Thomas De Luca 12/31/11 a
al IN, A 1 p v \I °` : t i BEA
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
1/20/2011
Thomas DeLuca
1662 Lincoln Court. #307
Miami Beach, Florida 33139
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, " !x Design Review Board -Des6 [
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Congratulations. You have been reappointed by the City Commission to the above
referenced agency, board or committee for a term ending: 12/31/2011.
If you are unable to accept this appointment, please notify the City Clerk's Office at
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(305) 673 - 7411.
Please read the enclosed material carefully. Again, congratulations and 9 ood luck.
Sincerely,
/ 4/ 0 _ 7 t
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Thomas Mooney
ATTACHMENTS:
1
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)
r
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.
, A, „AA /
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 Thomas DeLuca
RE: Design Review Board
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 Miami d 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: 12/31/2011.
I have been issued a copy of Section 2 -11.1 of the Miami -Dade County Code (Conflict of Interest
and Code i of Ethics Ordinance), as well as theF/orida Commission on Ethics Guide to the Sunshine
i
Amendment and Code of Ethics for Public Officers and Employees, and understand that as a member
of a City of Miami B disclosure* ty Miami each 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 yea • n hich I have served.
•
Thomas DeLuca
Sworn to and subscribed before me this day f
yo f-'-.Ob&}\2Oi 1.
�► -'
ilvia 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 safely to all who live, work and play in our vibrant, tropical, historic community.
M1AAA1BEACH
CITY OF MIAMI BEACH
BOARD AND COMMITTEE APPLICATION FORM
NAME:
Last Name First Name Middle. Initial
HOME ADDRESS: y \ (kZ. outirr. M "
Apt No. House No. /Street City State Zip Code
PHONE: r5 OV S !Es —4(03 g . /
Home Work Fax Email address
Business Name: a Position:
Address:
No. Street City State Zip Code
�
Professional License (describe) --("N Expires:. ; Attach a copy of the license
Pursuant to City Code section 2 -22 4 a and b: Members of agencies, encies boards, and committees shall I i
tY' � O g a 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 ownershipfinterest for a minimum of six months in a business established in the city.
• Resident of Miami Beach for a minimum of six (6) 6 months: Ye r No 0
• Demonstrate an ownership /interest in a business in Miami Beach for a minimum of six (6) months: Yes 0 or Nikk
• Are you a registered voter in Miami Beach: or No
• (Please circle one): I am now a resident of: orth Beach Middle Beach
• I am applying for an arpointment because I have special abilities, knowledge and experience. Please list below:
• Are you presently a registered lobbyist with the City of Miami Beach? Yes 0 or NSIg.
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 Cite Clerk's Office. (Regular Boards of City)
0 Affordable Housing Advisory. Committee ❑ Marine Authority
❑ Art in Public Places Committee 0 Miami Beach Commission for Women
❑ Beautification Committee 0 Miami Beach Cultural Arts Council
❑ Board of Adjustment* 0 Miami Beach Human Rights Committee
0 Budget Advisory Committee 0 Miami Beach Sister Cities Program -
0 Capital Improvements Projects Oversight Committee 0 Normandy Shores Local Government Neigh. Improvement
p
0 Committee on the Homeless 0 Parks and Recreation Facilities Board
0 Committee for Quality Education in MB 0 Personnel Board
❑ Community Development Advisory 0 Planning Board*
0 Community Relations Bogard 0 Police Citizens Relations Comm ittee
❑ Convention Center Advio Board 0 Production Indust Council
• se a - . _ 0 Public Safety Advisory Committee
0 Safety Committee
0 Disability Access Committee 0 SingIe Family Residential Review Panel
❑ Fine Arts Board 0 Sustainability Committee
0 Ga Lesbian, Bisexual a'nd Trans. ender GLB 0 Trans•ortation and Parkin. Committee
0 Golf Advisory Committee ❑ Visitor and Convention Authority
0 Health Advisory Committee 0 Waterfront Protection Committee
0 Health Facilities Authority Board 0 Youth Center Advisory Board
0 Hispanic Affairs Committee
0 Historic Preservation Board
❑ Housing Authority
0 Loan Review Committees *Board Required to File State Disclosure Form
Note: If applying for Youth. kdvisory Board lease indi Board, please indicate your affiliation with the Scott Rakow Youth Center:
1. Past service on the Youth Center Advisory Board: Yes '
ry es � No ❑ Years of Service:
2. Present participation in Youth Center activities by your children Yes0 No 0. If yes, please list the names of your children, their
ages, and which programs. List below:
Child's. name: 1 Age: Program:
Child's name: Age: Program:
F \ :LxER\$ALL \oFORMS \BOARD AND COMMITTEES \BC: Application.doc
•Have you ever been convicted of a felony: Yes 0 or N If yes, please explain in detail:
• Do you currently have a violation(s) of City of Miami Beach codes: Yes ❑ or
r
. If yes, please explain in detail:
i
• Do you currently owe the City of Miami Beach any money: Yes 0 or r b* If yes, explain in detail
I
• Are you currently serving on any City Boards or Committees: r No 0. If yes; which board?
f .D6Z.:D I
• What organizations anizations ir, the Miami
g � e Clty of M aml Beach do you currently hold membership in .
