Keith Menin 12/31/2011CIh/ Df Migmi .B@CIC~1~ "1700 Convention Center Drive, Miami Beach, Florida 33139, ~ww:miamibeachfl.aov
OFFICE OF THE CITY CLERK, Robert Parches, Ciry Clerk
TeL• (305) 673-7411,'Fax: (305).673-7254
..03-26-201.0
Keith :Menin .
. 11 OO West Ave. TS 1 ~ - .
Miami Beach, Florida 331.39
SUBJECT: Visitor and Colnvention Authority -
Congratulations! .You have been appointed by the City Commission to the agency,
board br committee named above for a-term: ending: 12/31/2011. ~.
` - Pursuant to Ordinance No. 2006=3543;. commencing with terms beginning on or after
January,1 st, 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
_ , Glerk's Office at -305-673=7411. Please read the enclosed materials carefully.
Congratulations again and good luck.
..Sincerely,. ,
. S~
!~~
Robert Parches -
City Clerk _
cc: 'Saul Frances, Parking :Director-
Glrisette Roque .,
-, 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=bade 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 MIAMI6EA,C~i
City of Miami Beach, 1700 Convention Center Drive; Miami Beach, Florida 33139, www.miamibeachfl.gov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel: (305 673-741 1, Fax: (305 673-7254
TO Keith Menin
RE: Visitor and Convention Authority
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 Emp/ogees, 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.
Keith Menin
Tl~-
Sworn to and subscribed before me this ~ day of ~/ ~, 2010.
~L
S
f~- 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 safely to all who live, work and play-in our vibrant, tropical, historic community.
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NAME• ~~~ ~ ~ I ~ l~-L.,
Last Name - - First Na ~ fiddle initial:-
:. •
.. HOME ADDRESS: ~ `~ ~",o,~- ~-'e . 1 ~ \ ..1 r -` ~.°'~Z. ~C ~ ~ I .~~ .
• • Apt No. •~ House No./Street _ C y State Zip`Code
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y PHONE: ~ U~ ~~ ~ . ~ ~ ~ , ~~~' c,~-L; ~ ~ C~ c;>~ r .C~ • ~--
- - ~ ~ ',Home. ~~ Work .Fax •Emaiiaddress~
' Business Nrame: ~~n ~" ]~1~ 1 } • Position: ~~ ~ -
" ~ ~ Address: d ~ ~5~ ~~V`'ti"~ ~U~ ~ (~ ~c~t . `~~ I'Z~~: .
. - _ No.... Street City- ' " State Zip Code
-Professional License (describe)-. '~' Expires: A4dacir`~ copy of the{icense.
' Pursuant to City Code ectioh 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 peeh a resident of the: cit for a minimum of six
Y
' , months; or b) an individual shall demonstrate owne~shiplint rest fora .'~ mum of six months intia business established in'the city.
• Resident of Miami Beach for a mihimum of six (6j mon es ~ or No ^
_• Demonstrate an ownership/interest.in a busines iami'Beach for a minimum ofsix (6) months: Yes or No ^ •
• Are you:a registered voter in Miami Beach: Y ^' or No ^ •. - ~ '
• (Please,circle one): I am now a resident of North .Beach South;Beac Middle Beach
' • I am ,applying for an appointmenfibecause I-have. special abilities, know a ge and ex rience. Please list below:
• Are you presently: a registered lobbyist with the City of Miami Beach? Yes r~No 0
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 wilt be~.observed by the City Clerk's Office.. (Regular Boards of City)
Affordable Wousin Adviso Committee ^ Housin Authorit
^ Art-in=Public Pldces Committee ~ ^ Loan Review Committee
^~Beaufification:.Committee ^ Marine Authorit-
Board of Ad~ustment* •. ^.Miami Beach Commission for Women
o Bud et`Adviso Committee - ^ Miami Beach Cultural Arts Council
•0 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. lm rovement
^ Committee for Quali Education in MB ^ Parks and Recreation Facilities Board
0 Commuhit Develo ment Adviso
..
^ Personnel Board '`
^ Communi `Relations Board ^ Plannin .Board" '
~ Convection Center Adviso Board. ^'.Police Citizens Relations Committee
^ Debarment Committee ^ Production Industr Council
o Desi n Review,Board* ' ~, ^ Public Safet Adviso Committee '
Disabilit Acdess Committee ^ Safe Committee
^ Fihe Arts Board ~ ^ Sin le Famil Residential Review Panel
^ Ga ,Lesbian, Bisexual and Trans ender GLBT ^.Sustainatiilit Committee -
^Golf Adviso Committee , , ^?rans arenc Reliabilit &Accountabilit Committee "TRAC" '
^`Health Adviso Committee. ^ Tran rtation and Parkin Committee ~ '
D Health Facilities Authorit 'Board isitor and Convention-Authorit
His anicAffairs Committee ~ Waterfront Protection. Committee
'^•Historic Preservatioh`Board `• ' ` ` ^ Youth Center Adviso Board
*Board Required to File State 17isclosure 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 chitdren~Yesp No ^. If yes, please,lis the :names of your children, their
ages, andwhich programs. List below:
Child's name:. - Age:, Program;
.:Child's name: Age: Program:
` - F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC ApplicationOG2609 NEW.doc
.Have you. ever been convicted of a felony: Yes ~_ se explain in detail:'h~ ~ .
