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Flavia Loweinstein-Elortegui 12/31/2011City of Miami Beach, 1700 Convention Center Drive, Miami Beach,. Florida 33139, v,~ww.miamibeachfl.aov . OFFICE OF THE CITY CLERK, Robert Parchei, City. Clerk ., - ; . Tel: (305) 673-741 1, Fax: (305J 673-7254 - t. .. 01 /26/2010 - ~ , ° Fiavia Lowensteirti=Elortegui ~ '" 94.07 E. Broadview Dr. •_ Miami; f=lorida 33154. •, .. .3~1' ° . * Art in Public Places- . ~: Congratulations! 'You have been reappointed. by the City Commission to the above referenced agency, board or committee for a term ending: 12%31/2011. -. If you-are uriable to accept .this appointment, please notify_ the .City Clerks Office at (3,05) 673=7411.. - -. -Please read_the enclosed materiaLcarefully. Again, congratulations and good luck. . , ~ .Sincerely, ~ , . , ., . . _ /~ 2~~ .: ~ ., - Robert Parches :. - ....':-...City Clerk ~ . , ~ ~ . _. _ "~ ~ '~ ~ cc: Saul-Frances, Parking Director ;, . , . , Dennis.Leyva ~ ~ ~ ~ " " ' :~ .ATTACHMENTS: ~ ~ ~ - - U. •. Letter of Appointment Oath .. .City'Code Ordinancesection, applicable to agency, board or committee. " CityuCode Section.2-22,.2-23,-224, 2-25,:226, 2 2458, 2=459 , .. ' f Ordinance 2006-3543 -Amendment to City Code Section 2-22 .. -" - " - ° Miami-Dade ,County Code Section."2-11,.1 -Conflict of Interestand Code of Ethics Ordinance - 'City Wide Permit Application- (Parking Department f=orm) Booklef - Guide to the Sunshine Amendment and Code of Eth"ice-for Public Officers and ' 'Employees r . ,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~~,4C~-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 January 26, 2010 TO: Flavia Loweinstein-Elortegui RE: Art in. Public Places 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 Florida 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* .requirements 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 glen ar year o ~thich I have served. Flavia Low~instein-Elortegui Sworn to and subscribed before me this ~ day of -, 2010. 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. ~O~~D ~4~~ C4~6~f(f~d@~"TEE ~~~1~9r~4~'6Q~ ~~~~ ' ' N ME. /. Last Name First Name Initial ~ Mif~dJdle ~ 'HOME ADDRESS: ~~~ ~` ~icP~ytG'ly . ~S rPrl~~ ,~}-+/~i~12 , .~/S~ f~(~' .L11fhU~S l y J pt No. ~ A House No./Street ~~ City State • Zip Code p~ PHONE: 3o.S 0(0.1 OS~~ ..~p5C7~'-~S~Cr .~0$~3~-/~-~1' ~LAl/E.~ivNS~on/C,N>T Hoi/ne ~ Work Fax ~/ ~ = Email address ~ Business Name: f~i ~ N ~~ c i~ ~ E d~ /DP~!'I EnJ f LL c, Position: V ~ L%.51~ - ~ ~ ,2 ~ ~ mac. Address: ~0~ ~iiJcv/~J ~v°~ yyhy, S'~ `'r'eo~ iel 1,/~-i'r+l ~u~,12 /'7~ ~3 /3 / ~ ' No. Street City State Zip Code Professional t.icense (describe) Expires:. Attach a copy afthe Jicense ..Pursuant to City Code section. 2-22(4) a and b: Members of agencies, boards, and committees shalt 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 o~ ; • Demonstrate. an ownershipMteresf in a business in.Miami Beach for a minimum of six (6) month Yes or No .Are you a registered voter in Miami Beach: Yes or~No~ • (Please circle one}: I am now a resident of: N<~r-`El~i 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 (31 choices will be observed bvthe City Clerk's Off', ice. (Regular Boards of City) AffordableHousin Adviso Committee Housin Authori • Art in .Public Places Committee Loan Review Committee ' . Beautification Committee. - Marine Authori -Board of Ad'ustmeht~ Miami t3each Commission for Women ' Bud' et Adviso Committee° Miami Beach CulturafArts 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 Gualif Education in MB Parks and Recreation facilities Board Communif Develo merit Adviso ~ Personnel Board Communit Relations Board Plannin $oard* Convention. CenterAdviso Board Police Citizens Relations Committee .Debarment Committee ~ Production Indust 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 Sustainabilit Committee Golf Adviso Committee Trans arenc Reliabilit & Accountabilit Committee "TRAC" Health Adviso Committee Trans ortation and Parkin Committee Health. Facilities Authorit Board Visitor and Convention Authori ' . His anic Affairs Committee Waterfront Protection Committee 'Historic Preservation Board Youth Center Adviso Board ' "Board Required to -File State pisclosure Form '• Note: tf 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 children Yes No . If yes, .please list the names of your children, aheir ages, and`which programs. List below: .Child's name: ` ` Age: Program: ' Child's name: Age: Program: .F:\CLER\$AL,L\aFORMS\BOARD AND COMMITTEES\BC Application062609 NEW.doc ~~• .Have you ever been convicted of a felony: Yes or No If yes, please explain: in detail: . • Do you currently have a violation(s) of City of Miami Beach codes: Yes or No . Ifyes,: please explain in detail: • Do you currently owe the City of Miami Seach any money: Yes , or No )f yes, explairi in detail • Ar yota currently serving on an City Boards or Committee :Yes or No If yes; which.board? ~~ ~,~ ~ l ~ >Qv g ~l ~ >~GA~G ~~ • What organizations in the City of Miami Beach do you currently hold membership in? ~ 4 :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 employed by ahe City of Miami .Beach: Yes r No ~ . ich 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 all that apply. Identify the department(s): ~J~ ; 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 Eyrope, North Afriq or the Middle East. .African-AmericanlBlack (NoTof Hispanic Origin); All persons having origins in any of the Black racial groups of Africa. Hispanic: AIP persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race. Asian or Pacific Islander: Ali persons having origins in any of the original peoples of the Ear East, Southeast Asia, the Indian Subcontinent, on the Pacific tslands: This area includes, for example, China, India, Japan, Korea; the Philippine Islands and.Somoa. American Indian or Alaskan Native: All persons having origins in any of the original peoples of North America, and who maintain Culturatidentificationthrough tribal affiliation or community recognition.. Physically Challenged: Yes or No , Employment Statu ~ Employe Retired _ Homemaker Other NOTE` Ifappointed, you will be required to follow certain .laws which apply to city board/committee members. • These laws include, but are. not limited to, the followings 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 section2-26). 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 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 570.61'1). Upon request, copies of these laws-may be obtained from the City Clerk. "I hereby attest t e accuracy and truthfulness of the application and have received, read and will abide by Chapter 2, Article - f ode "Standards of onduct for City Officers, Employees`~and Agency Members:" Applicant's Sign t re ~~.~ Date Name of Applicant (PLEASE PRINT) Please attach a co y of your resume to this application. a NOTE: Applications wilt remain on fife for a period of-one (1) calendar year. . _. / - / Received in the City Clerk's Office by : Dater _/ /2009 Control No:. c lo~ Date: / /2~` C'® ` . Name of De uty Clerk Tom ~) lease Print or Type Name: Mailing Address: City/State/Zip: First Name Middle Name/Initial Last Name .`LA11fA- V ~ ~v~ Sf~,~ g 07 L~• 13~e.ol~-~~r~u~ ~~~,1~ Disclosure For Tax Year Ending: Social Security Number: S9 ~ ~' ~7~ ~ ~ ~ y ~ ~ Filing as a: ® County Employee: `_ ~ -` ".~ ^~' `T~ ® Municipal Employee of: ~~ ' ---- - Position held or sou ht: " `' ~ 9 vaPA~~ ~vmrh ,TC~ ~j ~;n/3~.2 v ° rv ~ -- . , .. ~ t ,, Board where serving: ~, ~ ~~. ~ Term or Employment ~' -...~ Began on: Department where employed: Work Address: If your home address is exempt from public rewrds pursuant to ~~ c-U ~~~~7i ~~~6 Florida Statutes § 119.07 please check here (read instructions): ~ Work Telephone: Home Address: ~~a ~ ~ . ~R~~ drEw ~/2i ~~ Street Address City State 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 your spouse or any business partner need not be disclosed. If continued on a separate sheet, check here: " ,Name of Source of Income Add ress Description of the Principal Business Activi /~NSiONC C-/L1~DV E~ LLB G (oOS~ L/NC.o~iJ ~r!/~ ~S /-' l7~//.5 / ~i ~ n~T ~ I hereb ar (or a it that the aforesaid information is a true and correct statement. ~i S~~ ~o Signature of person isclosing Date signed .