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Michael Perlmutter 12/31/2011~~/~~nM~ g~~~~ City of Miami Beaeh, 1700 Convention Center Drive, Miami Beoch, Florida 33139, Yavw miamibeachfl aov OFFICE OF THE CITY CLERK, Robert Parcher, Ciy Clerk Tel: (305( 673-7411, Fax: (3051 673-7254 01!26/2010 Michael Perlmutter 1000 South Pointe Dr. Miami Beach, Florida 33139 Personnel Board 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. Syyi~~ncerely, I- ''~~'`'~ , Robert Parcher City Clerk cc: Saul Frances, Parking Director Ramiro Inguanzo 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 ro providing excellent public service and safety ro all who live, work and play in our vibrant, tropical, hisroric community. m MIAMI BEACH City of Miami Beach, 1700 Convanfion Center Drive, Miami Beach, Florida 33139, ~nvw miamibeachA aov OFFICE OF THE CITY CLERK, Robert Parcher, Ciy Clerk Tel: 1305) 673-7411, Fax: (305) 673-7254 January 26, 2010 TO: Michael Perlmutter 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 12/31/2011. 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. ~~ Michael Perlmutter Sworn to and subscribed before me this ~ day of / ~~//~~, 2010. ~~-~~ Deputy Clerk *Please visit the City of Miami Beach website at www.miamibeachfl.gov under City Clerk/Board and Committees for adtlitional information regarding the Financial Disclosure Requirements. Wa are committed to providing excellent public service and safety W oll who live, work and play in our vibrant, hopical, historic community. !V~ I AIVi I B EAC H NAME: 1 E21 M-u Last Nart HOME ADDRESS: 3 7D ( Apt No. PHONE: 3 y S S3 Hort~ Business Name: I tRlN.r ©ou S . House Nc f~v mlccie Imaal I~,E~~ ~~. 33( 39 State Zip Code Fax Email address n Position: ~x zCU-~: „ft - SP , V 0 Address: Y S 'f K I - /b6 11J/''« '!`. / L K /y/ _~[ CJ lS / D J No. Street ' City State Zip Code Professional license (tlescdbe) N /~ F~cplres: Attach a copy o1 the license 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 city. • Resident of Miami Beach for a minimum of six (B) months: Yes D or No D • Demonstrate an ownershiplinterest in a business in Miami Beach for a minimum of six (6) months: Yes 0 or No ^ • An; you a registered voter in Miami Beach: Yes ^ or No ^ • (Please circle one): I am now a resident of; North Beach South Beach Middle Beach • I am applying for an appointment because I have special abilities, knowledge and experience. Please list below • Are you presently a registered lobbyist with the City of Miami Beach? Yes D or No ^ Please list your preferences in order of renking [1] first choice [2] second choice, and [3] third choice. lease note that only three f31 choices will be observed by the CIN Clerk's Office. (Regular Boards of City) ^ Affordable Housin Adviso Committee ^Housin Authorit D Art in Public Places Committee ^ Lcan Review Committee ^ Beaufification Committee arine Authc ^ Board of Ad'ustment' ^ Miami Beach Commission for Women ^ Bud et Adviso Committee ^ Miami Beach Cultural Arts Council o C ital Im rovements Pro acts Overei ht Committee ^ Miami Beach Sister CRies Pro ram D Committee on the Homeless D Normand Shores Local GovemmeM Nei h. Im rovement D Committee for Quai' Education in MB ^ Parks and Recreation Facilities Board 0 Communi Develo ment Atlviso ersonnel Board !~- D Communl Relations Board ^ Piannin Board• ^ Convention Center Adviso Board D Police Citizens Relations Committee ^ Debarment Committee ^ Produc6onlndus Council ^ Desi n Review Board' ^ Public Sa Adviso Committee ^ Disabiti Access Committee Committee ~ Z-- ^ Fine Arts Board ^ Sin le Famil Residential Review Panel ^ Ga ,Lesbian, Bisexual and Trans ender GLBT ^ Sustainabil' Committee 0 Golf Adviso Committee D Trans aren Reliabi(' & Accountabith Committee "TRAC" ^ Health Atlviso Committee ^ Trans ortation and Parkin Committee ^ Health Facilities Autho ' Board ^ Visitor and Convention Autho ^ His anic Affairs Committee ^ Waterfront Protection Committee D Historic Preservation Board ^ Youth Center Adviso Board "Board ReQuiretl to Flle State Disclosure Fortn 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 D No,~ Years of Service: 2. Present participation in Youth Center activities by your children YesD No D. If yes, please list the names of your children, ages, and which programs. List below: Child's name: Age: Program: Child's name: Age: Program: CITY OF M[AMI BEACM ~ AND COMMITTEE APPLICATION FORM 1 their E\CLEP,\$ALL\oFORMS\BOARD AND COMMITTEES\BC Applicalion062609 NEW.doc .Have you ever been convicted of a felony: Yes 5 or NoT~lf yes, please explain in detail: • Do you currently have