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Moni Cohen 12/31/2010
,: . M ~ , ~~ .. . i . - - ~ • ~~ ~ .. ~ ~. C11')/ Of MIQR11 B@aC~'1~ 1700-Convention Cente+ Drive, Miami Beach, Florida ;33139, www.miamibeachfl.gov " ' ' . OFFICE OF THE CITY CLERK, Robert Parcher, Ciry Clerk Tel: (305) 673-741 1, Faz: (305) ;673-7254 i f •~ :.. . .~ :04-19-2010 _ ,. . ` ~° ~ ~ " • :. •Moni .Cohen i . . 880 Lakeview. Dr. ' ' -. t Miami Beach, F1 33140 ~ ~ : . . ~ ~ .. . ~' "_ ~ ,i ' ~~ ~ '~ SUBJECT: Transportation and'Parking Committee. ~., ~ , ~` Congratulations! You have been appointed, bye Commissioner Jerry Libbiri ..to the agency, board or committee named above for a term ending: 12/31%2010. • ~.. Pursuant to Ordinance No. 2006-3543,'cornrrie;ncing with terms beginning on or after . :. . January 1st, 2007, he term of board, memberswho are directly appointed by a° member of ` • the City<Commission shall automatically expirefori December 31 of the year the appointing ~ _ . • ~ elected. official leaves office. ~ • ~ • . ~' F .. • If.you :are unable to accept this appointment orhave any.questions, please call'the City Glerk's Office'at 305-673`7414. Please ,read the enclosed materials .carefully. " Congratulations again and good luck. ~ . •• .. i Sincerely, .. ~ ' i ~ : .- ~~ ~~L~/ 2 _ ~ ~~f ~ ~ . . Robert Parcher ~. ~ ~ - - -City Clerk : . • ~ ~ ,. . . cc: Sauf`Frances,-ParKing Director ~ , • . .. . 'Saul Frances . }. . . - ~ .ATTACHMENTS:.. r. . . - ' ~ ~ :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 • ' ~ i •, Ordinance No, .2006-3543 - AmendmenYto City Code Section 2-22 "(Vliarni-Dade County Code Section 2-11.1 -. Conflict ofi Interest and Code of .Ethics Ordinance City:Wide Permit Ap,pli~cation = (Parking Departm lent Form) .. ~ ' [ 'r • Booklet =,Guide to the Sunshine Amendment and, Code of Ethics for Public Officers and Employee , - ~~ 1 ~ ~ • ° .- 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~~,4CIH 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 l ,'Fax: (305 673-7254 t e~ :" ~ .~ .: `.! ' _ , . ~~~ ~ ;' ; TO Moni Cohen , RE: Transportation and Parking 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, land 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: 12/31/2010. I have been issued a copy of Section 2-11.1 of the Miami-Dade and Code of Ethics Ordinance), as well as theF/o~ida Commissic Amendment and Code of Ethics for Public Officers and Employee of a City of Miami Beach Board and/or Committee, I must comp) ments of Miami-Dade County or the State of Florida (depending I serve) on July 1st, following the closing of the calendar year ~¢r ~~ ounty Code (Conflict of Interest ~ on Ethics Guide to the Sunshine ~; and understand that as a member ~ with the financial disclosure"` require- jn the board or committee on which which I have served. n. / _ 99 Moni Cohen Sworn to and subscribed before me thisp~~ day of R! L , 2010. ~nvra rneto 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. I 2 m Pv11AMIBEACH NAME: Name , ~G T Y CyF ~6~ar~f ac~a~~-k ~ I . ~~~~~ :~i~C ~Di'i~ii'Ji(~° ~ ~E ~,Pr ~i'.~,~TIc~F~ F©R61;e HOME ADDRESS: n ~ O •~L~ K~ f~/~-~~I ~~) //~~ A t No. House No./Street.) PHONE: l3os-~ iZb~-33'~~ ' ,~r/~~L ~LQ~O.... Name 1 fiddle Initial q~ V~° ~clGm~ ~~4~ ~ ~~_ ~~~YQ City State Zip Code ~y~ ~~v~~ x6~- j3~ Home r Work-~/~ I I Fax M~En all ads ~~ j {o_~~~ . ~o Business Name: ~~~ ~S-~ ~-Q ("~, ~P~Ort.ScS Position: .S'~'eS Address: ~~1 Yr~~ i~ 5 C?Q~ QV~_ - No. Street ~ City 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: 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 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 ^ or No ^ • Demonstrate an ownership/interest in a business in Miami B ~ach 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 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 ^ 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 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 ^ Bud et Adviso Committee I ^ Miami 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 rovement ^ Committee for Quali Education in MB { ^ Parks and Recreation Facilities Board ^ Commuhit Develo ment Adviso { ^ Personnel Board ^ Communi Relations Board f ^ Plannin Board* ^ Convention Center Adviso Board ' ( ^ Police