Edison Farrow 12/31/2011m M(P~MI ~EAC~i
City of Miami BeOCh, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.oov
OFFICE OF THE CITY CLERK, Robert Percher, Ciy Clerk
Tal: i305) 673-7411, fax: 1305) 673.7254
1 /13/2010
Edison Farrow
536 14th Street #105
Miami Beach, Florida 33139
ILBJfiCT:;° Gay, Lesbian, Bisexual and Transgender
Congratulations! You have been reappointed by Commissioner Jerry Libbin
to the above referenced agency, board or committee for a term ending: 1 213 7 12 01 1.
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
Rebecca Wakefield
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 safey to all who live, work and play in our vibrant, tropical, historic community.
I~
m MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachH.aov
OFFICE OF THE CITY CLERK, Robert Parcher, Ciy Clerk
Tel: 13051 673-7411, Fax: (305) 673-7254
TO Edison Farrow
RE: Gay, Lesbian, Bisexual and Transgender (GLBT)
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 theF/onda Commission on Ethics Guide to the Sunshine
Amendment and Code of Ethics for Public ~cers and Employees, and understand that as a member
of a City of Miami Beach Board and/or Committee, 1 must comply with the financial disclosure' require-
ments 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 calend~ yeafbn which I h~ served. <
~~~//
Edison Farrow
Sworn to and subscribed before me this ~ day of ~r. , 20QQ
Silvia Prieto
Deputy Clerk
*Please visit the Gty of Miami Beach website at www,miamibeachfl.govundet City Gerk/Board and Committees
for additional information regarding the Finandal Disclosure Requirements.
We are committed ro providing excellent public service and safey b all who live, work and play in our vibrant, topical, hisroric communiy.
NAM°_:
~ ! /~ BOAC H
CITY 0= MIAIJI! 3=ACH
BOARG AND COMMi i i EE APPLICATION FORM.
Gn
HOME AD~D,RrESS
PHONE: ~'~'"?'
Hpn
Business Name _
Address: __.~
,r r Uv-,
Lass Name
5 ~c
3s-~~9~
e
~~.
$Q nl~
No,
Profe5S10na LlCenee (describe)
Expires: Anech a copy or the li:ertse
Pursuant to City Code section 2-22(4) a and h: Members of agencies, poards, and committees shall be atflliated with the city; this
requirement shall be fulfilled in the following ways: a) an individual shall have been a resitlent of the Gty 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.
• Resitlent of Miami Beach for a minimum of six (6} months: Yes p or No D
• Demonstrete an ownershipliMerest in a business in Miami Beach for a minimum of six (6) months: Yes D or No p
• Are you a registered voter in Miami Beach: Yes D or No D
. (Please dr_cle 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 p or No ^
Please list your preferences in order of ranking (1) first choice (2J second choice, end [3j third choice. Please note that oniv three t31
choices will be observed by the City Clerk's l?fiice. (Regular Boards of City)
D Affordable Housin Adviso Committee ^ Housin Atrtho
^ Art in Public Places Committee ^ Loen Review Committee
^ Beautification Committee ^ Marine Atrtho
D Board of Ad'ustmertP D Miami 9sach Commission for 1NOmen
D Bu Advia Committee ^ Miami Basch Cultural Arts Councl
D C ftal fm rrts P acts Overs ht CommMtae ^ Miami Beach Sister Cities Pro
D Committee on the Homeless p Norman Shores Local Government Nei h. Im ment
p Committee for Qual Education in MB D Perks and Recreation Facilities Board
^ Commun Deveic ant Aiiviso p Personnel Board
D Commun Retaticns Board D Plannin BoaRf'
^ Convention Carrier Advil Board p Police Citizens Relations Committee
D Debarment Commttiee D Production Ind Council
D Design Review Board' ^ Public 5 Adviso Committee
D Disabil Access Committee ^ 5 Committee
p Fine Arts Board p Sin fe Famii Residential Review Panel
Ga ,Lesbian, Bisexual and 7ransoender GLBT ^ Sustairrabli Committee
^ GoY Advil Committee D Tra ran Reliabi(' & Ac~urrtability Committee 'TRAC"
^ Health Adviso Committee p Tran ortation and Parkin Committee
^ Health Fadlities Atttho ' Board p visitor antl Convention Atrtho
D His snit Affairs Commitme ^ waterlrent Protection Committee
D Historic Preservation Board p Youth Center Atlviso Board
"Board Required to File State Disclosure Fore
Note. if applying for Youth Advisory Board, please indicam your affiliation with the Scott Rakow Youth Cemer
7. Pas service on the Youth Center Advisory Board: Yes C No ~ Years of Service:
2. presen~. pertrcioation m Youth Carrier activdies by your children Yes_~ No =. If yes, please till the names of your children, their
ages, and which programs. List below
Child's ham=. Age: Program.
Cnild~s ham=_
Hd=~ Prooram:
vs-/'Y4S- ~adS
lK~ Cl~~ Positionrax
- .=!?P.b4!' ~a~JRMS\B74P,D 4ND 2OMMnTEh82 Hooimonon0626DP NEH'.do:
wave got ev=~ peer. ~~~e!~Gt°:: ~ ieiDnc "e=_ ~ No ~°S Dlaaee eXDla In Ir ae:air.
• ~c you currently nave a vlaatianls; of Cny a' tJuam~ 3eacr~, copes Yes .. ~N~ I` qes aiease erbtair r a=tai!.
