Josh Gimelstein 12/31/2011~-
m MIAMI~E,~CH
City. of Miami Beach, 1700 Convention Center Drive, Miami Beach; FloricJa 33.139, vyww.miomibeachfLoov
OFFICE OF THE CITY CLERK, Robert Parcher, Ciry Clerk '
Tel: (305) 673-741 1, Fax: (305) 673-7254
03-12-2010
Josh Gimelstein
tJBJECT: 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 directlyappointed 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
Maria Ruiz
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~~6;C" ,,
t,,;•_; ,,-, ;>., ..; ~-~+;,.Cltyaof Mia,mraBeach,;~t7ooco~yentionCenter.Drive;''MiamizBeach;°Floe'da;33'139,,www:miamibeachfl:gov -:'.:w ~;y ~:,,: ~..~.:,~ f-.°
• FFI E:OF THE.CITY,CLERK; Ro ert Parcher, Ciy.Clerk ~a „_ _ .. ,~. _. .•: a._,.,. ! _ _ j`~ :. .
Tel; (305.673-74.1'1:; Fax: (305) 673-7254; !_ }.;^ ;? a, . ,;•#".., ,: a r.x: ~; u~.~' :~i' ... j a ^ ~ ' ...,.
TO Josh Gimelstein
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 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 a board mmittee on which
I serve) on July 1st, following the closing of the calendar year o~wt~h I h e rued.
..~ U--- ~----------- ~ o
Sworn to and subscribed befo me this ~ day of /~~ 00/
~-
Silvia Prieto
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.
m PJ~IAPf~IBEACH
~€ ~ Y CAF itfi~4/;6•ei~E ~~~;uF!
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NAME: x`11 ~'Yli~i~S#'>QI/~ C I d5 ~l 1'~I .
Last Name First Name M~~ i^^ddle Initi2al
HOME ADDRESS: ~~/ ~ Zb 1/~ • ~~~- ~1 G(iWl.! Y~i >~~ 3~
Apt No. House No./Street City p /' State Zip Code
PHONE: 3bs-L~D7i "~'~~-4 ZJ C~ ! M e~S~~f"a~r'~I ~ ~.a~•C~
Home ; Work Fax Email address-
Business Name: Position:
Address:
No. Street
Professional License (describe)
City
State Zip Code
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; orb) 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 t=r6r No ^
• Demonstrate an ownership/interesYin a business i iami 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 Bea Middle Beach
• I am applying for an appointment because I have special abilities, know a ge and experience. Please list below:. l~°y1^e
• Are you presently a registered lobbyist with the City of Miami Beach? Yes ^ or No
_..r
Please list your preferences in order of ranking [1] first choice [2] second choice, and [3].third choice. Please note that only three (3)
choices will be observed by the Citv Clerk's Office. (Regular Boards of City)
^ Affordable Housin Adviso Committee ^Housin Authorit
^ Art in Public Places Committee ^ Loan Review Committee
^ Beautification Committee ^ Marine Authorit
^ B.oard of Ad~ustment* ^ Miami Beach Commission for Women
D"(3ud et Adviso Committee ^ Miami Beach Cultural Arts Council
D Ca ital Im rovemehts 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 ^ Parks and Recreation Facilities Board
^ Communit bevelo ment Adviso ^ Personnel Board
^ Communi Relations Board ^ Plannin Board`
^ Convention Center Adviso Board ^ Police Citizens Relations Committee
^ Debarment Committee ^ Production Industr Council
^ Desi n Review Board* ^ Public Safet Adviso Committee
^ Disabili Access Committee ^ Safe Committee
^ Fine Arts Board ^ Sin le Famil Residential Review Panel
^ Ga ,Lesbian, Bisexual and Trans ender GLBT ^ Sustainabili Committee
^ Golf Adviso Committee ~ ^ Trans arenc Reliabilit & Accountabilit 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: -~,~) ] ! 1,! ; .
2. Present participation in Youth Center activities b our children YesC No ~ ~ ~`~ ~ ° ~ "i ~ r ~~ "'
Y Y ~ If yes, please list the names'of your~ch~ldrerj,, their
ages, and which programs. List below: .~
Child's name:. Age:. 'Program: ~ ~ '~• d ~ ! ;~~~_vi_
.Child's name:
Age: ,Program:
F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC ApplicalionOG2G09 NEW.doc .~ Cam„/~ J~
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- ~ ° - •Have~yoia ever.been convicted of a felony: Yes ~'~ ,please explaih in detail:.
' ` ~ "- • Ob you ~ctarrently have a violation(s), of City of Miami' Beach codes: Yes C or No ~. If yes, please explain iri detail:
' ~ •: Do'you currently owe the City:of-Miami Beach any money Yes r, or No If yes, explain in .detail
• Are you currently serving on any City Boards or Committees: Yes ~; or No ~ . If yes; which board? .
