Jessica Londono 12/31/2010t.
rm- ,ran I ;~,l,,nt E ~ SAC ~
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, W.vw m' m'beachR o0
OFFICE OF THE CITY CLERK, Robert Parcher, Ciy Clerk
Tel: 13051 673-7411, Fax: 1305) 673-7254
02-10-2010
Jessica Londono
110 Venetian Way
Miami Beach, Florida 33139
Beach
Congratulations! You have been appointed by Mayor Matti Herrera Bower
to the agency, board or committee named above for a term ending: 12/31/2010.
Pursuant to Ordinance No. 2006-3543, 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,
~-y~ ~elLt ~G~k:~~/ S
Robert Parcher /
City Clerk
cc: Saul Frances, Parking Director
Diana Martinez
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, 2-458 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
m- MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach; Florida 33139, www.miamibeachR.aov
OFFICE OF THE CITY CLERK, Robert Parcher, Ciy Clark
Tel: (305( 673-7411, Fax: (305( 673-7254
TO Jessica Londono
RE: Miami Beach Sister Cities Program
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
Amendmentand Code of Ethics for Pub/ic Olfic~is 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.
Jessica Londono
Sworn to and subscribed before me this ~ day of ~_, 20~~
f ~ ~.~-~
Silvia Prie o
Deputy Clerk
*Please visit the City of Miami Beach website at www.miamibeachfl.gov under City perk/BOard and Committees
for additional information regarding the Financial Disclosure Requirements.
We are committed ro providing excellent public service and safety ro all who live, work and play in our vibrant, tropical, hisroric communiy.
m MIAN'~EACH
NAME:
HOME A
PHONE:
Business
Address:
Professional License (describe)
Expires: Attach a copy o/the IJcense
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: a) an individual shall have been a resident of the city for a minimum of six
months; orb) 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 (6) months: Year No ^
• Demonstrate an ownership/interest in a business in Miami BeaF;h for a minimum of six (6) months: Yes ~9 No
• Are you a registered voter in Miami Beach: Yes No ^
• (Please circle one): I am now a resident of: North Beach South Beach Middle Beach
• I am applying fowr pa Ap oin en be~(ce~us IQhave e ial abilitie~, k~n^p~rie~ . ~ g~~ 4p~lgw:
• Are you preslerRly a lreg~te ob ykt wr~fi the ity of Miami e8 adFf? ~es C or ~~ I" / (~j
Please list your preferences in order of ranking [t] first choice [2] second choice, and [3j third choice. Please note that only three (31
choices will be observed by the CIri Clerk's Office. (Regular Bpards of City)
^ Affordable Housin Adviso Committee ^Housin Authorit
^ Art in Public Places Committee ^ Loan Review Committee
^ Beautification Committee ^ Marine Authori
^ Board of Ad'ustment' ^ Miami Beach Commission for Women
^ Bud et Adviso Committee D Miami Beach Cultural Arts Council
^ Ca ital Im rovements Pro'ects Oversi ht Committee iami Beach Sister Cities Pro ram
^ Committee on the Homeless Normand Shores Local Government Nei h. Im rovement
Committee for Quali Education in MB ^ Parks and Recreation Facilities Board
^ Communi Develo ment Adviso ^ Personnel Board
^ Communi Relations Board ^ Plannin Board'
D Convention Center Adviso Board ^ Police Citizens Relations Committee
^ DebartneM Committee ^ Production Indust Council
^ Desi n Review Board' ^ Public Safe Adviso Committee
D Disabil' Access Committee ^ Safe Committee
^ Fine Arts Board D Sin le Famil Residential Review Panel
^ Ga ,Lesbian, Bisexual and Trans ender GLBT ^ Sustainabili Committee
^ Goff Adviso Committee ^ Trans aren Reliabll' 8 Accountabilit Committee "TRAC°
^ Health Adviso Committee ^ Trans ortafion and Parkin Committee
^ Health Facilities Author' Board p Visftor and Convention Authori
^ His snit Affairs Committee ^ Waterfront Protection Committee
^ Historic Preservation Board ^ Youth Center Adviso Board
"Board Required to Flle 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 ^ No ^ Years of Service:
2. Present participation in Youth Center activities by your children YesD No C. 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:
F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC Application062609 NEW.doc ~/ 7~ /
CITY OF MIAMI (BEACH
2D AND COMMITTEE APPLICATION FORM
.Have you ever been convicted of a felons ~ or Noyr; if yes, please explain in detai
• Do you currently have a violation(s) of City of Miami Beach codes: Yes ~ or No~lf yes, please explain in detail:
• Do you currently owe the City of Miami Beach any money: Yes ~ or No~lf yes, explain in detail
• Are you currently serving on any City Boards or CommRtees: Yes ^ or NI'~. If yes; which board?