• Do you currently owe the City o` IJliam; Beach any money: Yes . p!No~=~ I` v>=_. explain m detail
• .4.r~° yo/u^curre~t_lv_s=,-tvmc or any`Cit~ 9oarys or ~omm¢taes Ye or No_ L' v_Is w~lor ooard~
• What organizations Ir. the Ciiy
Name.
3each oc you currently Hale membersnlF, Ir,~
Title
Name Title:
• List all properties owned or have an interest in, which re located within the
S ~ ( I V.~~ ~" ~ ~[~S' ~ tom., hvrro
of Miami Beach
• I am now employed by the City of Miami Beach: Yes ~ or Nom. Which department?
• Pursuant to City Cade Section 2-Z5 (bj: Do you have a parent C, spouse =~, child C, brother C, or sister D who Is employee o~~ tns~
City o`. Miami Beach? Check all that apply. Identify the department(s): q t
Tne following Information Is volumary end Is neHher pert of your applieatton nor has arty lwering on your eonaltleradon for appofntmen: P, ie
oeing caked to comply with fetlerel equal oppottunlty reporting requhamems.
Gender: gt/~Jtale ~ Female
Ct: rile vrtgtrt: cheer, one only ,1)
White (Not o' Hispanic Oripin): All persons haung origins in any of the original peoples of Europe, North Africa or the Mitltlte East.
Afrt~n-AmerieanlBleek (Nrn of Htepenlc Origin): All persons having origins in any of the Bled: rectal groups of Africa.
0 Hiepantcc All persons oT Mexican, Puerto Rican, Cuban, Central or Sputh American. or other Spanish culture or origin, regardless of race
~' Aaten or PacfFic felandar: All persons !swing origbu in any of the original peoples of the Far East, Southeast Asia, the Indian Subcontinen.. or
the Pacific islands. This area irxdltates, tvr erampte. China, hrdia, Japan, Korea, the PMllppine tstands end 3omoa.
J Amerfpan In6ian or Alaskan ffetlwa: PJI parsons having origins in any of the original peoples of North Anrerica, entl who maimein
Cukurel iderlttfication through tribal aflUie-tian/or Ixmtnwnhy recopnRion
Physically Challenged: Yes D or NorIl~'
Employment Status: employed ~/ Retired ^ Homemaker p ether p
NOTE. If appoirrted, you will be~required to follow certain taws which apply to city boardfcotmmtttae membees.
These Yaws include, but are not limited to, the following.
o Prohibition from directly dr indirectly lobbying cfty personnel (Miami Beach Ciry Code section 2-459)
., Prohibition from contracting with the dty (Miam~Dade County Code section 2-11.1)
o Prohibition from lobbying before board/committee you have servetl on for period of one year offer leaving office fMlam
Bsach City Code section 2-26).
c Requirement to disclose certain financial interests ono gibs (Mlam~-Dade County Cade section 2-11.1),
(re: CMB Community Development Advisory Committee) prohibition, during tenure and for one year eflar leaving office
from having any ineerest in or receiving any benefit from Communtty Development Block Grant funds for either yoursel'
or those with whom you have buairre~ or immediate family ties (CFR 570.611?.
Upon request, copies of these lams may be ot>tiairtetl from the City Clerk..
"' ne attest to the accuracy and truthfulness of the application and have received, read anC will abitle by Chaote~ ]
A II - of'tMt~lty Cotle "Standartls o` Co du t for City Officers. Empbyaes antl Agency Members."
` ' f(,?
_ ~. ( /U ;.sow ~r'tro~
App erica Slgrta[ure ate/
Name of 4poacan! (~ EP,SE pF;INTi
°lease attach a copy o' your resume to tins applleahor
N6TE: Aopheatipns will remain or. file for a period of one iL earenper year
F;ecewec ir. the Cnn ~ienrr. Jffice ov Ga[~ - ,'ZpOc :,ontro~ No Galr _!
Name o' Geoury :aen~. -
®~ SOURCE OF LNCOME STATEME
Please Print ar Type First Name mioaie rvame~inrnai ~asc name
Disclosure
For Tax Year
Name: ~2 ~~~ ~ ~ ~ ~~~ Ending:
Melling Address: y~ J ~ ' LI ~ r ~ ~ ~/ O7~ G
City/State/Zip: I `\i~~ C~'\ ~ ~J ~ ~ /
Social Security Number: ~ ~~ ~ ~ U ~ ~ 1 ~
Filing as a: ® County Employee;
~ Muniapal Employee of:
Position Reid or sought;
Board where serving: ~~ ~JS~ n~S ~u~~-~ Term or Employment
-~ ~egan on:
Dapartmeurt where employed:
work Address: SC!y'^Q ~l
1f your Rome address u err®ePt from Public records pursuant to
Florida 5'tanrtea § 116.Q7 please dretlc here ((read irrslrrretionsj:
Home Address: ~ ~ ~ I ~/fiL Sfi
Street Address
tyti.P~ ~~ ~ 33 ~ 3~
City State Zip Code
Wease list below in descending order with the Largest source fn-st, the name, address and
principal business actrvlty of every source of your income including public salary you
received or any parson received far your 6anefit or use during the d'esciosure period, The
inrnme of your spouse or arty business partner need not be d'lsciosed. If continued on e
separate sheet, check here: 0
Name of Source of Income
Address Description of the Principal
Business Adi
Sv C (, InS 3 l3 ~
I hare~b,}/~we (or affirm) et the aforesaid information is a true an co act statement.
`~7-C~~, ~- ( l U
Signature or parson discVosing Q to igned
~ Work Telephone: