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Josephine Pampanas 12/31/2012 trA AA M City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov OFFICE OF THE SPECIAL MASTER Tel: (305) 673 -7181, Fax: (305) 673 -7182 1/18/2011 Josephine Pampanas 4444 Prairie Ave Miami Beach, Florida 33140 ft:cT Transportation and Parking g 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 Office at (305) 673 -7411. Please read the enclosed material carefully. Again, congratulations and 9 ood luck. Sincerely, /eolejd 4Zeie2/C/ Robert Parcher City Clerk cc: Saul Frances, Parking Director Saul Frances 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. Y tri Ai\ I Am 1 BEAc H City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov OFFICE OF THE SPECIAL MASTER Tel: (305) 673 -7181, Fax: (305) 673 -7182 TO Josephine Pampanas RE: Transportation and Parking 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. 1 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 sere- • . 1 A ue . lt ; – — _,,e, 1 ( ohi'ePampan. Sworn to and subscribed before me this ig , da of 4 ��/, 2011. day , / fr # / fr A 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. F-- /V\I/A/V11 btAL ti CITY OF MIAMI BEACH .-° -- BOARD AND COMMITTEE APPLICATION FORM NAME: ) 4 M& 4 J/4 SJ L st Name first ame Middle Initial HOME ADDRESS: ! 0. � � [ � i t a ,,,,,a, - I l e j t b Apt No. H. - se No. /Street CI State Zip Code PHONE: 3e?- ‘,7‘.- - „r • - a.S 3es"- - • • Home ork Fax Em - it address Al — aVit . ,, , 0 Business Name: £b. ,; 1L1 ' Position: / F A 4 4/ 1 • / Address: I t No. Street City State Zip Code Professional License (describe) C �� ac":3 G� P / c . Expires: /c L Attach a 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 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: Ye or No 0 • Demonstrate an ownership /interest in a business in Miami Beach for a minimum of six (6) months: Ye or No 0 • Are you a registered voter in Miami Beach: Yes or No 0 • (Please circle one): I am now a resident of: orth Beach South Beach fi ddle Beach • I am applying for an appointment because 1 have special abilities, knowledge and experience. a slow: • Are you presently a registered lobbyist with the City of Miami Beach? Yes 0 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 City Clerk's Office. (Regular Boards of City) 0 Affordable Housing Advisory Committee 0 Marine Authority. ❑ Art in Public Places Committee . ❑ Miami Beach Commission for Women 0 Beautification Committee ❑ Miami Beach Cultural Arts Council 0 Board of Adjustment* 0 Miami Beach Human Rights Committee 0 Budget Advisory Committee ❑ Miami Beach Sister Cities Program 0 Capital Improvements Projects Oversight Committee 0 Normandy Shores Local Government Neigh. Improvement 0 Committee on the Homeless 0 Parks and Recreation Facilities Board ❑ Committee for Quality Education in MB ❑ Personnel Board ❑ Community Development Advisory 0 Planning Board* ❑ Community Relations Board 0 Police Citizens Relations Committee ❑ Convention Center Advisory Board _ 0 Production Industry Council ❑ Debarment Committee 0 Public Safety Advisory Committee 0 Desi• n Review Board* 0 Safe Committee ❑ Disability Access Committee 0 Single Family Residential Review Panel 0 Fine Arts Board 0 Sustainabili Committee 0 Ga , Lesbian, Bisexual and Trans. ender GLB 0 Trans • ortation and Parkin. Committee ❑ Golf Advisory Committee 0 Visitor and Convention Authority ❑ Health Advisory Committee 0 Waterfront Protection Committee 0 Health Facilities Authority Board ❑ Youth Center Advisory Board 0 Hispanic Affairs Committee 0 Historic Preservation Board ❑ Housing Authority ❑ Loan Review Committee *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 0. 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: F : \CLFR \$ALL \oFORMS \BQARD AND COMMITTEES \BC Application.doc •Have you ever been convicted of a felony: Yes ❑ or No I f yes, ex lease explain in detail: P p • Do you currently have a violation(s) of City of Miami Beach codes: Yes ❑ or No 1f es please explain in y, p p detail: • Do you currently owe the City of Miami Beach any money: Yes ❑ or No . If yes, explain in detail • Are you currently serving on any City Boards or Committees: Yes or No 0. If es; which board? Y , • What organizations in the City of Miami Beach . e you currently hold membership in? Name: i _..,4 .r . Air . 4a .arrti _ - r Title: ... Name: Title: . • List all prope . s owtaed or have an interest in, which are located within the City of Miami Beach: i f V PailiLtA • I am now employed by the City of Miami Beach: Yes ❑ or . .r. Which department? • Pursuant to City Code Section ,2- 25.(b): Do you have a parent 0, spouse ❑, child 0, brother 0, or sister ❑ who is etriplOyed lyiihe City of Miami Beach? Check all that ap /y. Identify the department(s): The following information is voluntary and is neither part of Stir application nor has any bearing on your consideration for appoirent. ' being asked to comply with federal equal opportunity reporting requirements. Gender:' t3 Male X Female Ethnic Origin: Check one only (1) ,,,,,k.- ird ; ❑ 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) MI persons holing origins in any of the Black racial groups of Africa. , , `„ .r ; , Hispanic: All persons of Mexican, Puerto Ran; - bn, Central Ot"6outh American, or other Spanish culture or origin, regardless dfr. ❑ 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 N Employment Status: Employed. Retired D Horrieraker ❑ Other ❑ • NOTE: If appointed you will be requiredlo follow certain laws which apply to city board /committee members. These laws include, but are not limited to, the following: o Prohibition from directly. lobbying city . rs ' nnel (Miami Beach City Code section 2 -459). O Prohibition from contracting with the city (Miami-Dade County Code section 2- 11.1). r ”` O Prohibition from lobbying before board /rnmittee you have served on for period of one year after Ie " ° ' Y 9 Y p Y �- t��i ��t - , - . Beach City Code section 2.26). 