Todd Narson 12/31/2012 M AM IBEACH
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
03 -10 -2011
Todd Narson
7820 Noremac Ave
Miami Beach, Florida 33141
Miami Beach Human Rights Committee
Congratulations! You have been appointed by the City Commission to the agency,
board or committee named above for a term ending: 12/31/2012.
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,
"f e) s/
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Ralph Granado
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.
m MIAMI
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 Todd Narson
RE: Miami Beach Human Rights 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 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 Miami Beach Board and /or Committee, I must comply with the finan - • • isclosure* require-
ments of Miami -Dade County or the State of Florida (depending on the board • . mittee on which
I serve) on July 1st, following the closing of the calendar year on which I , . ve - ed.
Tod. Narson
Sworn to and subscribed before me this / ?day of (4 , 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 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.
i
! , .-
? V\IAt ' VI B CITY OF MIAMI BEACH
BOARD AND CO APPLICATION FORM
NAME: Narson Todd M
Last Name First Name Middle Initial
HOME ADDRESS: 7820 Noremac Avenue Miami Beach FL 33141
Apt No. House No. /Street City State Zip Code
PHONE: 3059846336 3056722225 3056744449 miamibeachdoc @yahoo.com
Home Work Fax Email Address
Business Name: Miami Beach Natural Sports Medicine Position: Partner & Primary Treating Physicia
Address: 400 Arthur Godfrey Road -Suite 412 Miami Beach FL 33140
No. Street City State Zip Code
Professional License (describe): Chiropractic Physician Expires: 03/31/2012 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
• Demonstrate an ownership /interest in a business in Miami Beach for a minimum of six (6) months: Yes
• Are you a registered voter in Miami Beach: Yes
• (Please circle one): I am now a resident of: North Beach
• I am applying for an appointment because I have special abilities, knowledge and experience. Please list below:
As a business owner in the City of Miami Beach, a physician, lecturer, parent & resident 1 believe I can add solid and
unique perspective & creative solutions
• Are you presently a registered lobbyist with the City of Miami Beach? 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)
AffurJable Nuuain AJ viauiy Cut unit1e Marin Autl Jul ily
Art in Public Places Committee 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 Improvements Projects Oversight Committee Normandy Shores Local Gov't Neigh. Improvement
Committee on the Homeless Parks and Recreation Facilities Board
Committee for Quality Education in MB Personnel Board
Communi Develo.mentAdviso Plannin• Board*
Community Relations Board [2] 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
[1] Health Advisory Committee [3] Waterfront Protection Committee
Health Facilities Authority Board Youth Center Advisory Board
Hispanic Affairs Committee
Historic Preservation Board
Housing Authority
Note: ii-E913414WIWiliSkillirAilWory Board, please indicate your affiliation AlffirtlitiSt±tifefklikfrileft3tfi Oefileure form
1. Past service on the Youth Center Advisory Board: No Years of Service:
2. Present participation in Youth Center activities by your children Yes 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 feh • No If yes, please explain in de
• Do you currently have a violation(s) of City of Miami Beach codes: No If yes, please explain in detail:
• Do you currently owe the City of Miami Beach any money: If yes, explain in detail
• Are you currently serving on any City Boards or Committees: No If yes; which board?
• What organizations in the City of Miami Beach do you currently hold membership in?
Name: Mt. Sinai Hospital Young Founders Title: Member
Name: Miami Beach Chamber of Commerce & Pillars Title: Member
• List all properties owned or have an interest in, which are located within the City of Miami Beach:
7820 Noremac Avenue, Miami Beach, FL 33141
• I am now employed by the City of Miami Beach: No Which department?
• Pursuant to City Code Section 2 -25 (b): Do you have a 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: Male Race: White
Ethnic Origin: Check one only (1)
White
Physically Challenged: No
Employment Status: Other Other: Local business owner
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 accuracy and truthfulness of the application and have received, read and will abide by Chapter 2,
Article VII — of the City Code "Standards of Conduct for City Officers, Employees and Agency Members."
I Todd Narson agreed to the following terms on 2/2/2011 9:53:51 AM /l /
Ptease attach a of your resume to this application
NOTE: Applications will remain on file for a period • one (1 - lendaryear.
Received in the City Clerk's Office by: - I Date: 'W / No. Date: /
Name of Deputy Clerk
•
M IAMtBEACH
City of Miami Beach,
1700 Convention Center Drive,
Miami Beach, Florida 33139,
www.miamibeachfl.gov
CITY CLERK Office CityClerkCmiamibeachfl.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: NI, N ASS
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.
/ .3/9//
Signatur-: Date:
OU T SOURCE OF INCOME STATEMENT
Please Print or Type First Name Middle Name /Initial Last Name
Disclosure
1 l ` For Tax Year
Name: �- J�/ Ending
Mailing Address: 302" O fOort
M 4,Az / Ft331
City/State/Zip:
Filing as a: ® County Employee:
Municipal Employee of:
Position held or sought:
Board where serving: ( V/ 4 t /41)4,04., /,,r4' g (j'f'erm or Employment
` l 'gegan on:
Department where employed: /�
Work Address: ` (ft-2- 4 ,/S � S "[/ 2.e q/? / . & &J ,g.0
If your home address is exempt from public records pursuant to 672. Z 12 ,S
Florida Statutes § 119.07 please check here (read instructions): 0 Work 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:
Description of the Principal
Name of Source of Income Address Business Activity
/-fence_ (pi bR-, &0 1/0,) 1/0,) S /
1 <lf d L/ /z �ctwr 0• -P)
eC// 3 skD
I hereby swear (or affir ) th • e aforesaid information is a true and correct statement.
YA
Signature of person disc .sing Date signed