Niza Motola 06/30/2011m MIAMI~E.ACC~
Clty Of MIQ9111 ~eQCh, 1700 Convention Center Dri"ve, Miami Beach, Florida 33139, www.miamibeachfl.aov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk - ~ . .
.Tel: " f 305J 673-74.1 1, _Fax:.. (305) b73-254 ~ .
°May 25, "2010 .
Niza Motofa - .
.. ,
. ~ 891 O Froude Avenue _ .
Surfside,~ FI 33 l 54
~S~J~JECT: C~IdlM1TTEE F®R ~UAL~TI(~E®UCATLON 1ti1-IVI~lAnlll -~EA~~1
. ~ ~. Dear Ms. Nlotola, "
.~ :~
Congratulations) Youhave been -appointed as a Representative ofthe PTA for RutK K. Broad Elementary
.School to the above-referenced agency., board or committee for a term ending, b/30/201'1. .
1f you ;are unable to accept-this appointment, please notify he City Clerks Office at (3.05) .
.673-741 1.
..
Sincerely, ~ .
- -
.. 6 ~~.-e~Z- .
.Robert ~Farcher . -.
- - City~Cler-k ~ .
. cc: Saul. prances, Parking ®irector
~i.eslie ttosenfeld, Liaison ~ ~ .. ~ .
3 ~ . ~ A'~TACHiVtENTS ~ -
" - Letter of Appointment
-Oath - .
City Code Ordinance section, applicabte to agency, board. or committee ,
City Code Section_2-22, 2-23, 224, 2;25, .226; 2=2458, 2-459
. .Ordinance 2006-3.543 - Amendmen# to Ciay Code- Section 222
,Miami-Dade County Code Section .2-1 "1 .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 cotnm~tted to-.providing excellent public service and "safety to all who live, .work and play in our vibrant tropical historic community,
.~~^i:: 7i~ l,t ~7'u't.;tE"] iC ^iJ C;r~G ~\::`.: iiC', P.i puD;~~ 5~'i'v.C:(' ~~1 ^i)~ Si~~?~/ f~'~ Qti vl~ily ~F~1:-~, \'"DiY, Qri i~ ~ii~~i ~n ~ :i7i V ~ lC:ll% 1i:~iii::C:, ii .i0,'ICJ :::::liar;?!:^i~j'
f i
r
i
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, wwvv.miamibeachfLgov
OFFICE OF THE CITY CLERK, Robert.Parcher, City Clerk "_ .. • .
Tel: (305J 673-741 1; Fax: (305j 673-7254 ~ :' .,. - ` a "~
TO Niza Motola
RE: Committee For Quality Education in MB
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 fora term ending: 6/30/2.011.
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
l serve} on July 1st, following the closing of the calendar year o whic I have served.
C~, ~ Niza Motola
9q ~ .
Sworn to and subscribed before me this7"~ day of / `/~ , 2010.
~,~7 ~a
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.
-. {
.- ~ '..
` (
"
.~ • .. - .
}
,..
n~
NAME:. ~ /~ `b°f~L,~ ~ ~ ~ ~ ~~ ~ . '
.,. .
. ~ •, - Last:Name " , , First Name Middle initial -
•.
_/y
HOME ADDRESS; ~~ l ~ ~~CC~~.C.-~.r v _ _. ~~5[ ~ ~~ ~ 3 f.~ C.~
Apt' No. - House. No./Street City State Zip Code
_ .
PHONE: ~ 5"':~~ ~%~ ~.~ -~~ . 3~.5' ~~ - ~"-.~'C~ S~ f~7`'~ L / ~f'~I P/'. ~C~~t
. " ~ ~ .Home : , 1Nork. Fax - Email address .
/J~~
• ~ Business Name:, ~,1 7~7 "i~e~"- . G~-~-ei~.4'~a~'1 ~ ~C _ Position: ~/~'C'.ns ~~n~
..
..
-. ,
- . " `Address: 2 ~. l~ , C~-~ ~~d~~--' ~a..~(~ - :S''~f' /~C'~ `i` l~l~ic ~1-.... ~~ / S ~ f
' •
. d . - ; . " State Zip Code
• - No. Street City..
~~ - Professional License (describe) ~ tf r(~ -~~ ~ - Expires:~,~'~" A>r~acYr a copy of the Jicense
- " Pursuant to City Code section 2-22(4) a and'b:' Members of agencies, boards, and committees shaft 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 hall derionstrate :ownership/interest for a minimum o .six months in_a'business established in the city..
• Resident of Miami Beach for a minimum" of six (6)"months: Yes C~ or. No
• Demonstrate.an'ownersh~ip/interest in a business in Miami~B ch fora riminimum of six (6) months: Yes ^ or~No
" • Are you a registered,voter in..Miami Beach:. Yes ~ or No
• (Please,circl~ one): 1 am now a resident of: North Beach South Beach Middle Beach IFS
- ~ . I am applying for appointment because ! ave special abilitie owledge and experience. Please list below: -
n
,... """!.Are y~ presently a registered lo'bby~st with the~ity of~iami•Be ch? Yes C~ or No~~C~'" " . "
..
- ~
_ ` " - Please list your preferences in. order of ranking [1] first choice ~2] second choice, and [3] third choice. Please note #hat only three (3)
~` ~ choices: will be observed by the:City.Clerk's Office. (Regular Boards of City) "
^ Affordable -Housin Adviso : Committee " ^ Housin Author'it ' ~`
~^ Art;in °Public Places Committee ~ ^ _oan Review Committee '
^ Beautification. Committee n " " ^ Marine Authorit -
~^ Board of Ad•ustment* -. -- . , ~ ~ ^ Miami Beach Commission for Women -
17.Bud et Adviso - Committee • ` ^_Miami• Beach Cultural Arts Council -
Ca ital~Jm rovements Pro•ects Oversi ht Committee ^ Miami .Beach Sister Cities Pro ram-
17 C mmittee on the Homeless : p Normand Shores Local Government Nei h. lm rovement
Committee-for Quali Education in MB : ^ Parks and Recreation Facilities Board
^ Communit Deveio ment Adviso ~ ~ ^ Personnel $oard .
0 Communi Relations Board ^ Plannin Board* `-
^Convention Center Adviso Board ^ Police Citizens Relations .Committee -
~~Debarment Committee ~ , ^ Production Industr Council _
Desi n.Review:-Board" ~ ^ Public..Safet Adviso Committee
-O Disabilit Access Committee ^ Safe Committee
F^ Fine Arts _Board ^ Sin le Famii Residential .Review Panel
Ga ~ Lesbian, Bisexual and Trans ender GLBT ^ Sustainabilit Committee
. ^ Golf Adviso: Committee - : ~ 0 Trans arenc Reliabilit & Accountabilit Committee "TRAC"
^ Health'Adviso .Committee ^ Trans ortation and .Parkin ' Committee •
,
D Health Facilities Authorit .Board D Visitor and Convention Authorit -
^ His anicAffairs Committee ^ Waterfront Protection Committee
~` Historic Preservation .Board" ;. - • . " ~ - '~ ^ Youth Center Adviso Board
_ ,
*Board .Required to":File State Disclosure Form
2. Present .participation in Youth Center activities by your; children Ye No ~~: If yes, please list the names of your children, their
- :ages, and whicho~ ms. List:bel - f ~~%~ -
.' Child's Warne: ",~ ~ y`~ - Age: C7 Program:
" -. :. -
q, J /~ -
- Child's ,r a me : ~~h/f't L;CiiaJ (;Ir+.~f~~ ~' ~. - ~C~j~-~_
. - Age:. ~„ Program:
".: - • ;
Note: If applying forYouth Advisory Board, .please indicate your affiliation with the Scott Rako'w Youth Center: -.
- ~. - ~ •
1. Past service on the Youth Center Advisory. Board: Yes !: ~ -No ~ ais of S ice:.
~.,
~~
Have,,you ever been convicted of a felcany: Yes ~~ , .please explain in detail:
• Do~you currently ;have a violation.(s) of City of Miami Beach codes: Yes.` or No'J. If yes, ;please explain ~ih detail:
' • Do.yo.u currently owe the City of Miami-Beach any money: Yes ~ or No If yes, explain- in.detail
~, .•, Are you currently serving on any City E3oards or Committees::Yes .~~ or~No C. ~If yes; which board?
.
..,
~-~ t ~ ~_ ~c.e_ . ~`~ . ~-e~~~ firms"""` _ -
- .
• V1/hat organizations:in the City. of°Miami :Beach do.you'currently hold membership in?
~:. Name: .. ^ . Title: _ .
Name; , ' ~.. ~, .. .
Title:
.. •' List aII properties owned or have an interest in, which ai-e located within: the City of Miami. Beach:. ~ ~ .
. ..
• 1 am now employed by~the City of Miarni $each: Yes ~~ or No .Which departme~nt~
Cite of M amtBea'ch`CChe k al~'tha a2~f(bldD ty~the de artment: ~' spouse i~,,child ~, 6rotherp,;or sister ^ who is employed by~the +
The following information is voluntary and is, neither part ofyour-application nor has any.bearing-on~your consideration for appointment. It is
'tieing asiced.to comply witfi federal equal oppoirtunity reporting requirements.
. .. .-
- ;,
Gender; ' p Male= emale ~ :. .:
.
. Ethnic Origin: ,Check one only~(1) .. ~ . .
~.~. -~` ~ n 111/L.tL.. ~/A L.L`. ..tLJ:.. ~. _..:_ /1_:_:_.~: nn'~-_---'-- ~ .~ - . ,. - .~
NOTE:.1f appointed;'.you will be requiired to follow.certain laws which apply to city board/committee members.
These. Jaws include,~but are not'limited to, the following; ~ ; '
o Prohibition from directly'or indirect9y 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 tioard/committee you. have served ~on for period: of one year after leaving office (Miami
Beach .City ~ . `Code seetion.2=26},
. o" . ~Requirement'to disclose certairi.financial'interestsavd gifts (Miami-Dade County Code section 2-11.1').
.: (re: CMB Community Development Advisory Committee): prohibition, during tenure ancJ :for one ,year after leaving office,
from. having ~ ar-y interest:in-or receiving ,any benefit from .Community Development Block Grant funds for either yourself ,
or~tiiose' with whom you have business or immediate family ties (CFR 570.611): '
Upon request; copies of these 1aws~may be obtained from the City Clerk. . .
"I 'hereby attest to he accuracy and truthfulness of the application and,have'received, read and will abide by Chapter 2,
Arti e:Vll - of the City Code "Standards of Conductfor City Officers, Employees and Agency Members."
°.- ~ .:
:. cant's Signature' ~ Date ~ Name of Applicant (PLEASE PRINT)
. Please~attach~a~copyaof,your resumextoth~s a~phcation
`N;OTE: Applic.~tions~wtlly aimoin~tlle~for<a;period~of:one (1):calendaryear.
., - : .
. ;, .
Received: ..
in the City Clerk's Office by : Date:.. / /2010 Control No.` ~ Date: //2010
' Name of Deputy-Clerk F:\CLER1$ALL\aFORMS\BOARD A C MMITTEESIBC Application.doc
or .No ~-_: 'If yes