Dr. Barry Ragone 12/31/2012 I I M * C
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miarnibeachfl.aov
OFFICE OF THE SPECIAL MASTER
Tel: (305) 673 -7181, Fax: (305) 673 -7182
01 -18 -2011
Dr. Barry Ragone
6961 Indian Creek Drive
Miami Beach, Florida 33141
£ Miami Beach Human Rights Committee
Congratulations! You have been appointed by the City Commission to the agency,
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board or committee named above for a term ending: 12/31/2012.
Pursuant to Ordinance No. 2006 -3543; commencing with terms beginning on or after
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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
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elected official leaves office.
If you are unable to accept this appointment or have an. questions, call the City
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Clerk s Office at 305 - 673 - 7411. Please read the enclosed materials carefully.
Congratulations again and good luck.
Sincerely,
/ / a)//e# P 1) , 2 / 1
il
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
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
9 P 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.
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NA A it's BEACH
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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
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TO Dr. Barry Ragone
I �
RE: Miami Beach Human Rights 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.
1 64
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Dr. Barry Ragone
Sworn to and subscribed before me this: day of , 2011.
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, tropical, historic community.
f- /V\ 1 A/V\ 1 13 I CITY OF MIAMI BEACH
BOARD AND COMMITTEE APPLICATION FORM
NAME: rs.:.. T C 1?)/IgIZY -
LastName First Name Middle initial
HOME ADDRESS: G 3 .3
Apt No. t, / House No. /Streeter City State Zip Code
: ' D Gd "� PHONE. C � _ � � � � Qot
Home Work Fax Email address
Business Name: i7;O 1 C_i2 Position: 01A.;8#
Address: il es -- 4.) V )t , j - t 7 ./ 3
No. Street City State Zip Code
Professional License (describe) Expires: 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: YAor No
• Demonstrate an ownership /interest in a business in Miami Beach for a minimum of six (6) months: Yep or No ❑
• Are you a registered voter in Miami Beach: Yew or No,0
• (Please circle one): I am now a resident of: rolah 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 City Clerk's Office. (Regular Boards. of City)
O cXAffordable Housing Advisory Committee ❑ Marine Authority
0 Art in Public Places Committee ❑ Miami Beach Commission for Women
0 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 0 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 (7
❑ Ga , Lesbian, Bisexual and Trans .ender GLB ❑ Trans. ortation and Parkin • Commi
tt .r ?`• '`� �� Std Lir„;
.iKL.
❑ Golf Advisory Committee ❑ Visitor and Convention Authori s
l
0 Health Advisory Committee ❑ Waterfront Protection Committee
❑ Health Facilities Authority Board ❑ Youth Center Advisory, Board
❑ Hispanic Affairs Committee _ c u
❑ Historic Preservation Board
❑ Housing Authority
0 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: g Program:
. CLER \$AL L\oF ARM \BOARD AND CCMMI f T EE \ BC Applic .do
atias� ,c .
•Have you ever been convicted of a felony: Yes ❑ or Ni? If yes, please explain in detail:
• Do you currently have a violation(s) of Cit of Miami Beach codes: Yes - x No 0. If yes, p lease explain in detail:
Y Y ,p p
0 you currently owe the City of Miami Beach any money: Yes 0 or N 2. If yes, explain in detail
Are you currently serving on any City Board or Commi ees: Year No 0. If Y es; which board?
.!
• What organizations in the City of Miami Beach do you currently hold mem - ershi in?
Name: o Title: ..
, - f-
Name: f Title:
• List all properties owned or have an interest in, which ar-'Iocated within the City of Miami Beach:
6 / i4 vV? 0 A ly.„07:—Ls24) Piv 4'7
® I am now employed by. the City of Miami Beach: Ye II or N• xi Which department?
O Pursuant to City Code Section 2 -25 (b): Do you have a parent 0, spouse 0, child 0, brother 0, or sister 0 who is employed b the
City of Miami Beach? Check all that apply. Identify the departments)
- '''
by
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:; la Male 0 Female
Ethnic Origin: Check one only (1)
rftwhite (Not of Hispanic Origin): AII persons having origins in any of the original peoples of Europe, North Africa or th
P p the Middle East.
0 African - American /Black (Not of Hispanic Origin): All persons having origins in any of the Black racial groups of Africa.
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❑ Hispanic: All persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race.
0 Asian or Pacific Islander: AII 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: AII persons having origins in any of the original eo les of North America, and who
P P d ho maintain
Cultural identification through tribal affiliation or community recognition.
Physically Challenged: Yes 0 or No0.
Employment Status: Employed 0 Retired 0 Homemaker 0 Other ❑c r
,
NOTE: If appointed, you will be required to follow certain laws which apply to city board /committee members.
These laws include, but are not limited to, the following:
0 Prohibition from directly or indirectly lobbying city personnel (Miami Beach City Code section 2-
Y 2-459).
0 Prohibition from contracting with the city (Miami -Dade County Code section 2- 11.1).
0 Prohibition from lobbying before board /committee you have served on for eriod of one year after le i
Beach City Code section 2-26).
P y leaving office (Miami
0 Requirement to disclose certain financial interests and gifts (Miami -Dade County Code section 2 -11.1- .
(re: CMB Community Development Adviso Committee): 'prohibition, tenure }
Advisory ) p ton, 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 ourself
or. those with whom you have business or immediate family ties (CFR 570.611). Y '
Upon request, copies of these laws may be obtained from the City Cit Clerk.
"I hereby attest to the accuracy and truthf Iness of the application and have received, ,read and will abide .. ,
Article VII — of the City Code "Standards o ; Conduct for City Officers, Employees and Agency Members."
