Bruce Orosz 12/31/2012 m r C
Cit of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 331 39, www,miomibeQChfl.gov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel: (305) 673-7411, Fax: (305) 673 -7254
01/26/2011
Bruce Orosz
5025 Collins Ave.
Miami Beach, Florida 33140
SUBJECT: Production Industry Council
Congratulations! You have been reappointed by Commissioner Ed Tobin
to the above referenced agency, board or committee for a term ending: 1213112012.
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 good luck.
Sincerely,
_/
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Graham Winick
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.
1 l
m A A//1 BEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachA.aov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel: (305) 673 -741 1, Fax: (305) 673 -7254
TO Bruce Orosz
RE: Production Industry Council
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 theF /orida Commission on Ethics Guide to the Sunshine
Amendment and Code of Ethics for Public Officers and Employees, and under bland 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 sery .
Bruce rosz
Sworn to and subscribed before me this day ofi v 7201
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.
\ \ t H/ V \ DL n CITY OF MIAMI BEACH
BOARD AND COMMITTEE APPL!CATJQN FORM
NAME: 0 S L
Last Name First flame Middle Initial
HOME ADDRESS: 9 0 ( cD Z S � c�c7 '`' S � L ` 33'/
Apt No. House No. /Street City State Zip Code
PHONE: _ 30 n (07 • c2 / L.c•)S e 4:( scJ • C✓
Home \Nork Fax Email address
Business Name: / �` -��✓ �-'' S Position: //R
Address: 467 7Z_/ /16
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: Yes or No ❑
• Demonstrate an ownership /interest in a business in iami Beach for a minimum of six (6) months: Yes E. or No ❑
• Are you a registered voter in Miami Beach: Yes Vor No E /
• (Please circle one): I am now a resident of: North Beach South Beach Mi Beach
• I am applying for an appointment because I have special abilities, knowledge and experience. lease list below:
• Are you presently a registered lobbyist with the City of Miami Beach? YeV 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)
❑ Affordable Housing Advisory Committee ❑ Marine Authority
❑ Art in Public Places Committee ❑ Miami Beach Commission for Women
C 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 C Parks and Recreation Facilities Board
Committee for Quality Education in MB ❑ Personnel Board
0 Community Development Advisory ❑ Planning Board*
❑ Community Relations Board I ❑ 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
❑ Gay, Lesbian, Bisexual and Transgender (GLBT) ❑ Transportation and Parking Committee
❑ Golf Advisory Committee ❑ Visitor and Convention Authority
C Health Advisory Committee ❑ Waterfront Protection Committee
❑ Health Facilities Authority Board ❑ Youth Center Advisory Board
❑ Hispanic Affairs Committee
❑ Historic Preservation Board
gt5S
❑ 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 7 No L Years of Service:
2. Present participation in Youth Center activities by your children Yes? No 1. 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:
•Have you ever been convicted of a felony Yes - or No If yes please explain !n detail.
• '-Jc you ,urrently have a vioiation(sl of City of rvliami Beach codes: Yes - or No f yes, please explain in detail.
• Dc ;cu currently owe he City of Miami Beach any money Yes or No f yes explain ,r etaii
• ti.re ,� �_� ��urrently seising on any C■ty Bcards or (Committees: Yes or No If 'des, :i;nicn board"
• 71/hat organisations in the City of Miami Beach do you eurrent!y Hold membership In
Name 4( {
Name Title:
• List all properties owned or have an interest in, which are located within the City of Miami Beach:
o J
• 1 am now employed by the City of Miami Beach: Yes L. or NocWhich department?
• Pursuant to City Code Section 2 -25 (b): Dc you have a parent spouse child II, brother or sister II who is employed by the
,Ity of Miami Beach"' Check all that apply. Identify the department(s): A/Q
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: r-, ale E Female
Et is Origin: Check one only (1)
White Not of Hispanic Origin): AU persons having origins in any of the onginal peoples of Europe, North Africa or the Middle East.
1 African - American /Black Not of Hispanic Origin): All persons having origins in any of the Black racial groups of Africa
Hispanic: Ail 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 ongins 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 r! or No
Employment Status. Employe Retired ❑ Homemaker ❑ Other 1
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:
Prohibition from directly or indirectly lobbying city personnel (Miami Beach City Code section 2 -459).
Prohibition from contracting with the city (Miami -Dade County Code section 2- 11.1) .
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).
Requirement to disclose certain financial interests and gifts (Miami -Dade County Code section 2- 11.1).
r,rei CME 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 .vith whom you have business or immediate family ties tCFP 570.61 1 i.
Upon request, copies of these laws may be obtained from the City Clerk.
"1 hereby attest to the accuracy - d truthfulness of the application and have received, read and will abide by Chapter 2,
Article ✓II — f ae City Code 1 andards of Co d t for City Offic Employees and gencyM mbers."
Applira• '° =
g ure at N dme or Applicant . PLE= SE PRINT
Please attach a copy of you esume to this application
NOTE: Applications will remain on file for a period of one (1) calendar year.
t. "_lei _iffiee Date i2010 Control tt _ Date 2
Name ct Deputit CierF
n Y A /V\ BEACH
City of Miami Beach,
1700 Convention Center drive,
Miami Beach, Florida 3313?,
wwv.-.miamlbeochfl.gov
CITY CLERK Office CifyCler'kC m i ❑mibeachfi.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 -1 1.1(i) (2)
Board Member name: Je C� 0 S
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 to recommend
legislation or give advice to the City Commission, must fife, 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 fife, according to the Miami -Dade County Code Chapter 1, General
Provision, Section 1 -5 may subject the person or fine to a fi ne not to exceed
$500.00 or by imprisonment in the county jail for a period not to exceed sixty
days, or both.
/ _ y/
:igna re: IIa -.
}
T
cou SOURCE OF INCOME STATEMENT
First Name Middle Name /Initial Last Name
Please Print or Type DtsClosure
• For Tax Year
Name: lit LL (! Endin�
Mailing Address: 4� 7 � , , `' e , t9 �''�
GLl 3)! _
City/ State/Zip:
Filing as a: In County Employee:
® Municipal Employee of:
Position held or sought:
ment
Board where serving, ��G�`" ?' Tenn or Employ
/
. Began ❑n: /�7
Department where employed:
Work Address:
If your home address is exempt from public re cards pursuant to � d 3
Florida Statutes E "..19.07 please then. here (read instructions); L Work TBlephDne:
Ii Home Address: c° Z C '�� t
I Street Address
/// City State Zip Cade
the Please list below in descending order with the largest source first, th :name, address and
principal business activity of every source of your income including R salary you
received or any person received for your benefit or use during the disclosure period. The
income of your spouse or any businpcc partner need not be disclosed. If continued an 8
separate sheet, check here: ,
Description of the Principal
Name cif Source of Income Address Business Activity
I / I
I hereb • .1r (or aft rn) that the aforesaid information is e true and correct statement, 1
11 ... ,.....,- A .Signature of person disciQSinp at signed