Antonio Hernandez, Sr 12/31/2011~;
,~. : ~ . aka F:m ee` G ~, 5 #= ~.
City ®f d1Ai®eni beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel: (305) 673-741 1, Fax: (305) 673-7254
12/21 /2009
Antonio Hernandez Sr.
8230 Hawthorne Ave.
Miami Beach, Florida 33141
,. _
Sl7~JE~To Budget Advisory Committee
Congratulations! You have been reappointed by Commissioner Jorge Exposito
to the above referenced agency, board or committee for a term ending: 12131/2011.
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,
~~~~ s~
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Jose Cruz
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
We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community.
.`
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m N`,IANIIBEACH
City ®f IVliami Beach,-17oo Convention Center Drive, Miami Beach; `Florida 331'39, www.miamibeachfl.gov
OFFICE OF THE CITY CLERK, Robert Parcher, Ciy Clerk
Tel: (305) 673-741 1, Fax: -(305) 673-7254
TO Antonio Hernandez Sr.
RE: Budget 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 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 w ich I have se ed.
~4ntonio r andez Sr.
Sworn to and subscribed before me this ~ ~ day of ~ , 20~ ~
c
Silvia Prieto
®eputy Clerk
*Please visit the City of Miami Beach website at www.miamibeachfl.gov under City Clerk/Board and Committees
for additional information regarding the Financial Disclosure Requirements.
We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community.
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p; House o.lStr+e~l ' Cit~/y]~ _ Stet Zip erode
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Business Name: ~ ~~ ~-~LS ---~ ~~ ' rosition: ~ ~.Q"/~ =
Address: GrC~ ~ ~ ~~ ~-~ ~' `~~Q._ '~ 1~. t'Y1 ~ -~L~ ~~ ~ ~f
- ~~~, Street CrtY State Zlp .; ode
Professional License (describe)
Expires: ~'" Aftach b copy of the license
Pursuant to City .Cotle section 2-22(4) a and b: Members of agencies, boards, and committees shall be affiliated with the city; this
requirement shall be fulftlled 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 ownershiplinterest for a minimum of six months in a business established in the city,
• Resident of Miami Bsach for a minimum of six (6) months: Yes~or No D
• Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six (6) months: Yes ^ or R4o~, ~
• Are you a registered voter in Miami Beach; Yep,
. (Please circle one): I"am now a resident of: North Bsach .South Beach fNfiddle Bsach
• I am applying for an appointment because I have specs a r rties, knowledge and experience. Please fist below:
. Are you presently a registered lobbyist with the City of Miami Beach? Yes D or No I,,
Please fist your prefi3rences in order of ranking (1] first choice (2] second choice, and (3] third choice. Please note that only three f31
choices will be observed by the City Clerk's OfFice. (Regular Boards of City)
^ Affordable- fiousfn Adviso Committee D Housfn Autho '
D Art in P~tbiic Places Committee D -Loan Review Committee
D Beautification Committee D Marine Autho '
D -Board of Ad" ustmer>t" D Miami Beach Commission for Nbmen
Bud Adviso Committee D Miami Beach Collura{ Arts Council
D a ftal im rovements Pro ects Oversi ht Committee D Miami Beach Sister Cifies Pro ram
D Committee on-the Homeless D Nomzandv Shores Local Gvvemrnerrt lei h. Imvrovement
D Committee for Qual' .Education in MB 0 Parks and Recreation Facilities .Board
0 Commun' Dovefo merit Advise D Personnel Board
^ Commun Rotations Board ^ Plannin Board'`
O Convenrtion Center Advise Board D Police Citizens Relations Committee
^ Debarment Committee ^ Production indu Council
i ^ Desion Review Board" ~ D Public Sa Advfsorv Committee
D Disabii' Access Committee ^ Safe Committee
D Fine Arts Board D Sin ie Famii Residentia I Review Panel
D Ga ,Lesbian, Bisexual and Transgender GLBT ^ Sustainabiiity .Committee
0 Gotf Advise Committee D Trans area Refiabii' 8. Accountability Committee °TRAC"
^ Health Advise Committee D Transportation and Parkin Committee
p Health Faciitties Autho " Board D Visitor and Convention Autho "
^ His ani~ Affairs Committee D Waterfront Protection Committee
^ Historic Preservation Board ^ Youth Center Advise Board
"Board Required to File State Disclosure Form
Note, tf applying for Youth Advisory Board, please indicate your affiliation with the Scott Rakow Youth Center:
', .Des` serv-ce on the Youth Center tidvisory Board: Yes _~ No ~~. Years of Service:
Dresen~ parti;.ipation in Youth Center activities by your children Yes~~ Nc ~ If yes, please list the names of vour children, their
age, and which programs. Lis; below
Child`s nam= Age: _ Program:
Cnild's nam= Aa= Program:
_ , :L:° .~AL_~o=~RM,;~E~AP,_ AN~% ~~MMi??'".~\B~ !~~oii~ahonOd2b09 ~~~v', .do:
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0~-;8\/c `rO:: a\rc• ;j°°r ~~`l\~:~:°~ ., ~ i°IJ'"1`.' ~~~5 {1d'~ +\i°c ~I@~S~: °xDiatr: fr, ~°~cti'..
~o you currantl} r,av~ ~ vfo,atlon;s c~ Cit}- o- (Jiia ~ 3eac~ codes Yes : o~ __ 1= ves aieas~ exo;a Ir ae,ai!.
~ Do you cy..rrentiy owe the City o' i~iam: Beacr`~ any money: Yes . or No -, fI ves exeiair`~ fr, octal!