0 Requirement to disclose certain financial interests and gifts (Miami -Dade County Code section 2- 11.1). J - ( re: CMB Community Development p Advisory Committee): prohibition, during tenure and for one yea�'after leaving ��' • 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 atte to - - accuracy and truthfulness of the application and have received, read and will abide by Chi r 2, . "' p icie V11 o t Code "Standards of Con • uct for City Officers, Employees and Agen Members." i 4 r te . ► VA _ � . r / 'Ara' t ►► ` ' pi ' • ` :. is S • - re • :te ; -me of Applicant (PLEASE PRl ease attac a copy of your resume to this application NO Applicationsw remain on file for a period of one (1) calendar year. Received in the City Clerk's Office by : Date: / .__ /2010 Control No. Date: /2010 Name of Dep Clerk M1AMIBEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov CITY CLERK Office CityClerk@m i arnibeachfl.gov Tel: 305.673.7411 , Fax: 305.673.7254 wl d m t of fines/suspension Ackno a ge en for Board Members for failure to comply with Miami -Dade County Financial Disclosure Code Provision Code Section 2- 11.1(1) (2) Board Member name: a _i9 _ . _ . • I understand that no later than July 1, of each Y ear 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 ail for period not to exceed sixty tY1 p y days, or both. Si. a ure: Dat • i I I� l I t 1 KAMF COUNTY SOURCE OF INCOME STATEMENT Please Print or Type First Name Middle Name /Initial Last Dame �-- Disclosure Dame. ,� For Tax Year Ending: a Mailing Address: / c2a0 1".." City /State /Zip: , Filing as a: El County Employee: El Municipal Employee of: Position" held or soughtLigi Board where serving: Term or Ern to `� p ym nt 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 (reed instructions): El Work Telephone: Home Address: Street Address City State Zip Code Please list below in descending order with the largest source first, he name, ad ' �► , dress and principal business activity of every source of your income including public salary you received or any person received for your benefit or use during the disclosure period. The income of your 9 � y spouse or any business partner need not be disclosed. If continued on a separate sheet,, check here: (� Description of the Principal Name of Source of Income Address Business Acti ' V 4 '' /Ar ji ■ I hereby swear (or affir ) - the aforesaid information is a true and correct statement, IMF Signa - t re o erson isciosin to gned I xi Please Print or Type { Source of Income Information (Required by the Miami -Dade County Code, Section 2-11.1(i), as amended.) q y -rt � The term INCOME shall include, a but is not limited to, the following items: wages, salaries; tips; t bonuses; com • missions & fees; dividends, interest; profits from businesses and professions; your share of profits from partnerships and small business corporations; pensions, annuities endowments, profits fr. . , , sale . n e of real estate, securities or other property, including _._..._ • _ •= to or trust income, including accumulated personal residence; re � - �_, , , 4 ... n - . ` �.- ,,... . -� •. - support payments; prize1; s distributions; alimony, separate maintena: or supp • PaY workmen's compensation, an Executor, Administrator or Director, disability retirement payments; insurance; damages; etc. Filing instructions • � Statement, Form A Source of Income Form, Financial Stateme � 1 or copy of the personal Income Tax forms may be filed to satisfy the filing requirement for County, Municipal employees and advisory board Y a; members. This form must be filed by 3uiy 1 of each year This form should not be used as a substitute for Form 1 for those required to file under state requirements. ' Board members shall file completed forms with: Miami -Dade County Personnel and Advisory Miami -Dade Elections Dep artment • 2700 NW 87 Avenue Miami, Florida 33172 Or P.O. Box 521.550 Miami, Florida 33152 -1550 Municipal Personnel and Advisory Board Members shall file completed forms with: Their respective Municipal Clerk. For further information contact the s De artment at 305 - 499 -840 or your Municipal Clerks , Office Miami _ Dade Election p is calve and maintain the forms filed as public record. If your home Note: The role of our office is to re from public records and you do not wish it to be address appears on the form and you are exempt P made The following persons should not use public, you should use your office or other address. P their home addresses: active and form er law enforcement personnel, including correctional and • officers; current or former state attorneys, assistant state attorneys, correctiona! probation office , •uyrtices and judges prosecutors; firefighters, � statewide rosecutors, and assistant statewide pi'os�� 9 include the investigation of stet P of Department of Children and Family Services . whose duties include ei nvesti ti the personnel o p exploitation, fraud, theft or other criminal activities, an p abuse, neglect, P Department of Revenue or 1 governments overnments responsible for revenue collection and enforcement • souses of the above; and county and municipal code inspectors and child support enforcement, p code enforcement officers. 4'4 Source of Income Statement /dr •