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Christina Cuervo 12/31/2011m MIAMI BEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beoch, Florida 33139, www.miamiheachfl.oov OFFICE OF THE CITY CLERK, Robert Percher, Ciy Clerk Tel: 13051 673-7411, Fax: 13051 673-7254 01 /26/2010 Christina Cuervo 4325 N. Meridian Ave Miami Beach, Florida 33140 Capital Improvements Projects Oversight Congratulations! You have been reappointed by the City Commission to the above referenced agency, board or committee for a term ending: 12131/2011. 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, ~.' ~=~~ J~ Robert Percher (,~ City Clerk cc: Saul Frances, Parking Director Charles Carrefio ATTACHMENTS: Letter of Appointment Oath Ciry 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 commiBed to providing excellent public service and salary ro oll who live, work and play in our vibrant, Tropical, hisbric communiy. m MIAMI BEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www miamibeachfl.aov OFFICE OF THE CITY CLERK, Robert Percher, Ciy Clerk Tel: 13051 673-7411, Fax: 13051 673-7254 January 26, 2010 TO: Christina Cuervo RE: Capital Improvements Projects Oversiaht 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 Florida Commission on Ethics Guide to the Sunshine Amendment and Code 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" requirements 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. Christine Cuervo Sworn to and subscribed before me this 3 day of _, 2010. Clerk / 1/~4~ *Please visit the City of Mlami Beach webslte at www.miamibeachfl,gov under City CIerWBOard and Committees for additional information regarding the Financial Disclosure Requirements. Wa ore committed ro providing excellent public service and sofey ro oll who live, work and play in our vibrant, tropical, hisroric communiy. NAME: HOME ADDRESS: PHONE: ~()') ° .~S 1 'b ! 7 ~ , HomTe~ ''~ ~ ~ WorJ~... /~ ~ Fax` 1 Business Name: l 1~ 11(~JJ=~~~Q1.1 1G1~11~ Position: V 7 City Address: No. Street City State Zip Code Professional License (descdbe) Expires: Atdach a copy ofthe ticense 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 dty.' • Resident of Miami Beach for a minimum of six (6) months: Yes~or No ^ • Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six (6) months: Yes or No ^ • Are you a registered voter in Miami Beach: Yes~or No ^ • (Please is rde one): I am now a resident of: ortfi Beach South Beach Middle Beach n~'' • I am applying for an appointment because I have special abilities, knowledge and experience. ease list below: 1~'f • Are you presently a registered lobbyist with the City of Miami Beach9 Yes ^ or No~ ~~ic. s)F,Wt Please list your preferences in order of renking [1] frst choice [2] second choice, and [3] third choice. Please note that only three 131 choices will be observed by the City Clerk's Office. (Regular Boards of City) ^ Affordable Housin Adviso Committee ^Housin Autho ^ Art in Public Places Committee ^ Loan Review Committee ^ Beautification Committee ^ Marine Authorit ^ Board of Ad'ustment' ^ Miami Beach Commission for Women ^ Bud et Adviso Committee Ca ital Im rovements Pro ects Oversi ht Committee ^ Miami Beach Cultural Arts Council ^ Miami Beach Sister Cities Pro ram ^ Committee on the Homeless p 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 ^Communit Relations Board ^ Plannin Board' ^ Convention Center Adviso Board ^ Police Citizens Relations Committee ^ Debarment Committee ^ Production Indust Council ^ Desi n Review Board* ^ Disabilit Access Committee ^ Fine Arts Board ^ Public Safet Adviso Committee ^ Safe Committee ^ Sin le Famil Residential Review Panel D ^ Ga ,Lesbian Bisexual and Trans ender GLBT ~ ^ Sustainabilit Committee ^ Trans arenc Reliabili 8 Accountabilit Committee °TRAC" D Golf Adviso Committee ^ Trans ortation and Parkin Committee ^ Health Adviso Committee ^ Health Facilities Authorit Board ^ His anic Affairs Committee ^ Visitor and Convention Authorit ^ Waterfront Protection Committee ^ Youth Center Adviso Board ^ Historic Preservation Board 'Board Re ufred to File State Disclosure Form 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 P' 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: Name ~]TY ~~ ttAlAM6 g~Aeaa AI~C~ COMMITTEE AF'PLICATiC?N F®RM E~.CL:[2\"~At1ioFORMti$\E!OAKU A.NJ ~.6MMi7TEESVBC Apul~ccifianOt~2$09.doc .Have you ever been convicted of a felony: Yes ^ or No ~ yes, please explain in detail: • Do you currently have a violation(s) of City of Miami Beach codes: Yes o or NOyS, If yes, please'explain in detail: i r :t • Do you currently owe the City of Miami Beach any money: Yes ~ or Nom If yes, explain in detail ~ _ , ., .. • Are you currently serving on any City Boards or Committees: YegE1 or No ~.. 