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Norberto Rosenstein 12/31/2011 ~1$~/ O¢ 1~9CBn"1! BeCIC~1, 1700 Convention Center Drive, Miami Beach, Florida 33139, vvww.miamibeachfl.~ov OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk Tel: (305) 673-741 1, Fax: {305) 673-7254 01 /26/2010 Norberto Rosenstein 1023 Hollywood Bivd Hollywood, Florida 33004 Historic Preservation Board Congratulations! You have been reappointed by the City Commission to the above referenced agency, board or committee for a term ending: 12/31/2011. 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, ~r96, v.{ ~~~c/lr ~~~ ~J• Robert Parcher ''`J~Jf 'J City Clerk cc: Saul Frances, Parking Dorector Thomas Mooney 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 Jive, work and play in our vibrant, tropical, historic community. m MIA~VIIBEACH City of Miaet~i beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.~ov OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk Tel: (305) 673-741 1, Fax: (305) 673-7254 January 26, 2010 TO: Norberto Rosenstein RE: Historic Preser~ration Board 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. 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 Florida 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* requirements 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 ~ h I have served. i1 /~ / ~ _ _-. - y Norberto Rosenstein . ~~ . ,~~` Sworn to and subscribed before me this day of ~/~ ~'/ , 2010. Deputy 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. ~~~~~ ~ ~~~~~ ~ ~~ cET~ OF AIIIAM! BEACH BOARD~-}AIVD COMtV1iTTEE APPLICATIOt~t FORM NAME: ~,OSQw~3l Q~~ ~Or~~YI~ Last Name Firs Name Middle initial HOME ADDRESS: ~ 3 ~ 4 ~l-~1 V O Q ~ ~ ~ O Apt No. Hou No./Street i y ~- State Zip Co e PHONE: " l ~ `fi ~~ -Horne Business Name: Work Fax Em~~l!.l a~d~es~s 1v~.~o ~oSQn~~leir~l~-~~l Q c ,~~w~ ~'0 3 Y ~ `Position: T ~L'S1 Address: ~- ~ ~ ` _ 3 O No. Str / ~- City State Zip Code Professional License (describe) l~V ~~ Q ~ ~ ~ ~ ~ Expires: .~. O Attach a copy of fhe 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: Yes ^ or No ~.. • Demonstrate an ownership/interest 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 circle one): I am now a resident of: North Beach South Beach INiddle Beach _ • I am applying for an appointment because I have special abilities, knowledge 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 [3J third choice. Please note that only three (3) choices will be observed by the City Clerk's Office. (Regular Boards of City) ^ Affordable Housin Adviso Committee ^Housin Authorit 0 Art in Public Places Committee D Loan Review Committee ^ Beautification Committee ^ Marine Authori ^ 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 Quali Education in MB D Parks and Recreation Facilities Board 0 Communi Deveio ment Adviso ^ Personnel Board ^ Communi Relations Board D Plannin Board* 0 Convention Center Adviso Board D Police Citizens Relations Committee ^ Debarment Committee ^ Production Indust Council 0 Desi n Review Board ^ Public Safe Advisa Committee 0 Disabili Access Committee ^ Safe Committee 0 Fine Arts Board ^ Sin le Famii Residential Review Panel 0 Ga ,Lesbian, Bisexual and Trans ender GLBT ^ Sustainabilit Committee ^ Golf Advisor Committee ^ Trans arenc Reiiabili & Accountabilit Committee "TRAC" ^ Health Adviso Committee ^ Trans ortation and Parkin Committee ^ Health Facilities Authori -Board ^ Visitor and Convention Authori ^ His anic Affairs Committee ^ Watertront Protection Committee ~ Historic Preservation Board ^ Youth Center Adviso Board *Board Required to Fiie 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 G. 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 C((JJJ .Have you ever been convicted of a felony: Yes = or No~C If yes; please explain in detail: • Do you currently have a violation(s) of City. of Miami Beach codes: Yes _ or No ~If yes, please explain, iri'detail: • Do you currently owe the City of Miami Beach any money: Yes ~? or No`s( If yes, explain in detail • Are you currently serving on any City. Boards or Committees: Yeses or No :~. If yes; which board? ~~ ~Or ~ ~ ~Y,e~~Y . 70 lob What organizations in the City of Miami Beach do you currently hold membership in? Name: ~^~ .Title: Name: Title: o List all properties owned or have an interest in, which are located within the City of Miami Beach: ~~ • I am now employed by the City of Miami Beach: Yes ^ or Ndl~ Which department? • Pursuant to City Code Section 2-25 (b): Do you have a parent ^, spouse ^, .child C, brother G, or sister C~ 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: ~. Male ^ Female Ethnic Origin: Check one only (1) ~.Vithite (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 !slander: 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 ident~cation through tribal affiliation or community recognition. cally Challenged: Yes ^ or Nod. Employment Status: Employed' Retired 0 Homemaker ^ Other ^ NOTE: If appointed, you will be required to follow certain laws which apply to city boardicommittee 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 baard/committee you have served on for period of one year after leaving office (Miami Beach City Code section 2-26). o Requirement to disciase 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 hereby attest to the accuracy and truthfulness of the application and have received, read and will abide by Chapter 2, Arti 1 VI{ - of he City de "Stand ds of Conduct for City Officers, Em ioye s and A ency Members." O ~ r ~ 0 S' L~~ Applicant's Signature Date Name of Applicant PLEASE PRINT) Please attach a copy of your resume to this application NOTE: Applications will remain on file for a period of one (1) calendar year. Received in the City Clerk's Office by : ~t(VcC~ ~~i1~L~C3 Date:./R /20 Control No. 2oS~ Date: _/_/2009 Name of Deputy Clerk STATE OF FLORIDA aC# 4 1° 7 -',, DEPARTMENT OF :BUSINESS .AND ~.~,,,.~~ PROFESSIONAL -.=REGULAT,ION AR001667-4 12/10/08 08:0277873 .ARCHITECT RO'SENSTEIN, NORBERTO -I$ -LICENSED 'under the provisions of Ch.481 Fs. Expiratioa'date: FEB -28~ .20:1'1 - L08121D00676 '~°~ SOURCE OF I-~C0~1E STATF~~~YT Please Frint or ?ype F~~+ r;!~n,F h~iddie Name/Znrtial Last Name Name; Ntaifing Address; City /State/ZiR; IV~r-o~.r I o ~o3en~.Sl I2 6 s- S. o 1.3 DtsCIaSUr~ For Tax 'Iga r Enr~ing; J q` .2g~t~ .~ s~•- ~ Social Security 1~lumber; Fiiang a5 a; ® County Employee; ® Miunicipai Employ®e af: Pcrsitic~n~ held ar sought; Beard where serving; ~~~~ Department where amployect: 1Mor~. address; Term ar ~rnpiv}~rr~ant began an : ~ ~ / © ~ if your home acltireas is exempt firam public racorhs pursuant to Florida Statutes § 115.Q7 p9sase shack here (read iustruetions~; ® lA~Ot'is TB~®pE~avree: Home Addra9s; Street Address City State Zip Code her swear v. affirm) that the afivresaid infvrrnativn is 2 true acted correct statement. :~ ~' 1 ~ 1 e 5igria re of person disc-QSing mate signed please lest b-eia-w in descending artier with the Largest source first, t:he name, address and prencepal buseness activity of Avery source of your income inc~c~ciar~g public salary y®u received or any person received for yaur bane~it or e~Se ciurerag the c~isclQSUre periad, The income of your spouse or any business partner need net be c6isclaes~a3. If cvnt4roued on a separate sheet, check here; ~ J