Rosalie Pincus 12/31/2011/V1, l ,M I B EAG H
City of Miomi Beachr 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeochfl.aov
OFFICE OF THE CITY CLERK, Robert Percher, Ciy Clerk
Tel: (3051 673741 I, Fax: (3051 673-7254
01-26-2010
Rosalie Pincus
11 Island Ave Apt.1512
Miami Beach, Florida 33139
Personnel Board
Congratulations! You have been appointed by the City Commission to the agency,
board or committee named above for a term ending: 11J31/2011.
Pursuant to Ordinance No. 200ti-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 enclosed materials carefully.
Congratulations again and good luck.
Sincerely,
M~"r ~.
Robert Percher
City Clerk
~~
cc: Saul Frances, Parking Director
Ramiro Inguanzo
ATTACHAAENTS:
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, 2-456 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 salary ro all who live, work and play in our vibrant, tropical, hisroric communiy.
Im- MIAMI BEACH
Ciry of Miami Beach, 1700 Convenfion Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.aov
OFFICE OF THE Cltt CLERK, Robert Percher, Ciy Clerk
Tel: 13051 673-7411, Fax: 1305) 673-7254
January 26, 2010
TO: Rosalie Pincus
RE: Personnel Board
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
12/37/2011.
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.
~~w ~J~
Rosalie Pincus
Sworn to and subscribed before me this ~ day of QU 2010.
Deputy Clerk
*Please visit the City of Miami Beach website at www.miamibeachFl.gov under City Clerk/Board and Committees
for additional information regarding the Finandal Disclosure Requirements.
We are committed b providing excellent public service and safey to all who live, work and play in our vibront, tropical, historic community.
~~ .
'~` MIAMI BEACH
NAME: ~( ,V C (J 5
Last Name
HONE ADDRESS: Na ^ -A~~~
PHONE: ITb ~ ~ 3 ~ •.T~'7
Home Work
Business Name:
Name
Fax
Position:
Email
Code
Address:
No. Street City State Zip Code
Professional License (describe)
Expires: Attach a copy of fhe license
Pur~rant to City Code section 2-22(4) a and b: Members of agenaes, 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 ownershiplinterest 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 LrY6r No ^
• Demonstrate an ownershiprnterest 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 ~No ^
• (Please check one): I am now a resident of: North Beach ^ South Beach ~e Beach ^
• I am applying for an appointment because I have special abilities, knowledge, experience. Please list below:
Please list your preferences in order of ranking [1] first choice (2] secorxt choice, and [3] thins claice. Please note that only three f3)
choices will be observed by the Citv Clerk's l?ffice (Regular Boards of City)
^ Art In Public Places Committee
^ Beach Preservation Board
^ Beautification Committee
^ Board of Adjustment
^ Budget Advisory Committee
Committee on Homeless
^ Committee for puality Education in MB
^ Community Development Advisory'
^ Community Relations Board
^ Convention Center Advisory Board
^ Debarment Committee
^ Design Review Board'
^ Disability Access Committee
^ Fine Arts Board
D Golf Advisory Committee
^ Health Advisory Committee
~yHealth Facilities Authority Board
^ Hispanic Affairs Committee
^ Historic Preservation Board'
' Board Required to File State Disclosure form
P9.CLe R1SALL`.B2C Application Ravi^.eA October 25, ?~OZdoc
~_.
CiTb' ~Jr MIAMI eSEA1:H
BO,RRD~ AN^ C~.)i~%tiV9iTTEE :+PPLICATii7N Fc'}ffi'ri
r/~
^ Housing Authority'
^ Loan Review Committee'
^ Mayor's Green Ad-Hoc Committee
^ Marine Authority'
^ Miami Beach Cultural Arts Council
^ Miami Beach Commission For Women
^ Miami Beach Florida Sister Cities
^ Normandy Shores Local Gov't Neigh. Improvement
^ Oversight Committee for General Obligation Bond
^ Parks and Recreation Fadlities Board
Personnel Board'
^ Planning Board'
^ Police Citizens Relations Committee
^ Production Industry Council '
^ Public Safety Advisory Committee
^ Safety Committee
^ Transportation and Parking Committee
^ Visitor and Convention Authority'
^ Youth Center Advisory Board
scanned
5~
,.~
Note: If applying for Youth Advisory Board, please indicate your affiliation with the Scott Rakow Youth Center:
.. Past service on the Youth Center Advisory Board: Yes ^ No ^ Years of Service:
2. Present participation in Youth Centar activities by your children Yes? No n. 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:
..Have you ever been convicted of a felony: Yes ^ or No Gl.lf yes, please explain in detail:
• Do you currently have a violation(s) of City of Miami Beach codes: Yes ^ or Nom 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~No 0. If yes; which board?
