Barbara Hershkowitz - 12/31/2012 MIAMIBEACH
Cit of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel: (305) 673-7411, Fax: (305) 673 -7254
12/6/2010
Barbara Hershkowitz
4345 Jefferson Ave.
Miami Beach, Florida 33140
SUBJECT :tt,! Waterfront Protection Committee
Congratulations! You have been reappointed by Commissioner Jerry Libbin
to the above referenced agency, board or committee for a term ending: 12/31/2012.
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,
,q,d4102d '
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Lisa Botero
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.
erA MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel: (305) 673-74.11, Fax: (305) 673 -7254
TO Hershkowitz Barbara
RE: Waterfront Protection 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: 12/31/2012.
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 theflorida 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.
Hershkowitz Barbara
Sworn to and subscribed before me this r day of J'-
6._
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.
ea M
City of Miami Beach,
1700 Convention Center Drive,
Miami Beach, Florida 33139,
www.miamibeachfl.gov
CITY CLERK Office CityClerk @miamibeachfl.gov
Tel: 305.673.7411 , Fax: 305.673.7254
Acknowledgement of fines /suspension for Board Members for failure
to comply with Miami -Dade County Financial Disclosure Code Provision
Code Section 2- 11.1(i) (2)
Board Member name: 04/4V fWeZ■`
I understand that no later than Jul 1, of each July c year all members of Boards and
Committees of the City of Miami Beach, including those of a purely advisory nature, are
required to comply with Miami -Dade County Disclosure Requirements. This means that the
members of City Advisory Boards, whose sole or primary responsibility is to recommend
legislation or give advice to the City Commission, must file, even though you may have been
recently appointed.
You must file one of the following with the City Clerk of Miami Beach, 1700 Convention
Center Drive, Miami Beach, Florida, by July 1 each year.
1. A "Source of Income Statement" (attached) or
2. A "Financial Statement" (attached( or]
3. A Copy of the person's current Federal Income Tax Return
Failure to file, according to the Miami -Dade County Code Chapter 1, General
Provision, Section 1 -5 may subject the person or firm to a fine not to exceed
$500.00 or by imprisonment in the county jail for a period not to exceed sixty
days, or both.
Signature: Date:
CITY OF MIAMI BEACH
BOARD AND COMMITTEE APPLICATION FORM
NAME: y I C'12.. ()14. f J� r ' � A
Last NaName � M First Name f Middle Initial
HOME ADDRESS: ( .� q! OY'S'-+' ( C"t h .-rc 33/ P
Apt No. House No. /Street City State Zip Code
PHONE: 477)- •/ C et/14 ►Q�/i ev Qo/ • (044 Home Work Fax ( Email address
Business Name: Position:
Address:
No. Street City State Zip Code
Professional License (describe) Expires: Attach a copy of the license
:....
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 Housing Advisory Committee ❑ Marine Authority
❑ Art in Public Places Committee ❑ Miami Beach Commission for Women
❑ Beautification Committee ❑ Miami Beach Cultural Arts Council
❑ Board of Adjustment* ❑ Miami Beach Human Rights Committee
❑ Budget Advisory Committee ❑ Miami Beach Sister Cities Program
❑ Capital Improvements Projects Oversight Committee ❑ Normandy Shores Local Government Neigh. Improvement
❑ Committee on the Homeless ❑ Parks and Recreation Facilities Board
❑ Committee for Quality Education in MB ❑ Personnel Board
❑ Community Development Advisory ❑ Planning Board*
❑ Community Relations Board ❑ Police Citizens Relations Committee
❑ Convention Center Advisory Board ❑ Production Industry Council
❑ Debarment Committee ❑ Public Safety Advisory Committee
❑ Design Review Board* ❑ Safety Committee
❑ Disability Access Committee ❑ Single Family Residential Review Panel
❑ Fine Arts Board ❑ Sustainability Committee
❑ Gay, Lesbian, Bisexual and Transgender (GLBT) ❑ Transportation and Parking Committee
❑ Golf Advisory Committee ❑ Visitor and Convention Authority
❑ Health Advisory Committee Waterfront Protection Committee
❑ Health Facilities Authority Board ❑ Youth Center Advisory Board
❑ Hispanic Affairs Committee
❑ Historic Preservation Board
❑ Housing Authority
❑ Loan Review Committee *Board Required to File State Disclosure Form
F: \CLLR \$ALL \aFORMS \BOARD AND COMMIT1EES \BC Application.doc
•Have you ever been convicted of a felony: Yes ❑ or Not. Xf yes, please explain in detail:
• Do you currently have a violation(s) of City of Miami Beach codes: Yes ❑ or No 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 you currently serving on any City Boards or Committees: Yes door No LI. If yes; which board?
04 i0/ - i 4 I c 7) at/1
• What organizations in the City of Miami Beach do you currently hold membership in?
Name: Title:
Name: Title:
• List all properties owned or have an interest in, which are located within the City of Miami Beach:
• I am now employed by the City of Miami Beach: Yes ❑ or NWhich 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 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 ptnale
Et i.nic Origin: Check one only (1)
White (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 LI or Not/'
Employment Status: Employed ❑ Retired ❑ Homemaker/ Other ❑
Received in the City Clerk's Office by : Date: _/ /2010 Control No. Date: _/_/2010
Name of Deputy Clerk
(
Please Print or Type First Name Middle Name /Initial Last Name
Disclosure
For Tax Year
Name: '�"�, Ending: t c=am
Mailing Address: - ( :5 q S J E-Pre )L f av
City /State /Zip: PD 3 "3
Social Security Number:
Filing as a: ® County Employee:
® Municipal Employee of:
Position held or sought: bd
Board where serving: ippT (or...i -T- Y 1- or Employment
Began on:
Department where employed:
Work Address:
If your home address is exempt from public records pursuant to
Florida Statutes § 119.07 please check here (read instructions): • Work Telephone:
Home Address: /5L15
Street Address
H-b "ft 3,3/q 9
City State Zip Code
I hereby swear (or affirm) that the aforesaid information is a true and correct statement.
•
1 ./. �`
Signature of person disclosing IP Date signed