Oren Lieber 12/31/2012 i
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Cit of Priami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.9ov
OFFICE OF THE SPECIAL MASTER
Tel: (305) 673 -7181, Fax: (305) 673 -7182
1/19/2011
Oren Lieb r
4400 Sheri an Ave
Miami Bea , h, Florida 33140
gilMr,,,,' Safety Committee
Congratulattlons! 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) 673-7
Please read the enclosed material carefully. Again, congratulations and good luck.
Sincerely,
ieple41 ePz-6,2)el> Sr'
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Clifford Leonard
ATTACHMENTS:
Letter of App intment
Oath
City Code Ordinance section, applicable to agency, board or committee
City Code Se tion 2-22, .2 -23 -
y � 2-23, 2 24, 2-25, - .226, 2-2458, 2-459
Ordinance 2006 - 3543 " - Amendment to City Code Section 2 -22
I
Miami -Dade qounty Code Section 2 -11.1 Conflict of Interest and Code of Ethics Ordinance
City Wide Per Application - (Parking Department Form)
Booklet Gui
Il
a 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.
M BEA C H
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City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www,miamibeachf.gov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel: (305) 673 -7411, Fax: (305) 673 -7254
TO Oren Lieber
RE: Safety 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 abo
ve 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 ty o 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 se -d.
. 01r 010/ 11°. :0 011°.I.w
Oren Lieber
Sworn to and subscribed before me this gpda 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
o al 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.
#3:1
NAME: t
ore. r)
[last Name First Name Middle Initial
HOME ADDRESS: i SCa9 Ptn1ftt Pr iniouni eep.e.11 P L. 33 )o
Apt No. House No. /Street City State Zip Code is i
PHONE: ACIPP— 0 - Jr/A g.4.037 301 * / . 4rie,OcalPrziAt +m%CP
Home I Work Fax Email address
Business Name: Pie 2a#eJ4 i'Z zip Position: PA I ) (v 7 v
Address: 4/4—
"' •` 't .� 3 iv 4 m• ' p._
33/ 27
Nor Street City State Zip Code
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Professional License (describe) /1 Expires:
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Pursuant to City C section 2 -22(4) a and b: Members of agencies, boards, and committees shall be affiliated with the city; this
requirement shall IS 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 Miaml Beach for a minimum of six (6) months: Yes or No ❑
• Demonstrate an ownership /interest in a business in Miami Beach for a minimum of six (6) months: Yes ❑ or No ❑
• Are you a registered voter in Miami Beach: Yes Xor.No ❑
• (Please circle ones): I am now a resident of: North Beach South Beach • • - =each
• I am applying for n 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 gid
i
Please list your references in order of ranking first choice second choice, and third choice. Please note that only three 3
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choices will be observed by the City Clerk's Office. (Regular Boards of City)
❑ Affordable Housing Advisory Committee ❑ Marine Authority
❑ Art in Public PlaceslCommittee ❑ Miami Beach Commission for Women
❑ Beautification Committee ❑ Miami Beach Cultural Arts Council
❑ Board of Adjustment* ❑ Miami Beach Human Rights Committee
❑ Budget Advisory Committee ❑ Miami Beach Sister Cities Program
❑ Capital Improveme Projects Oversight Committee ❑ Normandy Shores Local Government Neigh. Improvement
❑ Committee on the; Homeless ❑ Parks and Recreation Facilities Board
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❑ Committee for Qual!ty Education in MB ❑ Personnel Board
❑ Community Development Advisory ❑ Planning Board*
❑ Community Relatiorlis Board ❑ Police Citizens Relations Committee
❑ Convention Center Advisory Board ❑ Production Industry Council
❑ Debarment Committee ❑ Public Safety Advisory Committee
❑ Design Review Board* I Safety Committee
❑ Disability Access Committee ❑ Single Family Resi e ntial Review Panel
❑ Fine Arts Board 1 ❑ Sustainability Committee
❑ Gay, Lesbian, Bise )ival and Transgender (GLBT) ❑ Transportation and Parking Committee
❑ Golf Advisory Com ° ittee ❑ 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
❑ Loan Review Committee *Board Required to File State Disclosure Form
I
Note: If applying for Youth Advisory please lease 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 O. 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:
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s
•Have you ever been convicted of a felony: Yes ❑ or No34 If yes, please explain in detail:
• Do you currently have a violation(s) of City of Miami Beach codes: Yes ❑ or No) If yes, please explain in detail:
• Do you currently lwe the City of Miami Beach any money: Yes ❑ or No% If yes, explain in detail
• Are you currently Servin on any City Boards or Committees: Yes•O or No D. If yes; which board?
