Harold Foster 12/31/2011~/ • •
m I'S,IAMIBEACH
City of .Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, wvvw.miamibeachfl.aov
OFFICE OF THE CITY CLERK; Robert Parcher, City Clerk
Tel: (305) 673-741 1, Fax: (305) 673-7254
04-16-2010
Harold Foster
3100 Collins Ave #404
Miami Beach, Florida 33140
SlJ13J.ECT: 'Health Advisory Committee -
Congratulations! You have been appointed by the City Commission 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.
tf 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
Cliff Leonard
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 MIAMIBEd~,C~l
City.of Miami, Beach, 1700 Convention Center Drive,. Miami Beach, florida:33:1:39, www.miamibeachfLOov . . . ...
..
OFFICE OF THE CITY,CLERK, Robert Parcher, Ciry Clerk '~ - ''
- -. a .. .. _ ,.
Tel: (305) 673-741 1, Fax: (305 673-7254. "
' .. F.~.. .. ,.. 3 / ... ~ ... ... ~.
TO Harold William Foster
RE: Health. 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 which I have served.
M -
Harold William Foster
Sworn to and subscribed before me this`q t~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
m /CIA/V~I6lACH
NAME:
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Last Name 1a~' C F ~ 1 ~ ~~ ~~~ FirSt- l/(~vY ' U ° i ~G~ ~ !-~Ci~~ ~dd~~ nit~~ `~
HOME ADDRESS: •-~~/
' Apt No. House No./Street City State Zip Code
PHONE: ~Q~~ -' ~J( '~ - l~f'(b ~D~7~ .!~~~L n~ ~ mil'
Home
Business :Name:
Address:
Work
Fax
Position:
Email address
No. - Street Ciiy State .Zip Code
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:` 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 established in the city.
a
•. Resident of Miami Beach for a minimum of six (6) months`° Yes;~or No ^
• Demonstrate. an ownership/interest in a business ' Miami Beach fora 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 Middle Beach
• I am applying for an appointment because I have special abilities, knowledge and experi c . ist below:
• Are you.presentlyacegistered lobbyist with the City of Miami Beach? Yes ^ or No 7~
Please list vour preferences in order of ranking r1T first choice f21 second choice and f31 third rhnira PipaGp n~+p +h~'r nnly 4h~cn X31
choices will be observed by the City 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 '
^ Board of Ad'ustment* ^ Miami Beach Commission for Women
b and et Adviso Committee ^ Miami Beach Cultural Arts Council
^ Ca ital'Im rovements Pro'ects Oversi ht Committee ^ Miami Beach Sister Cities Pro ram
0 Committee on'the Homeless ^ Normand Shores Local Government Nei h. Im rovement
^ Committee for Quali Education in MB ^ Parks and Recreation Facilities Board
^ Communit Develo merit Adviso ^ Personnel Board •
^ Communi 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 ^ Safe Committee
^ Fine Arts Board ^ Sin to 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
J
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:. 1-'f' Age: Program:
Child's name:, - Age: Program:
F:`,CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC ApplicationOG2604 NEW.doc
.Have you ever been convicted of a~.._,ony: Yes ~~' o o ~_; If yes, please explain in'\`:;fail:
• Do you currently have a violation(s) of City of Miami Beach codes: Yes u91~1o ~'. If yes, please explain in detail:
~/
• Do you currently owe the City of Miami Beach any money: Yes ^ ~r~Ip~G'. If yes,. explain in detail
• Are you currently serving on any City Boards or Committees: Yes~or No C. If yes; which board?
• What organizations inff--the City of Miami Beach do you currently hold membership in?
Name: ~.fJ(~~(o (,~ n~ ~ ~ ~ U in('~c'7 Title:
Name: Title:
• List all pr~erties owned or have an interest in, which are located w~fn the City of Miami Beach:
• I am now.employed by the City of Miami Beach: Yes ^ dl~ioo. Which department?
• Pursuant to City Code Section 2-25 (b): Do you have a parent ^, 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 mpiy with federal equal opportunity reporting requirements.
Gender: Male ^ Femaie
Ethnic Origin: Check one only (1)
White (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 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 ^ o~o^.
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 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,
Articl .VII - of the City o e " tandards of Conduct for City Officers, Employees and Agency Members."
l~xnJl -~rJ ~ ~ l ~ i~C~~ ~j ..~
Apptl 's Sig ature ~ati~ -> Name of Applicant (PLEASE PRINT)
Fleasertattai3h~aacopyaof,youriresume to:this,appllcation
NOTE: YApplicatioiiswlll
r i -,
Received in the City Clerk's Office by : y `~d~_w_ Date
Name of Depu y Clerk F:\CLER1$f
Control No. Date:
SIBOARD AND COMM TTEES\B~
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