- ~ , ,, ~~t
~' • Do you currently have a violatiori(s) of City of Miami. Beach codes: Yes ~ or:No r~. yes, .please explain ih detail:
.. _ _, ,
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• Do you currently owe the City of:Miami,Beach ariy moriey: Yes ~ or No ~ yes, ex-lain In detail. ~.
..Are you currently servirig on any City:,Boards or Committees: Yes i-i or No-'^.r if yes; which'board~?.~
..., •
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.:What organizations in the City of Miami Beach do you currently hold membership in? • •
.. ... __ .
.,..',Name; _ Title: :,
...Name: Title:- ~ .
' ~. List all,,proPerties owned or have an interest in, which are to ted within the City of Miami Beach:.
' Y ~ ~'~-
° ~
.
-.. I am now employed by'the City of Miami-Beach: Yes C or N ~. ich department? '
Pursuant to Ci Code Section 2-25- b 'Do ou have a anent ^, s ouse q child i~~, brother n
. ~ tY {) Y p p ~, orsister ~ who.is employed by the •
.City of Miami Beach? Check~all that apply: Identify the department(s): ~~ -
G
The following informatio 's voluntary and is neitherpart of your application norhas any bearing.on your consideration for appointmehf. It is
being asked to com ~ with federal equal opportunity reporting requirements.
Gender; ale ^ Femaie .
.~ , Et c 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.
. . ( p g ) .
' ~:^ African-American/Black Not of His anic Ori in :All persons having origins in any of the,Black racial groups. of Africa:
^ Hispanic: All persons of Mexicali, Puerto. Rican, Cuban, Central or South American, or other Spanish culture o~ 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 8ubcontinehf, oh
- the Pacific Islands. This area includes, for example, China, India, Japan, Korea, the Philippine:Islahdsarid Somoa.
^ American Indian or Alaskan Native: All persons ving origins in any ofahe original peoples of North America, and who maintain •
' 'Cultural identification through tribal affiliati community recognition.
Physically`Challenged: Yes. C or off.
.Employment Status: Employed ^ : Retired ^ Homemaker ^ Other ^
' NOTE: if appointed, you willbe required to follow certain laws-which apply to city board/committee members. •
:These laws include, but are. notlimited to, the following:
- -o Prohibitiori~from directly dr indirectly lobbying city personnel (Miami Beach City Code section 2-459).
o .,Prohibition from contracting with the city (Miami-Dade County Code ection 2-11.1).
o .Prohibition from'iobbying before. board/committee you have served oh for period of one year after .leaving office (Miami
BeaCti. 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`°haying ariy ihterest in or receiving any'benefit from Community Development Block Granfftands-for either yourself ,.
or those with whom you` have business or immediate family ties (CFR :570.61'1): •
...
' 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;
- - City Co `Standards of Conduct for City Officers, Employees and Agency Members:"
ature ~. Date Name of Applicant (PLEASE PRINT)
Pleaseiatfa~+hra'.Copy<of>your;resume'to:this'appiication '
NOTE Applications:wlll remain onsfile fora period of•one:(1)calendar.year.
.Received in the City Clerk's:Office by : .Date: _/ /2010 Control No. Date: _/_/2010
" Name of Deputy Clerk F:ICLERI$ACL1aFORMS\BOARD AN CO MITTEESIBC Application.doc
r ~: If ye ;plea
I A M !•DADE
~~ SOURCE OF INCOME STATEMENT •
.Please Print or Type
Name:..'
Mailing Address:
City/State/Zip: '
Disclosure
For Tax Year
Ending:
Social Security... Number:. ~~ ~ ~ ~ 3 ~ ~ J'
,filing as `a: ~ County Employee: - . ,
® Municipal fmployee.of: ~ < ~'
• Position held•or sought:
Board where serving: ~ ~~ ~. Term or Employment
.Began on: ~~ ~~rF- (S 2d I d.
,~ -Department where employed:
.Work Addressc ~----' .
• If your home address is exempt from public records pursuantto ~ ~ Jj '~. 9 ~j,-03 SZ
Florida Statutes § 119.07 please check here (read instructions): ® Work~Telephone:
Home Address: S ~ ~ ~ ..
Street Address
. City Stater 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 yourspouse or any business partner need not be disclosed. If continued on a
separate sheet, .check here:
I herebi : wear-(or affir ) that.the aforesaid information is a true. and correct statement.
~-
natare of person :disclosing 'Date signed
Name;af Source of Income
Address. `'Description''of thePrincipal
- Business ACtivi
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