Delvin Fruit 12/31/2011M~an~~ ~~~c~
City of Miami B®aeh, 1700 Convention Center Drive, Miami Beach, florida 33 T39, vvww.miamibeachfl.aov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel: (305) 673-7411, Fax: (305) 673-7254
February 4, 2010
Delvin Fruit
4590 N. Jefferson Ave.
Miami Beach, FL 33140
SUBJECT: Transportation and Parking Committee
Congratulations) You have been re-appointed *by virtue of your being a Representative for the
Mid-Beach Community Association to the agency, board or committee named-above for a term
ending 12/31/1.1.
If you are unable to accept this appointment, please notify the City Clerk's Office at (305)
673-7411.
Sincerely,
Robert Parcher
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, 2-2458, 2-459
Ordinance 2006-3543 -Amendment to City Code Section 2-22
Miami-Dade County Code Section 2-1 1.1 -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
We are commiMed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community.
l4e ore cemmitrod !o pinvidinc exce%eor ~u5i~c sew:ce ono' sai2q- to oil whc; !ive, r: ark, and eiCy in our vibrant. ta~pical, hislouC Gommunit~ .
Employees
m MIAMI BEAC~I
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, vtww.miamibeachfl.aov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel: i305i 673-741 1, Fax: 1305) 673-7254
TO Delvin Fruit
RE: Transportation and Parking 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 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 Ure Sunshine
Amendment and Code of Ethics for Public Officers and Emp/ogees, 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.
~elvin Fruit
Sworn to and subscribed before me this ~S day of ~, 200_.
~~~ C
1?K-- ilvia Prieto
Deputy Clerk
*Please visit the Gty of Miami Beads wet>site at www.miamibeachfl.gov under Gty Gerk/Board and Committees
for additional Information regarding the Fnancial Disclosure Requirements.
We ar yommined rcj~ofoyiding excelle~tpY~licservic@ and.sa~e~,ro cjl ~hq live work a/~c~ play`in our vi{,rant trppicpl hisroric c mmuni
41 e oie Ccrtuni t pio~.u~ny eAn~„f,n aDlrc 5,.rnc.e i~rtd s(I e. v c,i wt~o .ive, ~(x rt, an0 p.U)~ :. ~~~ .c~rctnl~ (~opfm('IIIS~o'C CCrmnun~P' ~'
~.
NAME:
°~~QV l~
CfTY DF MIAIJI{ 6=ACH
BOARG AND CDMMiT T EE APPLICATh7N FORN
> ,°--~ !2
Las! Name -i ~ Name Middle Initial
HOME ADDRESS: ~I S y ~ /~ . ~~ S~ ~ ~~~ ~"R.) 15'~r.~ : aG( 3 3
Ap; No -7House No / treat City State Zip Code
PHONE: _ 3 U j - S ~ ~ ' ~ .~ i
Home Work Fax Email address
Business Name:
Posifion:
Address:
No. Street City State Zip .Code
Professional License (descrlhe)
Expires
Attach a copy of the license
Pursuant to Ctty 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; or b) an individual shall demonstrate ownershiplirrterest fora inimum of six months in a business established in the city.
. Resident of Miami Beach for a minimum of siz (B) mo ths: Yes or No D
. Demonstrate an ownership/frrterest in a business r rami Beach for a minimum of six (fi) months: Yes or No D
. Are you a registered voter in Miami Beach: Yes or No D ~""~--""'- ;.
