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Stephen Zack 12/31/2010t i - City of Miamr Beach, 1700 Convention Center Drive,. Miami:Beach; Florida 3313.9, wwvr.miamibeachfl.aov OFFICE OF THE CITY CLERK, Robert Parclier, City Clerk '. "TeL• (305).673-7411, Fax: (305) 673-7254 . i` • . 3/;23/201'0 ' - . • . Sfephen Zack , • 11~ E: Dilido Dr y , ~ Miami ..Beach, Florida 33139 ,~ Sl1BJECT: Debarment.Committee Con ratulationsl You have been rea t g ppointed by Mayor'Matti Herrera "Bower to;the above referenced a enc ,board or committee for a t Crm ending: 12/3112010. 9 Y .If.you are unable to acceptthls appointment, please notify the City Clerk's.Office`at '(305)..673-7414. Please read the enclosed material carefully. Again, congratulations and good luck. i • Sincerely, ' Robert Parches • . City Clerk . ;. cc: Saul Frances, Parking Director • _ - , .. Gus Lopez , 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 County Code'Section 2-11.1 -Conflict of lhterest 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 . Employees ' • • We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical,. historic community: , ~ I. ~~ m MIAMIE~E.~sC~l • '-Clty.Of MIAMI Beach; 1700 Convention~Center Drive`,, /vliami:Be'ach; 9 www.miamibeachfl.gov': ..~;,. ...~, '~~ :....., - ~ OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk' `_ "' ~ ~ ~ .r :~ . , ' • ~" Tel: X305) b73-7411, Fax: (305 673-7254 ~ •' ,~ ,, ,~ ,~ ~, ~? .., 3 , ~ .,,,..} ,_; .: r' , >, TO Stephen Zack RE: Debarment 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 i II the duties of a memberof the above-mentioned board or committee of the City of Miami Beach to which I have been appointed for a term ending: 12/31/2010. I have been issued a copy of Section 2-11.1 of the Miami-Dade County Code (C and Code of Ethics Ordinance), as well as theF/orida Commission on Ethics Guio Amendment and Code of Ethics for Public OfFcers and Employees, and understar of a City of Miami Beach Board and/or Committee, I must comply with the financ ments of Miami-Dade County or the State of Florida (depending on the board or 1 serve) on July 1st, following the closing of the calendar year on wh~ have sE Stephen Sworn to and subscribed before me this o'?.'~day of nflict of Interest ' to the Sunshine that as a member tl disclosure* require- ommittee on which 2010. Stitv~ia-~rret~ ~;~~,P, ~~~ Deputy Clerk *Please visit the City of Miami Beach website at www.miamibeachfl.gov under City for additional information regarding the Financial Disclosure Requirements. We are committed to providing excellent public service and safety to all who live, work and Committees ,~ .. play in our vibrant, tropical, historic community. ` JAN-26-2007- 1137 CYTY MlAM1 BCH CLERK ,.DEPT 305 6737254 P.03 • ,' ~~ ' _ ~iMtAMI E~~~ . cia~~ OC`IVd{ ~33~~C;{ .,. . °`` i~t?p~F?G:.= tat;; f.-r3jf~r~1M4~'"3''~~ ,~~P~'a:?C.,A~4G~~R rr'aFS~: . ~~E~ Z ~~-K ~ SrF~HEt\I. ~ N `. Last Name First Name ~ Middle Initial rt E .' DELI (~O ~RIyE, h'r-AM-3EAC~ ~~_:3~~3 1 ROME ADDRESS: - r • N0, , Street ~ City State Zip Code t3p5 (,,~~ +-~8.0~8 c3a ~53,9:8yoo`305~q~ . ~ ~!awnl~.' ~ ~l 5 53.f5- 35 S`ZAG>~~13SFt_~P.GoM, Home Work ~ Fax ~ ~"-` ,Email address • BuslnessName~QCl~, SCE-IIt.LE~ ~ FLEXNEtQLLP position:- ~~Mtr~lf$TRATIVE 1"~}R7`N~/~' ... . . ~ _.: _" oo sE 2 SrREE~ ~c~lrE~Boo M- ~r~-j I FL 33-~3~ .