` : What`orgahizations in ttie City of Miami Beacli do"yota currently hold membership in? ~ -
1. .- - :.
.. .. ~ N,ame: .. Title: .
. Name:q ~ Title: ,
• List ap;-properties owned or have"an interest.in, which al-e located within the City of Miami Beach: ;
• 1 am now employed by the City of Miami ;Beach: Yes C or Nom;. Which department?
• Pursuant to.City Code $ection 2-25 (b),: Do you-.have a parent ^, spouse u, child rJ„brother ~, or sister ~"who is employed by the
` City of Miami Beach?. Checkall that apply. Identify.the department(s}: - ,
. ,
The following information is boluntary and is neither part of your.application nor has any bearing on your consideration for-appointment. It is .;.. -
being asked,to co ty,vrith federal=equal opportunity reporting requirements. "
Gender: ~ ate ^.F.emale _ .. ~ -
., , - _ :. ,
' .. " ' Ethnic Origin: Check one only (1) " . , _ ,
.. .
- ^ Whi e" (Not of Hispanic Origin): All persons-having origins in any of the original peoples of Europe, North Africa-orthe Middle'East. ,
^ AfriAfri" . _ "
can-AmericanlBlack" (Not of Hispanic Urigin): All persons having origins.ih any of the Black racial groups of Africa. "
. e ~s snit: All persons ofiMexican, -Puerto Rican, Cuban, Centralbr South American, or. other Spanish culture or origin; regardless of face. '
_^ Asian or Pacific Islander: All persons having origins many of the original peoples of the Far'East, Southeast Asia, the lhdianSubcontinent, on
the Pacific Islands: This area includes, for "example, China, India, Japan, Korea, the Philippine .Islands and $omoa.
' D~American Indian or Alaskan.Native: ~ All persons having origins in any of the origihal peoples of North America, and who maintain
Culturai identification through;tribal affiliatiomor.community recognition.
"` Physically Challenged: Yes ~ dr-No~,
~" : Employment Status: Employed°(~ Retired ^ " ~ ~ ~ ~ -
Homemaker ^ Other
NOTE: If appointed, you will be required to follow certainaaws which apply to city boardlcommittee members.
` ~ These laws include, but;are not limited°to, the following:
o ~ Prohibition firom directly.or indifectly lobbying city personnel. (Miami Beach City Code section 2-459). ,
o ~ Prohibition from contracting with the city (Miami-Dade County Code section 2-1.1.1). '
- ' ~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 Corrimunity Development Block-Grant funds for eithef yourself ,
br those with whom you have business or immediate family ties (CFR b70.611).. -
` lJpon request, copies"of these laves enay be obtained from the City Clerk. .
• . "I her y a to a accuracy and truthfulness ofahe application and have received, read and will ,abide by Chapter 2;
- Arti a VII . f i de "Standards of Conduct for City Officers; Employee nd Agen 'Members."
/~ .
` pli nt's natrire ate • Name of App scant {PL E^PRINT) .
R" ase)attachrarcgpyyof~yourresume.toitfiis application
NOTE:.APphcatiorsawllhre imon~fl "fora;period~ofone.(4):catendanyear.
-, Date: _/ /2010 Control No~ Date: _/2 1
Received,ih the City Clerk's Office by : Name of De ut Clerk F:ICLER\$ALL\aFORMS\BOARD AND C MMITTEES\BC ppli)cati n.doo
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or No-_: If yes
®~ SOU62CE OF INCOME STATEMENT
Position held or sought: '~- '~' ~ ~r
~: cn ~'i
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Board where serving: ~t Term or Employment ~~ '~
-~/ 1-C Began on: - ~ ~ ; ~
Department where employed: ;~ co
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
income of your spouse or any business partner need not be disclosed. If continued on a
separate sheet, check here: ~ -
e First Name Middle Nam' a/Initial Last Name
~5 ~ V (M e
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Disclosure
For Tax Year
Ending:
t~(~'~/
Social Security Number: ~~ /' Y~~ ~ ~/N L Z
G" > N
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Filing as a: ® County Employee: ~---= -~ o
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Municipal Employee of:
Name of Source of Income
Address Description of the Principal
Bossiness Activi
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I .hereby swe r affirm) that the aforesaid information is a true and correct statement.
~-~ ( 2~ ~ ~
Signat o rson d sclosing Date signed
Please Print or Typ
Name:
Mailing Address:
City/State/Zip:
Work Address:
If your home address is exempt from public records pursuant to
Florida Statutes § 119.07 please check here (read instructions): ~ .Work Telephone:
Home Address: ~ ~-d (~ ~S~ ~ ~ --~ ~ 2 _ __
p ~ Street Address
l~ 1 ~ ~-~ -3~ ~ ~ ~
.City State Zip Code