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Jared Dokovna 12/31/2010m MIAMI BEACH City of Miami Beach, 1700 Convenfion Center Drive, Miami Beath, Florida 33139, www.miamibeachA.aov OFFICE OF THE CITY CLERK, Robed Parcher, Ciy Clark Tel: (305) 673.7411, Fax: 1305) 673-7254 02-16-2010 Jared Dokovna 3411 Indian Creek #903 Miami Beach, Florida 33140 SUBJECT: "i Public Safety Advisory Committee Congratulations! You have been appointed by Commissioner Michael Gongora 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, Robert Parcher City Clerk cc: Saul Frances, Parking Director Chief Yuhr 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 We are commiBed ro providing excellent public service and safey ro oll who live, work and play in our vibrant, tropical, hisroric communiy. m- MIAMI BEACH City of Miami Beach, 1700 ConvanKon Center Drive, Miami Beach, Florida 33139, www.miamibeachA.aov OFFICE OF THE CITY CLERK, Robert Parcher, Ciy Clerk Tal: 13051 673-7411, Fax: (305) 673-7254 TO Jared Dokovna RE: Public Safety Committee I do solemnly swear or affirm to bear true faith, loyalty and allegiance to the Government of the United States, the State of Flodda, 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/onda Commission on EUrics 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 caler~r year on which 14ave served. Dokovna Sworn to and subscribed before me this) q~ d~a~y of~~, 2-09 Silvia Prieto Deputy Clerk 'Vlease visit the Gty of Miami Beach wet>site at www.mlamibearhfl.gov under Gty Gerk/Board and Committees for additional information regarding the Financial Disclosure Requirements. We are committed b providing excellent public service and safey M oll who live, work and play in our vibrant, tropical, hisroric communiy. IAM4 m~ii7 50URCE OF INCOME STATEME Please Print or Type Name: Mailing Address; City /State/Zip: Social Security Number; Filing as a; ~ Co mpioyee; ® Muni I Employee af: Pnsitian held or sought; ~,,, r~ V~f>~.1~! Q~~l ~ ~ SP~e i-y Board where serving: Department where empinyedt Di6CIQ5:Je For Tax Ysar Ending; ~YU Term yr Employment Eagan on: WorkAddress: U~~7 NC b~ 5~. 1'i'limw~~ i i-~ 3~3~ Sf yner home atldreas a exempt from public records ourmtant to ~~ Q6 I- ~~ 2 0 worlds 5meetec g 7.7.4.II7 pholae chacl: here (read innrccnectloncj; ~ mark 7aiapbvne: Hams Address; Street Address City Zip Code Please list below in descending order with the Largest source first, the name, address and prin©pal business activity of every source of your income including public salary you received or arty parson received ivr your banaiYt or use during t:he disclosure period. The income of your spouse or any business partner need not be d'esciQS:ed. Zf corrtinuad on a se~sarate shee>k check hems; ptivn of the Prin®pal of Snrome 1 her swear (or affirm) that the aforesaid information 5' nature of person disclosing is z true and correct statement. 2-11~ly Bate signed