Ileana Bravo-Gordon 12/31/2011m /~1':A,MIBEACN
- ~ City of Miami Beach, T700 Convention Center Drive, Miami Beach, .Florida 33:139, v~ww.miamibeachfLgov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel: (305) 673-74T 1, Fax: (305) 673-7254
3/24/2010
Lleana Bravo-Gordon
5411 Alton Rd
Miami Beach, Florida 33140 .
,SUgJEyCT: ,a; Miami Beach Cultural Arts Council
Congratulations! You .have been reappointed by the City Commission to the above
referenced agency, board or committee for a term ending: 12/3112011.
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 iuck.
Sincerely,
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Gary Farmer
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.
m MIAMI~~~4CW
'City of Miami .Beach, ]700-Gonyention Center Drive",,Miami°Beach.Florid6~331.39,'vrww.miamibeachfl.aov .... ..
.. ,
"- ' "' OFFICE OF THE CITI: CLERK; .Robert Parcher, Ciy Clerk " '•° ': ~:: -" '' ' ~ ' ~~ ~ ~" , - , . .
.. _. ~:
,Tel: (305( 673-741 1; Fqz:' (305 673-7254 i ~ ' ~; ,~ . ,. , .
TO .Ileana Bravo-Gordon
RE: Miami Beach Cultural Arts Council
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 n which
I serve) on July 1st,. following the closing of the calendar year on 'ch I have served.
Ileana Bravo-Go~rdo,~n
Sworn to and subscribed before me this ~~day of ~ l~v~-e-, 2010.
Si via Prieto
Deputy Clerk
i
*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.
~ MIAMIBEACH
CITY OF MIAMI BEACH
BOARD AND COMMITTEE APPLICATION FORM
NAME: () IC-f(V(J- (o I~K+~N ._.~f~/`f'Nr' M•
Last Name / First Name ~ ~ ~y~~ Middle Initial
HOME ADDRESS: ~~`~ ~~ ~~ /7l~__~~~-~! ~ ~~~
_ Apt No. House No./Street City State Zip Code
PHONE:
Home
Business Name: -
Address
~'• ~3qo
No.
Professional License (describe)
City
State
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; or b) an individual shall demonstrate ownership/interest f`o/r 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 fiddle Beach
• I am applying for an appointment because I have special abilities, knowledge and experience. ow:
• Are you presently a registered lobbyist with the City of Miami Beach? Yes ^ or No ~1
Please list your preferences in order of ranking [1] first choice [2] second choice, and [3] third choice. Please note that o~v 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 `~''
^ Board of Ad'ustment" ^ Miami Beach Commission for Women ---~ '
^ Bud et Adviso Committee iami 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 rov~Pnent
^ Committee for Qualit Education in MB ^ Parks and Recreation Facilities Board
^ Communit Develo ment Adviso ^ Personnel Board
^ Communit 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
^ Disabili Access Committee ^ Safet Committee
^ Fine Arts Board ^ Sin le Famil Residential Review Panel
0 Ga ,Lesbian, Bisexual and Trans ender GLBT ^ Sustainabilit Committee
^ Golf Advisor 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 ^~Q ^ Years of Service: ~ !, j
2. Present participation in Youth Center activities by your children Yes^ No ^. If yes, please li~t,Ztie~,names~df your children, their
ages, and which programs. List below: ~''+1 ~~~-~
Child's name: Age: Program: ~? ;a~
Child's name: Age: Program: ~~ ~ _.:~ '~`;
Work ~ ~ Fax /~ Email a dress
~']•D~1S .~~• Position: 1 ~S'!AC'X~-
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.Have you ever been convicted of a felony: Yes ^ or Nol~i If yes, please explain in detail
• Do you currently have a violation(s) of City of Miami Beach codes: Yes ^ or No~lf yes, please explain in detail:
• Do you currently owe the City of Miami Beach any money: Yes ^ 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 organizati ns in the City of Miami Beach do you currently hold membership in?
_.>
Name: ~~ Title:
Name: Title: -
• List all,propertie~ owned or have an interest in, which are located within the City of Miami Beach:
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
is 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.
^ frican-American/Black (Not of Hispanic Origin): All persons having origins in any of the Black racial groups of Africa.
l~jspanic: 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. - cN-..~
^ American Indian or Alaskan Native: All persons having origins in any of the original peoples of North America, and who"main ; -.,
Cultural identification through tribal affiliation or community recognition. --~ ,.v'~~
=t7
Physically Challenged: Yes ^ or Nc~i., : - ~ ~'~
Employment Status: Employedl~( Retired ^ Homemaker ^ Other ^
~: ~..t
NOTE: If appointed, you will be required to follow certain laws which apply to city board/commitEee rt~rtber~'
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.
Mttest to h y nd truthfulness of the application and have received, read and will abide by Chapter 2,
~ of the C d ' ` ds of Conduct or City icers, Employees and Agency Members."
3 a 5 ~0 S ~
Signature Date Name of Applicant (PLEASE PRINT)
Please attach a copy of your resume to this application
NOTE: Applications will
Received in the City Clerk's Office by : ~-'Ld'~`' ~.J~y Date: _/ /2010 Control No.~L Date:
_~ Name of Deo v Clerk F:\CLER\$ALL\aFORMS\BOARD AND CnMMITTFFR\R
/ v
• I am now employed by the City of Miami Beach: Yes ^ or No~ Which department?
;E.~
• Pursuant to City Code Section 2-2 - {bj: Do you have a parent ^, spouse ^, child ^, brother ^, or sister ^ who is empE!®yed by the
City of Miami Beach? Check all that apply. Identify the department{s): ~
URGE OF INCOME STATEMENT
me Middle Name/Initial Last Name
Disclosure
~ "^' For Tax Year
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Ending: ~d~
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npioyee: ~
Employee of: ~
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~•-~ Term or Employment
Began on: o?DD
Department where employed:
Work Address: '
9s ~~ GU,4 ~ oo ~,e~. 1,~S
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If your home address is exempt from public records pursuant to 33 /3~
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Work Telephone:
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Home Address: J
• Street Address
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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 or any business partner need not be disclosed. If continued on a
separate sheet, check here: 0
Description of the Principal
Name of Source of Inwme Address Business Activi
~ r
,.,, ~,
..w
N~~ ~5
I hereby swear (or a rm) t aforesaid info~l~~rits ~ true and~correct statement.
~ ~~; ,s _ ;~~•o2S~ l ~
Signa pe Isdosing Date signed