Barbara Patchen 12/31/2011~~J~ I A~J~ I ~ E~~ ~#
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, vww.m'amibeochfl aov
OFFICE OF THE CITY CLERK, Robert Parcher, Ciy Clerk
Tel: 13051 673.7419, Fax: (3051 673-7254
01 /26/2010
Barbara Patchen
2068 N. Bay Road
Miami Beach. Florida 33140
Personnel Board
Congratulations! You have been reappointed by the City Commission to the above
referenced agency, board or committee for a term ending: 1213112011.
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~' Ro<b-ert Parcher
U 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 to providing excellent public service and safey ro all who live, work and play in our vibrant, tropical, hisroric communiy.
m MIAMI BEACH
City of MiamP Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.aov
OFFICE OF THE CITY CLERK, Robert Parcher, Ciy Clerk
Tel: 13051 673-7411, Fax: 13051 673-7254
January 26, 2010
TO: Barbara Patchen
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 whirb-Eve served.,
Barbara Patchen
Sworn to and subscribed before me~tlis ~ /day of f , 2010.
Deputy Clerk
*Please visit the Gry of Miami Beach website at www.miamibeachFl.gov untler City Gerk/BOard and Committees
for additlonal information regarding the Finandal Disclosure Requirements.
Wa ore committed ro providing axcellanr public service and safey to all who live, work and play in our vibrant, tropical, historic community.
N~J,AIV~I BEACH
NAME:
HOME ADDRESS:
PHONE: (~~.h .~°"5X -
Home -.I.. WOrK
Business Name: /I D?
Address:
Professional License (describe)
CITY OF MIAMI BEACH
!E EoPP1.+ICATION FORM
Expires: Attach a copy of the license
Pursuant to Clty 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: e) an individual shall have been a resident of the city for a minimum of six
months; orb) an individual shall demonstrate ownership/interest f`or'a minimum of six months in a business established in the city.
• Resident of Miami Beach for a minimum of six (6) months: Yes qor No ^
• Demonstrate an ownership/interest in a businesMiami Beac for a minimum of six (6) months: Yes ^ or No ^
• Are you a registered voter in Miami Beach: Yes r 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 abilitles, knowledge and ~cpprience. ease rst below:
• Are you presently a registered lobbyist with the City of Miami Beach? Yes ^ or No t~i~/,
Please list your preferences in order of ranking [t] first choice [2] second choice, and [3] third choice. Please note that oniv three f31
choices will be observed by fire City Clerk's OfFice. (Regular Boards of City)
^ Affordable Housin Adviso Committee ^Housin Authori
D Art in Public Places Committee ^ Loan Review Committee
D Beautification Committee D Marine Autho
D Board of Ad~ustment' D Miami Beach Commission for Women
D Bud et Adviso Committee D Miami Beach Culture) Arts Council
D Ca ital Im rovements Pro acts Oversi ht Committee D Miami Beach Sister Cities Pro rem
0 Committee on the Homeless D Normand Shores Local Government Nei h. Im rovemeM
D Committee for Qual' Education in MB D Parks and Recreation Facilities Board
D Communi Develo ment Adviso D Personnel Board
D Communi Relations Board ^ Plannin Board'
D Convention Center Adviso Board D Police Citizens Relations Committee
D Debarment Committee ^ Production Indus Council
D Desi n Review Board' D Public Sa Adviso Committee
D Disabil' Access Committee D Safe Committee
D Fine Arts Board
^ Ga ,Lesbian, Bisexual and Trans ender GLBT D Sin le Famll Residential Review Panel
D Sustainabil' Committee
D Golf Adviso Committee ^ Trens aren Reliabii' & Accountabili Committee °TRAC"
D Health Adviso Committee
D Health Facilities Authori Board ^ Trans ortatian and Parkin Committee
^ vshor and Convection Authori
^ His anic Affairs Committee D Waterfront Protecbon Committee
D Historic Preservation Board D 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
1. Past service on the Youth Center Advisory Board: Yes Q(No ^ Years of Service:
2. Present participation in Youth Cen r activities by yo r children Yes^ No G. If yes, please list the names of your children, their
ages, end which programs, List bet
Child's name: ~ ~~ Age: Program:
Child's name:
Age: Program:
Fax
Position: c-
F:\CLEP,\$ALL\aFORMS\BOARD AND COMMITTEES\BC Applicafion062609 NEW.do<
.Have you ever been convicted of a felony: Yes _ c~/No "= If yes, please explain in detail:
• Do you currently have a violation(s) of City of Miami Beach codes: Yes . or No~lf yes, please explain in detail:
• Do you curzently owe the City of Miami Beach any money: Yes ^ or No If yes, explain in detail
• Are you currentl~s$rving on any City Boards or CommRtees: Yes _Xor No ~. If yes; which board?
• What organizations in the City of Miami Beach do you currently hold membership in?
Name: Title:
Name:. Talo
• List all properties owf+sd ~ have an ~fest in, which are located within the City of Miami Beach:
... r~
• I am now employed by the Citq~bf Miami Beach: Yes Cxor Noo. Which department?
• Pursuant to City Code Section 2-25 (b): Do you have a parent D, spouse 0, child q brother G, or sister ^ who is employed by the
City of Miami Beach? Check all that apply. Identify the department(s): A /~(
The following infonnatlon Is voluntary and Is neither part of your applieetlon nor has any beating on your wnaltleredon for appointment. It Is
being asked to comply with fade 1 equal opportunity reporting requirements.
Gender: D Male Female
etnnrc vngm: cnecK one only (1) --
0 White (Not of Hispanic Origin): All persons haWng odgfns In any of the original peoples of Europe, North Afdce or the Mitldle East.
^ Afrlean-AmerieanBlaek (Not of Hispanic Ortgin): All persons having origins In any of the Bieck retie) groups of Africa.
0 Hispantc: All persons of Mexican, Puerto Rican, Cuban, Centre) or South Amencan, or other Spanish culture or ongin, regaMless of rece.
^ Asian or PaeNie Islander: All persons haWng origins in any of the original peoples of the Far East, Southeast Asia, the Indian Subcontinent, on
the Pedfic Islands. This area indudes, for example, China, India, Japan, Korea, the Philippine Islantls end Somoa.
^ Amertcen mdlan or Alaskan Native: Ail persons having odgfns in any of the original peoples of North Amedca, end who maintain
Cultural ideMificsfion through tribal affiliarion or communhy recognition.
^ or Noo.
Employment Status: Employed ^ Retired Homemaker ^ Other ^
NOTE: N appointed, you will be required to follow certain laws which apply to city boardlcommitkee members.
These laws include, but are not limbed 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 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 Blodc 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.
attest to the accurst and truthf ness of the
of the City Co ndar s of nduct for f
Please attach a copy of your resume to
Received in the City Clerk's OfFlce by
and have received, read and will abide by Chapter 2,
Em~lpyees and Agency Me}rrpersJ')
will remain on nle for a period of one (1) calantlar year.
Control No. Date: _! 09