Wendy Unger 12/31/2012 CA MIAMI BEACH
Cit of. Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miami.eachfl.go'
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel: (305) 673 -7411, Fax: (305) 673 -7254
1/11/2011
Wendy Unger
5750 Collins Ave. # 12A
Miami Beach, Florida 33140
E.;
Disability Access Committee
Congratulations! You have been reappointed by Mayor Matti Herrera Bower '
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 Offi e a
(305) 673 -7411.
Please read the enclosed material carefully. Again, congratulations and good I ck.
Since ely,
1 „ / fc?)?,e9-40-Al
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Duane Knecht
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 Ordin nc
City Wide Permit Application - (Parking Department Form)
Booklet - Guideto the Sunshine Amendment and Code of Ethics for Public Officers an
Employees
We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, hstoric community.
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CA MIAMIBEACH
Cit of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamiEeachf1.go
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel: (305) 673 -7411, Fax: (305) 673 -7254
TO Wendy Unger
RE: Disability Access 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
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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 I ,
of a City of Miami Beach Board and /or Committee, I must comply w' - , e financial disclosure* require-
ments of Miami -Dade County or the State of Florida (depending o . th s oard or committee on which '
I serve) on July 1st, following the closing of the calenda y =ar on wh I have -rved. j
jL I'J / A est ,1
Wen . it , er
Sworn to and subscribed before me this t day of 7,. 011. �.
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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.
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We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, pic•l; his'oric community. I
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C A MIAMI BETH CI O , ,IVIA111 BEACH
NAME: LkJ BOARD AND COMMITTEE P / TI N FORM
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Name n �( i 1 U C Fi i me Mid c e Initial
HOME ADDRESS: 741 *-0 1.,L 1 Al s /4 i/,'n / 1_� . * I i- 1 3/ ZQ
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PHONE: Apt o f t �6 0 <0 .k. N b / ) � O .2 PLUS i j 3 l : � . d f �i "l� Code
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H. Wor F Email � ss
B Na . b. / :. ,, 44 ,A '` G %Ito : 44% ...41•71/ Address: _A � d
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No. Street City St ; Zip Code
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Professional License (describe) Expires: , ttach , copy if the license
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Pursuant to City Code section 2-22(4) a and b: Members of agencies, boards, and committees shall be f fitiaee d with ttie city; this
requirement shaft be fulfilled in the following ways: a) an individual shall have been a resident of the - for a minimum of six
months; or b) an individual shall demonstrate ownersh pfinterest for a minimum of six months in a business established in the city.
• Resident of Miami Beach fora minimum of six (6) months: Yes U or No U
• Demonstrate an ownershipfinterest in a business in Miami Beach for a minunum of six (6) months: Yes U or No U
• Are you a registered voter in Miami Beach: Yes u or No J •
• (Please circle one): I am now a resident of North Beach South Beach Middle Bea
• 1 am applying for an appointment because I have special abilities, knowledge and experience. Please list B eto
• Are you presently a registered lobbyist with the City of Miami Beach? Yes u or No u
Please list your preferences in order of ranking [1] fast choice [2] second choice, and (3) third choice. Please not
choice, e :that only three (31
choices will be observed by the City Clerk's Office. (Regular Boards of City)
