Rachel Zuckerman 12/31/2011m MIF~MIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, vrvw.miamibeachfl.~ov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel: (305) 673-741 1, Fax: (305) 673-7254
03-09-2010
Rachael zuckerman
,SUBJECT: Committee on the Homeless
Congratulations! You have been appointed by Commissioner Deede Weithorn
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,
,~ ~~.e~ a~~Y~ s~
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Ingrid Usaga
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, tropicol, historic community.
m MIAMI~EACC1
x .; ~,:•City~of,Miami:Beach'`::l'7,OO:Conventiori;Cenfer,Dtive 'Miami~Beacii;.Flonda381i39,~.www:miami•jeachfl,~' ov '. ~'.~+~, : - 3~.~,:-'" -z,i.
. '..: ;OFFICE OF THE`CITY CCERK; Ro•jert.Pdreher; City Cletk ; ~`<,~: ; _:~ .., .lF ~:;tt ~ ....r~, _,;,.:..:: '' _"+:w.ci; . S'~ "'•.,r
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.._•.. : <• ....Tel: (305) 673`741.t,:Faxi (305 673-7254... .. ~ -TG (.i';; _.' , ..: ~ ~7xi . ~,..>... ,_ ~..,
TO Rachel J. Zuckerman
RE: Committee on the Homeless
1 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 Pub/ic 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 wJ~h I have served.
R ch~ Zuckerman ~
~ ,
Sworn to and subscribed before me this day of 2010.
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.
'HOME°ADDRESS: ~J
Apt Nol ~ House No./Street
PHONE: ~ r: ''fi'"(V " ~ O~
Business Name: CN V~ Q~~l~ j~ Ul~ ~~Y ~-
Address: ~, J I~,~~Vl ~~~ ~ ~~ l~l U" r 1. l~J~``~
° No. " " . Street"
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City State Zip Code
Fax ail address ' r}'X,ti
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City State _ Zip Code
' ' Expires ~ • At#a~h' a copy of the license
.Pursuant to City Cotle section 2-22(4) a and b: Member's 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 fora minimum of six months:in a business estab(ished"in.the. city.
• Residehtof Miami Beach for a minimum of six (6) months: Yes ^ or No ^ -
v. Demonstrate an ownership/interest is a business in Miami Beach for a minimum of ix (6) months: Yes ^ or No ^ ~ -
~+ Are,you•a registered voter in Miami Beach: YesiO,or No ^ ' '
• (Please circle one): I am now a resident of: '~'_°North~Beach South Beach Middle 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 ^
riease ns>: your prererences to order or rantong l~l nrst choice Iz~ second choice, anq 13J trnra choice. Please note that only three (3)
choices,witl be observed by the City_Clerk's Office. (Regular Boards of City) ^ `~
^ Affordable Housin Adviso Committee `. ^.Housin Authorit-
^"Arvin 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
D Ca`ital Im rovements Pro'ects Oversi ht Committee o.Miami Beach Sister Cities'Pro ram
ommittee on the Homeless ^ Normand Shores Local Government Nei h. lm rovement
Committee for Quali .Education in M8 ^ Parks and Recreation Facilities Board
^.Communif Develo merit Adviso ^ Personnel Board
Cl Commurii Relations'Board - _ ^ Plannin Board'
^ Convenfion Center•Adviso Board ~ ^ Poiice Citizens Relations Committee '
°Debarment Committee ~ ^ Production Indust Council
O'Desi n'Review Board" ` ' ^ Public Safet Adviso Committee
Disabilit Access `Committee ~"Safe ' Committee
D Fine Arts Board ^ Sin le Famif Residential Review Panel
Ga ,Lesbian, "$isexual and Trans ender GLBT ^ Sustainabilit 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 ~ ^ 1Naterfront Protection Committee
''b Histo~icPreservation`Board ~^ Youth Center Adviso Board
"Board Required to File State Disclosure Form
Note. {f 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 n No ^, Years of Service: ~ - ~ ,
2: Present participation in Youth Center activities by your children Yes No ^: )f 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 ApplicationOG26"09 NEV~!.doc •.
.Have you ever been convicted of a felony: Yes ~Qr Nf yes„please explain in detail.
