David Smith 12/31/2010City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.~ov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk ~ ~ .
Tel: (305) 673-741 1, Fax: (305) 673-7254 ~ .
3/26/2010
.David Smith
4538 Sheridan Ave
Miami Beach, Florida 33140
SUBJECT:. Affordable Housing Advisory Committee
Congratulations! You have been reappointed by the City Commission to the above
referenced agency,. board or committee for a term ending: 1.2/31/2010.
If you are unable to accept this appointment, please .notify th,e City Clerk's Office at
(305) 673-7411.
Please read the enclosed material carefully. Again, congratulations and good luck.
Sincerely, ;
d S !~
Robert. Parcher
City Clerk
cc: Saul Frances, Parking Director
Anna Parekh
ATTACHMENTS:
Letter of Appointment ~ ~ -
Oath
City Code Ordinance section, applicable to agency, board or commifttee ~.
.City Code Section 2-22,.2 23, 2-24, 2-25, 2 26, 2.2458, 2-459 .
I i
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.
V ,~l~~b 1I LU~~~~ U
City of Miami Beach,.l7oo Convention Center Drive;_Nliami:Bedch;:Florida:33:139,~www.miamibeachfl:gov . . " ~...
• OFFICE OF -THE CITY• CLERK, Robert Parcher, Ciry Clerk
Tel: (305) 673-74.1 1, Fax: ;(305) 673-7254
TO David Smith
RE: Affordable Housing 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 Beaclh, 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: 1Z/31/2010.
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.
t
David Smith
Sworn to and subscribed before me this j ® day of 10.
,-
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.
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HOME ADDRESS: ~ . :' ~~ j ~ ~,-. ~~~ ~ ~ Q ~ .-~ . ~~ ~~, '~~ ~ ~ ~ ~
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,Professional:License (describe). _.. ~ 1 ~ Expires: ~ ~ _ ~fi«~~1~ ~ cQp~r of fhe~lfcense ,'.
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. ~'Pursuanf to City Code section 2-22(4)' a and b: Members of agencies, boards, and .committees shall 'be affiliated with the city; this
yrequirement shall be fulfilled in the:following ways: a) an individual shall have -been a resi'dent:~of the ,city :for a minimum of -six
months; orb b) an individual shall 'demonstrate. ownership/interest for a mirnmum of -six months in a business established in the city: ,
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' • Residenfiof Miami Beach for a minmiarn•of six (6):months Yes o ^ ~'
•;Demonstrate.an ownership/interest m ~~ business m Miami Beach fora minimum of six {6) months. Yes ~o~ 0.
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• Are you a registered voter in :Miami Beach: Yes . r No ^ ~ ;
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' • Please circle one I am now' a resident of:. North Beach
( _, ) fi South Beach `~ Middle .Beach ,
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~: I am applying for, an appointment becacise I have speciah abilities, ~nowledge,~experience.. Please list below:
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Rlease~list your preferences in order of Tanking j1] first choice [2] second choice,, and.[3]!third~chQice: Please note that onlythree (3)
- ` ~ ~ choices will be observed by the'City Clerk's Office. (Regular ;Boards of City) ~~
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^Affordable-Housin .Adviso Committee ^~Historic Preservation Board* ~ ~,
~' Art in-Public Places Committee ` :. ~ . ,: ^ Housin Authorif * ~ ~ ~ ,
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^ Beach .Preservation ..Board` ^ .Loan Review Committee*
:~^ Beautifiaation_Committee ~~~ ~' ' ~
.:...,
0 Marine Authorit * `
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^'$oard of Ad'ustment* . ,
,
Miami ;Beach, Comrriission for Women
D Bud efi Adviso Committee. ~` ~ ;
_ _ ^ Miami Beach Cultural Arts~Council
~.Ca ital Im rovements' Pro'ects Oversi ht "Committee .. ,
^ Miami. Beach SisterCities Pro ram
Committee on the Homeless" ~ ' . ~ ^ Normand ~_Shores Local:Gov't Nei h. Im rovement
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0 Committee for Qualit `Education. in MB~ ~ ~ ' _
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^ Parks Arid Rec~eation~ Facilities Board '`
mmunit Develo ment Adviso
~ ^ Personnel ~Board* _ .
" `
Communit
Relationa,.Bo"ard,::: ~ _
^ Plannin Board .~ ~ ~ .