• What organizations i(~l~the~C' ,y,~off Mi ml(geach do you currently hold membership in,?, `~M ' ,,, ~
Name: m. ~._ ~i- 1~ r J r~ ~ 1 f]~~.Vt~ Title: C q" Wu I KwA vJ
Name: Title: ~a(
• List all properties owned or have an interest in, which are located within the City of Miami Beach:
• I am now employed by the Ciry of Miami Beach: Yes ~ or Not"]~QWhich department?
• Pursuant to City Code Section 2-25 (h): Do you have a parent ^, spouse ^, child ^, brother ~, or sister ^ who is employed by the
City of Miami Beach? Check ali that apply. Identify the department(s): n If1
The following information is voluntary and Is neither part of your application nor has any bearing on your eoneideredon for appointmem. It Is
being asked to comply with federel equal opportunity reporting requirements.
Gender: ^ Male
ecnmc c.rrlgm: anecK one omy (1)
~jPlhite (Not of Hispanic Origin): All persons having odgins in any of the original peoples of Europe, North Africa or the Middle East.
,,,^aaa ~~lAfdcan-AmerlwNBlack (Not of Hispanic Odgin): All persons having odgins In any of the Black racial groups of Atka.
yavrlspanle: Ail persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or odgin, regardless of race.
!^ Ian or Pacific Islander: All persons having odgins in any of the odginal peoples of the Far East, Southeast Asia, the Indian Subcontinent, on
the Padfic Islands. This area includes, for example, China, India, Japan, Korea, the Philippine Islands end Somoa.
^ Amercan Indian or Alaskan Native: All persons having odgins In any of the original peoples of North Amedce, and who maintain
Guttural identification through tdbaf afflliadon or community recognition.
Physically Chalienped: Yes ^ or Non.
Employment Status: Employec~7 Retired ^ Homemaker ^ Other ^
NOTE: If appointed, you will be required to follow certain laws which apply to city board/commktae members.
These laws include, but are not limited 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 benefd 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.
"~aIrr~~hrr~~e~~revv6~6~ aatteeEte-tP (` h'~Y and truthfulness of the application and have received, read and will abide by Chapter 2,
tirds of Con uct f°~ City Officers, Emp oyees and Age^Fy Members."
~' X1211 ~~ `~2SSt Ca IA ~~-l~
Applicanrs Signature Dale Name of Applicant (PLEASE PRINT)
Please attach a copy of your resume to this apptteadon
NOTE: Applicetlona will remain on file for a period of one (1) calendar year.
Recervetl in the C~1 Ofe~b~ce by : I ~~ Df Date: K~`/2 9 Control No. ~fN Dat ~ _/ @009
~~.. 1.:- °. .: ~ ` . > , t Name o Deput~lerk ~-~
(; ~ ,:: ~_~. z~ scanned
I®~
Please Print or
SOURCE OF INCOME STA
Name:
Melling Address:
City/State/Zip:
Social Security Number;
~, 33r 3
Di6C{Q6Ue
For Tax Ysar
Ending;
o~X ~~ 3~~(
Filing as a: ® County Employee:
® Municipal Employee of:
Position held or sought, G ~ 1 Sl~s/S
Board where serving; ~1 ~ ~~~ Term or Employment
/^~ ~~ Began/an:
Department where employed: ~~ /-4fA U''``~~ u ~~ //~ ~/
Work Address: ["{ ~ U ~>~Q,, ~ (~liH~^-/ , M i~
if your Dome sddreas rb exempt from public retards pursuant >x r2 n L ? S g (~"7G/s'
Fonda SYaix+tea § 118.Q7 plaeee ehadt here (read iust:ruetionsj: ® Work Telephone: '~lJ J
Home Address:
t l to ~/~ n.e~n
~~ Street I
Clty
State
.~_
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 inwme including public salary you
received or any parson received far your benefit or use during the disclosure period, the
income of your spouse or arty business partner need not be disciased. If continued on a
sapara~ sheet, check here; 0
Description of
of Income
I hereby swear (or affrrm) that the aforesaid irrFDrmativn is a true and correct statement.
Z (~' a
Signature of person disclosing Bate si ned