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Caroline Cardenas 12/31/2012 t\A I At\A 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 -25 -2011 Caroline Cardenas 5875 Collins Ave. #606 Miami Beach, Florida 33140 ,. f Committee on the Homeless Congratulations! You have been appointed by Commissioner Michael Gongora 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 9 g 9 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, Robert Parcher City Clerk cc: Saul Frances, Parking Director Katherine Martinez 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 IAMI BEACH 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 Caroline Cardenas RE: Committee on the Homeless 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 Eth /cs 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 year on which I have served. Caroline Cardenas 1i-1 Sworn to and subscribed before me this LC) day of Ma k c h , 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 safely to all who live, work and play in our vibrant, tropical, historic community. ea- -AA 1 AAA 1 BEAC H CITY OF MIAMI BEACH BOARD AND COMMITTEE APPLICATION FORM NAME: Cardenas Caroline R Last Name First Name Middle Initial HOME ADDRESS: 606— 5875 Collins Ave Miami Beach FL 33140 Apt No. House No. /Street City State Zip Code PHONE: 3052986007 3058665066 3058665478 ClineCardenas @aol.com Home Work Fax Email Address Business Name: Shriver Art Position: Senior Director, Licensing Address: 6145 La Gorce Dr Miami Beach FL 33140 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 • 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: Middle Beach • I am applying for an appointment because I have special abilities, knowledge and experience. Please list below: 1 am interested in helping the homeless on Miami Beach. • 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) Arlin Liable HOuainy Adviauly Cul, nilittee Ft/641e Aull 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 [1] Committee on the Homeless Parks and Recreation Facilities Board Committee for Quality Education in MB Personnel Board Communi Develo • ment Adviso Plannin• Board* Community Relations Board 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 [2] Fine Arts Board Sustainability Committee Gay, Lesbian, Bisexual and Transgender (GLBT) Transportation and Parking Committee Golf Advisory Committee Visitor and Convention Authority [3] Health Advisory Committee Waterfront Protection Committee Health Facilities Authority Board Youth Center Advisory Board Hispanic Affairs Committee Historic Preservation Board 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: Years of Service: 2. Present participation in Youth Center activities by your children 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: • Nave you ever been convicted of a felony: If yes, please explain in detail: • Do you currently have a violation(s) of City of Miami Beach codes: 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: 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: 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: Female Race: White Ethnic Origin: Check one only (1) White Physically Challenged: No Employment Status: Employed 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 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 Caroline Cardenas agreed to the following terms on 3/22/2011 5:06:37 PM Received in the City Clerk's Office by: :�/ Control No Date: / y Name of Deputy Cle M IAMBEACH • City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.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 -1 1.1(i) (2) Board Member name: - 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 fora period not to exceed sixty days, or both. fl41,, 3/20/2 01) Signature: Date: MIAMMADE SOURCE OF INCOME STATEMENT Please Print or Type First Name Middle Name /Initial Last Name Disclosure For Tax Year t I\ Name: (AKA n R. Cavil 1w Ending / Mailing Address: 5580 L� (20rtc D{ City/State /Zip: PliarnI $ ca (h F .33) 4 0 Social Security Number: — Filing as a: 0 County Employee: Municipal Employee of: Position held or sought: Board where serving: p rn el CS S Com m CC_ Term or Employment Began on: Department where employed: Work Address: 6145 la Gone Dr. Mid Bah i h 339 ifo If your home address is exempt from public records pursuant to 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 Slav Ive s A L4 &cKtc O✓ Prv+ / Lt ( 'ells I ✓�� �'►1 6c41,, Ft_ I hereby swear (or affirm) that the aforesaid information is a true and correct statement. (111, o1 S ature of p rson disclosing Dat signed