Glenda Krongold 12/31/2012 i
' MIAP '',, : > ^� ' :.mac 4 ___ 1 ....... ,, ‘
Cit of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfi.gov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel: (305) 673 - 7411, Fax: (305) 673 -7254
01/26/2011
Glenda Kronb old
130 S. Hibiscus Dr
Miami Beach Florida 33139
sv Police Citizens Relations Committee
Congratulations! You have been reappointed by Commissioner Ed Tobin
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) 67 7411.
Please read the enclosed material carefully. Again, congratulations and good luck.
Sincerely, t i / ,
,Li ,,. sve
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, -
ty 3, 2 24, ,2 2-25, 2 -26, 2 -2458, 2-459
Ordinance 20063543 - Amendment
to City Code Section 222
Miami Dade Co my 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 p oviding excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community.
'1 113F L\'H
D L
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 -741 1, Fax: (305) 673 -7254
TO Glenda Krongold
RE: Police Citizens Relations Committee
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 term ending: g 12/31/2012.
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 :B 1 ach Board and /or Committee, I must comply with the financial disclosure* require-
Y � � p Y qu
ments of Miami -Dade County (depending endin or the State of Florida de on the board or committee on which
9
serve) on July 1st, allowing the closing of the calendar year on which I have served
Y
Glenda , r. gold
9
Sworn to and subscribed before me this day • • 4 4 "' 2o1 1 .
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, tropi
cal, historic community.
/V \ V DE/JAL-11 CITY OF MIAMI BEACH
BOARD AND COMMITTEE APPLICATION FORM
NAME:
: _ _
as Nam fe3 0 /0 Pie ober
First Name Middle Initial
HOME ADDRESS: 0 0 /5 C U5 , 33/
Apt No. 1 House No. /Street Ci State Zip Code
PHONE: 3os 3 3 4 ► ro / 42 so
Home Work Fax Email a. dress
Business Name: Position:
Address:
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 ci •
ty 4 (1 9 � � 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 ❑
• Demonstrate an ownership /interest in a business to,Miami Beach for a minimum of six (6) months: Ye or No ❑
• Are you a registered voter in Miami Beach: Y or No ❑
• Please circle one): 1 arm now a resident of North Beach South Bea Middle Beach
• I am applying for an appointment because 1 have special abilities, know e ge and expe • nce. Please list below:
• Are you presently a registered lobbyist with the City of Miami Beach? Yes ❑ or No
Please list our references in order of ranking [1] first choice [2] second choice and [3] third choice. Please note that only Y A 9[ l [] I l hat v (3)
choices will be observed by the City Clerk's Office. (Regular Boards of City)
❑ 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* 1 ❑ 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 ❑ -tanning. Board*
❑ Community Relations Board :4 Police Citizens Relations Committee
❑ Convention Center Advisory Board ❑ Production Industry Council
❑ Debarment Committee 0 Public Safety Advisory Committee
❑ Design Review Board* I ❑ Safety Committee
❑ Disability Access Commit#ee ❑ Single Family Residential Review Panel
❑ Fine Arts Board I ❑ Sustainability Committee
❑ Gay, Lesbian, Bisexual acid Transgender (GLBT) ❑ Transportation and Parking Committee
❑ Golf Advisory Committee ❑ Visitor and Convention Authority
❑ Health Advisory Committee ❑ Waterfront Protection Committee
❑ Health Facilities Authority Board ❑ Youth Center Advisory Board
❑ Hispanic Affairs Committee
❑ Historic Preservation Board
❑ Housing Authority
0 Loan Review Committee 1 *Board Required to File State Disclosure Form
Note: if applying in for Youth 4dvlsorY Board lease indicate our a Y 9 , p y ffiliation 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: 1 Age: Program:
Child's name: Age: Program:
F `s;CLE? $ALL \aF DRM \BOARD AND COMMITTEES\BC: Application.doc
•Have you ever been convicted of a felony: Yes 0 or N f yes, please explain in detain:
• Do ou currently have violation(s) currently a iolation(s) of City of Miami Beach codes. Yes 0 or No . If yes, please explain in de #ail:
• Do you currently owe the City of Miami Beach any money: Yes 0 or No If yes, explain in detail
• Are you currently serving o . ny City Boards or Committees: Yes lor No 0. if yes; which board?
Pohce lize4
• What organizations in the. City of Miami Beach do you currently hold membership in?
Name: Title:
Name: .
Title.
