Gabriel Paez 12/31/2012 MIAMIBEACH
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
Gabriel Paez
100 Lincoln Road #1638
Miami Beach, Florida 33139
P4 TS 4 1.1 Personnel Board
Congratulations! You have been reappointed by the City Commission to the above
referenced agency, board or committee for a ter ending: 12131/2012.
If you are unable to accept this appointment, ple se notify the City Clerk's Office at
(305) 673 -7411.
Please read the enclosed material carefully. Again, congratulations and good luck.
Sincerely,
off / S-12
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Ramiro Inguanzo
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 Z11.1 - Conflict of I terest and Code of Ethics Ordinance
City Wide Permit Application - (Parking Department Fo m)
Booklet - Guide to the Sunshine Amendment and Cod= of Ethics for Public Officers and
Employees
We are committed to providing excellent public service and safety to a I who live, work and play in our vibrant, tropical, historic community.
MIAMIBEACH
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 Gabriel Paez
RE: Personnel Board
I do solemnly swear or affirm to bear true faith, loyalty and allegian e to the Government of the
United States, the State of Florida, and the City of Miami Beach, a d to perform all the duties of
a member of the above - mentioned board or committee of the City f 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 Co my Code (Conflict of Interest
and Code of Ethics Ordinance), as well as theFlorida Commission o 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 ith 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 • • ich I have served.
Gabriel Paez
Sworn to and subscribed before me this MI day of ' , 2011
Silvia Prieto
Deputy Clerk
*Please visit the City of Miami Beach website at www.miamibeachfl.gov ender City Clerk/Board and Committees
for additional information regarding the Financial Disclosure Requiremen
are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community.
1 � / l �
L!V ! U,1 V' t/-1L, 1 1
CITY OF MIAMI BEACH
/ --IB � O ARD COMMITTEE APPLICATION FORM
NAME: e
La't_N / /AJ CO LA/ / First / 3 / "1 r &AT/ id d
HOME ADDRESS: !! �� (te
Apt No. House No. /Street City State Zip Code
PHONE: ' 6 / � f�--- l pop 3 os 5S 5 50 4
Home ` ork Fax Email address
Business Name: V / v ( t� Position:
Address: to � , cA1141.1 f L 53/3
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
q g y ) 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) months: Yes 0 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 ❑ or No ❑
• (Please circle one): I am now a resident of: North Beach South Beach Middle Beach
• 1 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 0 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)
0 Affordable Housing Advisory Committee ❑ Marine Authority
❑ Art in Public Places Committee 0 Miami Beach Commission for Women
❑ Beautification Committee ❑ M' i Beach Cultural Arts Council �
0 Board of Adjustment* iami Beach Human Rights Committee L"/
❑ Budget Advisory Committee ❑ Miami Beach Sister Cities Program
0 Capital Improvements Projects Oversight Committee ❑ Normandy Shores Local Govemment Neigh. Improvement
❑ Committee on the Homeless 0 P and Recreation Facilities
❑ Committee for Quality Education in MB ersonnei Board . (� 1
❑ Community Development Advisory ❑ Planning Board* v
❑ Community Relations Board ❑ Police Citizens Rela •ns Committee
❑ Convention Center Advisory Board 0 Production Industry Council
❑ Debarment Committee ❑ Public Safety Advisory Committee
0 Design Review Board* ❑ Safety Committee
❑ Disability Access Committee ❑ Single Family Residential Review Panel
0 Fine Arts Board 0 Sustainability Committee _
O Gay, Lesbian, Bisexual and Transgender (GLBT) 0 Transportation and Parking Committee
❑ Golf Advisory Committee ❑ Visitor and Convention Authority
❑ 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
0 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, 1 ,/�
1. Past service on the Youth Center Advisory Board: Yes 0 No 0 Years of Service: �}
2. Present participation in Youth Center activities by your children YesO 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: Program:
\ CLER \SAL L \aFORMS \BOARD AND COMMITTEES \BC Application.doc
•Have you ever been convicted of a felony: Yes 0 or No yes, please explain in det i1:
• Do you currently have a violation(s) of City of Miami Beach codes: Yes ❑ or . If yes, please explain in detail:
• Do you currently owe the City of Miami Beach any money: Yes ❑ or No ❑. es, explain in detail
• Are you currently serving on any City Boards or Committees: Yes ❑ or O. If yes; which board?
• What org niza tions in the City of Miami Beach do you currently hold membership in?
Name: ► ^ 2/VS Y Q a li`Ct 4C/?bIn Title: C1 /4 /,r J
Name: Title:
• List all properties 9wned or have an interest in, which are located within the City of Miami Beach:
it- / At
• I am now employed by the City of Miami Beach: Yes ❑ or NoL l ch department?
• Pursuant to City Code Section 2 -25 (b): Do you have a parent 0, spouse 0, child ❑, 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 is voluntary and is neither part of your application nor has any bearing on your consideration for appointment. It is
being asked to comp ith federal equal opportunity reporting requirements.
Gender: ale 0 Female
Ethnic Origin: Check one only (1)
❑ White (Not of Hispanic Origin): All persons having origins In any of the original peoples of Europe, North Africa or the Middle East.
❑ Af ' an- American/Black (Not of Hispanic Origin): All persons having origins in any of the Black racial groups of Africa.
ispanic: 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 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 Retlred Homemaker ❑ Other 0
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:
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.
"1 . - reby a - st • the accuracy and truthfulness of the application and have received, read and will abide by Chapter 2,
• isle VII — • t e i o•e "Standards of Con uct for City Offi ers, Employees and A cy Members."
/46 • a
f 9- 1// A Isar E.L .1 f-(4.--z.
A -t's Signa 73 Date Name of Applicant (PLEASE PRINT)
Please attach a copy of your resume to this application
NOTE: Applications•will remain on file for aperiod of one (1) calendar year.
Received in the City Clerk's Office by : Date: _ / /2010 Control No. Date: _ / _ /2010
Name of Deputy Clerk
c' MIAMIBEACH
City of Miami Beach,
1700 Convention Center Drive,
Miami Beach, Florida 33139,
www.miamibeachfl.gov
CITY CLERK Office CityCIerklmiamibeachfl.gov
Tel: 305.673.7411 , 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: aA & - `1 a. e
I 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 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 "Financial Statement" (attached( or
3. A Copy of the person's current Fede I 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 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.
9,,i
J q--//
Si Date:
uU TY SOURCE OF INCOME STATEMENT
Please Print or Type First Name Middle Name /Initial Last Name
Disclosure
For Tax Year
Name: Ending: i t,
Mailing Address:
l q) D �/ i✓eDC..v at 76
City /State /Zip: _ /1J " Fes /3
Social Security Number:
Filing as a: ® County Employee:
Municipal Employee of:
Position held or sought:
Board where serving: Term or Employment
Be ,, on :: n
Department where employed:
I ► L I �}11�L( CLGh ic- �l'� r. i; o A fed
Work Address:
If your home address is exempt from public records pursuant to
Florida Statutes § 119.07 please check here (read instructions): 0 Woric Telephone:
Home Address:
Street Address
City State Zip Code
Please list below in descending order with the largest source first, the name, address and
principal 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: El
Description of the Principal
Name of Source of Income Address Business Activity
vi.// • • of AI, &c, c h 633 67 S' /Yd 44:33/3
1 h= eby sw= ar (or aff m) that the aforesaid information is a true and correct statement.
.Signature of person di -. losing Date signed