` . Addr®ss- , I R, , Na. _ : Street Clry ~ Slate Zip Code ~' Profeeaional License (tlescripej' EI pirest ~[r iCir / ; ~~y of tE+r, ir~r:nse . ~ Puraur~nt to Gity Cods section 2=22{4} a and' b: Members of agencies, boards, and committees shall be affiliated with the city; this ~ ; .,, _ requirement shall. be_tulflll®d,in the. following ways: a) an-individual shall have been a resident of the-city for a minimum Of six ` - monthshor-b) an individual"shalt demonstrate ownershipCmterestfor aminimum of siz months in a business established in the city:- - • Resident of-Miami Beach for a minimum of six {6} months: Y®a U or No:_ ~ : . . ~ e Demonstra4e an ownership/infecest in a business in Miami Beach for a minimum of six (6) months: Yes 1:: or Nod . ,~ j ~ +~ Are' you a registered voter in Miami Reach: Y®s ^ or Pilo O o , '' ' + (Please check one}: I am now a• resitlent ofr North 8t3ach 0 South Beach u Middle Beach C~ v o I am applying for an appointment because I have special ab~lltles, knowledge, experience: Please list below: . , . ~ , PIea8+~7istyour prefst®nces in order. of ranking [9J first choice (2J second choice, andj3J, third choice. P that ont threw 3 • • choFces Milll_be: obs®rro®'d bar the Clttt.Cterk's Offic® (Regular Boards of City).. • . _ ~; Art in-Public-Places-Gammitte® ~, - ~ Beach Pr®servation Boarc1 ~O Housing Authority' C Beautifieation Committee ~` C"loan Review Corrtmitteet ~ • { , ^Board of Adjustment' ^ Marine Authority' [1 Budget-Advisory Gommittee~ D Mlami-Beach-Gulturat Arts=Gounci} Committee on Homel®ss ~ ^ MiemtHea~h Commfission on Stetus~of Women ~, o Committee for Quality Educatiiin in MB' l7 Mlaiml"Basch Florida Sister Cities ' ^ Community peveloprinerit Advisory'" `q Normandy Shores Local Gov't Neigh. improvement ` , ~ ~ ^ Community~Relatons"Board-- ^Oversight Gommittea foreeneral Obligation i3ond ~ - . ~- 0 Convention Center Advisory Hoard ~ ^ Parks and Recreation Facilities Board • -Debarment Committ®e. p P®rsonnel Board° , • O Design Review Board'. ' q Planning Soard' • ' _Q"Diisability Access Committee O Police Citizens Relations Committee ^,Fine Arts Board . 0 Production lndustry~Council ^•Golf Advisory Gommittee° ^ Public Safety Advisory Committee ' , . ~ Health AdvisoryCommittee - d Safety Committee ~ ~ - , ^ Health-Facititiea•AUthority Board-- O-Transportation-and-Parking Committee . 0 Hispanic Affairs .Camrrtiltte® ^ Visitor and Convention Authority' p Historlc'Prsservation Board° ^ Youth,Center Advisory Board " ~ . , ' ° 8PAf0 taapulred to File State olsdoaure Corm r . t - F.:aGLER\SALLtAR<: Apl)lie~14ipp\FlBC Atip6r_ation Ftcvle,[an q~)1 Sp6 jakes.doc ~' •~ ~{~ s, ~~ 1 f~~~ 7l ~~~~ 3 `~ L . ` . _fZ0 `d ~ti101 • . _ .. Note; If applying forYouth:Advisory Board;-please indicate-your-.affiliation with t ~e Scott Rakow Youth Center: ,• - -Y - No if yes • 1. Pask' service on-the Youth Ceritg~ Advisory: t3oard: Yes ~ ~ No ~ a-Years•ai Service. .. - 2• present participation in Youth Centeractivlt+es by.your children Yes' ' '~ , please'lisl the names-ot your children, their' - -~ . -. r_ ~ ' ages; and which .programs- List 5elow: ~ " ' Child's name: Aqe:Program: :. .q - child`s name; Rge: ~Pr®gram: .Have you