Marc Umlas 06/10/2014City of Miami Be®ch, J 700 Convention Center Drive, Miami Beach, Florida 33139, ~cvy.miamibeachfl.gov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk '
Tel: (305) 673-741 1, Fax: (305) 673-7254
6/18/2010
Marc Umlas
1424 S. Biscayne Pt. Rd
Miami Beach, .Florida 33141
Health Facilities Authority Boarc!
Congratulations! You have been reappointed by ;the City Commission to the above
referenced agency, board or committee for a term ending: 6/1.012014.
If you are .unable to accept this appointment, please notify the City Clerk's Office at
(305) 673-7411. .
Please read the enclosed material carefully. Again, congratulations and good luck.
Sincerely,
~'~°
Robert Parcher.
City. Clerk
cc: Saul Frances, Parking Director
Patricia Walker
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 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
..Employees
We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community
• •
MIAMIEA~
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
I
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel: (305) 673-741 1, Fax: (305) 673-7254
TO Marc Umlas '
i
RE: Health Facilities Authority Board
i
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: 6/10/2014.
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 ~cers and Emp/ogees, and understand that as ~ member
of a City of Miami Beach. Board and/or Committee, I must comply with the financial disc) sure* require-
ments of Miami-Dade County or the State Hof Florida (depending on the boa or com ee on which
I serve) on July 1st, following the closing of the calendar ye on ich I h serve .
i
Sworn to and subscrib
Marc Umlas
before me this ~ day of ~ od~ 2010
..
Silvia Prieto
Deputy Clerk
*Please visit the City of Miami Beach ~
for additional information regarding the
at www.miamibeachfl.gov under City Clerk/Board and Committees
Disclosure Requirements.
We are committed to providing excellent public service and safely to all who live, work and play in our vibrant, tropical, historic community.
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No. Street City State Zip Code
Professional License (describe)
Expires: ~f~~e~ ~ ~o~~ ~ ~~ d~~~~~
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:
• 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 [3] third choice. Please note that only three (3)
choices will be observed by the Citv 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* ^ 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 Qualit Education in MB ^ Parks and Recreation Facilities Board
^ Communi Develo ment Adviso ^ Personnel Board
^ Communit Relations Board ^ Plannin Board*
^ Convention Center Adviso Board ^ Police Citizens Relations Committee
^ Debarment Committee ^ Production Indust Council
^ Desi n Review Board* ^ Public Safe Adviso Committee
^ Disabilit Access Committee ^ Safe Committee
^ Fine Arts Board ^ Sin le Famil Residential Review Panel
^ Ga ,Lesbian, Bisexual and Trans ender GLBT ^ Sustainabilit Committee
^ Golf Adviso Committee ^ Trans ortation and Parkin Committee
^ H th Adviso Committee ^ Visitor and Convention Authorit
ealth Facilities Authori Board ^ Waterfront Protection Committee
His anic Affairs Committee ^ Youth Center Adviso Board
^ Historic Preservation 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 list the names of your children, their
ages, and which programs. List below:
Child's name: Age: Program:
Child's name:
Age: Program:
~-
oHave you ever been convicted of a felony: Yes ^ or No ~f yes, please explain in etaiL
/` ;~~-~_
s 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
o Are you currently serving on any City Boards or Committees: Yes ^ or Ng~ If yes; which board?
o What organizations in the City of Miami Beach do you currently hold membership in?
Name: Title:
Name:
Title:
• List all properties oiw~ ed or have an .interest in, which are located within the City of Miami Beach:
hCO~'t ~' --
o I am now employed by the City of Miami Beach: Yes ^ or No~Which department?
o 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 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 for appointment. It is
being asked to comply with federal equal opportunity reporting requirements.
Gender: 'Male ^ Female
Ethnic Origin: Check one only (1)
/te (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 in 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 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 0 __
NOTE: If appointed, you will be required to follow certain laws which apply to city boardlcommittee members.
These laws include, but are not 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 ftom 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 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.
"I her est tot a accuracy and truthfulness of the application and have received, read and will abide by Chapter 2,
A e VII - f the ty Code "Standards of C nd ct for City Officers, m loyees and enc Members."
l~ ~~ ~ ~
Applicant ignature Date Name of Applicant (PLEASE PRIN
Please attach a copy o your resume to this application
NOTE: Applications will an o le for a period of one (1 calendar year.
Received in the City Clerk's Office by :, T?rC- ./ Date: l ~ / 0 0/ ~trol No Date~_~ /20 0 ~ v
Name of Deputy Clerk F:\CLER1$ALL FO MS\BOARD AND COMMITTEES\BC plication.doc
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Florida statutes § 119.07 .please check here (read instructions): ® yilork Teleph®ne:
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Please list below in descending order with the largest source fret, the Warne, address and
principal business activity of every s®urce of your income including public .salary you
received or any person received for your beneft or use during the disclosure period. The
income of your spouse or'any business partner need not be d'asclosed. If continued on a
separate sheet, check here: