Mark Weithorn 12/31/2011- ..
rte. ,~.'"`~' ',~. ,.
kC' I ~-
,;. Y ~ a,.
' r4 ,.. _~
~~w
. -
. Q 1 /24/201.0 -
.
- ~ Mark Weithorn
,~ t
l l 30 Stillwater Drive
Miami Beach, FL 3314.1
SUBJECT: Transportation and Parking Committee
. ;
'Congratu'lations! You have been re-appointed *by virtue of your being a Representative for the
~.
.
North Beach Development Corporation #o the agency, board or committee named above for a
.
fermi ending 12/31 /'2011.
- ~ !f~you are unable to accept this appointment, please: nofify the City Clerk's` Office at {305)
, - ~ -.673-741 l -
Sincerely, . ~ .
Robert Parches i
~. ~ - ~ ~ .
- City Clerk -
.- ~~ ;
cc: ~Sau1 Frances, Parking Director ~ ~ .
:,
.~
a .. ~ ATTACHMENTS::
- letter:of Appointment ~ ~
Oath ~. ~ k
.~
Ci Code Ordinance section, appf'icab
' ty le to agency, board or committee -
`City Code. Section 2-22, 2-23, 2-24, 2-2.5,- 2-26, 2-245'8, ~2-459
Ordinance 2006-3543 -Amendment to City Code Section 2-22 . .
{
Miami-Dade County Code. Section. 2-1 l .1 -Conflict of Interest and Code of Ethics
'-
`Ordinance ~ . .
.~ i
City Wide Permit Application - (Parking Department Form): ~ ~ .
Booklet -Guide to the Sunshine Amendment and Code.of Ethics for Public ;Officers and
- Employees -
- ~ - j
..
• 'vr:r E~ :off'-' (~r f ~ >i; iiE:.s.. ~,iC)V'C.7;riE,~ E~ `;~t~n' i_)U;~~:; ;i `,.'iV; C;Cn;.t :C !~..,f)r !`C;' E ;~/t/; ~..i ~f~:/~'~ ~~+C. K, ,)t iC >,-.Ci `,/ in (:vr `/,r ~'jfti fi; ()~ CE t
.r
.. ~ . - ~ -
m MIAMI~f~~a~~
CIiF~/ O MIQm~ BeQCh 1700 Convention Center Drive~MiamixBeach~:Florida-3,3W1t39~www:irmiamibeachfl:(ry'~ov'_ .,.- .{' {.,'~'~r~~~ =i9 ~:~
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk :;; . ._ _ "`~- ~ t ~ ~':~ ~' ,. + _:, ,<.,'...~ . =~ -cf~.~ , n ,;,. . ; ~= ~.;; ' .. `., ._ . .. - ~~ ,
Tel: (305) 673-741 1, Fax: (305) 673-7254 ,, . !" . _, . ,,, , - ,.
TO Mark Weithorn
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, and to .perform all the duties of
a member of the above-mentioned.board or committee of the City of Miami Beach. to which 1 have
been appointed .for a term ending: 1Z/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 Pub/ic 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.
Mark Weithorn
Sworn to and subscribed before me this Z ~ day of /`~ A ~ , 200 .
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
_ 1
./
/~
V ~ . '
l 3 ; Imo.
i I
,.,
" ..
. .NAME:. (,~~~/ 7~/~19f .~. ~ ~7r~JR.-t~ j
F
°` Last Name ~ ~ `First Name ~ Middle Initial
~ ~
HOME ADDRESS:.. . . ~ ~r~~L ~~ %~c~r- ~,>. f /`~;-~ . ~ ~L ~'~ <<r
~ l3p .
,. .. Apt No. - ,. .. ~: House. No./Street City- ~ State Zip Code
. °- ... ;• PHONE: y- , -- . ~L P..~ - ~ .~~ l - ~'~
.. Home.. Work ;. -. Fax Emailkaddress
~: !
.Business Name: ~Position:
.°
. ,. , . .
Address:....: ~• ' .. - ~ .
No. Street . City ~ State - Zip Code
Professional License- (describe) ~ ~ ~ 'Expires: ~ ~ } ~&tach ~ copy of the license
.
. t
`~ .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 thefollowing ways; a) an °individual shall .have been. a resident of the city for a minimum of aix .~
months;: or b) an individtaal shall demonstrate ownership/interest for aminimum-of six months in :a business established in the city.
P ~
_ :Resident of Miami Beach fora minimum of six (6) months: Yes ~~r No .'~:
• Demonstrate an ownership/interest in a'business, in Miami Beach for a mini"mum of~siz (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: " orth Be~ 'South `Beach Middle Beach
• I amapplying for an appointment..because I Navel special`abilities, knowledge and experience. Please list below:
y . ~ •.Are:you presently a registered lobbyist with the City of:Miami Beach? Yes ^ or-No r
., ~ .
+ , .
' ~ <Please list your preferences in order. of ranking [1] firsfichoice [2] second choice, .and [3] third choice_ Pfease note "that only three (3)
choices w~lf-be observed bythe Ci~Clerk's Office. (Regular-Boards of City) . '.
^ Affordable Housin .Adviso Committee. ~ ~ ^ Housin .Authorit -
Art in PubficPlaces'Committee ~ ~ ~ ~ Cl Loan Review Committee
Beautification Committee ~ ^ .Marine Authorit ~
Board of Ad~ustrnent* ~ . -. ^ Miami-Beach Commission. for Womeri .
O Bud et Adviso Committee ~ ~ ~.. ~ f .` ~ ^ Miami Beach Cultural Arts Council
^ Ca ital.fm rovements Pro'ects Oversi ht Committee _ ~ 0 Miami Beach Sister Cities Pro ram
^ Committee, on he Homeless .. ~ . ~ ' ~ ~ ^ Normand Shores Local Government, Nei h. Im rovement
_^ Committee'for Quali Education in MB ~ ~ ^ Parks and Recreation Facilities.Board
^'Communit Devefo meet Adviso ; ~ ^ Personnel Board
^~Commun Relations'Board.. '^~Piannin Board*:
^ Convention Center Adviso ,Board ; _ ^.Police Citizens Relations Committee
Debarment Committee ~ ~ ~ .
. ^ Production Industr Council
; "
^ Desi n Review Board*
^ :Public Safet Adviso Committee
• 0 Disablit Access `Committee ~ ^ Safe Committee ;
0 Fine Arts Board ~ ~ ~ ^ Sin le Famil Residential.Review'Panel .
_
.
'^ Ga , Lesbian,.Bisexual-arid- Trans ender GLBT :° .:
:
^ Sustainabilit Committee '
D Golf AdvisoCommittee ~ ~ ~ j ~ Trans arenc Reliabilit & Accountabilit Committee "TRAC"
^ Health Adviso .. Committee I ~ ^ Trans ortation -and Parkin .Committee
Health Facilities Authorit .Board ~ {
^.Visitor and Convention Authorit
^'His'anicAffairs Committee
^ Waterfront Protection Committee
^ Historic Preservation$oard
f ~
^ Youth Center. Advisory Board
: .. ~ ,
..
- .. ~ ~ I *Board Required to Fife State :Disclosure Form
Note: If applying for Youth Advisory Board, please.. indicate your affiliation with the Scott Rakow Youth Center:
:.
.
-. ..
.. F .. -
1. Past service on the Youth Center Advisory Board:•Yes ^ No C, Years of Service: ~ ~ -
~2., Present participation in Youth .Ce.nter activities by-your.children Yes^ No ^. If yes, please, list the names of your .children, their
.ages, and whichprograms: List below: ..
'Child's. name: ~ ~ _
Age: Program:
}
Child's name: :. ~ L ~ Age:. Progr'am:. :
,:
.Have you ever been convicted of a,felony: Yes ~ ~ or No ~~f yes, please explain in detain:
o Do-you currently have a violation(s) of City of Miami `Beach codes: Yes ^ or No~lf yes, please explain. in detail:
.. ~ ~ .
• Do you currently owe the City. of Miami Beach. any money: Yes ^ or No ~lf yes, explain in detail
~~c
• Are you currently. serving on any City Boards or Committees: Yes ~r No ^. If yes; which board? '
• What organizations in the City of Miami Beach do you currently hold membership in?
Name: ivOr- ~ 1-+ '~ c~ ~ ~,a ~ ~~ / P, C ~~'n Title: ~ /~ ~=~.s ..~. ~ ~..
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 the City of Miami Beach: Yes ~ or No~'Which department?
• Pursuant to City Code Section 2-25 (b): Do you have a parent C~spouse ~, child ^,. brother ^, or sister ^ 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 forappointment. It is
being asked to comply with federal equal opportunity reporting requirements. . -
.. i
Gender: 0`Male ^ Female
Ethnic Origin: Check one only {1 } I .
C~3'llVhite (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 Mexican, .Puerto Rican; Cuban, Central or South American, or other Spanish culture or origin; regardless of'race.
^ Asian or Pacific Islander: All persons having origins iri 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.lndian or Alaskan Native: All persons having origins in any of the original peoples of North America, and who maintain
Cultural identification through tribal affiliation or community recognition.
Physically Challenged: Yes ^ or NoB' .
Employment Status: Employed ~ Retired 0 ~ Homemaker ^ Other
NOTE: If appointed, you will be required to follow certain laws which apply to city board/committee members.
.These laws .include, but are nvt 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). i
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.
j
`.`I hereby attest to the .accuracy and truthfulne
Article VII - of the City Code "Standards of Con
Applicant's Signature Date
f?lease~attach~a~copy3of°your resumeYto-this applicatic
s of the application and have received, read and will abide 'by Chapter 2,
uct for City Officers, Employees and Agency Members."
Name of Applicant (PLEASE PRINT)
,:a;period=:ofone°(1:)>calendar year.
Received in the City Clerk's Office by : / /~V~~ Date: _/ /2010 Control No. 1 Date: ~ /2010 ~r ~
Name of Deputy Clerk F:ICLERI$ALL\aFORMS\BOARD AND COMMITTEESIBC pplication.doc
,.
.
-
.
- 7 ,
~.
:.. , "
. - Mme ~ SOUR CE OF INCOME STATENIEf1tT
. ..
Please Print or Type -First Name
P~tiddle Name./.InitiaC._ .Cast Name
. , -
. _ Disclosure
~
~ ~
i For Tax .Year
` Name: `: .. ~ i~n-rc
. ~ ~ ~!~=r ~1~~~/ Ending:
-.
~
k
Malting Address:.-. ~ / ~:~ S~i ~~ ~
~c c ~~ ~~- , ~,-,
CIty~State~Z1~3. /`7 P1~n 1 ~
. . ~~ c /~ ~ ~- - ~
SociaE Security Number:. D 5 ~ ± ~ ~ ~ ~ ~ ~ ,~ ~ .
Filing as ~a: ~ County Emplo
al
ici
.
M yee. +
of:
lo
p
Emp
un
.~ .
yee
- PQsition~ held or soa~ght: .
. .Board where serving: ~ -- ~' ~ G .:Term or.Employment
.. Began on: 2 ~~ ~ ..
.: , .
. 67epartment where erripioyed:
. r
~
~
Work Address:. :j~ 13 ~
.: ~~
.SS~i c c ~-..~ A ~~ -- ~~
~
If your home address is exempt from pu
Florida Statutes § 119.07 please .check h
blic records:pursuant.to
ere ,(read instructiore5): ~ Work Telephone: 3 `' ' ~ ~ '~ ~' " ~ ~' 3
•
- Home Address:: , f
..
. ~, ~ ~
. ~ Street Address , ~ , _`
.. ~
.
..
-City
.
State Zip Code
Please Gst below in descending: order with the largest source fist the naone, address and
prmctpal business
activity of ev ery 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. b usiness partner need not ~be .disclosed.- Ifcontinued on a
:~ separate sheet. check here:
. ~
~
Description of the `Principal
~
Name of . Source of .Incorv~e ~ Address. Business Actvi .
- f e
~ . \
- :Z fiereby swear ,(or affirm} that a
- he 'aforesaid information is :a ;true ar~d correct statement,
.'w
..
i
.rt . ,_„~
.-
-
~:, ,:. Signature of person'disclosing
. - Date signed i
i