Loading...
Merri Mann 12/31/2011m MIAMI~~~~G~ City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachR aov OFFICE OF THE CITY CLERK, Robert Porcher, Ciy Clerk Tal: 1305) 673-7411, Fax: (305( 673-7254 2/23/2010 Merri Mann 11 Island Ave #2102 Miami Beach, Florida 33139 r-- 1 ~- eoe.PEC /ED ~SUBJECT:_, Committee for Quality Education in MB Congratulations! You have been reappointed by Commissioner Michael Gongora to the above referenced agency, board or committee for a term ending: 12/31/2011. 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. Sincepre_ly, ~ / / Robert Porcher City Clerk cc: Saul Frances, Parking Director Leslie Rosenfeld 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 ore commiMed ro providing excellent public service and safey to all who live, work and play in our vibrant, tropical, hisroric communiy. m MIAMI BEACH City of Miami t3each, 1700 Convention Center Drive, Miami Beach; Florida 33139, wvrH.miamibeachfl aov OFFICE OF THE CITY CLERK, RobeA Parcher, Ciy Clerk Tel: 13051 673-7411, Fax: (305) 673-7254 TO Merri Mann RE: Committee for Quality Education in Miami Beach 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 wet{ as theFlorida Commission on Ethics Guide to the Sunshine Amendment and Code of Ethics for Public Ofi"icers 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. G~~ Merri Man{n~ Sworn to and subscribed before met ' day of 1 ~~ , 20~~C I via rte Deputy Clerk *Please visit the City of Miami Beach website at wvnv.miamibeachfl.gov under City Gerk/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. CD NAME: HOMER PHONE: Business Name: ~ri I APL Address: ~ ~ O ~ 1 r Professional license (describe) No. ~~i ~f ti.i' w'l~li~,d~i ~G; i"~..~i"I €~'~T~F:L"t :~r`iC Ht?r'Vlib9(T f k~4~ ~..F"~~E_it;r"i°I''I~;i°! 'r`~.73dE'~1 Name Fax Email address t Position: ~o.QXl t ZP~` Expires: f#Ft~rcPi a rt~t:~i~ of ri~n fir;ar:esc 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; orb) an individual shall demonstrate ownershipfinterest for a minimum of six months in a business established in the city. • Resident of Miami Beach for a minimum of six (6) months Yes or No • Demonstrate an ownershiplnterest in a busine s in Miami each for a minimum of six (6) monihstY~e or No • Are you a registered voter in Miami Beach: es or No • (Please circle one}: I am now a resident of: North Beach auth Beach Middle Beach • I am applying for an appointment because I have special abilities, k experience. Please list below: YG'}. ~ rec~ • Are you presently a registered lobbyist with the City of Miami Beach? Yes or No ~~".°i~~ ~~~~ iAy/fo/1 S~'Q,~~ Please list your preferences in order of ranking [1] first choice [2] second choice, and [3] third choice. Please note that oniv three (31 choices will be observed by the Citv Clerk's Office (Regular Boards of City) Affordable Housin Adviso Committee Housin Authorit Art in Public Places Committee Loan Review Committee Beautycation Committee Marine Authori Board of Ad'ustment* Miami Beach Commission for Women Bud et Adviso Committee Miami Beach Cultural Arts Council Ca ital Im rovements Pro'ects Oversi ht Committee Miami Beach Sister Cities Pro ram Committee on the Homeless Committee for Qualit Education in MB Normand Shores Local Government Nei h. Im rovement Parks and Recreation Facilities Board Communit Develo ment Adviso Personnel Board Communit Relations Board Plannin Board* Convention Center Adviso Board Police Citizens Relations Committee Debarment Committee Production Indust Council Desi n Review Board* Public Safet Adviso Committee Disabilit Access Committee Safe Committee Fine Arts Board Sin le Famil Residential Review Panel Ga ,Lesbian, Bisexual and Trans ender GLBT Sustainabilit Committee Golf Adviso Committee Health Adviso Committee Health Facilities Authorit Board Trans arenc Reliabilit & Accountabilit Committee "TRAC" Trans ortation and Parkin Committee Visitor and Convention Authorit His anic Affairs Committee Historic Preservation Board Waterfront Protection Committee Youth Center Adviso Board *Board Required to Fiie 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 Yes No . 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: ~~~~~~~ 1 ~.