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' 1.--N :P -1 / - ' 1 ,'" fi 1 -1-- : a 0-X il 043 ,, ‘.:_._ v im, ,
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pp t s nature r- to
Name of Applicant (PLEASE PRINT)
Please attach a copy of your resume to this application
NOTE:. Applicationsswill,remain • file.for:a,period:of-one..1) calendar year.
0 . , i
Received in the City Clerk's Office by : f� -� � '
r / c fi /
• Date / /2 10 Control No. Date: / _ /201 / /
Name of Deputy CI rk ,
,• ' 6961 INDIAN CREEK DRIVE 305- 865 - 6961,786- 443 -9848
-, MIAMI BEACH FL, 33141 . • Levite6@ad.com
BARRY a RAGONE M.
Objective CITY OF MIAMI BEACH BOARD AND COMMITTEE RESUME •
REQUEST OF COMMITTEE ASSIGNMENTS: HUMAN RIGHTS -1
• COMMUNITY DEVELOPMENT ADVISORY -2 AFFORDABLE HOUSING
ADVISORY COMMITTEE -3
Exp Bence 2006 -2011 DENTIST MIAMI BEACH/MIAMI FLORIDA
• INDIAN CREEK DENTAL MIAMI BEACH
• 1971 -2006 PRIVATE PRACTICE SOUTH FLORIDA
• • 1971 -1973 ADJUNCT CLINICAL PROFESSOR, DEPT. OF
PEDIATRICS UNIVERSITY OF MIAMI -.
•
Education 1964 -1969 UNIVERSITY OF LOUISVILLE SCHOOL OF DENTISTRY,
LOUISVILLE, KENTUCKY
• GRADUATED 1 969 D.M.D. .
• 1 961 -1964 UNIVERISTY OF MIAMI MIAMI, FLORIDA
• UNIVERSITY OF ALABAMA
• 1958 MIAMI BEACH HIGH SCHOOL
CURRENT CIVIC CHAIR CITY OF MIAMI BEACH LOAN REVIEW COMMITTEE
ACTIVITIES
SEC/TREASURER TEEN JOB CORPS MIAMI BEACH
• CIVIC ACTIVITIES MEMBER crly OF MIAMI BEACH AFFORDABLE HOUSING
ADVISORY COMMITTEE
MASS DISASTER IDENTIFICATION TEAM WORKED ON �,: � r .
IDENTIFICATION OF VICTIMS OF VALU -JET CRASH
• i.wilorb
BROWARD COUNTY EMERGENCY MEDICAL RESPONSE TEAM tit
HURRICANE ANDREW
FOUNDING BOARD MEMBER DIZZY GILLESPIE CHARTER SCHOOL
. STUART, FLORIDA . .
. • BOARD 'MEMBER KIWANIS CLUB OF MIAMI BEACH
PRESIDENT, NORTH BEACH DEVELOPMENT MIAMI BEACH.
MEMBER NATIONAL SOCIETY OF FUNDRAISING EXECUTIVES
•
MIAMIBEACH
City of Miami Beach,
1700 Convention Center Drive,
Miami Beach, Florida 33139,
www.miamibeachfl.gov
CITY CLERK Office CityClerk@miarnibeachfl.gov
Tel: 305.673.7411 , Fax: 305.673.7254
Acknowledgement of fines/suspension for Board Members g for failure
to comply with Miami -Dade County Financial Dsclosure Code Provision
Code Section 2 -11 ..1 (I) (
Board Member name: 12¢ G7) IV
understand that no Iciter than .l 1 of I uncle ., y each year all members of .Boards and
Committees of the City of Miami i 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 ith the .Ci Clerk of Miami Beach, 1700 Con
9 City 0 vention
Center Drive, Miami Beach, Florida, by July 1 each year.
1. A "Source of Income State' '
Cement' .(attached) or
2. A "Financial Statement" (ttached( or]
3. A Copy of the person's current Federal Income Tax Return
Failure to file, according to the Miami -Dade .Count Code Chapter 1 General
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Provision, Section 1.5 may subject the person or
y subject p firm to .a fine not to .exceed
$500. or by imprisonment in the county. jail for a period not to exceed sixty
days, or .both.
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Signature: ; ate:
•
i .
. •
MIAMI.
.. COUNTY • SOURCE OF INCOME STATEMENT ..
•
. . - Please. Print .or Type First Name Middle Name /Initial Last Name
Disclosure
.. • .For Tax Year
: y • QL . • 4 &� ' ' • Ending:
- 4. NaName:, � �� 1 .
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Mailing Address: 6 X16 / ,..77,2-0Q .j \J' C ->
Ci Mate / Zip. _ • , � . - Z 4 •••3 3 1 'LI - . . • .
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Social :Securi er: • .
Filing as a: El County Employee:
i al Ern to ee of:
® !Mluni cp p y
Position held 'or sought:
S
here ser�in � 'fern or Empla rnen
4 Board w L .
Began r�
merit where -em lo. ed: ``
Depa p Y
. . Work Address: ‘.. 9 6 / _ /kJ 4 Pt., L e i' ar-S, 1 1®
• If your. - home address is exempt from public records pursuant to •
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• k are. read instructions Work Telephone: 3 Florida Statutes � �i9,0� please chec h : t 1
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Home Address:
a
. e
Street Address
, . . . r 1 - 3 .
• City State Zip Code • . Please list below in descending
order with the far g est:source .first, the name, address and
principal business .activity of eve� .J
ry 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 P
our spouse ouse or any business partner need not b e disclosed. If continued on -a .
Y
separate sheet, check here: o• ;. .
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_,
Description of the Principal .
Name of Source of .Income Address • Business Activity
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. . ,5 ,_,fi ...ciac ,„,,,,6 Li_ g . G,- . . . 1
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1 hereby .swear (or affirm) that aforesaid information is :e true .and correct statement. •
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