Ore you currenti~~ 5ar '1C or an\' Cft~' ~Oard o' '...~^1^lfttA°S YeS ~` NO i' v°_ Vd`i!~" ooard"'
s ~/1/i,a` oryani~ations Ir, trle Cli1' ~' (~riiaml ~°9~~, dC vJli currer'~tiy r1JIC memoersnl~: fr,?
Name: ~ ~' ~ itie
Name: Title
® t 11 roperties owned or have an interest in, which are located-within the City of Niami,~Beach~
o I am now employed by the City oT Nfiami Beach: Yes ~ or t~4c~Which department?
~ Pursuant to City Cone Section 2-25 ~b1: Do you have 2 .parent- , spouse ~~, child ~; brother L, or sister ^ who is employes o~ ±hL
City of (Miami 3each % Check ail that apply, identify the department(sJ:
The following inforrrsation is voluntary and is rtelther part of your apptteation nor has any tssaring on your consideration for appointment. l: l~.
betrtg asked to comply with federal equal opportunity reporting requtremetrte.
Ethnic OCigeR: Check one only (1j
~Whtte fNat Qf ~iisvanic Origin): All persons having origins in any of the original peoples of Europe, North Africa or the Middle mast.
D Afri:.an-AmertcanlBlactc (Not of Hispanic Origin): Ati persons having origins in ern- a` the Btacl: racial groups o` Africa.
tspanic: All persons of Mexi~n, PuertA Rt~n, Cuban, Central or South Ameri;,an, or other Spanish culture or origin, regardless o` race
C Astan ar Pacdfic tstander: AI( persons having origins in any of the anginal peoples of the mar mast, Southeast ksie, the Median Subcontinen~, or
the Pacific Istartds. This area includes, for example, China, India, ,lapse, Koraa, the Philippine islands and Svmva.
American tr4cften or Aiasicart Rtattve~ All persons having origins in arn~ of the original peoples of North America, and who mairttatri
Culture( ideritificatton through tribal nation or community recopnitior.
Phvsicaliy Gitalienged: Yes p or l~
Employment Status: cmptoyed D Refired D Homemaker D Othe~ LAS ~ ~. S ---~- ~ ,
~lC3T~: If appointed,. you will be -requtrred to 4oitow certain lainrs which apply to city baardicomn~it#ee members,
These latvArs incluc#e, but are not Ilmlbed tn, the foltowtng:
o Prohibition from directly or indirectly lobbytng cit}~ personnel ((Jiiami Beacr. City Code section 2-~~9).
Prohibition from corrtraci:ing with the city (Niiam+-Dade County Code section ~- ~ 'i .1 j
o Prohibition from lobbying before board/committee you have served on for period of one year after leaving offrce liVi;am
Basch City Cade section 2-26).
o Requirement to disclose csrtainfinancia! interests and gifts (hli~am~-Dade Count}~ Code section 2-1 i.1).
~I (re: CMB Community Development Advisory Committee)' prohibition, during tenure and for one year -after isavtno ofilct
from having any interest in or receiving any beneftt from Community Development Stock Grant funds for etth>er yoursel=
or those with whom you have business or immediate family ties (CFR ~70.6'i 1).
Upon rec}uest, copies of-these laws may be obtained from the City Cierh.
"' Hereby aft ~to the accuracy and truthfulness of the application and have received, read ant will a }~ :hapte•
A isle VII of the ~ ode "Slander off Con ctf`~or City Officers..m fees rid Agerrc~-. mac
f
Appiica t`s aig a ;:~a NamE~ of Apt7lrcan! (°'_~~.5~ PRINT; -
i ,
Please attar' ..op}~ o~ yocrr resume to this application
NC3T~: Applications will remarr or fiiE tar ~, Harlot! o` one !1 i calenae~ veer
Recervec it the ^ity ~ier~~ s Jffi~~, or c._. (Vl ~ i~1..~~ irate ~ ;'20 ~ontro~ Nv ~ 3 (g Date ,20pt
Name a` GeHUty Cleri; -`
~ SOURCE OF I~CC~I~tE ST~,TEMEt~IT
Please Print or Type First Name Niiddie Name/Initial Last Name
game:
Mailing Address:
City/State/ZiR:
Socsal Security Number;
Filing as a: ® County Ernplayee:
® Municipal Employ®e of:
Pasition~ held or sought;
ivu,o fri. He~'ncu~clP2
e
i 3'~~4!
ISD-~ -OC `70
Soard where serving: ~~~
®isclQSUr~
For Tax 1!aar
Ending:
Terra or Enap6oyrnent
E~..~
~ Began on ~ ~ (~) U
Department where employed:
Vliork ~elc~ress:
if your hams atlciress es exempt from public retards purstaant to
Florida Statutes § 2Y9aQ7 please check here (read instructions: ® 1~®rk T@~®ph®r'96:
Flome Ac6d{ress;
Street ~4~iciress
City State Zip Code
Please Gist below in ciescenciing order with the Largest source first, the name, ar~clress and
principal business acEiwaty of every source of your incoane inciuciing public salary y®u
received or arty Person received for your berieft or ~ se dureng .the ciiscbosure period. T'he
income of your spouse or any business partner need not be cliscio~sesi. If continued on a
seRarate sheet, check here:
R
O~escrdptwon of the Principal
Marne of Source of Incci':nne p-citiress i;3~ss®ness Aetivi~,y
~ hereby swear (or affirm) that the aforesaid information is a true avid correct statement.
~ ~ .:~
°~ ~^' ~ /
Sign ure of pertng Q to signed