: All persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regarclless of race.
Asian or Pacific Islander: All persons having origins in any of the original peoples of the Far East, Southeast Asia, the Indian Subcontinent, on
the Pack Islands. This area includes, for example, China, India, Japan, Korea, the Philippine Islands and Somoa.
Amedcan Indian or Alaskan Native: All persons having origins in any of the original peoples of North America, and who maintain
Cultural identification through tribal affiliation or community recognttion.
Employment Status: ~rtiployed~) 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 indirectly lobbying city personnel (Miami Beach City Code section 2-459).
o Prohibition from contracting 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 office (Miami
Beach City Code section 2-26).
o Requirement to disGose certain finandal 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 benefd 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.
"I hereby st to a accuracy and truthfulness of the application and have received, read and will abide by Chapter 2,
Article VI -of th ty Code "Standards of For)duct for City Officers, Employees and Agency Members."
a copy of your resume to this applicadon
NOTE: Applications will
on file for a pedod of one (1) calendar year.
Received in the City Clerk's Office by : ~ =1->. u-E'J~~J~~ Date:/ /l2lfB9-Control No. Data: _/ /ZSQ$