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Mario Coryell 12/31/2012
/ 'v IAMIBEACH Cit 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 1/5/2011 Mario Coryell 1255 Marseille Drive #124 Miami Beach, Florida 33141 , ;5 -- i jE, A li Loan Review Committee Congratulations! You have been reappointed by Commissioner Jorge Exposito to the above referenced agency, board or committee for a term ending: 12131/2012. 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, 4d Robert Parcher City Clerk cc: Saul Frances, Parking Director Rocio Soto 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 • r CA 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 Mario Coryell RE: Loan Review 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 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 understand 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 1 serve) on July 1st, following the closing of the calendar year •n which 1 have se -d. .../116.11/11I �� Mario Coryell Sworn to and subscribed before me this f ofpJ 6 7 1 2 1 r 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 safely to all who live, work and play in our vibrant, tropical, historic community. ' liar MIAM1BEACH • CITY OF MIAMI BEACH BOA D AND COMMTTEE APPLIC ON FORM C "/ afhie Vite/D L S Last N �J , F t N © Middle / Initial HOME ADDRESS: �pl T /0 7 5 # tie /�--Z iJ /I - Mc7I £ 4 /L 33/ 5 Apt No. r House / �j City State Zip Code 25- g6/--/ 6 S 340 -77 - 4'O /cage // ' % eww OM 6. C Q Home Work r Fax m ail ress Business Name: �6041CV/3 Position: ,doe1J -vto/Q ',Pf Address: f 4 M O 1 1 ' e Xlgo No. Street City State Zip Code Professional License (describe) ,u , e . 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 Vor No I • Demonstrate an ownership /interest in a business in Miami Beach for a minimum of six (6) months: Yes ZNo • Are you a registered voter in Miami Beach: Yes • (Please circle one): I am now a resident of orth Beac South Beach Middle Beach • I am applying for an appointment because I hav uau aduifl'es, knowledge and experience. Please list below: • Are you presently a registered lobbyist with the City of Miami Beach? Yes 1 1 or No Al 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) C; Affordable Housing Advisory Committee ❑ Marine Authority 0 Art in Public Places Committee 0 Miami Beach Commission for Women ❑ Beautification Committee 0 Miami Beach Cultural Arts Council ❑ Board of Adjustment* ❑ Miami Beach Human Rights Committee 0 Budget Advisory Committee ❑ Miami Beach Sister Cities Program 0 Capital Improvements Projects Oversight Committee ❑ Normandy Shores Local Government Neigh. Improvement 0 Committee on the Homeless ❑ Parks and Recreation Facilities Board 0 Committee for Quality Education in MB ❑ Personnel Board ❑ Community Development Advisory ❑ Planning Board* 0 Community Relations Board ❑ Police Citizens Relations Committee ❑ Convention Center Advisory Board ❑ Production Industry Council ❑ Debarment Committee ❑ Public Safety Advisory Committee ❑ Design Review Board* 0 Safety Committee ❑ Disability Access Committee ❑ Single Family Residential Review Panel 0 Fine Arts Board 0 Sustainability Committee 0 Gay, Lesbian, Bisexual and Transgender (GLBT) ❑ Transportation and Parking Committee ❑ Golf Advisory Committee 0 Visitor and Convention Authority ❑ Health Advisory Committee 0 Waterfront Protection Committee 0 Health Facilities Authority Board ❑ Youth Center Advisory Board 0 Hispanic Affairs Committee 0 Historic Preservation Board ❑ ousing Authority oan 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 i No 1 Years of Service: 2. Present participation in Youth Center activities by your children Yesr_I Nor 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: • F: \CLER \$All \oFORMS\BOARD AND COMMITTEES \BC Application.doc •Have you ever been convicted of a felony: Yes or No 4es, please explain in detail: • Do you currently have a violation(s) of City of Miami Beach codes: Yes ❑ or No1,'If yes, please explain in detail: • Do you currently owe the City of Miami Beach any money: Yes ❑ or No ! yes, explain in detail • Are ou currently serving on any City Boards or Committees: Yes No i. If yes; which board? Y Y g LaCP/l/ #Pe , a) CD /aim / �?ree • 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 inter st in, which a lo ated within the City of Miami Beach: /oz g5 /� *c /e ,I . /oZ 41 are elefO..4 L A'e 7?/6 ' c e • I am now employed by the City of Miami Beach: Yes or No[e! 1�11hich department? • Pursuant to City Code Section 2 -25 (b): Do you have a parent [1], spouse child Li, brother ❑ or sister ❑ who is employed by the City of Miami Beach? Check all that apply. Identify the department(s): 4// 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: [4 ale ❑ 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. ❑ African-American/Black (Not of Hispanic Origin): All persons having origins in any of the Black racial groups of Africa. Xspanic: 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 or =. No V Employment Status: Employed C� Retired ❑ Homemaker ❑ Other ❑ 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. "I hereby attest to the accur- a : tr hfulness of the application and have received, read and will abide by Chapter 2, Articl solo s City Co. " .i: re - of C ndu for City Officers, Employees and Age j y Members." / /_ . 0 ? 9 // iMlo Co Ie.ve// • plicant Signature Da a Name of Applicant (PLEASE PRIM) / 9001t 1► UM" 1ta008.:0 lkatfort P i1. IOtlai r 0iiiii i ' a perktofo no 4'1)M nten+ 'Year. Received in the City Clerk's Office by : Date: / /2010 Control No. Date: /_/2010 Name of Deputy Clerk , e ,,, , , ....., i I A BEACH City of Miami Beach, 1 700 Convention Center Drive, Miami Beach, Florida 33139, www.mi)miheachfl gov CITY CLERK Office CityClerk @miamibeachfl.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(i) (2) Board Member name: 44 AV 0 o2 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 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. Sig ature: v bate: F: \CLER \$ALL \aFORMS \BOARD AND COMMITTEES \BC Application.doc MIA MI.DADE SOURCE OF INCOME STATEMENT Please Print or Type First Name Middle Name /Initial Last Name Disclosure *. For Tax Year Name: /17./M0 C C2 Ale/7 Ending: 20/ h Mailing Address: / 5j /fi9RfefILe bL Vc City/State /Zip: ffpIi/ &e,c �� . ‘14,7/91_ — - i Social Security Number: - - Filing as a: ® County Employee: ® Municipal Employee of: Position held or sought: G r Board where serving: � �� /J alk*/ Te Term m or Employment /C Began on: d0/0 Department where employed: Work Address: If your home address is exempt from public records pursuant to 2057—$4/V6,05 Florida Statutes § 119.07 please check here (read instructions): 0 Work Telephone: Home Address: J J J 4// , eiL � t . #4» Street Address 4•(/Are/ 8e0C / ,131/ 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: 0ll0ln the '+ri ncipal Name of Source of Income Address m ess Activity 4 L G , o v e94Ij 'wC d. oAiSui 7 . 1 5 /11MfeilieD /1i /4 ( cj/ I hereby swear (or affirm) that the aforesa' • information is a true and correct statement. • Signa ure of person d' }'• '' D . to ign • d