Barry Ragone 12/31/2010m PJ11AM1 BEl~CH
City of Miami Beach, 1700 Convention Center Drive, Miami Beath; Florida 33139, www.miamibeochA.aov
OFFICE OF THE CITY CLERK, Robert Percher, Ciy Clerk
Tel: 13051 673-7411,, Fax: (3051 673-7254
12/23!2009
Bany Ragone
6961 Indian Creek Dr
Miami Beach, Florida 33141
SUBJECTS. Loan Review Committee
Congratulations! You have been reappointed by Commissioner Jonah M. Wolfson
to the above referenced agency, board or committee for a term ending: 12137/2010.
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.
Sincerely,
~~~ ~,~~~sr.
Robert Percher
City Clerk
cc: Saul Frances, Parking Director
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, 2-2456, 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 safety ro all who live, work and play in our vibrant, tropical, historic community.
m MIAMI BEACH
City of Miami Beachr 1700 Convenfion Censer Drive, Miami Beach, Florida 33139, www.miamibeachR.aov
OFFICE OF THE CITY CLERK, Robert Parcher, Ciy Clerk
Tal: (305) 673-7411, Fax: (305) 673-7254
TO Barry Ragone
RE: Loan Review 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 appointedforaterm ending: 12/31/2010.
I have been issued a copy of Section 2-11.7 of the Miami-Dade County Code (Conflict of Interest
and Code of Ethics Ordinance), as well as theF/orida Commissiar on Ethics Guide to the Sunshine
Amendmentand 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.
Barry Ragone
Sworn to and subscribed before me this ~/ day of ~..¢~O , 201.0
Fq2 Silvia Prieto
Deputy Clerk
*Please visit the Ci[y of Miami Beach website at www.miamibeachFl.gov under City Clerk/BOard and Committees
for additional information regarding the Finandal Disclowre Requirements.
We are committed ro providing excellent public service and salary ro all who live, work and play in our vibrant, tropical, hisroric community.
~~/~ ~ / '~.hi~ i B EAC H CITY OF MIAMI BEACH
BOARD AND COMMITTEE APPLICATION FORM
NAME: ~p ~° N~ ~H' ~>22y ~r
Last Name First Name Middle Initial
HOME ADDRESS:
PHONE:
>:
. I - 3~i -F6s-y`I I P
Work
Email address
Business Name: b.Uv iA~Kf C'"'Qetf- mow. 'Position: Cam'--~P O~P~
Address: ~ ~eh~r~
Code
Professional License (describe)7/V X07 9' ~Dw~® Expires: ?~~ /l Atteeh a ropy of the license
Pursuant to City Code section 2-22(4) a and b: Members of agendas, 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 rift 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 of six (6) months: Yes ^ or No ^
• Demonstrate an ownership/imerest in a business in Miami Beach for a minimum of six (6) months: Yes ^ or No ^
• Are you a registered voter in Miami Beach: Yes ^ or No ^
• (Please drele one): I am now a resident of North Bsach South Beach Middle Beach
• I am applying for an appointment because I have special abilities, knowledge end experience. Please list below
• Are you presently a registered lobbyist with the City of Miami Beach? Yes ^ or No ^
Please list your preferences in order of ranking [1J first droice [2] second choice, and [3] third choice. Please note that only three f3)
choices will be observed by the Cltv Clerk's Office. (Regular Boards of City)
^ Affordable Housin Adviso Committee ^Housin Autho '
^ Art in Public Places Committee oan Review Committee
^ Beautification Committee D Brine Autho
^ Board of Ad'ustment' ^ Miami Beach Commission for Women
^ Bud Adviso Committee D Miami Beach Cultural Arts Coundl
D C ital Im rovements Pro'ects Overei ht Committee D Miami Beach Sister Cities P ram
^ Committee on the Homeless ^ Normand Shores Local Government Nei h. Im rovement
D CommlUee for Qual Education in MB ^ Perks and Recreaticn Facilities Board
D Commun Devel ment Adviso D Personnel Board
^ Commun Relations Board ^ Plennin Board'
^ Convention Center Adviso Board ^ Police Citizens Relations Committee
^ DebartneM Committee D Production Indu Council
^ Desi n Review Board' ^ Public Sa Adviso Committee
^ Disabili Access Committee D Sete Committce
^ Fine Arts Board p Sin le Fami Residential Review Panel
0 Ga ,Lesbian, Bisexual and Tre octet GLBT ^ Sustainabil' Committee
0 Golf Adviso Committee ^ Trans aren Reliabil' & Accountabil' Committae'i'RAC'
^ Health Adviso Committee ^ Trans ortation and Parkin Committee
^ Heath Fadlities Autho ' Board p Visitor and Convention Attlho
^ His nic Affairs Committee ^ Waterfront Protection Committee
0 Historic Preservation Board ^ Youth Center Adviso Board
'Board Re aired 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 C No ^ Years of Service:
2. Present participation in Youth Canter activities by your children Yes^ No C. If yes, please
ages, and which programs. List below:
Child's name: Age: Program:
Child's name:
Age: Program:
list the names of your children, their
F:\CLEP.\$ALL\aFORMS\BOARD AND COMMITTEES\BC Application062609 NEW.doc
.Have you ever been convicted of a felony: Yes~DNo "" If yes, please explain in detail:
• Do you currently have a violation(s) of City of Miami Beach codes: Yes =~r No ~. If yes, please explain in detail:
• Do you currently owe the City of Miami Beach any money: Yes ^y~to u. If yes, explain in detail
. Are you currently serving on any City Boards or Committees: Yes _~a No ~. If yes; which board?
C^ r~ - Go m+ ~G2LrP~7 ~t71v `~~
What organizations in the City of Miami Beach do you currently hold membership
Name: %Q2sr tTeLJ G,. vi c - ,v.,z 3.®ai~ Tino~ 4'.. _.
Name: /-~r~.~:_e sl i41? Tifle: ~~x~ra7
• List all properties owned or have an interest in, which are located within the~ity of Miami Beach:
l0 9/ • ~.~Jb i if W i'yE;P /~ fit.. )... R / ~F7 -, n Y/ „~. ~~ ,- In
• I am now employed by the City of Miami Beach: Yes p or NoL~Which department?
• Pursuant to City Code Section 2-25 (b): Do you have a parent ^, spouse C, child D, brother C, or sister O who is employed by the
City of Miami Beach? Check all that apply. Identify the department(s): ,
The following Information is voluntary and le neither pert of your epplieatlon nor has any beadng on your eonaltlereflon for appointment. It Is
being asked to wmply with fetlerel equal opportunity reporting requiremams.
Male ^ Female
Origin: Check one only (~
^ White (Not of Hispanic Origin): All persons having origins in any of the original peoples of Europe, North Africa or the Middle Eest.
^ African-American/Black (Nat of Hispanic Origin): All persons having origins in any of the Black regal groups of Atdce.
^ Hispanic: All persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish cuhure or odgin, regardless of race.
p Allen or PaeMle Islander: All persons having odgins in any of me original peoples of the Far East, Southeast Asia, the Indian Subcontinent, on
the Padfic Islands. This area intiutles, for example, China. India, Japan, Korea, the Philippine Islands and Somoa.
^ American Indian or Alaskan NefWe: All persons having origlrrssrn any of the odginel peoples of North America, ertd who mairttein
Guttural identification through tribal aflgiation or cemmunhy recognition.
~ Physically Challenged: Yes ^ or NoD.
Employment Status: Employed p Retired ^ Homemaker p Other p S~ 1 I= ~ ~..,q I,v " _ "~ It',(~ I %S
NOTE: If appointed, you will be required to follow certain laws which apply to chy boardfcommittee members.
These laws include, but are not limited Yo, 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 Chy 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): prohibftion, during tenure and for one year after leaving office,
from having any interest in or receiving any benefit from Community Development 81ock Grant funds for either youreetf ,
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 Clark.
"I hereby attest to the accuracy and truthfulness of the application and have received, read and will abide by Chapter 2,
Article VII - of the City Cotle "Standards of/9,an/d}~ct for City Officers, Employees and Agency Members."
Pteese attach a copy of your resume to this appllcatlon
NOWT-E~Appilcations will remain on ale for a period of one (1) calendar year.
Received in the Clty Clerk's Office by ~}.~-v-.~1' (,j / pat,,,' ~/~ ~~Q ~ ~,,,,~, ~,~
Name nl n...., n„C,e.~ _._- ".•••°•~• C'oi2:__Y~^uu9
/� i
[-•1 'VI I A/ V, I L tAQ,, H CI O ! IAMI BEACH
BOARD AND COMMITTEE AP ' ATION FORM
NAME: A Go ►k1 f-- ° u . I) A C' fay N1
Last Name First Name , i Mi i dle Initial
HOME AD (fl, / 7&"D / /A `J C v -- Di , ) 6 PI / ' I� 3 /'1 /
Apt No. L.ig House No. /Streets / City jj�� i !;• L. 1 Sta I Zip Code •
PHONE: �(c+S 4 61 / fc- F 7 3 S `re s - i 6 f Y e)' 6
�7� €, '► ,DL. COit\ •
Home Work Fax Email address
Business Name: O' CI / XI & C_/2 E. K 1 "t-� "� I i
/ � Position: C7� 1 I
Address: r0 % / 2ti r, / Al N C-Y •)t t
No. Street City State Zip Code
Professional License (describe) A S 0 -7 9 Expires: 1 — Attach - i copy of the license
Pursuant to City Code section 2 -22(4) a and b: Members of agencies, boards, and committees shall be affiliat with :the city; this
requirement shall be fulfilled in the following ways: a) an individual shall have been a resident of the city for • minimum of six
months; or b) an individual shall demonstrate ownership /interest for a minimum of six months in a business establi -I ed in the city.