Sfig&e
• What organizations in the City of Miami Beach do you currently hold membership in?
Name: Title:
Name: Title:
• List all ro erti owned or have an interest in, which are located within the City of Miami Beach:
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3Qo / X^C.L. Or
• I am now employ 6d d by the City of Miami Beach: Yes ❑ or Nole Which department?
• Pursuant to City Code Section 2 -25 (b): Do you have a parent 0, spouse 0, child 0, brother 0, or sister D who is employed by the
City of Miami Beach? Check all that apply. Identify the department(s):
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: 10 Male ❑ Female
Ethnic Origin: Check one only (1)
❑ White (Not of Hispanic Origin): All persons having origins in an of the original eo les of Europe, North Africa or the Middle East.
I 9 any peoples P
❑ African - American /Black (Not of Hispanic Origin): All persons having origins in any of the Black racial groups of Africa.
❑ Hispanic: All ers ns of Mexican, Puerto Rican, Cuban, Central or p p 4 a t al o South American, or other Spanish culture or origin, regardless of race.
❑ 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 ll
Cha enged: Yes 0 or NOD.
Employment Status: Employed Retired 0 Homemaker ❑ Other 0
NOTE: If app ou will be required to follow certain laws which apply to city board /committee members.
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These laws in lude, 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 request, copies of these laws may be obtained from the City Clerk.
"I hereby attest to the accuracy and truthfulness of the application and have received, read and will abide by Chapter 2,
Article VII - o - - a' . • = . • s of Co du t for City Officers, Employees and Agency Members."
11 O -■* -----1!--- I do Il Drain t.i
bar
• piicants Signature ate Name of Applicant (PLEASE PRINT)
Please attach a copy of your resume to this application
NOTE:. Applic do will re - in on file for a period f one (1) calendar year.
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Received in the City Cle k's Office by : / Da . P /‘(10 Control No. Date: / /201 / //
Name of Dep y Clerk
1
flA
City of Miami Beach,
1700 Convention Center Drive,
Miami Beach, Florida 33139,
www.miamibeachfl.gov
CITY CLERK Office CityClerk @miamibeachfl.gov
Tel: 305.673.741 1 , Fax: 305.673.7254
Acknowledgement of fines /suspension 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: Q CC Y1 L i cle,r
1 understand that no later than July 1, of each year 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 boi 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 "Financi I 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 jail for a period not to exceed sixty days, or both.
44101..... ,
,441c:■00....' Signature: D at :
F: \CLER \$ALL \aFORM • \BOARD AND COMMITTEES \BC Application.doc
MIA MI•D DE
SOURCE OF INCOME STATEMENT
Please Print or Type First Name. Middle Name /Initial Last Name
Disclosure
For Tax Year
Name: Qrr 0 LJ&h.{ Ending: 40 /
Mailing Address: 3)9 Po2 I 1 /t[ sal`
City /St to /Zip: Mittml &eh PL 3 3/1t,
Social ! ecurity Number:
Filing as a: 0 County Employee:
0 Municipal Employee of:
Positioil held or sought: oh. 2,4,/ C
Board where serving: Term or Employment
Began on:
Depart ent where employed:
Work dress: a elf MI w e1 � k 3 c'� An ,a►mT �L 3
If your home address is exempt from public records pursuant to
Florida Statutes § 119.07 please check here (read instructions): ❑ Work Telephone: 3(6- 7 ?'"
Home ddress: 30. 6L, 7tvc Or
Street Address
"DM.' ees..4) Pep, 33 A
City State Zip Code
Please list below in descending order with the largest source first, the name, address and
princip I 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 spouse or any business partner need not be disclosed. If continued on a
separate sheet, check here: 0
i
Description of the Principal
Name of Source of Income Address Business Activity
Qiitte kape I �j 2Vr s'�eq>" &43OO 4I
I hereby.. swear (or affirm) that the aforesaid information is a true and correct statement.
..
Signature of person disclosing Da signed