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Linda Jackson 06/30/2011r`` ~//~ . . t _ _ . CI#'~/.Of MBQ1111 $E'CIC~'1~ 1700 Convention Center Drive, Miami Beach; Florida 33T39, www.miamibeachfl.aov ' ~ f _ ~ OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk , t TeL 1305), 673-741 1, Fax: (305) 673-7254 ' May 13 .2010 ~ ~ - f ,Linda Jackson. '. . _, _ ~ ,. . .; SUBJECT; COMMITTEE POR QUALITY EDUCATION IN MIAMI BEAC1~ , . , • , ~• Dear Ms. Jackson, ~ . ~' , Congratulations? You havebeen -appointed as a Representative of South Pointe Elementary' School to the r above-referenced agency, board or committee for a term ending, b/30/2011. ~" ~ o . - ( If you are unable to.accept this appointment, please notify the City Clerk's Office dt:(305} ` . " , , 673-74.1 1. , ~ ~ . ,, ., ~ . . , $incerel , ~ `. r o ~. - (. Robert Parcher `. ~ City Clerk - • a . ~ cc: Saul Frances, Packing,Director • -• " Leslie `Rosenfeld; Liaison - I ~ . . ! ' ` ATTACHMENTSt . • ' ( ~ Letter of Appointment .. ~ ... + Oath 4 ~ City Code Ordinance section, applicable to agency, board or committee • ~~ ~ City Code, Section 222, 2-23, 2-24, 2 25,.:2-26,.2 2458, .2-459 Ordinance 2006-3543.- Amendment to City Code Section 222 ~ _ • ~ Mipmi-Dad'e County',Code Section 2-l l .1 -Conflict of interest and Code,of Ethics O~diriance ~. ~ City•Wide; Permit Application - (Parking Department Form) ` "Booklet -Guide to the Sunshine Amendment and Code of Ethics for Public Officers•and Employees ` .~.' • We are ~omm~Hed to providing excellent ~ubhc service and,saf~ty to qIl vyho live work aid lay m our vibrant trgpical histonc community. ~'t r.E ~__'~ c.l ..c..~c;,.,.,.:~_.r ~>~ .. ~.::/:ce.: ::, :,'~/, rr,,.. tic:P ~.:.:~ ...~N, , r _ ~~}' m MIAMIBEF,CUi ' City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 331.39, www.miamibeachfl.go~ OFFICE OF THE CITY CLERK, Robert Parcher, Ciry Clerk - . . Tel: (305). 673-741 1; Fax: (305) 673-7254 ` . .' ' : ~ . TO Linda Jackson 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 alf 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: 6/30/2011. ' 1 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 Emp/ogees, 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 wh1ch I have served. ' Lind~ackson Sworn to and subscribed .before me this 3 day of , 2010. 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. y I$ h. ;'sue r ~' `~i ~ f, /, { ff l ppjfj~F~,~ ~, {{~~ f ~) . - . . ~ ll B . 1 ~ yyy C9TY OF BUl~A EACH. fi] i ~ . - ~OAR~3 AID `C01'~~J)i~`T~~.A~'P~:4Ct~T[Oi~.F~JFa61~ NAME: ~ ' ~I ~~.f~~Q'e~ ~ ~~~~ .. r ~ / fast Name • , `First Name Middle Initial u -. ,. ~ . HOME ADDRESS: °~ ~b~ / /s~ic'r'~ S ~/~• ~~~~ /~?~ ~Z ~.>J ~~ . ~' { ~, Apt No. House No./Street City /' ~ " _ - State Zip Code ' PMONE: 3~~ ~7~ ~: ~74'® ' ~~ ~ ~ ~, t: ~~ L~T ~X ~ ~ ~~~fy, ~~ ~ - ~ ` - ~ Home ~ ..Work ~~ Fax mail addres s~ ° ` " , .~ Business Name ~l''alv~~rz. ?~=•~!' ~.in.~ ;..Position: -, /~•~ . -~' !Address:. ~~Ci ~,. ~~71'~,t .= ~ .rC-G ~~. Z9.: J ` ~~ ~~ ~` . No. Street ity State Zip Cade ~,~ ~ =Professional License (describe)-. - ~.~~ ~4 Expires: ' . ~ Attach a copy of the fTcen~~ , _i Pursuant taCity Code section 2-22(4) a and b:'Members.of agencies, boards; and committeessh"aq be affiliated with the city; this requirement shall be fiulfrlled in the following ways:' a) an -individual shall. have been a resident of the city for a.min_imum of six` months; or b) an indiuidualshall demonstrate.ownership/interesf for a minimum of six months in a business established in the city. " - -.. ~ , ..'Resident of Miami; Beach for a minimum of six (fi) months: Yes~Qor No U ~ - ' r Demonsfrate an ownership/interest in a business in Miami Beach for a minimum of siz (6) months: Yes U or No U: " .• Are you a registered voter in Miami Beach: Yes~'I or No ~ . ` :.(Please circle one): I am now a resident of: ', North Beach : South B Middle Beach ~' . ,e I am applying for an appointment becausea have special abilities,. knowledge and experience. Please,lisfi below: ' • Are .you;pcesently a registered lobbyist'with the City of Miami-Beach?,Yes U orNo~}i •~ ,_ ,_ - - _. E. Please list your, pri=.ferences in order of anking.[1] •frst choice'[2] second choice, a_nd j3] third choice: Please note that only three (31 #-choices will be observed by the City Clerk's Office. (Regular Boards,, of City) J Affordable :Housing Advisory°Committee ^ Housin Authority. ~ ° ^ Art,in Public Places Committee .• ~ ^ Loan Review Committee "^ Beautification Committee ^ Marine Authori ." ' ^ Board`of Ad~ustment" ^ Miami Beach. Commission for Women ` ^ Bud et Adviso Committee ~: ^ Miami Beach Cultural Arts`Cotancit ^ Gapita! Imprbyemerats Pro~ects Oversight Committee _ ^ Miami Beach SisterCities Program ' ^Committee onthe:Homeless ^ Normand Shores LocaF Government Nei ha lm rovement Committeefior Quali Education in MB" - ^ Parks and Recreation. Facilities Board w - •^ Gommuni DeVelo menf Advisory. •' ;^>PersonnelBoard a ^•Community Relations Board • _ ^ Planning Board* ' ^:Convention Center Advisory Board ^ Police Citizens Relations Committee ^ Debarment Committee : ~ ^ Production Industry Council ~.^"Desi n Revievr Board" ~. ^ Public Safe `Adviso Committee ~ ` ° ^ Disabili Access Committee ~ ~ ^ Safe .Committee - . - ^ Fine Arts Board ^:Single Tamil "Residential Review-Pane! '^ Ga ,`Lesbian,'Bisexual.and Trans ender GLBT ^Sustainabili Committee - •~- ' ^ Golf Adviso Committee' , . ~ ^ Trans arency Reliabili & Aceounfability`Committee "TRAC" Health Adviso . Committee - ^ Transportation and Parkin Committee 0-Health Facilities Authori "Board . _ ^ Visitor and Convention Authori ~^ HispanicAffairs Committee ' , .Waterfront Protection Committee ^ Historic Preservation Board - ~ ~ ^ Youth Center Adviso Board . " ' ~ ~ *Board Required to File State Disclosure Form {Note: If applying for Youth Advisory Board,. please,iridicate your affliatian with the Scott Rakow Youth .Center: ,. .. ;1. Pastservice on~ahe Youth CenterAdvisory Board: Yes ~ No U Years of Service:' ;, 2: 'Present participation in Youth Center activities by your children YesJ No U. If yes, please list the names of your children, their < ` ', ages, and which.,programs. List,below:~ . - aChild`s name:. . /~'~ '_ Age: Program: ,, 'Child's name: Age: Program: . ~ . F:\GLEE~\$A9.1:\aFORi1Ji$\BflARl? AND COMMITTEES\BC Applicat(anQfi2609 NEVJ.doc .Have you ever been convicted; of a felony:".Yes U or Nom 1f yes; please explain in detail:. ..• • Do you currently have a violation(s) of.:City of Miami Beach codes: Yes U or fVo~t, If yes, please explain- in detail: ' • _ , • ! •''"Do you currentlyowe`the City of Miami Beach any money: Yes U or•No l~lfyes;.explain in detail ,; • , ~" r .-., . . •: • Are you currently serving on any City .Boards or Committees: Yes U qr Nor. If yes; .which boafd? - ~ • .,. _ _ - , • ~ •'Whaf organizations in the City.of Miami Beach do you currently hold membership in?: Name:; ~ ` ~ Title: • Name: _ , : _ Title: ' • List all ro ernes owned or~have an iriterest in, which are located within the City of Miami Beach: • ,. ,p p .. ". .; _ ~. - ,. _ • I am now employed by the City of.Miami Beach:. Yes LI or No~ Which department? ~ ~ ~ -3~~~Q _, , A •;Pursuantto City Code Section 2-25 (b)::Do you have a parent U, spouse u, child U, brother U, or sister J who is employed by the °~ City of Miaini Beach? Check-all thatapply.~ldentify.the department(s):. " ~~ . PL ,The followinginformation is,voluntary and is neithecpart of your application nor has any bearing on your considerationforappointment. It-is° a • being asked to complywith federal equal opportunity reporting requirements. _ Gender`: ^ 'Male ~ Female • ' Ethnic Origin: "Gheck'one'only (1). ~ - • White (Not,of Hispanic Origin): All:,persons having origins imany of the original peoples of:Europe, North Africa orthe Middle East. , (]°African-American/Black (Nof of Hispanic Origin): All persons having origins in any of-the Black.Pacialgroups of Africa.. ` ^ Hispanic: All. persons of Mexican, Puerto Ricah, Cuban, Central or South American, or other Spanish culture or origin, regardless of race. 'D Asian or Pacific'Islandeci All persons having origins in any of the°original peoples of the Far East, Southeast Asia, the Indian Subcontinent, on ~ the Pacificlslands. 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 Cultural.identification through tribal affiliation or community recognition. _ . :Physically Challenged:"Yes U or NoLj~.~ ~ ~• u"nNwyu~c~Il .a7 La LUA. CIIIFIIVyCUJh~I r[C Urea U ~ rl OfTlemaKGr U VtherLJ - NOTE::If appointed; you will be required #o follow certain .laws which apply to city board/committee members. These laws include, but are not limited to, the following: , o" Prohi6itign from directly.or indirectly lobbying city.personnel (Miami Beach City Code section 2-459). o Prohibitidn frorri contracting with the city (Miami-Dade County Code section 2-11.1). , Y o ,Prohibition from aobbying before board/committee you have served. on for periodaof one year after leaving, office (Miami Beach.City ,Code section 2-26). o • RequiremenYtodisclose cerfairi,finaricial interestsand,gifts (Miami-Dade County Code section 2-11.1'). • • (re: CMB Community Development Advisory Committee): prohibition, duririg tenure and for one year after leavirig office, ~ from having any interest in or receiving any benefit from Community Development Block Grant funds for eifher yourself , ' or hose 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. " ~ ."I hereby attest too-the accuracy and truthfulness of the application and have received,' read and will abide 'by Chapter 2, Articl~~N the Cit~ ode "Standards of Conduct for City Officers,,Employees and Agency Members." ~• !,1•pplicant's Signati.Tp~i to ~ Name of Applicant (PLEASE PRINK ' ~ .•. " ,Please attach a copy of your resume tothis application _ , " •. N07E; Applications will rema' n #ilefior a period of on (1) calendar year. •• Received inthe City Clerk's Office by : ~ .. Date: / 2010 Control No Date: ! 010 ' - Name of,Deputy Clerk F`.\CLER\$AL \aFORMS\BOARD AND C I EES\BC pplication.doc y - k M I A M FDADE e S®UitCE OiF INC®6~E STATEMEtVT ._ .. - Please Prinf or Type First Name . Middle Name/Initial last Name ` ' - ,. ,, . - . - Disclosure 1=or Ta ar x Ye •'Name: - ~~1Uw -coa Ending: o©O G Z .; I flailing Address:.,. a ~ Zc~~ ~ - c~c. - ~,~" ~ . i P City/State/Zip: - ~ ~ -. -a, F Social Security,Numberc~ N~%'`f Filing as a ~ County- Employee: , = ®`Nlunicipal Employee of: ~ , - 'Position held or sought: ~o~~,a~~ ~~ ~ ~~,^~ - ~. , ~c~~- _. ~ jBoard where serving; ..--=- Term oc Employment Began on: ----~ . .. ,. t ~.,. ~ Department where entlPloyed; ~ `-"'-' Work Address:. S'Q~ .5-, r~.(~i-~ tt~J'-'~ ~~f ~ . - ~ ~ - If your home address is exempt from public records pursuant to - Florida Statutes § 119;07 please check here (read instructions): ®-_ 'Work Telephone: ~ ~~~~ ~~~ ,. Home Address: ~ `~cz~ _ " ~ - ~ '~~~ ~ .,, - ` -. ° ._.. . , Street Add ess . . Cdy ~ State - ...Zip Code - Please list below in descending order with-the largest source first, the name, address and - prirncipal 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 incoime of .your spouse or any business :partner .need .not be disclosed. If continued on a separate sheet,•check here: - .: . ~ ! ®escription of-the Principal 6Vacwe of Source of Inc®¢ne - _- Address ~nsiness:Activi • C~ • ~ ~~- - ~i -- ~jr - , - ' ~.~ o .. e -, - '°>. I fiereby swear {or aff ran) that the aforesaid infort~ation is a true and correct statement.: ' - ," - - ... ~ Sig ature of per '.closing -~sign~ .