• Resident of Miami Beach for a minimum of six (6) months: Yekor No 0 , 1
• Demonstrate an ownership /interest in a business in Miami Beach for a minimum of six (6) months: Ye No n
• Are you a registered voter in Miami Beach: YeQ or No ❑ t
• (Please circle one): I am now a resident of: orth Beach South Beach Middle Bea 1
• I am applying for an appointment because I have special abilities, knowledge and experience. Please lis- below 1
• Are you presently a registered lobbyist with the City of Miami Beach? Yes 0 or N �°Q I !
Please list your preferences in order of ranking [1] first choice [2] second choice, and [3] third choice. Please not hat only three (3)
choices will be observed by the City Clerk's Office. (Regular Boards of City) l
J Affordable Housing Advisory Committee 0 Marine Authority 11
❑ Art in Public Places Committee ❑ Miami Beach Commission for Women
0 Beautification Committee 0 Miami Beach Cultural Arts Council 11 I E
❑ Board of Adjustment* 0 Miami Beach Human Rights Committee '.
0 Budget Advisory Committee 0 Miami Beach Sister Cities Program 11 • '
0 Capital Improvements Projects Oversight Committee 0 Normandy Shores Local GovemmentlNeigh. I provement
0 Committee on the Homeless ❑ Parks and Recreation Facilities Boarb 1
❑ Committee for Quality Education in MB 0 Personnel Board 11 1 {
O XCommunity Development Advisory 0 Planning Board* 11 I r
0 Community Relations Board ❑ Police Citizens Relations Committee 1I
❑ Convention Center Advisory Board ❑ Production Industry Council 11
❑ Debarment Committee _ 0 Public Safety Advisory Committee 11 •
❑ Design Review Board* 0 Safety Committee 11
0 Disability Access Committee ❑ Single Family Residential Review Panel
❑ Fine Arts Board 0 Sustainability Committee �
0 Gay, Lesbian, Bisexual and Transgender (GLBT) ❑ Trans•ortation and Parking Committe
❑ Golf Advisory Committee ❑ Visitor and Convention Authority I
❑ Health Advisory Committee ❑ Waterfront Protection Committee I ; I i '
❑ Health Facilities Authority Board ❑ Youth Center Advisory, Board
❑ Hispanic Affairs Committee ir1`1n "� L4 V a»n '
0 Historic Preservation Board
0 Housing Authority II
❑ Loan Review Committee *Board Required to File State DiscloS;ureFo
II
il
Note: If applying for Youth Advisory Board, please indicate your affiliation with the Scott Rakow Youth Cente {
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 0. If yes, please list the names of y• r children, their
ages, and which programs. List below: 1
Child's name: Age: Program: !
Child's name: Age: Program:
F. `•CLEF ,$ALL \aFORMS \BOARD AND COMMITTEES \BC Applicotion.doc
, \ A
*Have you ever been convicted of a felony: Yes ❑ or Noj If yes, please explain in detail:
• Do you currently have a violation(s) of City of Miami Beach codes: Yes -13zDr No D. If yes, please explain in detail:
• Do you currently owe the City of Miami Beach any money: Yes 0 or N yes, explain in detail `
• Are you currently serving on any City Board, or Commi ees: Yesr No 0. If yes; which board?
z.� ' -, 1
• What organizations in the City of Miami Beach do you currently hold mem ership in?
Name: Z D ..... T b Title:.v� l -'t sr�
Name: Title:
• List all properties owned or have an interest in, which are/located within the City of Miami Beach:
0,26 /y//i` >)4k (.;vim 0. (/ vr� 7, 0 A l�„" -'7
• I am now employed by the City of Miami Beach: Ye or Nip Which department?
• Pursuant to City Code Section 2 -25 (b): Do you have a parent 0, spouse 0, child 0, brother 0, or sister 0 who is employed by the
City of Miami Beach? Check all that apply. Identi fy the department(s):
The following information is voluntary and is neither part of your application nor has any bearing on your consideration for appointment. It is
being asked to comply with federal equal opportunity reporting requirements.
Gender: Male ❑ Female
Ethnic Origin: Check one only (1)
Ai (Not of Hispanic Origin): All persons having origins in any of the original peoples of Europe, North Africa or the Middle East.
❑ African - American /Black (Not of Hispanic Origin): All persons having origins in any of the Black racial groups of Africa.
❑ Hispanic: All persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race.
