Elizabeth Camargo 12/31/2011m i~~l/~~~~i BEA~~
City of Miami Beach, 1700 Convention Center Drive, Miami Beoch, Florida 33139, www.miamibeachfl.aov
OFFICE OF THE CITY CLERK, Robert Percher, Ciy Clark
Tel: 13051 673-7411, Fax: 13051 673-7254
01/26/2010
Elizabeth Camargo
1530 West 27th Street
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: 12137/2011.
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
cc: Saul Frances, Parking Director
Charles Carrefio
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 to providing excellent public service and saFey to all who live, work and play in our vibrant, tropical, historic communiy.
m- MIAMI BEACH
City of Miami Beaeh, 1700 Convention Center Drive, Miami Beath, Florida 33139, ynny.miamibeachA.aov
OFFICE OF THE CITY CLERK, Robert Parcher, Ciy Clerk
Tel: 13051 673-7411, Fax: (305) 673-7254
January 26, 2010
TO: Elizabeth Camargo
RE: Capital Improvements Projects Oversight 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
1 213 1 /2 01 1.
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 Ofhcers 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.
~~N
Elizabeth Camargo
Sworn to and subscribed before met ' ~ day of , 2010.
Deputy Clerk
*Please visit the City of Miami Beach website at www.miamibeachFl.gov under Gty Clerk/Board and Committees
for additional information regarding the Financial Disclosure Requirements.
We are committed b providing excellent public service and solety to all who live, work and play in our vibrant, tropical, historic tommuniy.
m- MIAMI BEACH
a
CITY OF MIAMI BEACH
BOARD ANL} COMMITTEE APPLICATION FORM
NAME: L~~Ga ELl?J 18~T)d G
Last Name First Name Middle Initial
HOME ADDRESS: I,
[530 W 2'1kt, $TRSar NIRtYIt 'e f~lCU ({- a314v
Apt No. House No./Street City State Zip Code
PHONE: C~0.S~ 67x1-~LGZ ~goS7 53g'- 1(~ ~~532~ $54~ P,GQT0.fQt) ~'ktt (71
Home Work Fax Email address
Business Name: ~C A~CNIraF,Ct 7AP.~ d- b6816r~ Position: VP~tJCx PA~-
Address: SAO 0.S fd3o~
Nn F}me} Cih. Cb.~e ~:., n..w..
Professional License (descdbe) ~ r;,tt i'1'6CiC Expires: 02~ 2tl i1 Alrach a copy of the llcortse
Pursuant to City Code sectlon 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 ownershiplnterest for minimum of six months in a business established in the city.
• Resident of Miami Beach for a minimum of six (6) months: Yes ~r No ^
• Demonstrate an ownership/interest in a business iry~iami Beach for a minimum of six (6) months: Yes ~'or 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 Iddle Beae
• I am applying for an appointment because I have special abilities, knowledge and experience. ease ist below: ihK~l'1'tTL` tom'
• Are you presently a registered lobbyist with the CRy 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 wilt ba observed by the City Clerk's Office. (Regular Boards of Cdy)
^ Affordable Housin Adviso Commdtee ^Housin Autho
^ Art in Public Places Committee ^ Loan Review Committee
D Beautification Committee ^ Marine Authorit
^ Board of Ad'ustmenY' ^ Miami Beach Commission for Women
^ Bud 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 Fadlities Board
^ Commun' Develo ment Adviso ^ Personnel Board
^ Communi Relations Board ^ Plannin Board'
^ Convention Center Adviso Board ^ Police Citizens Relations Committee
^ Debarment Committee D Production Indust Council
Desi n Review Board' ^ Public Safet Adviso Committee
^ Disabili Access Committee ^ Safe Committee
^ Fine Arts Board ^ Sin le Famil Residential Review Panel
~ ustainabilit Committee
^ Ga Lesbian Bisexual and Tran ender GLBT ^ Trans arenc Reliabilit 8 Accountabilft Committee "TRAC°
^ Golf Adviso Committee ^ Trans ortation and Parkin Committee
D Health Adviso Committee ^ Visitor and Convention Authori
^ Health Facilities Authori Board ^ Watertront Protection Committee
^ His snit Affairs Committee ^ Youth Center Adviso Board
^ Historic Preservation Board
'Board Required to File State Disclosure Form
Note: If applying for Youth Advisory Board, please indicate your affiliation with the Scott Rakow Youth Canter:
1. Past service on the Youth Center Advisory Board: Yes ~ No ~ Years of Service:
2. Present partidpation in Youth Center activities by your children Yes No D. 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.ACLER\$Al'\nPQxMS\Rt.~ARD ANL) CO/v1Ml'lTEES\BC ApplicaYion0s2$09,doc
.Have you ever been convicted of a felony: Yes ~ or No /If yes, please explain in detail:
• Do you currently have a violation(s) of City of Miami Beach codes: Yes ~ or No ~. f yes, please explain in detail:
• Do you currently owe the City of Miami Beach any money: Yes ^ or No ~': If yes, explain in detail
• Are you currently serving on any City Boards or Committees: Yes Thor No ^. If yes; which board?
• What organizations in the City of Miami Beach do you currently hold membership in?
Name: -fG'mPbE~ 8~f1.1 Si~10l.OM Title:~'1EM66~ of (3DR~0 OF 1121.tS't~GS ~ $U06~'~'
Name: Title: COMM 1 TT64
• List all properties owned or have an interest in, which are located within the City of Miami Beach:
lSBo W 2'1~htST M1Rm1 66A~f4 (R84io,GUt11l
• I am now employed by the City of Miami Beach: Yes ^ or No lvvvnich department?
• Pursuant to City Code Section 2-25 (b): Do you have a parent D, spouse ^, child ^, brother ^, or sister ^ who is employed by the
City o1 Miafm`f'i Beach? Check all that apply. Identify the department(s):
The following information is voluntary and Is neither pan of your application nor has any beating on your eonsitleretion for appointment. It is
being asked to wmply with tetlerel equal opportunity reponing requirements.
Gender: ^ Male ^ Female
one
^ White (NOl of Hispanic Origin): All persons having ongins in any of the original peoples of Europe, North Afdca or the Middle East.
^ Afrltan-AmericanBlack (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 witure or origin, regardless of race.
^ Asian or PaclFlC Islander: All persons having ongins in any of the original peoples of the Far East, Southeast Asia, the Indian Subcontinent, on
the Padfic Islands. This area includes, for example, China, India, Japan, Korea, the Philippine Islands and Somoa.
^ American Indian or Alaskan Natlve: All persons having ongins in any of the original peoples of North America, and who maintain
Cultural idengfica6onthrough tribal affliction or community rowgnidon.
Physically Challenged: Yes ^ or Nod.
Emolovment Status: Fmnlnved rv( RofireH n Hnmem~4er n robe, n
NOTE: If appointed, you will be required to follow certain laws which apply to city boardlcommittee 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 Prohibtion 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 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 Blodc Grant funds for either yourself ,
orthose 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 attest to the accuracy and truthfulness of the application and have received, read and will abide by Chapter 2,
ACLicle VII - of the City Code "Standards of Conduct for City Officere, Employees and Agency Members."
L~pa _ 01 X24 ~ to F-'I.tZAfaET1,t 6 CA M IsrC6o
Applicant's Signet DatO Name Of Aoolirant !PI FASF PRINTI
Please attach aeopy ofyourresum this applieatlon
NO . APpllcationswlll remain on a for a pedodrogf one (1) calendar year.
Received in me City Clerk's Office b Date~N7_ 277 Comrol No. Date: _/_/2009
am puty r ~O