`_C' 7Ail ioF(, ~, ~ 30Ah'D ANL' COMMIT L'ES\FiC F~pg~licatinn[ ~ ?,t7q NEi4V_doc .Have you ever been convicted of a felony: Yes or I~o If yes, please explain in detail: • Do you currently have a violation(s) of City of Miami Beach codes: Yes No . If yes, please explain in detail: • Do you currently owe the City of Miami Beach any money: Yes q~N ~. If yes, explain in detail • Are you on any Citiy Boards or or No If yes; which board? • What organizations in the city of Miami Beach do you currently hold membership in? Name: Taio~ Name: • List all properties owned or have an interest \in, which M.U Can ~ - l ~ ~S ` ~N1! • I am now employed by the City of Miami Beach: Yes • Pursuant to City Code Section 2-25 (b): Do you have a parent ,spouse ,child ,brother , or sister who is employed by the City of Miami Beach? Check all that apply. Identify the department(s): ~ ~ , The following information is voluntary and is neither part of your application nor has any bearing on your consideration for appointment. his being asked to comply with federal equal opportunity reporting requirements. Gender: Male Female in: Check one only (1) of Hispanic Origin): All persons having origins in any of the original peoples of Europe, North Africa or the Middle East. (Not of Hispanic Origin): All persons having origins in any of the Black racial groups of Afdca. Hispanic: All persons of Mexican, Puerto Rican, Cuban, Central or South Amedcen, or other Spanish culture or origin, regardless of race. Asian or Pacific Islander: All persons having origins in any of the odginal peoples of the Far East, Southeast Asia, the Indian Subcontinent, on the Pacific Islands. This area includes, for example, China, India, Japan, Korea, the Philippine Islands and Somoa. American Indian or Alaskan Native: All persons having origins in any of the original peoples of North America, and who maintain Cultural identifcetion through tribal " tion or community recognition. Employment Retired Homemaker Other NOTE: If appointed, you will be required to follow certain laws which apply to city board/committee members. These laws include, but are not limited to, the following: S o Prohibition from directly or indirectly lobbying city personnel~mi 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 boardfcommittee 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 Block 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. "1 hereby attest to the accuracy and truthfulness of the application and have received, read and will abide by Chapter 2, Ar~{cle VI_ i - of the Code "Standards of Con~c~t1 fo/)+City Officefrs,,t Employees and Agency Members." ''///1l.ln/r7/eTit~ (~i//1 /~~ IVIPr.r`. ~ nr...~n Please attach a copy of your resume to is application NOT plicatfons will remain Received in the City Clerk's Office by : ~ r~ within the City of Miami Beach: Which department? for a period of one (1) calendar year. Datp~/ /20 Control No. Date: _/ /2~ /.-. lease Print or Ty Name: Mailing Address: City/State/Zip: pe First Name Middle Name Initial Last Name N1~2~2- S. r'vI~~~J l L # La ~1~,~ a~ ~~ 33, Disclosure For Tax Year Ending: Social Security Number: ~~c~-~ -~2g - ~ ~ Filing as a: ® County Employee: ~ Munidpal Employee of: Position held or sought: ~uA.~ l.'.y1 ~ ~P Q p p D I nf-met-S1-' Board where serving: ~~ I ~ ~ ~ Term or Employment --~~ / 1 Began on: Department where employed: 1.1I'1 i '~ T~hP ~ ~ ~ ~~ ,~ Work Address: (~ i U 2Zo~ ~ ~~.~,n y ~ IVc~ IMl Ctm 1 ~~. i If your home address is exempt from public rewrds pursuant to 305- -0 ~~ Florida Statutes g 119.07 please ohedc here (read instructions): 0 Work Telephone: Home Address: Street Address M~ i s ,>n ° ~e~~ ~L 3 3 3 City 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 income including public salary you received or any person received for your benefit or use during the disclosure period. The inwme of your spouse or any business partner need not be disclosed. If continued on a separate sheet, check here: n Name of Source of Income Address Description of the Principal Business Activi l.t-111 O ~Q I © SeGV ~ ~ f I hereby swear (or affirm) that tfie aforesaid information is a true and wrrect statement. `-/ / lX/(/`tf~ / Yl~ir~ Signature of person disclosing Date signed