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Scott Diffenderfer 12/31/2011"~ ~ ~~ - '~~~~ ~CltyOf MIAMI $eQCI'Ir 1700 Corivention Center Drive,•.h/liami"Be6ch,'~Florida33~a.39, www.miamibeachfLgov °'~ ' ` OFFICE OF THE CITY CIERK,' Robert Parches, City Clerk , - -° ' ' -: Tei: (305) 673-741.1., Fax:.(305~ 673-7254 1~/12/20~40 ' • , . Scott Diffenderfer 20 Island Ave. #402 ` Miami Beach,' Florida 33.1..39 -- ~ .:~ SUBJECT: Transportation and Parking Committee >~ . ' . Congratulations! You .have .been reappointed. by Commissioner Jonah M. Wolfson to the above referenced agency, board or committee fora term ending: 1213112011. If you are unable~to accept this appointment, please notify the City Clerk's Office at (305) 673-741' 1: `. ,. . ,Please .read the enclosetl material carefully. Again,`congratulations and good luck. Sincerely, ~f' /s'~" Robert Parches : - . City Clerk ~ ~ ~ ~ p ~ ~ . 'cc: $aui Frances, Parking. Director ` . . ' . Sauf Frances ~ ." 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, 2-2458, 2-459 ' ~• Ordinance 2006.-3543- Amendment to City Code Section 2-22 Miami-Dade Gounty'Code Section 2-11.1 -Conflict ofilnterest and Code of Ethics Ordinance .` - City 1Nide Permit Application= (Parking Department Form) - Booklet - G~uide to the Sunshine Amendment and Code of Ethics for Public Officers and ' Employees , ., We are committed to providing excellent publiaservice and safety to all who live; work and play in our vibrant, tropical, historircommunity.' m MIAMI6L~~~HI _ ;Ci ~ of Miami: Beach i.1~700';Convention:Center Drive Miami;~Beach<F,Ionda~33~139,i:~twiN;miamibeachfl: ov) .~5`r a ~ r --~a . ,- ~~ ~ • OFFICE OF',THE>CITY.GhERK; Robert'P6rcher,:Ciy Clerk ~ ... ~~F t+-:~ .:` ,:.. «-: i:1'i"i .".,~a~icr ; t...c,,~ r->>er,~:~::~'Cfi<~r•. • s ,.. E ~ .', ::~ -; r .'. Te1:;;~305~.b73-7411, Fax: X305) 673-7254 ~> ., ,- n ,i.,trs,' ~ 7--:~'?i ~ e';x: t s:x"; w-a~ ~,~:, _ ~ , -} ., ?:i';,a w.~ TO Scott Diffenderfer RE: Transportation and Parking Committee v 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 Jufy 1st, following the closing of the calendar~,ron whtFh I hav,~~erved.i, Sworn to and subscribed before me *Please visit the City of Miami Beach website at www.mian for additional information regarding the Financial Disclosure We are committed to providing excellent public service and under City Clerk/Board and Committees to all who live, work and play in our vibrant, tropical, historic community. z m PJ~IAfJdBEACH ...E i~~le~~e~~ei ~aai ivanic HOME ADDRESS: ~ ~~ d""' ~o Apt No. C, House PHONE: .~©5.~,.3I,~~~ l ~~~ Home/` ` /~ J ork Business Name: t ~QI~W ~L ! ~~~~ ~' ~ Y ~~ n~s~aM1 ac~CC-~ ~~,~i~C1 ~,@+~E~ C~~t4h1°JIE t- T ~~ /a~'r~L.i~&. i i~~~ F~RhI~ First Name ,~ ~iC~ ,3oS Fax Position: Middle Initi -City State C:~-ray Email address Address: ~~ ~~ /~L (~i~q~-'i ~/~'r--~~~~~. 1 "i ~LJ ~~'" ~~~~ No. ~•_ ~, f~Street ~' 9~/ -7C~i~ State Zip Code Professional License (describe) I~P u YGJ 7~1 C ~~ /PS ~Q ` ! ~ / 7 Expires: Attach a copy of the license {~ 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 (6) months{. Yes ^ or No ^ •• Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six (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: North Beach South Beach Middle Beach • I am applying for an appointment because I have special abilities, knowledge and experience. Please list below: ~~ i • 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 [3j 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 ^ Beautification.Committee {' ^ Marine Authori ^ Board of Ad'ustment* 1.' ^ Miami Beach Commission for Women ^ Bud et Adviso Committee ( ^ Miami Beach Cultural Arts 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 Quali Education in MB { ^ Parks and Recreation Facilities Board ^ Communit Develo ment Adviso {~ ^ Personnel Board ^ Communi Relations Board {? ^ Plannin Board' ^ Convention Center Adviso 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 Panef ^ Ga ,Lesbian, Bisexual and Trans ender GLBT { ' ^ Sustainabili .Committee ^ Golf Adviso Committee { ~ ^ Trans arenc Reliabilit & Accountabilit Committee "TRAC" ^ Health Adviso Committee { - raps ortation and Parkin Committee ^ Health Facilities Authorit ..Board { ^ Visitor arid Convention Authorit ^ His anic Affairs Committee { ^ Waterfront Protection Committee ^ Historic Preservation -Board ( ^ Youth Center Adviso .Board I ~ *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 c ~ildren Yes^ No ^. If yes, please list the names of your children, their ages, and which programs. List below: Child's name: Age: Program: Child's .name: ~ ~ Age: ,'Program:, _ F:\CLER\$ALC~aFORMS\BOARD AND COMMITTEES\BC Applicatio ~OG2609 N,EW.cioc ~ / ~ y~ .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 Ng~ If yes, please explain in detail: ' • Do you currently owe the City of Miami Beach any money: Yes ^ or No ~f .yes, explain in detail • Are youAcurrently servingprr arty City Boards o~omn~jttees: Yes~or No r., lf,yes; which board? • What organizations in the City of Name: .Name: • .List all, properties ad an I rest~~ which are located within the City of Miami Beach: ~f~ ~`~7J`C. ~~~ • 1 am now employed by the City of Miami Beach: Yes ~ or N~. Which department? • Pursuant to City Code Section 2-25 (b): Do you have a palrent ^, spouse ^,.child ~^, brother ^; or sister ^ who is employed by the City.of Miami Beach? Check all that apply. Identify the depart ~ent(s): A ~ . /V. The following information is voluntary and is neither part of your application nor has any bearing on your consideration for appointment. dt is being asked to comply with federal equal opportunity reporting requirements. Gender:Male ^ Female k ~nic Origin: Check one only (1) White (Not of Hispanic Origin): All persons having origins in anyl of the original peoples of Europe, North Africa or the Middle East. ^ Afric9n-American/Black (Not of Hispanic Origin): All persons having origins in any of the Black racial groups of Africa. ^ Hispania:. All persons of Mexican, Puerto Rican, Cuban,. Centralkor South American, or other Spanish culture or origin, regardless. ofrace. ^ Asian or Pacific Islander: All persons having origins in any of thlle 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 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 ^ or No^: Employment Status: Employed Retired ^ 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 not limited to, the following: o Prohibition from directly or indirectly.lobb in cit y g y 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). o Requirement to disclose certain financial interests fnd gifts (Miami-Dade County Code section 2-11.1). (re: CMB Community Development Advisory Committee): prohibition, during tehure and'for one year after leaving office, from having any interest in or receiving any beneft from Community Development .Block Grant funds for either yourself , or those with whom you have business or immediati family ties (CFR 570.611). Upon request, copies of these laws may be.obtaine i from the City Clerk. _ . "I her y a sf to the accu cy •a truthfulness of the application and have received, read and will abide by Chapter 2, A cVll _ e C' o e 'S dards of Conduct for C" Officers, Employees and Agenc Memp ers." p licant''s.Si / r~ Date / Name of Applicant (PLEASE PRINT) .lease;atEaahgafcopyiofzyour~kesumetothisapPllcatfon NOTE:~Appllcatign "wlllsremai nsftle` r:a;period-of.~:one(1):calendaryear. j` Received in the City Clerk's Office by : i Date: _/ /2010 Control No Q Date: ~/N~!_'• /2010 Name of Deputy Clerk F:ICLER\$ALL\aFORMS\BOARD AN COC~~EESIR~Iq nlicatinn ,... i Beach do you ~ urrevitly hold membershi in? ~~ ~~ i, Ti ie:~ Titla• C© ~~ '~ • • • _. MIAMFO4D~ - SOURCE OF INCOME STATEMENT ., ` .: ddie '/dame Initial Last hiam Please Print or ?ype First tame Mi / e ` - ~ Discfasure For Tax yer~r ~~ ~ Name; ~ bl~~ivt~~ 4=L 1 T~ Ending;. -. i ~,o - . Mailing Address;, ;~?'~ ; { -vt ~f ~`~ .' . City/State/ZiR:- G~~(- ~~~~:.c~`"I ~L ,jJ ~5 1 ~ e ' Social Security. Number; ~ - ~~ . ~ p'•P\. .Filing as a: ~ County Employee; - - `~ c~ t . ® Municipal Employ®e of: .~: v; ,;~ - ~' Rasitian held or sought, ~ c-~ '~ ;'"t'i • ... , `~ ,. .. ._ . 'Board where.serving; ~ Term ar EmpivKmet~ ri Began on; - d ~ U , . , ' Department where .employedc ` ' ~ . _. ,.. WorkAdtirass, ' I, ,If yaut home address es exempt firom. public records pursuant to ,~ ry Florida Statutes § 119.67 piaase ctrack bare (.read inst:ruetiotts): 0 Work Teie9phone: ~~ ~~`~Q ~~.~® ,~~ • . ~ • :: _ Home "Address. ;~d ~~ /Ctrl' ~ ~`T ' I Street Asitlress,~. - ~ ~ City ~ State Zip Code , _ ~ ~ ~ Please list below. in descending order with the kargest source first, t:he name; atirires and `- principal business activity of every'I source of your inr_ome including public salary ,you ` rece'r.~ed or.>any person received far your benefit or use; during the cdisciosure peread, The income of your spouse or any business partner need not be disciased,~ If continued on: a ' :separate sheet; check tiara; l r. Descri tion of the.Principal . P . ' ~ (eta a of urea ,ofi Irecorne , Atidre~s B sines Activi ~ . . ~ I _ ` .g ~ tie ~... ~-~/ 5 - : = i . /~1 rza~ci ,- . ~l ~ ~ f . .. . . ,L. . • ~. ~ ~ I - . ~ ll . `~ T 'her swsa`r~;(~o af~ir ) at the of resold information is a true and correct statement. ~. , i ~ ~ . g ature or per esclQSing Da s' ned .. .- ---