ever been convicted of a felony: Yes ;:~ or No yes, pieaee explain in detail:. , ' ~ ~ - ~~ • ' violations of Cit of-Miami Beach codes: Yes~~ or No If yes; please explain in"detail: e•Do-you currently have a (.) Y y - • Do jyou currently owe the City of Miami t3each anymoney: Yes ~ or N f if yes, explain in d8tsil 's Ai'e you curreritiy serving on any Ciky'Soards br Committees: YesR9'or Pto 0. If yes; virtiich board? ;• • What organizations in he City of Miami Beach :do yau`currently hold m~ rnbership in7 :. - ,' . - idea. • ;, Name: { ' '' Name: _ t LG~ Tit1e:~~iY~/~'~(/~" ` ' a List all properties owned or have. an interest.in, which rare 6ocated with ~n the: City of Miarni Beach: ' ,-., i~ E P~~iod pR. M~q-r~,•-a.EAC.,N ~ ~33~,.39 am how. ennplo - , .` _: ~,: ;, -;. . ed b the Cit of Mlaml 8esch. Yss ,~ or No '. Whlc ' Y Y' Y . ~ ` ~ h department? ' k ~ • u-hawe a' arent'7: `s use ;~ ~ ` , ~- - ®Pursuant to Ctty Code Section 2=25~(t~)--Do yo r p y po ~ • achild-Gl, brother.-C7, o~ sister 0 who is employed by ttie . City of flAiami:9each? Check all that apply. ld8ntify tha department(s): ~' --This-Section is "not-required"_but desired: Age:_S ~ years old, ` ~ Gender: Male ~ Female 0 • Ethnic Origin (Check one). ~ ~ , ' White ~Af~ican'AmericanlBlack O Hispanic: [+>74sian or Pacific !slander Q American lndlan or Alaskan Native 0 ' Employment Status: Employed (Retired D Home-maker o.Other ^ ~ . ' "t h®rebp attest to the alccurecy and: truthfulness of the apptlcation and have recelvad; road-and wilt abid® by ChaptAr 2,' ` ' ' AUttcl® Vfl - of the°Ctty Code "Standardg-af-Conduct for city Offic®rs,-l pt ea_and.Agsncy ~smbers." - -gQpticant's.Slgnatur Date Nam of Applicant. (PLEASE PRINT) ' P1eaa® attach a copy. o(your resume to this appllcatton - .. ' E90TE: Appflcatiohs wtlt rem~i+n on fll ra period of one (1) calend~[r ear ~ ~ ' . ~ :. . :. ! ~. ' Rec•Ived in City Clerk's biflce by ~~ ., N o1 Deputy Clerk - - , . d _..,- DocumentControl Number iA9slgned~by the Clty Clerk's OMicel Enter a eY 03!8 tn~or - ,_ , a + 1d3Q 71t13~~ WAS ! Wti I W 1~l I ~ - 6~ : I I L00Z-9Z-Ntif:. I `. .. I I M®~ ~ SOURCE OF INCOME STATEMEt~fT Please. Pant or "type - First tvame . Middle NameJlnrtial Last htame . ~. - . Dt5CIR5tlIC n ,A ~ /v , ~C„ For Tax 'Isar .' ~" ~ Name; -~,`'~ ~ Ending; s~~`-- 4 .i Naffing Address; ~ (J j ~~l ~~ r , • ~ City/'State/ziR; C~'iYY1 ~G~- ~ 3.1.3 ~. ~ ~ Social Security Number; ~ Fiting as a: ~. 8~ County Empigyee; . Municipal Employee or": ' ., l . • Pasitian~ held or sought; ~Q~~Q~1")'~_.~ " ~ Term or 1=m ' Board where sQrving; ~ ptbyrnant Began an r " De ar-Jment where ern toyed; P P .( , Work J4ddress, 144 _ ~ Sf your home atldress is exempt from pubfi~ recortls pursuant t Florida Statutes § 1i9.Q7 please check here (read insti•uctions~: ~ Work Telephone: ~- I Home Address: Street Address , City State Zip Code Pbgaso list iaeiow in descending "order with the targeat source first, tine r~arroe, .address end _principal business activity of every source of your income including pubti~ salary you " rece:ivesd or any parson received for your benefit or dse .during the disclQSUre par~nd, T'he • ; income of year spo~ese or any business partner need net be disclosed, If continued on a separate sheet, check here; ,~ . ". . I .: " Description of .the Principal Name of ,5vurce of Zncame Address Business Activi ' '~ ., , I ~ ~. i ~ ~ " ~ ., ,i ,• ~ n i ' ~ hereby, swear (Dr affirm) that the aforesaid inforl ation is a true ar~d cprrect statement, . .~ " . Signature or person tiis:.iQSing ~ hate signed . ~ I __ ' STEPHEN HEAL ZACK ' ATTACHMENT TO SOURCE OF INCOME STATEMENT For tax year ending: 12/31/07 NAME OF SOURCE DESCRIPTION OF THE PRINC1PAi OF INCOME ADDRESS BUSINESS ACTIVITY Boles, Schiller & Flexner, LLP. 100 SE 2nd Street Suite 2800 Law Practice Miami, FL 33131 Stephen N. Zack PA 2699 S. Bayshore Dr Law Practice Miami FL, 33133 Waterford Village Developers, LLC 2665 5. Bayshore Drive #M 102 Real Estate Tinvestment Miami, FL 33133 Kings Capital Partners LP 201 Alhambra Circle #601 Real Estate Investment Coral Gables FL, 33133 - Altamonte Investors, LLC 3250 Mary Street #500 Real Estate Investment Miami, PL 33133 Pinehurst Club Developers, LLC 2665 S. Bayshore Drive Suite 100 Real Estate Investment Miami FL, 33133 Kensington (The Enclave Royal) 3250 Mary Street Suite 500 Investment Income Miami, FL 33133 . Armonk Partners, LLC 333 Main Street Real Estate Investment Armonk NY, ] 0504 Tanger Investments, LLC 2999 Brickell Avenue Real Estate Investment - Miami, FL 33129 . Claire Point Developers, LLC 2665 South Byyshore Drive # 1100 Real Estate Inveshnent Miami, FL 33133 CST Technology, LLC 1420 Brickell Bay Drive #PH4 Real Estate Investment Miami, FL 33131 Grand Bay Grove, LLC 2665 South Bayshor Drivc #1100 Real Estate Investment Miami, FL 33133 Hen-Lee, LLC 2665 S. Bayshore Drive Suite M-102 Real Estate Investment Miami, FL 33131 Reef Associates, Ltd 703 Waterford Way Suite 800 Real Estate Investment • Miami, FL 33126 Monterey Capital Partners, LLC 2665 South Bayshore Drive#1100 Real Estate Investment Miami FL, 33133 - MGP Partners, LLP 9655 S. Dixie Highway Suite 200 Real Estate InvesLnent Miami, FL 33156 Preserve at San Luis, LLC 3250 Mary Street Suite 500 Real Estate Investment Miami, FL 33133 Waterford Village Developers, LLC 2665 South Bayshore Drive#1104 Real Estate Investment Miami FL, 33133 22 Lantern, LLC 2665 South Bayshore Drive #1100 Real Estate Investment Miami, FL 33133 ' Sunset lnt'1 Medical Center Partners, LLC b705 Red Road Real Estate Investment Coral Gables, FL 33143 Ramsell Dining, LLC 350 McLaws Circle Suite 1 Investment Willimasburg, VA 23185 Equity. Capital Lending Parfiers 3125 W. Commercial Blvd #100 Investment Ft. Lauderdale, FL 33309 Energy Transfer Equity, LP 3738 Oak Lawn Investment Dallas, TX 75219 Rascon Associates 9404 S. Dadeland Blvd Suite 600 Investment Miami, FL 33156 Dolphin Plaza Investments 9655 S. Dixie Highway, Suite 200 Real Estate Investment Miami, FL 33156 5901 South Miami, LLC 2665 S. Bayshore Drive Real Estate Investment Coconut Grove, FL 33133 Morgan Keegan Fifty N. Front Street Interest Investment Memphis, TN 38103 Colorep, Inc 9119 Milliken Avenue Investment Rancho Cucamonga, CA 91730 Wachovia Bank 200 S. Biscayne Blvd, 15th Floor Interest Miami, FL 33131 Sun America Bank f/k/a Beach Bank 555 Arthur Godfrey Road Interest Miami Beach, FL 33140 Bank United 255 Alhambra Circle, 2nd Floor Interest Coral Gables, FL 33134 Phoenix Investments 56 Prospectus Street Interest Hartford, CT 46115-0480