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 owned or have an interest in, which are located within the City of Miami Beach: ~E3u I.lartnt..ai. ~,ie .~. ~~ S.~otA.4e ~2tse • I am now employed by the City of Miami Beach: Yes ^ or Nty~ Which department? • Pursuant to City Code Sectlon 2-25 (b): Do you have a parent D, spouse ~, child 0, brother D, or sister ~ who is employed by the City of Miami Beach? Check all that apply. Identify the department(s): .1 ~ ~ '`r ThefolloWing~information is voluntary and Is neither part of your application nor has any beadng on your eonsideretlon for appointment. It Is being asked~to comply with federel equal opportunity reporting requirements. Gender: ^ Male ~cemale Ethnic Origin: Check one only (1) ^ Whhe (Not of Hispanic Origin): All persons having origins in any of the odginal peoples of Europe, North Africa or the Middle East. ^ African-AmericanlBlaek (Not of Hispanic Origin): All persons having odgins in any of the Black rectal groups of Africa. ~Hispanle: All persons of Mexican, Pueno Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race. ^ Asian or Pacific Islander: All persons having odgins in any of the odginal peoples of the Far East, Southeast Asla, the Indian Subcontinent, on the Pacific Islands. This area indutles, for example, China, India, Japan, Korea, the Philippine Islantls and Somoa. ^ American Indian or Alaskan Nadve: All persons having odgins in any of the odginal peoples of North America, and who maintain Cultural identification through tribal affiliation or community recognition. Physically Challenged: Yes ^ or Nod. Employment Status: Employeti~ 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 ofice (Miami Beach City Code section 2-26). o Requirement to disclose 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 far 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 Cleric. "1 hereby attest to the accuracy and truthfulness of the application and have received, read and will abide by Chapter 2, A V~I Q- off t~ City Code "Standards of Cond ct for City Officers, Employees and Agency Members." X_A7C-U Q ~ ,t c-' .Z ~f ~~1 J `" / I (....~{., t,~ ~d r.lo~ Please atfaeha copy of,your.resume to this applicatlon NOTE: Applications wllFremaln on fllefor apenod of one (t) calendar year. Receivetl in the City Clerk's Office by : Date: _/ /2008 Conhol No. Date: _/ /2009 Name of Deputy Clerk ®~ SOURCE OF INCOME STA Please Print or Name; Iii n w" Mailing Address; ~.3ZS ' n ~°-~/ / I ~ city/state/Zip: l ~- 331y J e2 ~ •'15 • ova Social security Number: Fliing as a: ® County Employee; © Muniapal Employee of: Disclosure For Tax Ye3ar Ending: ~,y~G Position held or sought; C I ~ C~ C Cofl11 Board where serving; ~ 1 AA~I ( Tenn or Empl mant 9egan an Departrrrant where employed: Work Address: Sf year home eddreas u ulcamPt from pu6fic rowrd~ pursuant to wmtrm stemtc 5 ttsm pYae~ dledc ~ irmd irlotrne[lellsj: ® Work Telephone: Home Address; Sireat Address ~' State Zip Code Please list below in descending order with the Largest source first, the name, address and prinapal business ariivity of every source of your income including public salary yon received or arty parson rereived for your benefit or use during the d'esrJosvre period, The income aF your spouse ar any business partner need not be disclosed. If corrtinuad on a separate sheet, check hare; ~ Kama of sources of Income Address Desoripltion of the Prinopal Butsiness A[.tiv ~ F.a,~ 5 ! ll~- L tcx ~ 6L7 ,/.s 1 here }~ swear (vr affirm) that the aforesaid irrfvrrnation is a true and correct statement. tYT o~. i 2~ Signature of p rson dlsclosing B t signed