❑ Asian or Pacific Islander: All persons having origins in any of the original 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 identification through tribal affiliation or community recognition.
Physically Challenged: Yes 0 or NoO.
Employment Status: Employed ❑ Retired ❑ Homemaker ❑ Other ❑ c 1 ? - 4 �.
NOTE: If appointed, you will be required to follow certain laws which apply to city bo d /committee 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).
iii 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.
I
"I hereby attest to the accuracy and truthfylness of the application and have received, read and will abide by Chapter 2,
Article VII - of the City Code "Standards of Conduct for City Officers, Employees and Agency Members."
M
' i - n ,, C) /ill / I );:3 ;0 a • 0-`( f C U 17
Appl nature Name of Applicant (PLEASE PRINT)
K \\\
Please attach a copy of your resume to this application
NO TE Applications , w ill remain on file for a period of.`one (1) calendar year.
Received in the City Clerk's Office by : Date: _/ /2010 Control No. Date: _/_/2010
Name of Deputy Clerk
6961 INDIAN CREEK DRIVE 305- 865- 6961,786- 443 -9848
MIAMI BEACH FL, 33141 • Levite6@aoi.com
BARRYM.RAGONEDMD
Objective CITY OF MIAMI BEACH BOARD AND COMMITTEE RES ME
REQUEST OF COMMITTEE ASSIGNMENTS: HU RI c HTS-1
COMMUNITY DEVELOPMENT ADVISORY -2 AFFORD B LE HO SING
ADVISORY COMMITTEE -3
Experience 2006 -2011 DENTIST MIAMI BEACH/MIAMI FLORIDA
• INDIAN CREEK DENTAL MIAMI BEACH
• 1971-2006 PRIVATE PRACTICE SOUTH FLORIDA
• 1971 -1973 ADJUNCT CLINICAL PROFESSOR, DEPT. OF
PEDIATRICS UNIVERSITY OF MIAMI
•
Education 1964 -1969 UNIVERSITY OF LOUISVILLE SCHOOL OF DENT'S RY
LOUISVILLE, KENTUCKY
• GRADUATED 1969 D.M.D.
• 1961 -1964 UNIVERISTY OF MIAMI MIAMI, FLORIDA
• UNIVERSITY OF ALABAMA
• 1958 MIAMI BEACH HIGH SCHOOL
URRENT civic CHAIR CITY OF MIAMI BEACH LOAN REVIEW COMMITTEE
ACTIVRIES
SEC/TREASURER TEEN JOB CORPS MIAMI BEACH
CIVIC ACTIVITIES MEMBER CITY OF MIAMI BEACH AFFORDABLE HOUSING
ADVISORY COMMITTEE
MASS DISASTER IDENTIFICATION TEAM WORKED ON
IDENTIFICATION OF VICTIMS OF VALU -JET CRASH
BROWARD COUNTY EMERGENCY MEDICAL RESPONSE ; M
HURRICANE ANDREW
FOUNDING BOARD MEMBER DIZZY GILLESPIE CHARTER S •'HOOL
STUART, FLORIDA •
BOARD MEMBER KIWANIS CLUB OF MIAMI BEACH
PRESIDENT S NORTH BEACH DEVELOPMENT MIAMI BEACH
MEMBER NATIONAL SOCIETY OF FUNDRAISING EXEUTIV
i1~~ SOURCE
Please Print or Type First Name Midtlle Name Initial Last Name
Disclosure
Por Tax year
Name: ~crz Y /~tie~c-.e( ~o,eo~ Ending;~~~
Mailing Address: 6 / ~D/./ a~ G'Y~e,~
City/State/Zip: '1Lr~ 7ri 3 ~ ~~
Social Security Number:
Fling as a: ® County Employee:
~ Municipal Employee of: 7~! ~; ~ c 4
Position ~ii3ld or sought: ~p a,.~ ~~rK:~
Board where serving; S^ea.~... Term or Employment
Began on: /~-~~
Departmentwhareemp~oyed: -~~Tld1.~ Cv-e~el~~2u~1
Work Address: (Pq 6 i ? KnD/~i ~ L°r-coo fc ~ ~ w 1=~ 9
if your home address is exempt from public records pursuant m 3D.f - ~ 65 - (.)cc,(~,
Florida Stetuffis § 119.07 please check here (reed instructionsj: '® Work Telephone:
Home Address; ~~~
l Street Address
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. T'he
income of your spouse or arty business partner need not be disclosed. If continued on a
separai~ sheet, check hare; ~
Name of Source of Income
Addr Description of the Principal
Business Acti
~ D~.rw G^A.~ ! IKV. rat
I-c. ~
I hereby swear (or affirm) that the aforesaid iriformatlon is a tru and correct statement.
~/ / ~,
Signature o pa n disclosing Date signed