I
U Affordable Housing Advisory Committee 0 Marine Authority I
0 Art in Public Places Committee 0 Miami Beath Commission for Women I I i
0 Beautification Committee 0 Miami Beach Cultural Arts Council I (, ;
0 Board of Adjustment' 0 Miami Beach Human Rights Com • 1 ;
0 Budget Advisory Committee 0 Miami Beach Sister Cities Program 1
0 Capital Improvements Projects Oversight Committee 0 Normandy Shores Local Government Neigh: Improvement
0 Committee on the Homeless 0 Parks and Recreation Facilities Boa
0 Committee for Quality Education in MB 0 Personnel Board
0 Community Development Advisory ❑ Planning Board* 1 I ' f +
0 Community Relations Board 0 Police Citizens Relations Committee I 1
0 Convention Center Advisory Board 0 Production Industry Council 1 1
0 Debarment Committee 0 Public Safety Advisory Committee 1
0 Design Review Board* 0 Safety Committee
)5Disabiftty Access Committee 0 Single Family Residential Review Panel 1 I
0 Fine Arts Board 0 Sustainability Committee {
0 Gay, Lesbian, Bisexual and Transgender (GLBT) 0 Transportation and Paridng Committees I
0 Golf Advisory Committee 0 Visitor and Convention Authority
0 Health Advisory Committee 0 Waterfront Protection Committee ; 1
❑ Health Facilities Authority Board 0 Youth Center Advisory Board i '1
0 Hispanic Affairs Committee
0 Historic Preservation Board
0 Housing Authority !
0 Loan Review Committee *Board Required to File State Disclo : re Form
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Note: If applying for Youth Advisory Board, please indcate your affiliation with the Soott Rakow Youth Cente 1
1. Past service on the Youth Center Advisory Board: Yes U No U Years of Service:
2. Present participation in Youth Center activities by your children YesJ No J. If yes, please list the names of yon r children, their
ages, and which programs. List below:
Child's name: Age: Program:
Child's name: Age: Program: f
F: \CLER \$ALL \aFORMS \BOARD AND COMMITTEES \BC Application.doc
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*Have you ever been convicted of Sony: Yes U or NoX If yes, please explain it il:
• Do you currently have a violation(s) of City of Miami Beach codes: Yes U or No If yes, please explain i detail:
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• Do you currently owe the City of Miami Beach any money: Yes 0 or No' If yes, explain in deta I
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• Are you curre fly serving on any City Boards or Committees: YesAidor No U. If yes; which board.?
Ps C.-•
• What or anizations in the City of Miami Beach do you currently hold membership in? i 1 I
Name: AMfda,1CO J CA-Ai -_s 1 PC/ Tile: (O - 61 604-ko; A-1
Name: F.O , 2 . c . _ . , , , c . _ . , , , 1 = , Title: £ t V 1 tr Z I D'kk CO ir;-O(2.o J 4J - le-
• List all properties owned or have an interest in, which are located within the City of Miami Beachil 1 1
SISO Cos' iN5 1\ tk( Mi EL, s"" to -).– o— P....zy c. Cl/ 6 "ASy
• I am now employed by the City of Miami Beach: Yes 0 or No)( Which department? f
• Pursuant to City Code Section 2 (b): Do you have a parent U, spouse U, child U, brother U, or sister I wh o is e nplo by the
City of Miami Beach? Check all that apply. Identify the department(s):
Ai of PLi l
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The following information is voluntary and is neither part of your application nor has an y bearing
being asked to comply with federal equal opportunity reporting requirements. n9 on your consideration for nppo 1ntment. It is
Gender: 0 Male 'jFemale
Ethnic Origin: Check one only (1) f
ite (Not of Hispanic Origin): All persons having origins in any of the original peoples of Europe, North Africa or thciiMiddie Ei st
❑ African- AmericaNBlack (Not of Hispanic Origin): A9 persons having origins in any or the Bieck racial groups of Ahlca 1
❑ Hispanic: All persons of Mexican, Puerto Rican, Cuban, Central or South American, ri
can or other Spanish culture or g 11 , regardless of race.
❑ Asian or Pacific Islander. Ad persons having origins in any of the original peoples of the Far East, Southeast Asia, "' Indian Subcontinent, on
the Pacific Islands. This area includes, for example, China, India, Japan, Korea, the Ptaippine Isfon is and Somoa. I i
❑ 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 attifiation or communftty remotion.