. (Please circle one): I am now a resideni of North Beach South Beach Middle Beach
. I am applying for an appointment because I have special abilities, knowledge and experienye. ea~e-ffsttse
• Are you presently a registered lobbyist with the City of Miami Beachl Yes D or No
Please list your preferences in order of ranking [1] first choice [2j second choice, and [3] third choice. Please note that oniv three t3)
choices will be observed by the Clty Clerk's Office. (Regular Boards of City)
p Affordable Housin Adviso Committee D Housin Autho
^ Art in Public Places Commltlse D Loan Review Committee
^ Beautification Committee D Marine Autho
^ Board of Ad'ustrrrerrt" D Miami Bea!dt Commission for Women
D Bud Committee D Miami Beach Guttural Arta Courtdl
D C ttal tm rrts Ovens Committee D Miami Beach Sister Cities P
D Commtttee on the Homers D Norman Shores Local Government Nei h. Im rovemerrt
D Committee for Qual Educxttion in MB D Perks and Recreation Facilities BoadU
D Commun Deval meat Adviso p Personnel Board
D Commun Relations Board D P{annin Board'
^ Corrverrtion Cartier Advis Board ^ Police Citizens Relatiorss Committee
D Det~annent Committee D Production tnd Council
^ Desitm Review Board' D Public 5 Adviso Committee
D Disabil Access Committee ^ Sa Committee
D Fine Arts Board 0 Sin le Fami Residarttial F2eview Panel
D Ga ,Lesbian. Bisexual and Transgender GLBT D 5ustai it Commttttee
D Golf Adviso Committee D T s ran Rsliabil' 8 Accountability Committee 'TRAC"
D Health Adv~o Commtttae ran ortation and Parkin Committee
^ Health Facilttiss Autho ~ Board p Visitor and Convention Arttfta '
O His nic Affairs Committee ^ Watsriront Prtrtection Committee
~ Historic Preservation Board ^ Youth Gentler Adviso Beard
"Board Required to Flle State Disclosure Form
Note: if applying for Yeuth Advisory Beard, please indicate your affiliation with the Scott Rakow Youth Center
i . Past service on the Youth Center Advisory Board: Yes No _~ Years of Service:
2. Presern participation in Youth Center activiiies by your children Yes_~ No =. If yes, please list the names of your children, their
ages, antl which programs. List below
Childs nom=_: Age: Program:
Cniid s nom=_
Aae' Program:
~,:!?P`,54!'.\v~~RM.S~B74P,D AND ~OnnMITT==S\8~ Hwiicviion0526D4 nEv~'.do:
•-;2'JE VD''.. eVe' peer ~D1V: :i°:.- ^' c 191Jr1\~ voc .: H/ r, !' voc DI025E °XD12tr~ It'1
• ~G yDU Durrently nave 2 VID1atIDn(S~ O' vlty D. Idliam. B>acc cDdes Yes :. o~''~O _. I` ve~ Disase °Y.D ialr~ Ir aeial~, .
• Do you Durrently owe the City o' IViiam; Beach any money. Yes . ~o _:. f` vas exDlarn rn detail
..qre you currently servinc or ern' ~itc 3oards or ::ommlttees Yes d'No " I` vas w`tlDr ooardv
• What organizations/'Ir the "ity o= Miami 3eaDQh d~^~ y~ou Durrently hole memoersnlF. m~
Name: ~ /~ ~d~uGr ~l~lwPYti'r-,S' Z -itle
Name: ~r`+~s J '7x.o ~- Title:
• List all props "es owns or have an interest in, which are located within the City of iami Beach:
ys9° N ,7r ~~,--~__r17 k3 33~Y ~ ~sy3S- cis p; ?3c-v~ M l3 ,3 3 ~ Y /
. I am now employed by the City o* Miami Bsach. Yes ~ or N~hich department?
• Pursuant to City Code Section 2-25 (bj: Do you have 2 parent 0, spouse _, child _; brother C, or sister D who is employee D~• tn~
amity of Miami Beach? Check, all that apply. identify the department(s):
The following information is voluntary and is neither pert of your applicafton nor has any bearing on your considereffon for appotntmen. It it
being asked to c/~omply with federal equal opportunity reporting requtramertts.
Gender: C3'(~lafe D Female
Check one
J Whtte (Not of Hispanic OriginJ: All pereans having origins in any of the original peoples of Europe, North Africa or the Mitldle :est.
African-AmerieaMBlaek (Not d Hlapanic Origin): All persons having origins in any o` the Bled: radal groups of Africa.
D Hispanic: All persons of Ntettican, Puerto Rican, Cuban, Cenhal or South Ameri~n, or other Spanish culture or origin, regertlless of race
Aston or PaeKtc ktenrfer: A)( persons having origins in any of the original peoples of the Far East, Southeast Asia, the Indian Subeontinen: or
the Paclfrc fstartds. This area , for erantpYe, Chirta, fndia, Japan. Korea, the Philippine tstaritfs end 3omoa.
American Ynifian or Alaskan Dletiva: All persons ttavtrrg origins ir. any of the original peoples of North America, end who maintain
Cultural idantiftcatiohtttrough tribal tNflliefion or contrrtttnBy recognlfipn.
Physically Challenged: Yes ^ or NoD
Employment Status: ~mptoyed D Refired ~ Homemaker D Other D
NOTi=: If appointed, ypu will be rsyuhed to follow certain laws which apply to city boardieommlfxee members.
These Yaws include, but are not limited 1m, the following:
I
Prohibition from direly or indirectly lobbying city personnel (IJiiam~ Beach City Code section 2-459)
o Prohibition from contracting with the oily (IViiami-Dade County Code section 2-11.1)
o Prohibition from lobbying before board/commtttee you have served on for period of one year after leaving office lMlam
Bsach City Code section 2-26).
c Requirement to discYose certain financial interests and gifts (Mlam~-Dade County Code secBon 2-1 i.1).
Ire: CMB Community Develapmerrt Advisory Committee) prohibition, during tenure and for one year after feavino ofrlDe
I from having any trtlarest in or receiving any benefit from Communty Development Block Grant funds for either voursef`
or those with whom you have business or immediate family Pies (CFR 57.611;.
Upon request, copies of these Yaws may be obtained from the City CYerl;.
I
"! hereby attest to the ace cy and truthfulness of the application and have received, read and w111 abide by Chaote•
Article VII - of the Clty Co _°Standards of Conduct for City Officers. Employees and Agency Members."
~~ 3 ~~~ ~
Applicant's Stgnatur Date Name of Aoohcan~ o_ a
( cu,5~ RINTj
'~. Please attach a copy o! vaur resume to this application
~~ N6TE: ADpiicati ns will rams on file for a oerioc of on~~ejjfl incatenaer year
kece~w_c it tn= :its- ~len:~~ Office oy -- Dates' ~ (IOE/9 ntrol No _~_ Dare _ _/~DOr
- -- __ ~_.
I®~
Please Print or Typ
Name:
Mailing Address;
City/State/Zip:
.SOURCE OF INCOME STATEMEfYT
e First Name Middle Name/Initial Last Name
~ i_ }~k.. v ~ ~'
y S 9 a ~ ,~- ~.-•+
r ~9-•w' L~'~^ chi !C C~ 5 / y O
Social Security Number;
Filing as a: 8 County Employee;
® Municipal Employee of:
Position held or sought; ~'~' d- ~ C J*-+-~"'`- ~
Disolnsure
For Tax fear
Ending;
Board where serving: -"~-,~~0 Term or Employment
Eagan on: ~ , _ o ~ - I ~
Dapartmeurt where employed:
Work Address:
Sf your home address is exempt fmm public records puesuant ~
Rloride Stadtfzs § li9.Q7 please abed: bare (read irestruetionaj;
Home Address: ~ S"~% 0 ~ J~~
E] Work Telephone:
est Address
~~ ice' ~ L. ~ ~~ O
Clty State Zip Code
Please fist below in desoarrding order with the Largest source first, the name, address and
printapal business acEivity of every sauna: of your income including public salary you
received or arty person received for your benefit or use during fire desciosure period. The
income of your spouse or any business partner need not be discio~ssd. If continued an a
separate sheaf,. check here; ~
Description of the
of Income
I hereby swear (or affirm) that the esaid infvrrnation is z true arad correct statement.
~ ~
Signature of person dis:lo Ong ate signed