Do~~`you currently have a violation(s) of City of Miami Beach codes: Yes' ~ or No Ifyes,.-.please explain in detail:
i I.•_
- ~ ~ • Do you currently owe the City of Miami Beach ahy money: 'Yes ~i or No Ifiyes, explain~in detail -,
_ ,
~. ,. .-
+ Are you currently serving on any City Boards or. Committees: Yes ~ -~ or No If yes; which board? = .
. .' What or anizations iri the Cify,~oyf Miami Beach do you currently h id /m~,emc~bership in? - ;
Name:' VW~ - d I'15aV .~ "
" Name:,' Title::
• `List all properties owhed. or have en interest in, which are located withiri the City of iami B ach: '
~. - -
. . l am'now employed by'the City of Miami Beach: Yes ^ or ich department?
• Pursuant to.City..Code Section 2-25 (b): Do,you have. a parent ^,____////spous hild ~, other L~, or sister ~ who is employed by the
City of Miarni .Beach?-Check all that apply. Identify the department(s): ~ "
' ~ The following information is voluhtary and is neither part of your application nor has any'bearing on your consideration for appointment. It is
being asked to comply.with federalequalopportunity reporting requirements.
. ... ,
Gender; ^ Male - emale` - •
E nic Origin: Check one only (1 ), - .~
kite (Not of Hispanic Origin): AIt persons having origins in ahy of the original peoples of Europe, North. Africa°or the Middle East.
(] African-AmericanlBlack (Not of Hispanic Origin): Afl,persons havirig 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 origih, regardless ofrace.
^ Asian or Pacific .Islander: All persons having origins ih any of the original peoples of the .Far East, Southeast Asia, the Indian Subcontinent, on
the, Pacificlslands. This area includes, for example, China, India,. Japan, Korea, the Philippine Islands and Somo_a.
^ American Indian or Alaskan Native: All persons having origins•in any of the origihaf peoples of North America, and who maintain ~=~
' Cultural identification through tribal affiliation or community. recognition. '
' Physically~Challenged: Yes ~ or No `.'
Employment Status: Employed, Retired ^ Homemaker ^ Other
NOTE: -If appointed, you,vvill 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 ihdirectly lobbying city personnel (Miami .Beach City Code section 2-4.59).
o Prohibition from contracting with the city (Miami-Dade County Code section 2-11.1).
o , Rrohibition 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):•~ prohibitiori, during tenure and for. one year. after leaving .office,
from having " any ihterest 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 attes he accuracy and truthfulness of the ap
Artic{e Vll - the i Code "Standards of Conduct forCity
Applicant's Signature Date
- ' Pleasexattach~ascopy4oi'your~resume~to this application
NaTE: Apphcationsavvllls in on~f
Received ih'the City Clerk's Office by
` - Name, of De uty Clerk F
and ve received, read and.. will abide by Chapter 2,
E oyees and Agency Membe ."
Na a of Applicant (PLEASE PRINT)
;period-of gone °(1):calendar-year.
Date: / /2010 Control
R1$ALL\aFORMS\BOARD
Date:
doc
®~ SOURCE OF INCOPWE STATEMENT
Please Print or Type First Name Middle Name/Initial Last Name
Disclosure
Name: Q~JV 1C1.~ I ~U~.'~ ~ ~ For"Tagx Year
l CIn Endin
Mailing Address: l~ ~ Jr ~~ i~
City/State/Zip: !-~' J~ .
Social Security Number: `~" O ~ ~ ~ `' ~~
Filing as a: ® County Employee: `~n _
® Municipal 'Employee of; tJ d-~
Position held or sought: ~~
Board where .serving: ~-S_JM MI -~-e,~ ~> Term or~Empioymen
r l~ eganson:
Department where.employed: '
~~/
Work Address:
.. ~~ ~ ~~
If your -home address is exempt from public records pursuant to /~
Florida Statutes § 119:07 please check here (read in uetionsj: ~ Work Telephone: ~~ ~~2
Ho e A dress: _ ~~~~ ~~ l ~~ ~ `-~~ > # ~J~ ' 2-)
m d
/~ ~Street A~d2dre~
V ° ~ ~'~ ~-
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
.income ~of your spouse ar any .business .partner need not be disciQSed. ~ If continued on a
separate sheet, check hare: '®
Name of Source of Income
Add Description of thePrincipal
Business Activi
~ U
I hereby sw oraffirm) hat the aforesaid information is a .true-and correct statement.
I
Signature-o perso isciosing ' Da ig d