a violation(s) of City of Miami Beach codes: Yes or No ~!. If yes, please explain in detail: • Do you currently owe the City of Miami Beach any money: Yes ~ or Nod( If yes, explain in detail • Are you currently serving on any City Boards or Committees: Yesi~ or No =. If yes which board? • What organizact^ions in the CKy of Miami Beach do you curcently hold membership in? Name: Sa l-r~~ Title: ~Q~1 ~ Name: _ Tlna• • List all properties owned or have an interest iltn, which are located wRhin the City of 9 • I am now employed by the City of Miami Beach: Yes ^ or N~6.Whieh department • Pursuant to Clty Code Section 2.25 (b): Do you have a parent ~, spouse ~, child C, brother ~, or sister ~ who is employed by the City of Miami Beach? Check all that apply. Identity the departrnent(s): No The following informadon la voluntary and is neither part of your applleatlon nor has any beanng on your wnslderaflon for appotmment It Is being asked to comply wtth federal equal opporWntty sporting requhemems. Gender: ~Wiale ^ Female ~nic Origin: Check one only (1) White (Not of Hispanic Odgin): All persons having onglns in any of me original peoples of Europe, NoM Atdce or the Middle East. ^ AMcen•AmerlcanBlack (Nat of Hispanic Ortgin): All persons having origins In any of me Bledc redal groups of Atdce. ^ Hispank: All peraoru of Mexican. Pueno Rican, Cuban, Central or Soum Amedcen, or other Spanish culture or odgin, regardless of race. ^ Asian or Pacifle Islander: All pereons having odglns in any of the odginal peoples of the Far East, Southeast Asia, the Indian SubcontlneM, on the Pedfic Islands. This area Indutlea, for example, Chine, IrxIW, Japan, Korea, the PNlippine Islands and Somoe. ^ Amedeen Indian or A18ekan Nadve: All persons having origirs in any of the original peoples of NoM Amedce, and who maintain Cultures ideMttleatlon through tribal afNliatlon or commuMty recognition. Physically Challenged: Yes o or Noll tmpioyment Status: Employe Retired 0 Homemaker ^ Other ^ NOTE: H appointed, you will be required to follow certain laws which apply to city board/committee mambas. These laws include, trot as not Ilmked to, the following: o Prohibition from directly or indirectly lobbying city personnel (Miami Beach City Code secion 2-459). o Prohibition from contrecting with the dty (Miami-Dade County Code section 2-11.1). o Prohibition from lobbying before board/commitlee you have served on for period of one year after leaving office (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 Deveopment Advisory Committee): prohiblfion, during tenure and for one year after leaving office, from having any interest in or receiving arty benefit from Community Development Blodc Grant Funds for either yourself , or those with whom you have business or immediate family ties (CFR 670.611). Upon request, copies of these laws may be obtained from the City Clerk. "1 hereby at est to ~ to accurecy and truthfulness of the application and have received, read and wlli abide by Chapter 2, Article VII o th Code "Standards of Conduct for City Offices, Employnees a\nd Agency beJ~s _ /~ 2 ' ~l "' ~ U /''`~iC ftl~Q, //k IQ lCtc. Ij APPU e e igneture Date Name of Apphcent (PLEASE INT) Please aasch a copy of your resume to this applieatlon NOTE: Appllcatlons will remain on file for a psrlod of one (1) calendar year. r<ecerveo m the City Clerk's Office by : Date: _/ 2009 Comrol No. Date: _/_2008 Name of Deputy Clerk ®~ SOUR Please Print or Name: ~ C ~L Melling Address; />D S City/State/Zip: , ~4Mi OF INCOME STATEMEh1T k1~r:, ~ ~7~ / ~~,, ~( 33135 Disclosure For Tax leer Ending; Social Security Number; / ~ ~ `~ 2 - Y 2 ~r 7 Filing as a: ® County Emp{oyee: ® Municipal Employee af: Position Fisld or soughb Board where serving; Dapartmentwhare employed: Tenn or Elmployment Began on: Work Address; ~S `I ~.•_~% ! C.~ ~ l D•~ S ~~~ /F/1 ~ //.! tfi ~S j n door home atlnn~ a ®camvt t+om pabfrc rseordc purmta~rt m ~ J2 3 Y!-D7~~ Rlorros smmeec 5 i.ts.m pleeee made Hare {rmd i~srtuSfonsj: ® Work Telephone: Home Address; Street Address city State Zip Code Please fist below in desr~nd'ing order with the Largest source first, the name, address and prindpal business aciiVlty of every source of your income including public salary you received or arty parson rereived for your 6eneifit or use during the disclosure period, T'he income of your spouse ar arry husine~ partner Head not be desciorsed. If continued on a separate sheet, ehadc here; ~ Addrees 1 hereby swear (or affirm) that the aforesaid icrFormation is a true and correct statement. _ Dz -,~~--/o Sig u f p son dis~iosing Date signed