Billy Kemp 12/31/2012 r
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•
City of Miami Beach, 1 -700 Convention Center Drive, Miami Beach, Honda 33139, www:miamibeachfl . gov '
OFFICE OF THE CITY CLERK, Robert` Parcher, City Clerk
' Tel: (305) 673 -741 1, Fax (305) .673-7254 ''
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' f
0 3/14/2011
By Kemp
1775 Jefferson Avenue • '
• Miami Beach, Florida 33139_ ;
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,
SUBJECT: Gay, Lesbian,..Bisexu.ai and Transgender
Congratulations! You have been reappointed by 'Mayor 'Matti Herrera Bower
to the above referenced agency board or committee for term ending 12/31/2012.
t
If you are unable to accept this appointment, please notify the City Clerk's Office at •
•
.,(305) 673,-7411. . -
Please read the enclosed materiar:carefully. Again congratulations and good luck,
Sincere y, -
Robert Parcher
C tyrClerk
cc: Saul Frances, Parking Di r -
Rebecca Wakefield, -
a ��{�(., r r [�
- ' .ATTACHMEN 1.S• :,', ;
Letter of Appointment: t •
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
- We care coriimitted to providing excellent public service and safety to all 4vho live; work and play in our vibrant, tropical, historic community. -
el iV\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
TO Billy Kemp
RE: Gay, Lesbian, Bisexual and Trangender Committee
I do solemnly_ swear or affirm to bear true faith, iloyalty: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.
j
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 financial:disclosure* require-
ments of Miami -Dade County or the State of Florida (depending on `t i t board or committeeon which
I serve) on July 1st, 'following the closing of the calendar _year . wh h I have -rved. tof
mix / Billy°Kemp
aF f�
Sworn to and subscribed:before:me.this .day of /"! 01 1.
______________Ip../zere___ f
M .
Maria E. : Martinez
Deputy Clerk
*Please visit the City of Miami ;Beach .website:at www.rniarnibeachfl.gov under City Cierk /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
13, ..
r -'� . � CITY OF MIA 1= EACH
BOARD AND COMMITTEE APPLICATION FORM .
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NAME. ..
� ( . - � .
: ,...;��� .ma
Last Name First Middle Initial
tName
F -
HOME ADDRESS ..j S c/✓
S % "74 04..24 mil/ 33
, City :. Apt No: House No. /Street itY - S tate
.: ' , - Zip Code
... PHONE: �
Horne Work Fax 0/cc, .o .
Email ad ess
Business Name:
�r�' ,. Position: ',
Address: 2 °1 7
No Street City State Zip Code
ProfessionalLicense (describe) � � _ � E
xpires 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�mi imum of six months in a business established in the city..
• Resident of Miami Beach for. a minimum of six (6) months: Yes No 0 .
nium of
Y
ownership/interest w .. ' �r.No
:❑ .
• Demonstrate an in a .business in Miami Beach for a mini (6) months: Yes
• Are. you :registered voter in Miami Beach: Yes i 1 1Io
- • (Please' circle one): I am now ..a resident of: , North Beach outh Beac Middle Beach
• I am..applying for; an appointment because l have special abilities, k -.. - .
p d experience. Please list .below:
',Are you presently a registered lobbyist with the City of Miami Beach? Yes ❑ or No.
Please list your references' in order of ranking 1 first choice [2] second :choice, and [3] third choice. Please• that only three (3)
choices will be observed by the City Clerks Office. (Regular-Boards of City)
❑ Affordable Housing Advisory Committee
g ry 0 Marine Authority ..
0 Art in Public Places Committee
0 Miami Beach Commission for Women
❑ Beautification Committee.
O:Miarni Beach Cultural Arts Council
p Board of Adjustment*
0 Miami Beach Human Rights Committee
Budget Advisory Committee
❑ Miami Beach Sister Cities Program . .
❑ Capital Improvements Projects Oversight Committee ❑` Normandy .Shores Local Government Neigh. Improvement
0 Committee on the Homeless
❑ Parks and Recreation Facilities Board...
❑ Committee for Quality Education in .MB .,
Y 0 Personnel Board - ..
0 Community Development Advisory g .
y p ry � ❑ 'Planning Board*
❑ Community Relations Board
0 Police Citizens Relations Committee •
Convention Center Advisory-Board'
rY� � � 0 -Industry Council
0. Debarment Committee -
❑ Public Safety Advisory `Commi ttee
0:Design Review Board*
- 0 Safety Committee
❑ Disability Access' Committee n
❑ Single Family Residential Review Panel
❑.... Arts Board
❑ Sustainability Committee
O'Gay, Lesbian, Bisexual :and Trans ender (GLBT) ( ) ❑'Transportation and-Parking Committee
❑ Golf Advisory Committee
❑Visi tor and.ConventionAuthority
❑'Health Advisory Committee
❑ Waterfrort Protection Committee
0 Health Facilities Authority Board
Y � 111Youth Center Advisory.:Board
0 Hispanic Affairs Committee
0 Historic Preservation Board
❑ Housing Authority
0 Loan Review Committee -
: - *Board - Required to File State Disclosure Form
applying 9
Note: If a l �in 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 ❑.; 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 \aFORMS \BOARD AND COMMITTEES \BC Application.doc - .