• What organizations in the City of Miami Beach do you currently hold membership in?
Name:_ A A,Q__ RJ ~N..~S2.~ Title:
Name: Title:
• List all properties owned or have an interest in, which are located within the City of Miami Beach:
w
~. _•.I am now employed by the City of Miami Beach: Yes D or Noll Which department?
• Pursuant to City Code Saetion 2-25 (b): Do you have a parent a, spouse 0, child 0, brother ~, or sister ~ who is employed by the
City of Miami Beach? Check all that apply. Identity the department(s):
This section is "not required" but desired: Age: years old Gender: Male 0 Female t3/~
Ethnic Of~+~' in (Check one)
White Ia African-American/Black D Hispanic: D Asian or Pacific !slander D American Indian or Alaskan Native ^
Employment Status: Employed D Retired (i>~me-maker D Other ^
ul hereby attest to the accuracy and truthfulness of the application and have received, read and will abide by Chapter 2,
Article VII - of the City Code "Standards of Conduct for City Officers, Employees and Agency Members."
E j'U t_CA ~e ~~.'~S ~ o~o~ ~A~S'et~~C. `9l UC~t
Appli nt's Signature Date N~art a of Applicant (PLEASE
Please attach a copy of your resume to this application
NOTE: Applications will remain on file for a perlad of one (1) calendar year.
Received in City Clerk's Office by Date
Name of Deputy Clerk
Document Control Number (Assigned by Ne City Clerk's Office) Entered By ~ Date
TTTT""""II~~~~ ReiaeC 125/W jo
F \i:Lc R1SALL\H&C.; Appfication Revisetl October 25, 2007.dx 2 ice,
ROSALIE B. PINCUS
I1 Island Avenue Apt. # 1512 Miarm Beach, I7orida 305 532-4247
WORK EXPERIENCE
Miami Beach Senior High School, Miami Beach, Florida
• Counselor, College Assistant Program, 1982-2002
VOLUNTEER EXPERIENCE
;Minority and Women Crtvtted Business Advisory Board, Miami-Dade County
Appointed 2003
Personnel Boazd City of Miami Beach, Member and Past Chairperson
Appoinkd 1999
Mount Sinai Medical Center Board of Trustees, Miami Beach, Florida
Appoinkd 1977, Appointed Life Tirrta 1993
Miami Jewish Home and Hospital for the Aged ,Miami, Florida
Board of DinctorrAppaiated 1986
Douglas Gardens Community Mental Health Center
Board of Dinctorr, Appointcd 1982, Part Pnridcnt
Fine Arts Boazd, City of Miami Beach
Member 1981-1995
Community Relations Board, City of Miami Beach
Member 1995-1997
Miami Beach Commission on the Status of Women, Miami Beach, Florida
Board of Dincta>r 1997-1998
AWARDS RECEIVED
EDUCATION
Unsung Heroine Awazd City of Miami Commission on Status of Women
1995
Key to the City of Miami Beach Presented by Mayor, 1994
Rollins College Winter Park, Florida, Bachelor of Arts
~~.
~a~ SOUR
Please Print or
Name:
Mailing Address;
City/State/Zip:
OF INCOME STATEMEtYT
DiscJesure
l tJC~ For Tax Year
Ending:
0
vo) 1F' 1 `7/~
Social Security Number; ~ ~ ~ ~u~ ~ ~' ~ l ~
Filing as a: ® County Employee:
® Miunicipal Employee of:
Position held or sought:
&oard where sarving;`~:e ~ gpN ~e~ ~~y1-tea Term or Empioyrnent
Eagan an:
Department whore employed:
Work Address:
SF your home sddn:as ES e~cempt from public rewrds pursuant to
Rlorida amia,xc § itS.07 Aimee cheek bare (reed inetructionsj. ® Work Telephone:
Home Address:
Street Address
City
Zip Code
Please list below in descending order with the largest source first, the name, address and
principal business activity of every source of your income inciuriing public salary you
received or arty parson ra~ived for your benefit or use during the dsciosure period, The
income of your spouse ar any business partner need net be discio:sad. If continued im a
separate sheet, cheek here: ~
of
of Income
I here swear (or affirm) that the aforesaid irrfvrrnation is a true and correct statement.
Signature vi person d'es:iosing Date signed