Alan Randolph 12/31/2011
® MIAMI BEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, .Florida 331.39, ~w miamibeachFl aov
OFFICE OF THE CITY CLERK, Robert Parcher, Ciry Clerk
Tel: (305) 673-7411, Fax: (305) 673-7254
02-02-2010
Alan Randolph
1800 Cleveland Road
Miami Beach, Florida 33141
S~UBJ Community Development Advisory Committee
Congratulations! You have been appointed by Commissioner Michael Gongora
to the agency, board or committee named above for a term ending: 12/31/2011.
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,
~Y~^1 /~~
Robert Parcher
Ciry Clerk
cc: Saul Frances, Parking Director
Mercedes Rovirosa
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 committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community.
m MIAMI BEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachH.aov
OFFICE OF THE CITY CLERK, Robert Porcher, Ciy Clerk
Tel: (305J 673-741 1, Fax: (305) 673-7254
TO Alan Randolph
RE: Community Development Advisory 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 Ethic Guide in the Sunshine
Amendment and Code of Ethics for Public ~cers and Emp/oyees, 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 hic ve served.
Alan Randol h~~/1~
Sworn to and subscribed before me this ~ ~ day of - ~~~,~"`^ ', 20d~
- P3MSilvia Prieto
Deputy Clerk
*Please visit the City of Miami Beach wettsite at www.miamibeachfl.gov under City perk/Board and Committees
for additional information regarding the Financial Disclosure Requirements.
We are committed ro providing excellent public service and safety to all who live, work and ploy in our vibrant, tropical, hisroric communiy.
CITY OF MIAMI BEACH
® M1 1BE~H ~
OARD AND COMMITTEE APPL ATION FORM
NAME: _
Last Name ~ ~ first Name , / M~ Init' ~~~
HOME ADD2R~E`SS: ) ~~~y~
PHONE: ~7~r~b`o""~ ~,~~J ~~Ho~sYN/Street 3~S 6i~{~ y~~ Ste Zip Code ~ ~L.
Home Wo# ~ ,^ Email a d ss
Business Name: ~ Positio . lt'fM/
Address: ~~ 3
3 9G N ;City State Zip Cod
Professional License (describe) Expires: Attach a copy of the license
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; 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: Ye~or No ^
• Demonstrate an ownershipfinterest in a business in Miami Beach for a minimum of six (6) months: Yes~r No ^
• Are you a registered voter in Miami Beach: Yes
• (Please cirGe one): I am now a resident of: orth each South Beach Middle Beach
• I am applying for an appointment because I have spec nowledge and 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 [1] first choice [2] second choice, and [3] third choice. Please note that only three 131
choices will be observed by the Citv Clerk's Office. (Regular Boards of City)
^ Affordable Housin Adviso Committee ^Housin Autfiorit
^ Art in Public Places Committee ^ Loan Review Committee
^ Beautification Committee ^ Marine Authorit
^ 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 ^ Normand Shores Local Government Nei h. Im rovement
^ Committee for Qualit Education in MB ^ Parks and Recreation Facilities Board
ommunit Develo ment Adviso ^ Personnel Board
^ ommunit 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 ^ Safet Committee
^ Fine Arts Board ^ Sin le Famil Residential Review Panel
^ Ga Lesbian Bisexual and Trans ender GLBT ^ Sustainabilit Committee
^ Golf Adviso Committee ^ Trans arenc Reliabilit & Accountabili Committee "TRAC"
^ Health Adviso Committee ^ Trans ortation and Parkin Committee
^ Health Facilities Authorit Board ^ Visitor and Convention Authorit
^ His anic Affairs Committee ^ Waterfront Protection Committee
^ Historic Preservation Board ^ Youth Center Adviso Board
"Board Required to File 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:
F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC Application062609 NEW.doc
~-
•
.Have you ever been convicted of a felony: Yes ^ or No,~lf yes, please explain in detail:
• Do you currently have a violation(s) of City of Miami Beach codes: Yes ~ or No~J If yes, please explain in detail:
• Do you currently owe the City of Miami Beach any money: Yes ~ or No~ If yes, explain in detail
• Are you currently serving on any City Boards or Committees: Yes ~ or Nr~ If yes; which board?
• What organizations in the City of Miami Beach do you currently hold membership in?
Name: Title:
Name: Title:
• List all properties owned or have an interest in, which are located within the City of Miami Beach:
v
• I m now employed by the City of Miami Beach: Yes ~ or N Which department?
• Pursuant to City Code Section 2-25 (b): Do you have a parent D, 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 It Is
being asked to comply with federal equal opportunity reporting requirements.
Gender: 1A: Male ^ Female
Ethnic Origin: Check one only (1)
hate (Not of Hispanic Origin): All persons having origins in any of the odginal 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 Paclflc 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 ^ or NOD.
Employment Status: Employed 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:
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).
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 Blodc 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 hereby attest to the accuracy and truthfulness of the application and have received, read and will abide by Chapter 2,
Articl - of the Ci de "Standar ~ (C nduct for City Officer, Empl~ees d A ency Me ers."
Applican s Sig ure - ate- _ Name of Aooh nt (PLEAS PRINTI
,.._.
Please attach a copy of your resume to this appllcahori
fJOTE;TAp~p.~i`ca'tions will remain on file for a period off og~e/,(y1 jDca~endar year.
Received in the City Clerk's Office by : J„i~!'4 Date/efL7~ Control No. ~gS Date: _/_/ 009
Name of Deputy Clerk
M I A M I•DADE
~ SOURCE OF INCOME STATEMENT
Please Print or Type First Name Middle Name Initial Last Name
Disclosure
For Tax Year
~
Name: Qiv'1
~. Ending:
Mailing Address:
City/State/Zip: ~ ~ y
Social Security Number: r' I
Filing as a: ~ County Employee:
® Municipal Employee of:
Position held or sought:
Board where serving: Term or Employment
Began on:
Department where employed:
Work Address: ~3~~ d~, !,~ ~j~ITI~,~ 33~
If your home address is exempt from public rernMs pursuant ; ~ ~S_ yyl-53iy
Florida Statutes § 119.07 ple
as
e
c
heck her (read instructions :
Work
Telephone:
~
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l
4
~ ~Q
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Home Address: ~ O uy ~"
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re
C~~ir~.C/"met Add~~_ ..c/ ~ '7
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: ~
Description of the Principal
Name of Source of Income dress Business Activi
I hereby swear (or afFfr`m~) that the aforesaid information is a true and cor-,rlect statement.
'-''~/ ~ I,~ U
Signature of person disclosing Date signed
y