Darin Feldman 12/31/2011 M
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, w w,r.miamibeachfl.aov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel: (305) 673-7411, Fax: (305) 673-7254
03 -16 -2011
Darin Feldman
1662 Lincoln Road #308
Miami Beach, Florida 33139
it .i TP i Fine Arts Board
Congratulations! You have been appointed by Commissioner Michael Gongora
to the agency, board or committee named above fora term ending: 12/31/2011.
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,
X15 I
�. S E
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Gary Farmer
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.
11
CA MIAMIBEACH
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
TO Darin Feldman
RE: Fine Arts Board
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: 12/31/2011.
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* equire-
ments of Miami -Dade County or the State of Florida (depend' • : - • e board or commi . - e . which
serve) on July 1st, following the closing of the calen year on whi I ha
4111,016 AMOr
= d.
ace
e . n eldman
Sworn to and subscribed before me this day of /" tc 2(:I'.
4 114;(— lAi
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.
MIAMI BEACH CITY OF MIAMI BEACH
=IP
= BOARD AND COMMITTEE APPLICATION FORM
NAME: FELDMAN DARIN J
Last Name First Name Middle Initial
HOME ADDRESS: 308 1662 LINCOLN
COURT Miami Beach FL 33139
Apt No. House No. /Street City State Zip Code
305 -672 -6822 305 - 398 -7888 305 - 398 -7889
PHONE: dfeldman@majesticproperties.com
Home Work Fax Email Address
Business Name: Majestic Properties Position: sales
Address: 1682 Jefferson ave. Miami Beach FL 33139
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 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
• 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: South Beach
• I am applying for an appointment because I have special abilities, knowledge and experience. Please list below:
Fine Arts
• 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)
Af(v1JcLlc Hvuainy AJviavey Cu, nniltcc Maiinc Autlrviily
Art in Public Places Committee Miami Beach Commission for Women
[3] Beautification Committee [2] 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 • 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
[1] Fine Arts Board Sustainability Committee
Gay, Lesbian, Bisexual and Transgender (GLBT) Transportation and Parking Committee
Golf Advisory Committee Visitor and Convention Authority
Health Advisory Committee Waterfront Protection Committee
Health Facilities Authority Board Youth Center Advisory Board
Hispanic Affairs Committee
Historic Preservation Board
Housing Authority
>Zfi' 1Vf It 'fi%i4k1• ' : - _ = c - - - - - - - . - • . • - * - ' ia6:i1l4!i:!!i+ =3W 1WiN.•ii433" _ - • 1. Past service on the Youth Center Advisory Board: No Years of Service: 0
2. Present participation in Youth Center activities by your children No 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:
7
• Have you ever been convicted of a felony: No If yes, please explain in detail:
• 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: No 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: Title:
Name: Title:
• List all properties owned or have an interest in, which are located within the City of Miami Beach:
1662 Lincoln Court #308, 1662 Lincoln Court #404
• 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: 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� //
1 DARIN FELDMAN agreed to the following terms on 3/14/2011 3:05:06 PM
Received in the City Clerk's Office by: Date /` " //Control Noaqii
Date, /J/ ! /
Name of Deputy Clerk
M1AM BEACH
City of Miami Beach,
1700 Convention Center Drive,
Miami Beach, Florida 33139,
www.miamibeachfl.gov
CITY CLERK Office CityClerk@miamibeachfl.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(i) (2)
Board Member name: kei,4) /41) NAli
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 ofthe 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.
Si• . ure:
Date:
MIAMMADE
� SOURCE OF INCOME STATEMENT
Please Print or Type First Name Middle Name /Initial Last Name
Disclosure
' �! j For Tax Year
J-
Name: / (.tl�'l In ,� Fi f c,(# 0 Ending: / 0
Mailing Address: &6D_ L/nco f /r) Cf 1 W
City /State /zip: I / . +V . iL . 331. 7
Social Security Number: -
Filing as a: 0 County Employee:
0 Municipal Employee of:
Position held or sought:
Board where serving: Term or Employment
Began on:
Department where employed:
Work Address:
If your home address is exempt from public records pursuant to . - 3 1
Florida Statutes § 119.07 please check here (read instructions): 0 Work Telephone: •
Home Address: l (DbcR L I h L-C) / h C+. m• 6. FL 33/ •
Street Address
YY) • 6 33/3
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 induding 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: 0
Description of the Prindpal
Name of Squrce of Income Address Business Activity
616 e5fr c 'Prnv-I Its JAVc9 Stf e Ysoh Avg ? (Lt 1 .5
I =re • y swear (o affirm) • th : of • ' d information is a true and correct statement.
3 — eoi1
• gn ... - of person d - . rg Date signed