Citizens Relations Committee ^ Debarment Committee ~ ^ Production Industr Council ^ Desi n Review Board" ( ^ Public Safet Adviso Committee ^ Disabilit 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 i ^ Trans anent Reliabilit & Accountabilit Committee "TRAC" ^ Health Adviso Committee ~ rans ortation and Parkin Committee ^ Health Facilities Authorit :Board - ' ^ Visitor and Convention Authorit ^:His anic Affairs Committee ^ Waterfront Protection Committee ^' Historic Preservafion 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: i t 1. Past service on~the Youth Center Advisory Board: Yes ~ No p.Years of Service: 2. Present participation in Youth Center activities by your children Yes^. No's^' If yes, please list ttie-names ofyour children, their ages, and which programs. List below: Child's name: 'Age: Program: Child's name:, Age: Program: I F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC Application062609 NEW.doc I { f 5~ .Have you ever'beerrconvicted of a felony:-Yeso~lf yes, please explain in detail: -1 • Do yourcurrently have a violation(s) of City of Miami Beach codes: Yes ~ or No f . f yes, please explain in detail • Do you currently owe the City of Miami Beach any money: Yes ~l or No If yes, explain In detail ,< °~ - - °'° `• Are you•cu~rently serving on any City.l3oards or Committees: Yes C~ or , ~. If`yes,; which board? ;~ ._ 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 i terest in, which areaocated within the City of Miami Beach: ~. I am riow employed by the City of Miami Beach: Yes ^ or, Nq~Which department? • Pursuant to City Code Section 2-25 (b): Do you have a parent ^, spouse u, child r, brother ^, orai'ster ~ 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 comply with federal equal opportunity reporting requirements. Gender: ^ Male ~emale ~ • 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 Mexicali, 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 ih any of the original. peoples of North America, and who maintain Cultural identification through tribal affili~ation/or community recognition. Physically Challenged: Yes"~ or. No!aC Employment Status: Employe Retired ^ Homemaker ^ Other ^ r~4r~' ~~rn e i 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). f 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 cur" and truthfulness of the application and have received, read and will abide by Chapter 2, A i e VII - of the Ci C d t:andards of Condu t for C'ty Officers, Employees and Agency Memb rs." Z2 0 O ~ Q ~ A is is Signature D e ( Name of Applicant (PLEASE PRINT) ...... ~ Pfeaselattaoh€a~copy;of.youraresiime to this application i pperiod-of.~:oner(9):calendar'.year. Received in the City Clerk's Office by : _ ~~ ~ ~J~~ Date: _/ /2010 Control No. Date: / /2010 ~ // ame of Dep ty Clerk ~F:ICLER\$ALL1aFORMS160ARD AND CO MITTEES\B oolication oc I A M FD4Qc ! ¢~~ SOURCE OF INCOME STATEMET~fT Please Print or Type First blame Nfiddle Name/Initial, Last Name Co/ e~ ~~~ l !/~. Name: / Mailing Address: ~~ L~ ~~L%'~~ ~y ~ v~ City/State/ziR: ~/~/~r Gmc .~eaG~ , ~i - 33~ Disclosure For Tax Ysar Ending~~ D' Social Securit}~ Number; Filing as a: 8 County Employee: Municipal Empiay®e afi; Position held or sought; UQ lA~(}i ~r~' "Board where servin I ~an ' ` Term ar Em 6v mant g' ~Un ` AY~C} Began an: P y `, ~ ~ Zo j U Department where empioyect; W ork ,4ddress; If your home adtlreas es exempt from pubFi~ ra~ortls pursuant to Florida Statutes § 1iB.Q7 please chacN herce (read instructions: ~ Work Taiaphorre; Home Address, c.~ a• rn e. ~S ~ ~O VIP ' ~ Street Adtlress City State Zip Code Piease list beiaw in descending orderlwith the Largest source first, the name, address and principal business activity of every source of your income inciuding public salary you received or any parson received far your baneft or use during. the disciQSUre period, The income of your spouse or any business partner need not be discia~sed. Tf continued an a separate sheet, check here; ~ f~tame of Source of Income ~ Address .Description of the Principal Business Activi e a s S f4 r ~~ q~ s v~ e a ~ ~ ~~- l 1 i ~ ~ hereby swear (or afFirm) that the aforesaid information is z true arad correct statement, I ~ ~ z 2 / !C~ Signature of person dis:.iQSing I Date signed