Patxi Pastor 12/31/2011m MIAM1~3~~~~@
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33.139, www.miamibeachfl.~ov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk - ~•
Tel: (305) 673-741 1, Fax: (305) 673-7254. ~ ' . ~ .. ;
1 /4/2010
Patxi Pastor
530 South Shore Drive
Miami Beach, Florida 33141
)SUBJE`CT: Sustainability Committee
a
Congratulations! You have been reappointed by Commissioner Jerry Libbin
to the above referenced agency, board or committee for a term ending: 12!31/2011.
If you are unable to accept this appointment, please notify the City Clerk's Office at
(305) 673-741.1.
Please read the enclosed material carefully. Again, congratulations and good- luck.
Sincerely,
Gf~~
~.-~ - s
Robert Parcher
City Cle ~k
cc: Saul Frances, Parking Director
Fred Beckmann
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 nniAn~i~r~~,~~~
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:. ~ • ~ • C1~/•O M~am~ Beach,••1.7;00 Convention Center Drive;"rNlami~Beach~;.Florida:33„1'39,~www.miamibeachfl.~ov :. • ,:-. ~ .,. _ ... „ ,...,
. OFFICE•OF THE CIT°Y'CLER~K~_Robert~Parcher City Clerk ~ ,,':~sr_.4 ~,~. '~-~s: ;`~, ~' ~..~'~ ~~ =~k : ~,r-,:° •• • ~',s~r;~ ~..... • _.
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. Tel:•(305) 673-74TT~~:F~ax~(305)'-673-7254 -~ ~ y. ;;~~' ~ ~ ~ry..~:':.>:~ ~ `a,;'.._.,~ ~.' .'. ,;~ . . , .~'?• "~
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TO Patxi Pastor
RE: Sustainability 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 Ohicers 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 r committee on which
I serve) on July 1st, following the closing of the calendar year on ~~ I hay served.
~P Pastor
Sworn to and subscribed befo a me this da of , 200 ~ v
Silvia Priet
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~~~{ ~ rIEY~F MIAMI g~~CH
_ BJ~~~ ~N~ C~3i~t`i~~TTEE ~PPL6C//~TlC3N F~I~M
NAME: ~~~~ ~ ~ ~ , ~ ~ ~ l~ L i,
Last Name First Name Middle Initial
HOME ADDRESS: S 3° S~~ ~ ~ ~ (~ ~-1,~ ~~ q'v~'1.~ ~~ ~` ~"3 (~ ~
No. Street City State Zip Code
PHONE: ~ ~ ~ ~ $ l 1 ~ ~ ~ J~~C ~~ - c~f?~ (• Cd-~..
Home ~ Work ~~ .Fax Email addre s
S ~Z ~.
Business Name: _ ____ ~~
Address:
No.
Professional License (describe)
City State Zip Code
_ Expires: A#tach a cop}~ of the ticer~se
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`P1 or No ^
O
• Demonstrate an ownership/interesf 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 N
• (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, experience. Please Fist below:
a
Please-list your preferences in.order of ranking [1] first choice [2] second choice, and [3] third choice. Please note that oniy~three (3)
choices will be observed ~bv the City .Clerk's Office. (Regular Boards of City)
^ Affordable Housin Adviso Committee ^ Historic Preservation Board*
^ Art in Public Places Committee ^ Hous'in Authorit
Beach Preservation Board ~ ^ Loan Review Committee*
Beautification Committee ~ ^ Marine Authorit
^ Board of Ad~ustment* ^ Miami Beach Commission for Women
^ Bud et Adviso Committee ^ Miami Beach Cultural.Arts Council
^ Capital Improvements Oversi ht ^ Miami Beach Florida Sister Cities,
^ Committee on Homeless ^ Normand Shores Local Gov't Nei h. Im rovement
^ Committee for Qualit. Education in MB - ~ - ^ Parks and Recreation Facilities Board
^ Commu,nit Develo- ment Adviso *~ ~ ~~ ^ Personnel Board*
Communit Relations Board ~ ^ Plannin Board ~ ~.
^ Convention Center Adviso Board ^ Police Citizens Relations Committee
^ Cultural Arts Nei hborhood District Overla (CANDO ^ Production Indust Council
^ Debarment Committee ^ Public Safet Adviso Committee
^ Desi n Review Board* ~ ^ Safet Committee
^ Disabilit Access Committee ^ Sin le Famil Residential Review. Panel
Fine Arts Board ^ Sustainabilit Committee
Ga Business Develo ment Ad Hoc ~ Trans arenc Reliabilit & Accountabilit Committee "TRAC"
^ Golf Adviso Committee ^ Trans ortation and Parkin Committee
^ Health Adviso Committee ^ Visitor and Convention Authorit
^ Health Facilities Authorit Board ^ Youth Center Adviso Board
^ His anic Affairs Committee
* Board Required to File State .Disclosure form
Position:
Street
~~:1C;~LR~~~LL1Fsoarc; ~.::om~r~it"tees\Bo`; ~p;ali~~aiioc,\~~~~ f~,pr~lic;atio~~ P.evi~l~c ', ; 130c~.do::
Note: If applying for Youth Advisory Board,.. please indicate your affiliation with the Scott Rakow Youth Center:
4: Past service on the Youth Center Advisory Board: Yes ~~ No __: Years of Service: `
2. Present participation in Youth Center, activities by your, chlildren Ye`s_ No ~. If yes, please fist the name's of your children, their
ages, and which programs. List. below:
,;~, ` Child's name: Age: Program:
9
Child's name: ~ - Age: Program:
• Have you ever :been convicted of a felony: Yes ^ or No ~f yes., please explain in detail: ~ .
• Do you currently have 'a violation(s) of City of Miami Beach codes: Yes ^ or No'B!!f yes, please explain in detail:
• Do ou current) owe the Cit of Miami Beach an mone : Yes ~ or No If es, ex lain in detail .
Y Y Y Y Y, Y P
• Are you currently serving on any City Boards or Committees: Yes or.No ^. if yes; which board?
. i
_ _ e
• Vlfliat 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 located within the City of Miami Beach:
• I am now m to d` b he Cit of .Miami Be ch: Y s ^ or No~ ich
e p ye y t y a e . Wh department?
• Pursuant to City Code Section 2-25 (b}: Do you have a parent C, spouse C~, child ~, brother u, or sister C who is employed by the
City of Miami- Beach? Check all that apply. Identify the department(s):
This section is "not required".but desired: Age: ~~ years old Gender: Male Female ^
Ethnic Origin (Check one)
White ^Afrlcan-American/.Black ^ Hispanic: ^ Asian or Pacific )slander ^ American Indian or Alaskan Native ^
"I hereby attest to the accuracy and #ruthfulness of the application and have received, read and will abide by Chapter 2,
Article V!I -- of the~Cty Code "Standards of Conduct for Clay Officers, Employees and Agency Members."
t~ ~
Applicant's ignature Date ~ Name of Applicant,{PL ASE
PRINT)
Please atta h a copy of your resame to this application
NOTE: Appl,cations~wilt remain on file for a period of one (1) calendar year.
Employment Status: Employed ^ Retired ^ Home-maker ^ Other ^
Received in City Cferk's~ Office by Date
Name of Deputy Clerk
Document,Controt Number (Assigned by the City Clerk's Office) Entered By ~ Date
Revised 09/02/08 LH
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Florida Statutes § 3:1~A7. please cFa~cbc. here. (read instructions): ~r~ 'Teleph®tieo ' '-
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princip~a_l t~usi¢~ess` a~vitiy ®f every ~aur~e -~~ ,.~~ur ir~~®rr~e including public salary. you
' ~eceeve~6.®r'any ~pers®~ rec~:ived for ~®~r benefit or. use_du~ing the cliscl®sure ~Seridda 'o'ne
. income ®f y~ury s~~u~e ~~ ah~ bu~ln~ss panes need ~~~ be disclnsed~ I~ continued ~ ~r~ ~
:, ~ ~ ~ separate sheep; check hires ;. ~ . .