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Alejandro Bello ex-officio ea MIAMI BEACH City of Miami Beach,1700 Convention Center Drive, Miami Beach, Horida 33139, www.miamibeachfl.gov OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk Tel: (305) 673-7411, Fax: (305) 673 -7254 04 -13 -2011 -19A .� f�4 L� / 49 (3 a / //c o ��� -// 7 4/ A/ /19-w/ radriettAl }77,-) 77 e e Congratulations! You have been appointed by C-7-4// e /ear to the agency, board or committee named above /}s . fh N ©. 0771;149, x - ©lieson1Ew 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 automaticallyexpire 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, AQ Robert Parcher City Clerk cc: Saul Frances, Parking - Director 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 We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community. • D miAmi BEACH U 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 Sgt. Alejandro Bello RE: Police Citizens Relations 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: 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 the board or committee on which I serve) on July 1st, following the closing of the calendar year on which I have served. S gt. Alejandro Bello Sworn to and subscribed before me this 3 — day of ,t4k , 2011. , ip age ;At 4 i t 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. M 1 AM 1 B EAC H • LQ. CITY OF MIAMI BEACH BOARD AND COMMITTEE.APPLICATION FORM • •NAME f�: A ���N Last Name • First Name Middle initial. HOME ADDRESS: r I c. ¢tN1 xi � �}-V�- - / /411/1 33)37 Apt No.. - House No. /Street City : State .Zip Code PHONE 05 - a W - )775 - .4(c Home � . ... D � • 61, ' Work . � fax Email ad ess . • :Business Name: a ry ` - NOr A,aef Position: it cc- r cEyt, ✓� Address - 6 G� jibs.. c C �� - � Mc 4-114 L 33 j3, 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 city. -. = Resident of Miami. Beach for a minimum of six (6) months:: Yes ❑ or No • '4 Demonstrate an ownership/interest in a business in Miami :each for a minimum of six (6) months: Yes 0 or No4- • Are ° you a registered voter in Miami - Beach: Yes '0 or No` • :.(Please circle .one): - I am .nowa resident of North Beach South 'Beach Middle Beach • I: am-applying for an appointment because 1 have. special abilities, knowledge and: experience. Please list below: • Are you presently a registered lobbyist with the City of Miami. Beach? Yes 0 or 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 Office. (Regular Boards of City) .. •D Affordable-Housing Advisory Committee ❑ Marine-Authority. • ❑ Art in Public-Places Committee D Miami. Beach Commission .for -Women • = Beautification`Comniittee`` " ,. _ 0 Miami : - Beach Cultural Arts Council - 0 Board of Adjustment *.. � � 0 M iami Beach Human Rights Committee ❑ :Budget Advisory..Committee D Miami Beach Sister Cities Program - 0 Capital: Improvements Projects ,Oversi ht Committee o 9 - .0 Normandy Shores .Local Government Neigh.: Improvement ❑Committee on the Homeless - • • =0 Parks and Recreation Facilities Board 0 Committee for Quality -Education in MB D Personnel Board 0 Community Development Advisory ❑ Planning Board* - •❑ Community Relations Board � � 0 - . :Police .Citizens. Relations .Committee:. D Convention Center Adviso 'Board - . ry , 0 Production Industry Council - : O:Debarment"Committee D Public Safety Advisory Committee ❑'Design Review Board* .0 Disability Access_ Committee D S F R - ' ❑ Safety Committee � � • - ` Ingle :amity Residential Review Panel • o Fine. Arts"-Board 0 Sustainability 0 Gay, -- Lesbian, .Bisexual and Trans ender GLB C o g (GLBT) - 0 Transportation and Parking Committee 0 Golf Advisory .Committee 0 Visitor and Convention Authority 0 Health Advisory - Committee D.Waterfront Protection 0 Authority Board - • ❑ Youth Center Advisory Board 0 Hispanic Affairs Committee 0 Historic Board 0. Housing Authority 0. Loan Review Committee * Board :Required to {File State Disclosure Form ry. p" ote: If: applying for Youth Advisory Board, lease indicate your_ affiliation with the Scott Rekow Youth Center: 1. Past service on the Youth Center Advisory Board. Yes 0 No 0 Years of Service: • ' 2' by your children YesO "N. Present - participation "in Youth Center :activities b - o 0: If. yes, _please list the names of your children, heir - ages,:andwhich.;programs..:List below:: Child's name,: Age: Program: • -, • Child's name Age: Program: i F: \CLER \$ALL \aFORMS \BOARD AND COMMITTEES \BC Application.doc Cr- MAMBEACH • City of 'Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 331.39 • 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(1) (2) _Board Member-name: l er name. 1 . understand that no later than Jtily 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 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. • 5/3/// Signature: D • • • caU Y SOURCE OF INCOME STATEMENT Please. Print or Type First Name tviiddle Name /Initial Last Name Disclosure For Tax Year Name: A LCIA -N 8 co Ending 0 fO IMlailingAddress: 1) © Uv , h1 IN67r) .•••.) � State/Zip: Nil / c 't4 , L 3 3 .9i Cott'/ Sta / p /� -_ - - Filing as a: E County Employee: j Municipal Employee.of: C. t 1 O f4 s ,Aim I ,S CAC � J • Position held or sought: • Board where serv Term or Employment ® Began on: Department where :employed: t AM /1 ( h CE e--da'1 _ Work Address: i1 o - w f}C i t w 7'a Ave X11 No 1 &All+i ,e 3/3 f 'If your home address is exempt from public records pursuant to ��.� _ 3 _�77 Florida :Statutes § 119.07 please °check here (read instructions): =' Work Telephone: Horne 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 C rl MIAMI j 4c4l • o Po itec . Q I e ;set. i4 G ` � c t - 1 15-7 £ 331 ' v , i o IN ' -- 5'1 I hereby swear (or .affirm) that the aforesaid. information is a true.and correct statement. Si. • ature of •person disclosing 313/ � to 1 gned