• List all properties owned or have an interest in w ich are loc ted within the City of Miami Beach:
� /7 Nan/ (t '1'4 0 6e
• lamn
now employed by the City of Miami Beach. Yes 0 or NoV JJVhich department'?
• Pursuant to City Code Section 2 - (b): Do you have a parent 0, spouse 0, child 0, brother 0, or sister 0 who is employed by the
City of Miami Beach'? Check all that apply. Identify the department(s):
The following information ' •
g fo ion is voluntary and is neither part of your application nor has any bearing on your consideration for appointment. It is
being asked to comply witli federal equal opportunity reporting requirements.
Gender: 0 Male 0 Female
Ethnic Origin: Check one only (1)
White (Not of Hispanic Origin): All persons having origins in a o
P g any f the original peoples of Europe, North Africa or the Middle East
0 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.
❑ Asian or Pacific Islander: All ersons having origins '
p g 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 0 or No0.
Employment Status: Employed 0 Retired 0 Homemaker 0 Other 0
NOTE: If appointed, you will be required to follow certain laws board/committee s which apply to city board /committee members.
These laws include, but are not limited to, the following:
9
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 Comi Development Advisory Committee): prohibition, during tenure and for one year after leaving y g 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, l' •
p quest, copies of these laws may be obtained from the City Clerk.
"1 hereby attest to the accuracy and truthfulness of the application and have received, read and will abide by Chapter ter 2
Article VII — of the City Code "Standards of Conduct for City Officers, Employees and Agency Members."
Applicant's Signature Date Name of Applicant (PLEASE PRINT)
Please attach a copy of your resume to this application
NOTE: Applications•wilI remain on .file for a period of one (1) calendar year.
Received in the City Clerk's Office by : 5 �a//� ezig-- No. Date: / /2010
/ /2010 Control N • �� //
Name of Deputy Clerk
{{
1 _
n MIAMI BEACH
City of i Miami Beach
1700 Convention Center Drive,
Miami Beach, Florida 33139,
www. miamibeochfl .�ov,
CITY C=LERK Office CityClerkC m i arnibeachfl.gov
Tel 30 Fax 305.673.7254
•
of fines/suspension AckrLowledgemeflt for Board Mem hers for f ail ure
to c with Micimt-Dade Coun fiY Financial Disclosure Code Provision
nlp�y
Codi Section 2- 11.1(1) (2)
Board
Member name. fi dq A's#63)/(1
1 understand that no later than .July 1, of each year all members of :Boards and
i
Committees of the City of Miami Beach, including those of a purely advisory nature, are
.r-equiredio comply with Miami -Dade County Disclosure Requirements. This means #hat the
• memtiers 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 trust file one ofthe . following -with the City Cleric of Miami Beach, 1700 Convention
ent :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
aiiure to file, according to the 1MiamiMDade County Code Chapter 1, General a
F � _� 9 � P
Provision, Section 1.5 may subject the person or firm to a fine not to .exceed
00 :or by imprisonment in the count 'ail for a period not to exceed sixty
$500 .Y P Y� P
days sl , or both,
A -
a /7/
Date:
Signature: ! Da
I .
N
t
MIAMi,• • IN COME STATEMENT
Type First Name Middle Dame /Initial Last Name
Please. Print . ®r yp Disclosure
For T ax Year
Name: •
t'r)J %' Q End
/ C .) /5 _C Mailing � ►dclress. d i j State j dip: J �L A d 3 3 /3?
_
Social .Security Number:
Filing as a: Ei County Employee: •
Municipal Employee of
Position held or sought:
. - (2„„,, �Term or Employment
Board where serving. ('� - . . / " . '
Began on: /- //
•
Department- where employed:
Work Address:
if your •hams address is exempt from public records -pur ant to
Y �Teie h
Fioridi� Statutes 2i.9.07 please check here (read instructions): 0 �li�oric p ors.
Home. Address:
Street Address
State Zip Cede
- . a largest source first, the name, address and
Please . below an descending order with th r9 is you
public salary y
rinci al business activity of every source of your income including p
P , P for your benefit or :use during the disclosure period, The
received or any person received f Y � y our
•inco a of your spouse or any business partner need not be disclosed if continued on .a
■ . i. p
sepac ate sheet, check here: 0
Description of the Principal
Name of Source of Income
Address Business Activity
h eby swear (Dr affix • at the aforesaid information is.e :true .and correct statement.
i/ � f
I
:Signature of .person ciosi , Date sign