Regina Berman 12/31/2011
2/10/2010
Regina Berman
7970 Biscayne Point Circle
Miami Beach, Florida 33141
SUBJECT: Community Relations Board
Congratulations! You have been reappointed by Commissioner Michael Gongora
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,
/~~i~~~~Z/Sy
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Barbara Hawayek
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
m MIAMI BEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachR.aov
OFFICE OF THE CITY CLERK, Robert Percher, Ciy Clerk
Tel: 13051 673-7411, Fax: (305) 673-7254
TO Regina Berman
RE: Community Relation 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 pertonn 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/orida 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' 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.
yeefi
Regina Berman
Sworn to and subscribed before me this ~~daQy oaf ~ 20d 0
Silvia Prieto
Deputy Clerk
'Please visit the City of Miami Beach website at www.miamibeachfl.gov under Ciry gerk/Board and Committees
for additional information regarding lfie Fnancial Disclosure Requirements.
We are committed b providing excellent public service and safely to all who live, work and play in our vibrant, tropical, historic community.
NAME'
Las
CfTY ~F MIAIJI! 3cACr•
RG AND COfVIMITT°_E APPLICG.TIDN FORN
ame
Initial
HDMc ADDRESS; ~~ 6/fiQ ~ /AJ k OpJ,!/T C JQ /~~ /~ ,~/cJ/
Ap: No. H se NcJStreet City Srate Zlp Code
PHON_: ~~S a~gsa~~o lROt~4J~~v 3os ~av -,•sa-~,r /I~a,g,,:.c.,.oro~.x.
Home Work rax email address
Busines<_ Name: fA l~ <'~~~~t'~A ALQS' Position: ~~ ~
Adtlress:
Professional License (descnba) FxPires' Attach a copy of fhe livens
Pursuant to Clty Code section 2-22(4y a and b: Members of agencies, boaMs, and committees shall be affiliated with the city; thls
requirement shall be fulfilled in the following ways: a) an individual shall have bean a resident of the clty for a minimum of six
months; or b) an individual shall demonstrate ownership/interest for a minimum of six months in a busihess established in the city.
• Resident of Miami Beach for a minimum of six (6) months: Yes D or No D
• Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six (6) months: Yes D or No D
• Are you a registered voter in Miami Beach: Yes ^ or No D
• (Please tarrde one): I am now a resident of North Beach South Baaeh Middle Beach
. I am applying For en appointment because I have special abilities, knowledge and experience. Please list below:
• Are you presently a registered lobbyist with the City of Miami Beech? Yes D or No ^
Please list your preferences in order of ranking (1j first choice [2j second choice, and [3j thilth choice. Please note that only three f3
chokes will foe observed by the City Clerk's Office. (Regular Boards of City)
D Affordable Houain Adviso Commtttee D Housin Atrtha
^ Art in Public Places Committee D Loan Review Commfttae
^ Beeutifieation Committee ^ Marine Autho
^ Board af- 'llBtrrlerlt' D Miami Beech Commission for Women
0 B Adviso Cinnmfftee D Miami Basch Cutturel Arts Caurndl
^ C ttal im rrts ei~s Overai tit Committee D Miami Beach Sister Cities P ram
D Committee an the Homeless D Normandy Shores Loeal Government Ne' h. tm rovemem
^ Committee for pual Edugtion in MB D Parks and Recreation Facilities Board
^ mun Devalo ant Adviso D Personnel Board
Commun Relations Board D Plannin Board'
^ Convention Carder Adviso Board ^ Police Citizens Relations Committee
^ Debennent Committee ^ Predut~ion ind Council
D Deli n Review Boenf' ^ Public S Adviso Gommfttee
^ Disabit' Arxeas Committee ^ S Committee
^ Fine Arts Board D Sin le Faml Residential Review Panel
^ Ga .Lesbian, Bisexual and Trans ender GLBT D Sustainabil' Committee
^ Golf Advis Committee D Trans area Reliabll' & AcmimtebiliN Committee 'TRAC"
^ Heatth Atlviso Committee ^ Tre ortation and Parkin Committee
^ Heatth Faalities Autho ' Bbard D Visitor and Conventon Autho '
^ His snit Affairs Cpmmittce ^ WateAmm Protection Committee
^ Historic Preservation Board D Youth Carrier Adviso Board
"Board Required to Ftle State Disclosure Form
Note. Yf applying ivr Youth Advisory Board, please indicate your affiliation with the Scott Rakow Youth Center
1. Past seance on the Youth Center Advisory Board. Yes C No ~ Years of Service:
2 °resern. particloation in Youth Center aclivhies by your children Yes=~ Nc :. L yes, please list the names of your children, tneir
ages, and Wr11Ch programs. LISt below
Child's name
Cnitd's name
Age. Program:
Ac=. Program.
.2L?P',5A!' w^7RM,$~B74P,P 4NC 20MMnTES\B. Aool¢ononOG26Cti` N°_~-.oo: /
S///' .
•~avE yo'_ eve' :,e=; ~~-,~~.cte;: - ~ i=lone "es ;~ I' „as please _zolau~ Ir. aetai~,
• ~O y0L' OU rre:ntly nav= a VlOiatlOn; S, Ol City o4 Wuam~ Beach. coves Yes .. ~No _~ I` ve5 DlaaSe eY,Diair If data l!'.
• Do you currently owe the City a Miam~, Beach any money Yes . (~NO~:. I` vas emtam Ir. detail
• Ore you currently serum' or and Cite 3oards o- Committee Yes a No " [vas w7rr ooarC~
e~B -
• Wha? organizations rr the City o' Miami 3eacn Dc yoL ~~rrently nolc memoersnlF. Ir,~
Name:
Name.
• List all properties owned or have an interest
~q~ID g/3!'dvul
• I am now employeC by the City of Miami Beaoh: Yes J or Np~hich department?
• Pursuant to City Code Section 2-25 (b): Do you have a Darent ~, spouse =~~, chlltl G, brother C, or sister D who is employer' ~~• the
amity o` Miami Beacn? Check all that apply. Itlerttify the Department(s):
Tne following inForm>rtton Is volutttgry antl Is nadher pert of your applleatlon nor has any bearing on your consideredon for appolntmen; P, is
peing asketl to comply with tetleral equal opportunity reporting requhemettts.
Gender. 0 Mlale male
one only
White INO; o` Hisoenic Origin): All persons havMg origins in any of the anginal Dapples of ctlrope, North Africa or the Mitldle =est.
^ African-4merieanlBlaek (Not of Hispanic Origin): All persons having origins in any o` the BIeG: regal groups of Africa.
~-'aFiispanfc All persons of Mezi®n, Puerlo Ri®n, Cuban. Central or South Ameri~n, or oMer Spanish allture or ongtn, ragartlleas of rarx
:J paten or Paelfte ktandar: All pimttms ttavtrig origins in any of the anginal peoples of the Far cast, Soulheest Asia, the Imllen Subeontinen~.. or
the Padfic islerots. Tltis eras itrt, for , Ching, India, Japan. Korea, the PhlMppine Islands and Sprrioe.
U Amerlean tndlan or Alaskan NWva: All parsons having origins in any of the odglnel peoples of Nodh Amadcs, end who maintain
Citltural idarttlflca5ort through tell tiflgtalian or Y ratzgmftion.
Physically Cltellenped: Yes D or NoC.
Employment Status: Empfoyedr~etired 0 Homemaker p Other
NOTc H aPpointad, you will be regtdted m follow certain Paws which aPP1Y ~ cfty boardleommtttae mambets.
These laws include, btrt an: not IfmMed tn, the following:
c Prohibition from directly or mdire.^gy Ipbbying city personnel (Idlaml Beacn Chy erode section 2-459)
c Prohibftion from contracting with the dty (Miami-Dade County "Doe section <-11.1)
o Prohibition from lobbying before board/commtbee you have served on for period d one year after leaving office (M;art
Beach Chy Code section 2-26).
c r2equfrement to disclose certain financial interests aria gifts (Mlam~-Dade Dourny Cade serkon 2-11.1).
(re'. CMB Cammttrtlty Develapmerd Advisory Committee): prohibition, during tenure and for one year aflar leaving office
from having any interest fn m receiving any bartefit from Community Development Block Orent funds for etfher voursel`
or those with whom you Rave blreirtess or immediate famiy~ Pies (CFR 570.611).
Upon request, copies of these laws may be obtained from the Cfty Clerk.
auest to me accueac}~ antl truthfulness of the application and have received, reaC enC will abide by Chaote• 1
~- of the City Code "Stantlards of C9ntluct for Ch}' Officers, °_mptoyees antl Agency Members."
Signature
Plenae attBCh B copy o' vour resume [- tnrs epDlieabOr.
NOTE: Aoplrcetrons will
r~ er _
ke~ewec ~r. trw ~rrv ~ien:~r.:>ffice oc
-ilia
which are located wRhin the City of Miami Beach:
Name o7 Apphcen' (p:
on file for a person o' one (~ , ealenpa~ voe:
:Jat~ _ r'2gOG ;,onrro~ Nb ~ Jets ~1 ,' p`/ `
06'
MI®~
Please Print or Typt
Name:
Mailing Address;
City/State/Zip;
RCE
Disclosue
For Tax Isar
Ending;
Social Security Number: d6 ~ ~ ~~ ~y~°~?
Filing as a: ® County Employee:
® Municipal Employee of:
Position h'ilid or sought;
Board where carving; ~ ~ Tenn or Employment
~Mti y~~ /~E,~LVQT/~ Began on:
Department whore employed:
Work Address:
~ pour home aiwraes Fa erFentPt from pahU: revards pmsaent to 305 ~ 9/" 960
Florida StaGrtac § li6.Q7 Pieaae cbacl; bare (read inrtruedonsJ: ® W orl(Teaierphone: ~
Home Address:
~ Street Address
ICI L ~G .3.~ ~.ri/
City State Zip Code
Please fist below in descending order with the Largest sourre first, the name, address and
princapal business aeEivity of every source of your income including public salary you
received or arty parson received far your banaFt or use during the disclosure period, The
income of your spouse or arty business partner need not be disciQS~d. If continued on a
separate sheet, reek hare;
of the
of Income
I hereby swear (or eff~rm) that the aforesaid information is s true and correct statement.
f.
Si n re vi person ciisdvsing et signed
ATEM