Physically Challenged: Yes u or NoJ. C
Employment Status: Employed Retired 0 Homemaker 0 Other 0 C
ill be M me berg.
required to follow certain laws which apply to city board /co �
NOTE: If appointed, you w rn
These laws include, but am not Muted to, the following:
o Prohibition from d or indirectly lobbying city personnel (Miami Beach City Code section 2 I ). '
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 i r lea 'ng office (Miami
Beach City Code section 2 -26).
o Requirement to disclose certain financial interests and gilts (Miami -Dade County Code section 2- X1.1). i
(re: CMB Community Development Advisory Committee): prohibition, during tenure and for one year afth r leaving office,
from having any interest in or receiving any benefit from Community Development Block Grant funds i r either yourself ,
or those with whom you have business or immediate family ties (CFR 570.611).
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Upon request, copies of these laws may be obtained from the City Clerk.
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"I h by attest curacy and truthfu in s the application and have received, read and I I abide by Chapter 2,
• - ,' - 1 VII — of , , : City C , , e "Standards of C du for City Officers, Employees an A ency Mem ' s."
.�.' i ,, / /� 1 ( !i s.
re e Name of Applicant (PLEASE PRINT)
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Please attach a copy o your resume to this application !
NOTE Applicatio will Tema' on file or a period of one 1) calendar year. 1
Received in the Cleric's Office 1/Date ( i l r
�Y by = / r (,orttrol No. / ✓ � l�atel: ! / //
Name of De Clerk r
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® MIAMIBEACH
City of Miami Beach,
1 700 Convention Center Drive,
Miami Beach, Florida 33139,
www.miamibeachfl.gov
CITY CLERK Office CityClerkC►miami•a•chfl:gov
Tel: 305.673.7411 , Fax: 305.673.7254
Acknowledgement of fines /suspension for Board Members for failure to compy. with Miami -
Dade County Financial Disclosure Code Provision Code Section 2- 11.1(1) (2)
Board Member name:
�V
I understand that no later than July 1, of each year all members of Boards and Committee of the City of
Miami Beach, including those of a purely advisory nature, are required to comply with Miari Dade County
Disclosure Requirements. This means that the members of City Advisory Boards, Whose l s 'le or primary
responsibility is to recommend legislation or give advice to the City Commission, must file] ev. n though you
may have been recently appointed. j
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. I
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 Retum
Failure to file, according to the Miami -Dade County Code Chapter 1, ene, -1 Provision,
Section 1-5 may subject the person or firm to a fine not to exceed $500.00 • i r by. prisonment
in the county jail for a period not to exceed sixty days, or both.
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Signature: Date:
F:4CLER4$ALL1aFORMSGOARD AND COMMITTEESiBC Application.doc
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[ MIAMIO
SOURCE OF INCOME STATEMENT
Please Print or Type First Name Middle Name /Initial Last Name
p• use
Name: , -- &2 ,
Eno - Yearnn ib
Mailing Address: 5 l @ Lt ( i` 41- kit
City/ c 1 kl /Zip: � ' L / . °
Filing as a: 0 County Employee:
Municipal Employee of
Position held or sought
Board where senring:Gm G Term or Employment
Began on:
MIA
Department where employed: 4-r l I'A I [bt V A KIVP7 YV 0 v I! ► ft4 N4 t 4 C ,
Work Address: / A 1 1)1 k 1' 1 IA t RomAtii.
11 your home address Is exempt from public records pursuant to t 7)61
6 1 f
Florida § 119.07 please check here (read instructions): 0 Work Telephone: C(� J Ch21
Home Address: ��� CO u, / i 43-1
Street Address
City State
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Please list below in descending order with the largest source first, the na 1 ,; - a
principal business activity of every source of your income including pu lic j you
received or any person received for your benefit or use during the disclosu - r- The
income of your spouse or any business partner need not be disdosed. If • nth fu on a
separate sheet, check here:
Description of the i ' ipal
Name of urce of Income Address Business A
u'1L �1/'li"G►!Tlr :�s' 'rE %�I % !1IFITZE
y (or affirm) ,,k the aforesaid information is a true and correct sip , nt.
.4..°L14I .41141. Aut C l
Signature of l
ignatu person disclosing 1 signed i
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