Ken Stenicky 12/31/2011D6-16-201-0
Ken Stenicky
...~'
1330 Drexel Ave #202 ~ "
.
Miami Beach, 'Florida 331.39
. ~ SUBJECT: Disability Access Committee . ,
'.Congratulations! You have been appointed 'by Commissioner Michael Gongora
to the agency, board or committee named. above for a term ending: 1.2/31./2011'.
Pursuant to Ordinance No. 2006-3543,. commencing with terms beginning on or after
January 1st, .2007, the term of board members who are directly appointed by a member of
_ .,- " the City Commission shall automatically expire on December 31 of the year the appointing..
elected official leaves office. ,
If you are unable to accept this appointment or have any questions, please call the City
Clerk's Office at 305-673-7411. Please read the enclosed materials carefully.
Congratulations again and good luck. ~ _
Sincerely,
"Robert Parcher
.. ...,..City Clerk
cc; Saul Frances,. Parking Director
.. ~. ,.Duane Knecht..
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=458 and 2-459 -
"Ordinance No. 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 Employee
m MIAMI~~fiChl
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl,~~
OFFICE OF THE CITY CLERK, Robert Parches, City Clerk
Tel: (305j 673-741 1, Fax: (305j 673-7254 .'
TO Ker~Stenicky
RE: Disability Access 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 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.
~e~Stenicky
Sworn to and subscribed before me this ~~ day of _~~ ' 2010.
Silvia Pri to
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.
NAME:
Last Name Firsf Name addle Initial
HOME ADDRESS: ~~' ~ ~~'~_ ~ ~~-~~. ,AVG ~~ ~ 3~3`~
Apt No.
:PHONE: ~~' ~~~ '
Home
City State Zip Code
~'E-~.S``~ ! G~ ~Y ~ dol..
House No./Street
Work Fax.
Email address
Business Name: Position:
.Address:
' No. Street City ~ State ~ Zip Code
°Professional License (describe) Expires: Attach a copy oifhe license
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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 (Ei) mont s: Yes or No
. Demonstrate an ownershiphnterest in a bu ' sin Miamh fora mihimum of six {6) months: Yes
• Are you a registered voter in Miami. Bea :Yes or No
• (Please circle one): I am now a resident o : North Beach South Beach Middle Beach
• `I am applying for an appointment because I have special abilities, know a ge xperience. Please list below:
• Are you presentlya registered lobbyist with the City of Miami Beach? Yes r No ~..
Please list your preferences in order of ranking [1] first choice [2] second choice, and [3] third choice. Please note that only three (3)
choices will be observed. by the City Clerk's Office. (Regular Boards of City) .~
Affordable Housin Adviso Committee Housin Authorit
Art in Public Places Committee Loan Review Committee
Beautycation Committee ~ Marine Authorit
Board of Ad'ustment"
~ Miami Beach Commission for Women
Bud et Adviso Committee Miami Beach Cultural Arts Council
Ca ital Im rovements Pto'ects Oversi ht ,Committee Miami Beach Sister Cities Pro ram
Committee on.the Homeless Normand Shores Local Government Nei h. Im rovement
Committee for Qualit Education in MB Parks and Recreation Facilities Board
Communit Develo ment Adviso Personnel Board
Communi Relations Board Plannin Board*
Coriventiori Center Adviso Board' Police Citizens Relations Committee
Debarment Committee ~ Production Indust .Council
Public Safe Adviso Committee
Disabilit Access Committee Safe Committee
e 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 Authorit
His anic Affairs 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 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 fist the names of your children, their
ages, and which programs. List below:
Child's name: Age: Program:
Child's name: Age: Program:
F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC ApplicationOb2b09 NEW.doc
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•Have yota ever been convicted of a~feloriy: Yes' ~ r'No If yes, pleaseexplain in detail. •
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• - .... -
• ::: ~ _.
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`•• :• Do-you. currently Have a violation(s);ofCity of Miami:Beach cocles:.Yes' or No : I yes, please explain in detail:° ~,
ti
~.~ • Do you~cgrrently owe the City;of•Miami Beach-any rrioney; Yes r No I es,~ezplain in detail .
- .:
°' ~ ~ • ;qre you<currently serving on ariy City Boards or Committees: Y or No eyes; which board?
;: What organizations•in-the City of Miami'Beach dayou:curtently hold membership,in? ... ~ ~. •
: Title: ~ ..' :' ; .- ,, ••
~.,. • : , ° Name:: ' . •' ~ ~ ,. ~ ~ , • ,
.. .
, ,.
Name: . • •. ..
.. .. Title: , .
': • List all roperties owned or have,~an interest'in which are located~within the City of Miaml Beach:. •, ~ ~ ~ '
~. -
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.~ _
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• 1 am now employed~by the City of Miami°Beach Yes or 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 aN that~apply.-:Identify the department(s): '
,. ,,.,
• :,
' Thefollowing information is voluntary and is neither part of your application nor has any bearing on your consideration for appointment. It is ~ -
- a' beirig.asked to, comply with federal equal opportunity=reporting'requlrementS: •_
Gender .~ Male Female
. , , E `c Origin: Check one only (1) °, z _ , ' :- ..
Whi • (Not of Hispanic O'rigin): All~persons having:origins"'iri any of..the ~original.peoples of Europe, -North Africa or the Middle East. -
_ rcan=Amei^icanlBlack (Not of Hispanic Qrigin):,All'pe~sons having origins in any ofthe Black racial groups of Africa:
' ' Hispanic:. All persons of Mexican; Puerto.Rican, Cuban,.Central orSouth American, or other Spanish culture or origin,_regardless of race. ~ _ •
` ' ~ Asian •or Pacific lslanderrAll•pe~sons having origins in any of the orignafpeoples of the Far East, Southeast Asia,`the Indian Subcontinent, on
`• .
;the Pacifc Islands. •This area includes, for example,,China, India Japan, Korea, the Philippine Islands and Soinoa:: '
:: American Ind~an;or Alaskan Native..AlEpersons ha'v_ing origins in'anyof the original peoples of North America;and who maintain
~. Cultural identification through tribal,affiliation orcommunity recognition. ~.. .
,PhysicallyChallerig ds Yes t c No
.. ,.
~j~ "..Employment Status: Emp Dyed ~ ' ,Retired ,,. ~Womemaker Other ~~ ~ `
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° .:.~., .
`NOTE;. If appointed, you will be required.to follow ceitain.laws which apply to city. board/committee members.
`.,These laws include,"but.arenot limited to, the following: .... .. . •
-• "b: Prohibition;from directly,or indirectly lobbying city personnel (Miami'Beach City`Code section 2-459).: '
o~ ° Prohitiitiorr:from contracting with the city (Miami-Dade County Code section.2-11..,9):: - ": * . ,
,; .
• o. Prohibition:from aob,bying 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;.CM6 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 whorri-yau;tiave business orimmediate family ties (CFR 570.61'1).. ' : _ _
,.. r
`::Upon.request, copies of these laws may be obtained from the City Clerk: ', ~ .
~.: ` "I here y attest to the accuracy-~ #ruthfulness of the application and have received, read and will abide by Chapter-2,
Articl of the ~ ity C e" f Conduct or City Officers, ,Employees and Agency Members: ' _ '
$. e .
• : G ~ .,_
Applicant's Signature _ .:' _ Date "
-k Please attach a copy of your resume to this application.
_.
" :... ~ ~'" ~- .NOTE: Applications will re in
Receided in the City Glerk's Office by : /~
• ,~ Name of Deputy Clert
on file for a period of one (1) calendar year: ,
Date: _! /2010" Control N~ a D
F;\CIER\$AL' L\aFORMS\BOARD ANp CC-~MMI'TT~~ EE
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lease. Print or Type