Name: i Title:
Name: 1
Title:
• List all properties ow ed or have an interest in, which are located within the City of Miami Beach:
`6 , C —,
• I am now employed by the City of Miami Beach: Yes ❑ or IChich department?
• Pursuant to City Cod 2-
ty 2-25 (b): Do you have a parent 0, spouse 0, child ❑, brother 0, or sister ❑who is employed by the
City of Miami Beach? Check all that apply. Identify the department(s):
I
The following information i 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.
Gende ll ` ' ale i ❑ Female
Ethnic Origin: Check one only (1)
Z:PtiVhite (Not of Hispanic Origin): All persons havin origins in an of the original Europe, eo les of Euro North Africa or the Middle East.
i having any 9 peoples P.
❑ African - American /Black (Not of Hispanic Origin): All persons having origins in any of the Black racial groups of Africa.
0 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 an of the original eo les of the Far East, Southeast Asia, any peoples , S ast As a, the Indian Subcontinent, on
the Pacific Islands. This area includes, for example, China, India, Japan, Korea, the Philippine Islands and Somoa.
0 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,: e'.'�
Y Y ed: Yes 0 or Nb g
Employment Status: Employ Retired 0 Homemaker ❑ Other ❑
NOTE: If appointed, ou will be required to follow certain laws which apply i to city board/committee
Y q pp y cety members.
These laws include, but are not limited to, 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 (Miami
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 Development 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 re uest copies p q p of these laws may be obtained from the City Clerk.
ttest to the l
"I hereby accurac . and truthfulness of the application abide by Chapter 2,
� Y h application and have received, read and. will abi
Article t of the City Code "Standards of Con uct for City Officers, Employees and Agency Members." I lki '-- ?- 1 \\ .\\ ---- "V"Oi'A=._S ' D€ 2-2,_)
41111. Applicant � i • - ture Date Name of Applicant (PLEASE PRINT)
Please attach a copy of your resume to this applicati •
NOTE: Appl' tionst illi ain on file for a. period - of one (1) calendar year.
"7/1 rii 4'f- Received in the City Clerk's O ce by : -' 1 A ° (---, , Date "201e -- ontro' No. ( /
Date: /201 ./
Name • ' D eputy Clerk
....‘■"?
0 MIAMI BEACH
City of Miami Beach,
1700 C Center Dr
Miami Beach, Florida 33139,
www.miamibeachfl.gov
CITY CLERK Office CityClerk@miarnibeachfl.gov
Tel: 305 1673.7411 , Fax: 305.673.7254
Acknowled ement of fines/suspension for Board Mem ber..s for failure
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to com y
p I. with Miami -Dade County Financial Disclosure Code Provision
Code . Section 2- 11.1(1) (2) t
m e• ...S - 6 LLJ Board Member na �..t
1 understand that no later than July year 1, of each all _ members of .Boards and
Committees of the City of Miami Beach, including those of a purely advisory nature, :are
tY g P y �
re q q uird 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
le islafion or give advice to the City Commission, must file, even though ou ma have been
� 9 you Y
recently appointed.
You must one of the following with the City Clerk of Miami Beach, 1700 Convention
I
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
1
$500.00 or by imprisonment in the county. jail for a period not to exceed sixty
days, or : both.
,........._ ,, ,
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i na ate:
,
•
9 �
•
MIAMI. ; • OF INCOME STATEMENT
•
• Please. Print .or Type e First Name Middle Nametinitial Last Name
Disclosure
Far Tax Year
� ,Ending: �
�� Name. )tsN
Mailing b z �'79
l� g Address: 6
city/state/zip 14 ) .61') ` `�
Social. Security Number:
Filin g as a: ® County Employe. • D Municipal Employee of
Position held or sought:
Board where serving: - Term or Empioym , nt •
Began .on: izo
Department employed:
Work A ddress: 1462 L) 17 f .
3 C5
if your home address is exempt from public recor 'pursuant :to •
katutes 0 Work T ®ieph one:
Florida § :i19.07 please check here tread instructions):
Home Address
Street Address
City
State - Code
- i he largest source first, the name, -address and
Pleas hest below on descending order with � .9
principal la you inch al business activity of every source of your income including public sa ry y
r
- ' o any person received for your benefit or use during the disclosure period. The •
reeelved r Y P y
Income of your espouse or any business partner need not be disclosed If :continued on .111
separate sheet, check here: 0
Description .of the Principal
Name of Source of Income Address Business Activity
G'14?CoL( Nfo- ;..1.2>2.-5,9 6\7, p. e TT) 4)2.0%)..y
•
•
•
hereby swear (or affirm) that aforesaid information is.a true and corr ect statement.
Sign arson disclosing Da a ai ned