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Antonio Hernandez 12/31/2010m MIAMI BEACH City of Miami Beach, 1700 Convenfion Center Drive, Miami Beach, Florida 33139, www miamibeachFl.aov OFFICE OF 7HE CITY CLERK, Robert Parcher, Ciry Clerk Tel: 13051 673-7411, Fax: 1305) 673-7254 2/4/2010 Antonio Hernandez Jr. 8230 Hawthorne Ave Miami Beach, Florida 33141 Police Citizens Relations Committee Congratulations! You have been reappointed by Commissioner Michael Gongora to the above referenced agency, board or committee for a term ending: 12/31/2010. 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. Si~ rem ~~~ S~ Robert Parcher City Clerk cc: Saul Frances, Parking Director Chief Carlos Noriega 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 Z-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 safely to all who live, work and play in our vibrant, Iropicol, historic community. m- MIAMI BEACH City of Miami Beach, 1700 ConvenKon Center Drive, Miami Beach, Florida 33139, www miamibeachFl.aov OFFICE OF THE CITY CLERK, Robert Percher, Ciy Clerk Tel: (305) 673-7411, Fax: (305) 673-7254 TO Antonio Hernandez Jr. RE: Police Citizens Relations 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: 12/31/2010. 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/orida Commission on Ethics Guide to the sunshine Amendment and Code of Ethics for Public ~czrs 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' 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 calendar year on which I have served. Mtonio z Jr. Sworn to and subscribed before me this ~$ day of ~ 20ii~~ L {off (t.. Silva Prieto Deputy Clerk *Please visit the City of Miami Bearh website at www.miamibeachfl.gov under Gry gerk/BOard and Committees for additional information regarding the Fnandal Disdosure Requirements. We are committed ro providing excellent public service and safety ro all who live, work and play in our vibrant, tropical, historic communiy. m r ;~;i,{,=a'~i~~~ tl-3,CH NAME: HOMEADDRES5: Middle Initial \ ; 7 City State ZiD Code PHONE: j.30$ 1 15 E ~ - ~ ~~ ~i .InCY~1o..-~~tZ ~S ~L~yY~wy. -HOrt7e Work Fax Email address Business Name: ~/~~~'~- Position' N/~ Address: street Pmfessionel License (descnde) Zip Code Expires: Attach a copy of the license Pursuant to City Code section 2.22(4) a and b: Members of agencies, boards, and commRtees shall be affiliated with the city; this requirement shall be fulfilled in the following ways: a) an individual shell 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 at six (6) mordhs: Yea ^ or No ^ . Demonstate an ownership/irrterest in a business in Miami Beach for a minimum of six (6) months: Yes ^ or No ^ . An: ypu a registered voter in Miami Beech: Yes D or No ^ . (Please circf one): I am now a resident of: Nbrth'Beach Sorrth Beach Middle Beach • f arri applying for an appointment because I have special abilities, knowledge and expehence. Please list below: • Are you presently a registered lobbyist wRh the City of Miami Beech? Yes ^ or No 0 Please fist your preferences in orrier of ranking [1j first choice [2] semnd rdroice, and (3j third choice. Please note that oniv three f31 choices will be observed by the City Clerk's Office (Regular Boartis of City) D Affordable Housin Adviso Committee D Housin Autho ' D Art in Public Places Committee ^ Loan Review Committee D Beautification CommtCee D Marine Autho D Board of Ad'ustmertC ^ Miami Beach Commesfon for Women D Bud Adviso Commitiee D Miami Beach Cultural Arta Courtdl D C ital Im nerds P Oversi nt Committee D Miami Beach Sister Cities P ram ^ Committee on the Hamelaes D Normand Shores Local Oovemment Nei h. Im covenant D Commltlee for Duel 1=duration in MB D Parks end Recreation Facilities Board D Commun Devefo meet Adviso D Personnel Board D Commun Relations Board ^ P in Board" ^ Convection Center Adviso Board olioe Cit¢ens Relations Committee D Debarment Committee D Production Ind Council D Desi n Reva3w Boart1' ^ Public S Adviso CommiCee D Disabli Access Committee ^ Sa Committee D Fine Arts Board p Sin le Famll Residential Review Panel D Ge ,Lesbian, Bisexual and Transoertder GLBT D Stuteinabil' Committee D Goli Adviso Committee D Tre aren Rsliabil' & Aoxruntabil' Committee 'TRAC' D Heallh Adviso Commitee D Tren ortetion and Perkin Committee D Health Far9Bties Atrtho Boartl D Visitor and Convention Atttho ' D His snit Affairs Committee D Waterfront Protection Committee D Historic Preservation Board p Youth Cerrter Advis Board "Board Required to Flle Stale Disci Note. If applying for Youth Advisory Board, please indicate your affiliation with the Scott Ftakow j~l j~U S.k~t~~l~ ,~.tl~ . 1. Past service on the Youth Center Advisory Board. Yes 0 No G Years of Service: '- 2 Present p~rp~tic~dn ljbytt/,q~pMaOectivrties by your children Yas_ No = !f yes, please list the names of your children, their ages, and welch programs. rr K r GG Chiltl's name Age: Program'. (1 r .