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O Convention Cenfer Adviso ' Board , _
^'Police Citizens Relations-~.C,ommittee .:. ,
D Cultural Arts Nei hborliood District Overla CANDO ~ 0 Production Cndust Council. ~ '
^ Debarment.Committee ^ PublicjSafe Adviso Committee _
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^ Desi n Review. $oard* ,: ° _ ~ . ~ ~ ~ C1~ Safet ~Conimittoe , ~.
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^.:Disabilit Access Committee : ~. ~ ~ ~ Singlel,Famil Residential Review Panel '~ `
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^ Fine Arts: Board ~~ ,
^ Sustainabilit Committee
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^: Ga Business Develo ment~Ad Hoc. ~ ~ CI~Trans ~arenc Reliabiiit & Accountabilit Committee "TRAC"
^ Golf A~dviso ' ..Committee... _
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^ Trans ortation.arid Parkin Committee
^~~Wealth Adviso_ Committee ~ ~
. q Visitor and Convention Authorit * ~ ~ '
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Health Facilities Authorit $oand ~ ~ ~~
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. ^ Youth Center Adviso Board :.
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~^ His'
anic Affairs Committee
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; , , * $oard Required to File State~bisclosure form' s
~:~f:..~~'h1S1-~LL;~~o~ard ~`~~c:n~r~~itteeslBc~G ~~=~~iic~tion`ti3~G t~{~;alic~t;c~~i Revist~tl ~'~ 130~i 2.doc
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'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: YesO 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: ~ ' Age: Program:
Child's name:
Age: Program: ;
.Have you ever been convicted of a felony: Yes ^ or No`s If yes, please explain in detail:
o Do you currently have a violation(s) of City of Miami Beach codes: Yes ^ or No ~s, please explain in detail:.
• Do you currently owe the City of Miami Beach any money: Yes ^ or No Cf!'l~,~explain in detail
• Are you currently serving on any City Boards or Committees: Yeses-6r No p.~ If yes; which board?
• What organizations in the City of Miami Beach do you. currently hold membershipin?
Name: Title,:
Name:
Title:
• List all properties owned or have an interest in, which are located within the City of Miami Beach:
M
• I am now employed by the City of Miami Beach: Yes ^ or No hich .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 al{ .that apply. Identify the department(s):
This section is "no -re wired" but desired: A e: ~ {p ears old Gender: Male~'`~ Female ^
Race: White African-American/Black ^ White/Hispanic: ^ Asian or Pacific Islander ^ American Indian or
Alaskan Native ^ Haitian: ^ ~ Origin .Ethnic: Hispanic: Yes o~ No
"I hereby attest to the accuracy and truthfulness of the application and have received, read and will abide by Chapter 2,
Article VII. - of the City Code "Standards of Conduct for City Officers, Employees and Agency Members."
Applicant's Signature
PRINT)
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Date
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Name of Applicant(
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'LEASE
Please attach a copy of your resume to this application
NOTE: Applications'will remain on file for a period of one (1) calendar year.
Employment Status: Employed ^ Retired ^ Home-maker ^ Other ^
Received in City Clerk's Office by ~~ ~ _-- Date ~ ~ 2'" ~~'
Name of Deputy Clerk ~ /~
Document Control Number (Assigned by the City Clerk's Office),. ~ Entered By ~ Date ~ ~` j
Revised 09/02!08 LH
I":i~;~~R`,SALL~Boar~d ~ >~;orr~€~~i~teeslB&C Application!.B&C Appiicatio€~ Revi~,~,r~ 1113Q8 2.dc~c
isclosure
For -Tax Year
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Began ~on; .~ S ~~~b~ .~ ~ a
. . ~epar-~cnent where .ernploye~f: ~ -
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Work; Address:.
' =If your .home address is .exempt from pui~fic~records .pursuant to
Florida .Statutes §:1.2.07 please check here-(read instructions): ~1 Work T'eiephone: ,
dome. Address: ~ -_
- ~ ~ Street ~4ddress
' .. ~ pity ~ - State . ~ Zip Code
Please ais~ .below in, descending order` with the Largest -source first, the name, address and:
principal business activity ~of .every, source ®f your income including ~puf,iic satary you
received ar any person received for your benei"it, or use during. the disclosure .period. Ttoe
income of your spouse. ~or any -business partner. need not be citsc6o~sed. If continued on a
separatesheet, check here; I~ ~ . ~ ~ .
- hiame _ of :Source"~of :~;nc®me
Address pescr-ipton -of the Principal
Business '14,ctivi
`T~-hereby swear. (or ~affrirm) that the afioresaid information is -a true ar#d correct~s~atement,
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' Signa u o :person :disc osing Qate signed