Eugenio Cabreja Board application i k
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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
04 -18 -2011
Eugenio Cabreja
150 Alton Road # 816 -S
Miami Beach, Florida 33139
B M Housing Authority
Congratulations! You have been appointed by Mayor Matti Herrera Bower
to the agency, board or committee named above for a term ending: 10/11/2012.
Pursuant to Ordinance No. 2006 -3543, commencing with terms beginning on or after
January 1st, 2007, the term of board members who are directly appointed by a member of
the City Commission shall automatically expire on December 31 of the year the appointing
elected official leaves office.
If you are unable to accept this appointment or have any questions, please call the City
Clerk's Office at 305 - 673 -7411. Please read the enclosed materials carefully.
Congratulations again and good luck.
Sincerely,
,( I /i
5t
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Anna Parekh
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 -458 and 2 -459
Ordinance No. 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 Employee
We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community.
MIMAI BEACE
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 Eugenio Cabreja
RE: Housing Authority
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: 10/11/2012.
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
I serve) on July 1st, following the closing of the calendar -ar on which I have se d.
r ,
Eugenio Cabreja
Sworn to and subscribed before me this 25 day of /41r I , 2011.
- • .. (( /7a 73 /c44 //
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.
MIAM BEACH
City of Miami Beach,
1700 Convention Center Drive,
Miami Beach, Florida 33139,
www.miamibeachfl.gov
CITY CLERK Office CityClerk @miamibeachfl. 9 ov
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: ,4'7h o Ray
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.
' 2..5 (I
Signature: Date:
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MIAMI•
COUNTY SOURCE OF INCOME STATEMENT
Please. Print or Type First Name Middle Name /Initial Last Name
Disclosure
0 For Tax Year
Ai/ o A 64! 4 End ing: �� ..
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Name: C� U 27
Mailing Address: l5d A /re Ream) P/ 4 - s
City /Mate /dip: 7)9/4 , - e3
Social Security Number: - -v
Filing as a: ® County Employee: r..n
® Municipal Employee of: " ' -13 <
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Position held or sought: �
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Board where serving:
Term or Employment
4 A; ; ; ,r., ' Began on:
Department where employed:
A-
Work Address:
If your home address is exempt from public records pursuant to
Florida Statutes § 119.07 please check here (read instructions): 0 Work Telephone:
-- ra 1 12 g n
Home Address: / 5-0 4 I
Street Address
/L-
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:
Description of the Principal
Name of Source of Income Address Bu siness Activity
1 her y swear ( affirm) that the aforesaid information is a true and correct statement.
,, ,
Sign of perso i sclosing Date signed
GV >'U, I A\ /U\ I U L!'1C, 1 I CITY OF MIAMI BEACH
BOARD AND COMMITTEE APPLICATION FORM
NAME: 0 14 13 R E 3 fJ 7 E •t2 L b
Last Name / � J / First Name Middle Initial
HOME ADDRESS: /50 A//O 4 U ` b� S /1 NI ) )3F FICI-H ,92 331 - V
Apt No. House No. /Street City State Zip Code
PHONE: 3 0 5 5 3,R 7277 ۥVle *i.r OIL" rsa -(L 0 hi
Home Work Fax Email address
Business Name: �•r"" 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 city; this
requirement shall be fulfilled in the following ways: a) an individual shall have been a resident of the city fee n�t'mum of six
months; or b) an individual shall demonstrate ownershipfinterest for a minimum of six months in a business estatr hen thQy.
• Resident of Miami Beach for a minimum of six (6) months: Yes fSor No ❑ c'� rW
• Demonstrate an ownership /interest in a business in Miami Beach for a minimum of six (6) months: Yes ❑ or Nc
• Are you a registered voter in Miami Beach: Yes for No ❑
• (Please circle one): I am now a resident of: North Beach South Beach Middle Beach
• I am applying for an appointment because I have special abilities, kno' _ _ - d experience. Please list below =
• Are you presently a registered lobbyist with the City of Miami Beach? Yes 0 or No -*t
Please list your preferences in order of ranking [1] first choice [2] second choice, and [3] third choice. Please note th at only three (3)
choices will be observed by the City Clerk's Office. (Regular Boards of City)
❑ Affordable Housing Advisory Committee ❑ Marine Authority
0 Art in Public Places Committee 0 Miami Beach Commission for Women
0 Beautification Committee (. '`B/Miami Beach Cultural Arts Council
❑ Board of Adjustment* ❑ Miami Beach Human Rights Committee
❑ Budget Advisory Committee 0 Miami Beach Sister Cities Program
0 Capital Improvements Projects Oversight Committee 0 Normandy Shores Local Govemment Neigh. Improvement
0 Committee on the Homeless 0 Parks and Recreation Facilities Board
0 Committee for Quality Education in MB 0 Personnel Board
0 Community Development Advisory ❑ Planning Board*
0 Community Relations Board CD 4;;Police Citizens Relations Committee
0 Convention Center Advisory Board 0 Production Industry Council
❑ Debarment Committee ❑ Public Safety Advisory Committee _
0 Design Review Board* 0 Safety Committee _
0 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 0 Visitor and Convention Authority
0 Health Advisory Committee ❑ Waterfront Protection Committee
❑ Health Facilities Authority Board ❑ Youth Center Advisory Board
❑ Hispanic Affairs Committee
❑ Historic Preservation Board
Q RHousing 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. Past service on the Youth Center Advisory Board: Yes 0 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: Age: Program:
Child's name: Age: Program: /
. \CLER'.SALL \oFORMS \BOARD AND COMMITTEES \BC Application.doc Y
•Have you ever been convicted of a felony: Yes ❑ or No ›Qf yes, please explain in detail:
• Do you currently have a violation(s) of City of Miami Beach codes: Yes 0 or NoXlf yes, please explain in detail:
• Do you currently owe the City of Miami Beach any money: Yes 0 or No If yes, explain in detail
• Are you currently serving on any City Boards or Committees: Yes 0 or No! If yes; which board?
• 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, which are located within the City of Miami Beach:
• I am now employed by the City of Miami Beach: Yes 0 or NoXCWhich department?
• Pursuant to City Code Section 2 -25 (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 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: % 5( Male 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.
❑ African - American /Black (Not of Hispanic Origin): All persons having origins in any of the Black racial groups of Africa.
1›.11ispanic: All persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race.
0 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 N qk(
Employment Status: Employed 0 Retired Homemaker 0 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.
"I here y attest to the accuracy and truthfulness of the application and have received, read and will abide by Chapter 2,
Artic I — of the City de "Standards of Con uct for City Officers, Employees and Agency Members."
� • - -.=,1 2 �2 (I vC EN I't7 ,tfi R R 4
Appli S ' to Name of Applicant (PLEASE PRINT)
Please attach a copy of your resume to this application
NOTE: Appli lons,will re In on f e for a. period of ne (1) calendar year.
Q / l)
Received in the City Clerk's Office by : d Date. J201F' Control No.i te: 7201 / /
Name of Deputy Clerk