„ Cnild~s name. Hpe~ Program. CfTY Or MIL.MI BEACH BOARD AND COMMITTEE APPLICf,TION FOP.N °~`._L°P'.b AL'\a`~RM,S ~B~ARD AND 20MMI1T:ES~BC AoolicanonOL2509 N°_~'.do; •riave yon ever oeec oonvlcte"_ ~f=_iony Yes o No P vas please expla~ tletaiP. . Do you currently have a vlolation(sj of City o` Miami Beach cotles. Yes . ~No~ I` yes, please erptam Ir. detail: . Do you currently owe the City of Miami Beach any money: Yes . ot~No~ ~ IT yes. explain m detail .Are you curr ntly serving or any Ci/ty Boards or Commute s Yes " or No -. I` vas. whlct board? _~b / f GC ~Cl ~-V~ cGit f /~te1,,~/~a' ~o ~~ . What organizations in the City of Miami Beach tlc you currently holtl membership m? Name: Title: Name . List aft properties owned or have an interest in, which are located within the City of Miami Beach: . I am now employed by the City of Miami Beach', Yes C' or Ne ,~1Nhich department?, • Pursuant to City Code Section 2-25 (b): Do you have a parent S'spouae ^, child C, brother C, or sister D who is employed by the City oft iami Beach~,Cheyk all that~appty. Ident(fy the department(s): ~ / / , [~ ..~ ~ r The following Information is voluntary antl is netthar part of your applteadon nor has any bearing on your eonalderedon for appointment. It Is being askstl to comply with federal equal opporWnky reporting requlremeMS. Gentler: ale p Female cmmc ungtrt: Check one only (7) ^ White (Not of Hispanic Origin): All persons having origns in any of the original peeples of Europe, North Afica or the Mhldle East. Afrttan-AmerieanBlack (Not of Hispanic Origfn): All persons having origins in any of the Black racial groups of Africa. )~fiiapanlc: AIf persons of Mazi~n, Puerto Rtwn, Cuban. Cemrat or South American, or other Spanish culture or origin, regardless of race. U Aafen or Paelfic Islander: All parsons hevklg origins in any of the original peoples of the Far East. Southeast Asia, the fndian Subeominent, or the Pacific Isfamfs. Thk area kldtWes, for etample, China. India, Japan. Korea, the PNtippine Islands end Somoe. J Amedeen Indian or Alaskan Nidlve: All pareorts havhtg origins in any of the original peoples of North Amedca, eM who rnainfein CWturel idarttificefion thiough trtbel atllkadon or wmmunhy recognition. Yes D or NoD. Employment Status: Employed ^ Retired ^ Homemaker 0 Othar,~'_~'~v~- NdTE If appointed, you w11i he required to follow certain taws which apply to ctty boardfcommHLae membere. These taws include, but are not ItmMa~d to, fhe fotfowing: o Prohibition from directly or indirectly lobbying city personnel (Miami Beach City Cade section 2-459). o Prohibition from comrecting with the cRy (Miam~Datle County Code section 2-17.1). o Prohibition from lobbying before boardlwmmittee you have served on for period of one year after leaving office fMlam~ Beach City Code section 2-26). o Requirement io diadoae certain financial interests antl gifts (Miami-Dade County Code sae6on 2-11.7 ). (re: CMB Community Development Advisory Cmnmfkee): prohibition, tluring tenure and for one year after leaving office from having any interest in or receiving any benefu fmm Community Development Block Gram funds for either yoursef' 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. "I hereby attesf to the accuracy and truthfulness of the applieafion and have received, read antl will abide by Chapter 2 Art' le VII ~i~ City Code "Standards of Contluct for City Officers, Emplo ass andr°~eney Mambers.'~ _ I~r~~IO ~-y+~+J~J -Y(CYrI crceL r card's Sigt}ai re Uate Name at Apnhrani /P! crisp PPINT, Please attach a copy of vour resume to this application NOTE: Applications will Recewec in the Chy CIerK's Gfflce q~ on file for a period 01 one (11 calendar year. !O Gate ! 5 :;ontrol scanned IAM4 ~ SOURCE OF INCOME STATEMENT Please Print orTyp~ Name; Melling Address; City /State/ Zip; Disclosure For Tax leer Ending;-L s~y - ~~ ~~-O U Social Security Number: Filing as a: ® County Employee, © Municipal Employee of: Pcsitian held or sought; Board where serving; Poir~ (~~.~ ~,p~s G„„~,, Term or Employment Began an: ~ Tivi. 7~ Department where employed: Work Address: 2f your Home address fs exempt from puhflc records pursuant to worlds Stehtlac § 17.l1.Q7 phmee cbacY, he /re (read tnstruettonsj: ® Work Teielphone: Home Address; ~ ~-3U r~~~r~ ~G Street Address ~~~; ~ ~~ 33Jyi City State Zip Code Please list below in descendiing order with the largest source first, the name, address and prinsdpal business activity of every sounx of your income including public salary you received or arty parson received for your benefit or use tluring the disclosure period. T'he incc-me vF your spouse or any business partner need Hat be disciQSed. If continued on a separate sheet, check hare; 0 Description of the Principal -~tame of Source of Income Address Business Acti " /w,i ~./ I hereby swear (or afRnn) that the aforesaid intermation is a true and correct statement. ~~3//v Sig ature of P~ an t~~ sin9 Bate signed