' OP
AD ave'yvu ever been convicted of a felony: Yes ❑ or No f yes, please explain in detail: •
•
'• Do you currently a violation (s of City of Miami Beach codes` Yes ❑ `or No. C� . If es lease explain in l
Y Y O Y yes, . p detail:
p,
• Do you currently owe the City of -Miami Beach any. money: Yes D or No�CI. If yes. explain in detail
e Are -you ,currently serving on City Boards or Committees Yeses or;'No D. If yes; which: board?
• What organizations in the City. of Miami Beach do you currently hold membership in?
Name: o - Title:. X-'
.
Name: mss, - =. Title: `2-C ., -r
'+ 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 ❑ or N Which department?
•
e Pursuant;to City .Code Sectioh :2 -25 (b): Do you have a parent ❑, spouse ❑, child ❑, brother 0, or sister o 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
beingasked to comply with federal equal opportunity reporting requirements:
Gender: 0 . Male 0 Female
;Ethnic; Origin: . .Check : one only, (1)
White (Not of Hispanic. Origin): All persons having origins in any of the original of Europe; North Africa or the Middle East.
0 - African- American /Black in Not of Hispanic .Ori ::Alt persons having origins in. an of Black racial groups of Africa.
( 9) p 9 any
0 Hispanic; All persons of Mexican, :Puerto Rican, Cuban, Central or.South'American, for 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
thePacific Islands. This area includes, for example, China, India, Japan, Korea, the-Philippine Islands and Somoa.
0 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 co y recognition.
Physically Challenged :. Yes L1 . or °No
Retired
Employment. Status: Employed :D 0 Homemaker ❑ 'Other.❑
'NOTE: Ifappointed, you will;be required. to: follow certain laws which 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 served -on for _period of one year after leaving office (Miami
BeachCity .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 for either yourself. ,
or with whom you have business or immediate family ties. (CFR 570.611).
Upon rrequest of: these laws may be obtained from the City Clerk.
1 hereby att� t' to racy and ,of application and have received, read and will 'abide by Chapter '2,
Article VII — o4h • i ode - ndards of Conduc or C Officers,aEmployees and Ag ncy,Members .
lL /('
Applicant's, F atu Date Name of Applicant (PLEASE PRINT)
/ 1 . Clerk's Office by �'
Received in the City , .
Y Y � ��� !�� 'D ate: / /2010 Control No Date:..,.._ /_/2010
Name of Deputy. Jerk
•
M!AM BEACH -
Cit of Miami :Beach,
1700 Convention Center. Drive;.
Miami Beach, Florida 33139;
• www,miamibeachfl:gov ,y •
CITY CLERK Office CityClerk @mi:amibeachfl.gov •
Tel: 305:673 741'1 , Fax: , ,305.673:7254
Acknowledgement of fines /suspension for Board Members for failure
to comply with Miami -Dade CountyFinancial Disclosure 'Code 'Provision
Code Section 2- 1 1.1 (1) -(2)
}
Board Member .name: / i
1 .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 - orwgive;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 T, ax -Return
Failure to file, according to the .Miami -Dade County`Code Chapter 1., General
Provision, Section.1 -5 may subjectthe 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,.' both
/ •
l /
Si` ature r f : Date:
. .v
MIAMI
COUNTY' l 'aN SOURCE OF INCOME STATEMENT
Please Print or "Type First Name Middle Name /Initial Last Name '
Disclosure
For Tax Year
Name:
/ /L Ending:, jp
/ J 6 /e
;.1Wailing Address:
C1 State / / i
5•e_ 1
Filing as a: El County Employee::
ti l lunicipal`Employee of
Position "held -or sought ;
' Term or Ennployenen
Board where serving: 5 rj
Department where employed: .,
Work :Address: /) 7S ,3 S
: "If your,home�address.is exempt from public pursuant.to
� Work Tale .Leone: 65
Florida Statutes § 115:07 •please check here (read instructions): P
/" (.
Home Address:
Street Address
City State Zip Code
Please list below in descendin g 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 partner need not" be disclosed. If continued on ,a
{separate sheet, check here: ®
• `. ' • • f p Principal
Description of the `Prin
Name of Source. of Income'' Address Business Activity
sir
4.
1 hereby. swear (or raffirm) that the aforesaid information is _a true and correct statement.
Illikk
F Y 54/ /
L .Gri
Cig r of pe " on disclosing Date ::signed