Claire Warren 12/31/2011 MIAMI EACH
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 -7411, Fax: (305) 673 -7254
01 -07 -2011
Claire Warren
3050 Prairie Ave
Miami Beach, Florida 33140
S'UBJEOR Police Citizens Relations Committee
Congratulations! You have been appointed by Mayor Matti Herrera Bower
to the agency, board or committee named above for a term ending: 12/31/2011.
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,
i daP ' cl/14-112) 2 --/Cf
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Chief Carlos Noriega
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
We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community.
® MAMBEACH
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 -7411, Fax: (305) 673 -7254
TO Claire Warren
RE: Police Citizens Relations 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 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.
".„.„
Claire Warren
Sworn to and subscribed before me this // / day of 011.
,
, `., /
Silvia P lets)
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 safely to all who live, work and play in our vibrant, tropical, historic community.
4
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eZi � `; % `' �. �' �', },_ u CfTY Or' MlAfdll EACH
NA ��` /
g(ifrer AND COMMfTTEE APPLICATION FORM
NAME:
UV
`L aor� Name h ie/e. / � t Name 1g Middle Initial
HOME ADDRESS: ° m� // /"'' G% , t/ , h / 3 7 S�
Apt No. House No. /Street City ¢ St • / tate p " �� Zi Cod
PHONE - � d ��)Q cf g4P -(--
Home Work Fax Email address
Business Name: Position:
Address:
No. Street City State Zip .Code
Professional License (describe) Expires: Attach s 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 sh II have been a resident of the city for a minimum of six
months; or b) an individual shall demonstrate ownership /interest for a inimum of six months in a business established in the city.
• Resident of Miami Beach for a minimum of six (6) m s: Yes r No 0
• Demonstrate an ownership /interest in a business i iami Beach for a minimum of six (6) months: Yes 0 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 applyin ran p 'ntmee becauuse II ave special abjlities, kno�riedge,ar�d e .•erience. e is Blow:
Y p � e I "b wi th me r E ? Ye fN�
• Are you y /n3 re o b yist e C o Miami Beach? Yes 0 or N
Please list your preferences in order of ranking [1] first choice [2] second choice, and [3] third choice. Please note that only three (3t
choices will be observed by the City Clerk's Office. (Regular Boards of City)
D l►fiordable Housing Advisory Committee 0 Housing Authority
Art in Public Places Committee D Loan Review Committee
pcBeautiffiication Committee 0 Marine Authority
0 Board of Adjustment" 0 Miami Beach Commission for Women
D Budget Advisory Committee 0 Miami Beach Cultural Arts Council
0 Capital improvements Projects Oversight Committee 0 Miami Beach Sister Cities Program
0 Committee on the Homeless 0 Normandy Shores Local Government Neigh. Improvement
0 Committee for Quality Education in MB ❑ Parks and Recreation Facilities Board
❑ Community Development Advisory 0 Personnel Board
0 Community Relations Board 0 Planning Board'
D Convention Center Advisory Board a, ta'Pohce Citizens Relations Committee
D Debarment Committee 0 Production industry Council
D Desi•n Review Board' - ublic S- = Adviso Committee
D Disability Access Committee 0 Safety Committee
0 Fine Arts Board 0 Single Family Residential Review Panel
D Gay, Lesbian, Bisexual and Transaender (GLBT) 0 Sustainabifity Committee
❑ Golf Adviso Committee ❑ Trans•aren Reliabfl' & Accountabif Committee "TRAC"
D Health Adviso Committee 0 Trans• ortation and Parkin • Committee
0 Health Facilities Authority Board 0 Visitor and Convention Authority
❑ Hispanic Affairs Committee 0 Waterfront Protection Committee
0 Historic Preservation Board ❑ Youth Center Advisory 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 0 No n Years of Service:
2. Present participation in Youth Center activities by your children YesD 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: Aae: Program:
\CLEP. ,SALL \arORMS\BOARD AND COMMITTEES \BC Application062609 N= VV.do:
.Have you ever been convicte;: o� a felony Yes No I' yes. please explain tail:
• Do you currently have a violation(s) of City of Miami Beach codes. Yes _ o if yes. please explain in detail:
• Do you currently owe the City of Miami Beach any money: Yes No If yes. explain in detail
• Are you currently serving or any City Boards or Committee6e or No .:. If ves whicf board?
- afire te416
• What organizations in the��Cii y f Miami Beach do you currently hold membership in?
Name: /''�i�d Title:
Name: Title:
• List all properti s owned or have an interest tn, which are located within the City of Miami Beach:
• I am now employed by the City of Miami Beach: Yes D or No . Which department?
• Pursuant to City Code Section 2 -25 (b): Do you have a parent 0, spouse G, lid C, brother 0, or sister D who is employed by the
City of Miami Beach? Check a that apply. Identity 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: D Male male
A Et r nnie . Origin: Check one only (1)
_, (Not of Hispanic Origin): At 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.
U Asian or Pacific istander: All persons having origins in any of the original peoples of the Far East, Southeast Asia, the Indian Subcontinent, or
the Pacific Islands. This area includes, for example, China, India, Japan, Korea, the Philippine islands and Somas.
American Indian or Alaskan Native: Ali persons having origins in any of the original peoples of North America, and who maintain
Cultural identification through tribal affiliation or Ity recognition.
Physically Challenged: Yes 0 or No
Employment Status: Employed D Retiredp 0 Other 0
NOTE: If appointed, you MU be required to follow certain taws which apply to city board /committee members.
These laws include, but are not limited t ,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 from lobbying before board /committee you have served on for period of one year after leaving office (Miam
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 Devetopment 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 hereby attest to the accuracy and truthfulness of the application and have received, read and will abide by Chapter
Artic - 1 — of the i 1 Code "Standards of C nduct for City Officers, Employees and Agency Members."
Applicant's Signature a Name of Applicant (PLEASE °RINT)
?lease attach a copy of your resume to this application
NOTE: Applications will remain on fife tor a period of one (1) calendar year.
•
Received in the City Cierk's Office by Date ' /2009 Control No Date :_ /2009
Name of Deputy Clerk _
MIAMIBEACH
City of Miami Beach,
1700 Convention Center Drive,
Miami Beach, Florida 33139,
www. miamibeachfLgov
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)
14 A
Board Member name: 04,
I understand that no later than July 1, of each 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: te: