Paul "Cork" Friedman 12/31/2011 , .
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City of Miami Beach, •1700 Convention Center Drive, Miami Beach,, Florida 33139, wwvv.miamibeachfl.gov
OFFICE OF THE .CITY CLERK, •Robert .:Parcher, City Clerk
,Tel: (305) 673-7411, Fax (305) 673 -7254
= 4/29/2011
Paul Friedman ,
900 Lenox Ave, Apt 2:
.Miami Beach, :Florida :33139.
r SUBJ CT. , W aterfront ;Protection Committee
�� ��.���m.,�s�:
Congratulations! You have been reappointed by Commissioner Ed Tobin
to the above referenced - agency,;board or committee fora ending: 12/31/2011
If you are unable to accept this =appointment; please notify the City Clerk's Office at
-(305) :673 - 7411.
Please•read -the enclosed material carefully. Again congratulations and'good luck.
S
4-t
' /r
. , Robert :Parches
City Clefk
cc ''Saul ; Frances,. , Parking_`Director .
, •Lisa :Botero
ATTACHMENTS:
.Letter' of .Appointment
Oath ,
City :Code Ordinancetsection, applicable .:to agency, g 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 Interesfand Code of,Ethics Ordinance
CityWide Permit.Application (Parking Department -Form
`Booklet - Guide to the:Sunshine Amendment and Code of Ethics for Public Officers and
:Employees
We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical; historic community.
. .
CA MI A M IBEACH
Cit of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
OFFICE OF THE CITY CLERK, Robert ['archer, City Clerk
Tel: (305) 673-7411, Fax: (305) 673 -7254
TO Paul "Cork" Friedman
RE: Waterfront Protection 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: 12/31/2011.
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 co ply with the financial disclosure* require-
ments of Miami -Dade County or the State of Florida (depe •! g on the board or committee on which
I serve) on July 1st, following the closing of the calendar yt!. on which I have served.
1 Paul "Cork" Friedman
Sworn to and subscribed before me this 2-1' day of 4f22 L _ 2011.
i / ,
k
Liliam R. Hatfield f
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.
e_ ' M 1 A 1 B EAC
. CI OF I I EACH '., - .
___...
.......
BOARD ,' D COMMITTEE APPLICATION FORM
NAME: fa i EbikAAN P4UL
,
Last Name First Name • Middle Initial .
m I ',�, t
• .HO ft-- `� 31, 3i _
AtNo..
ME ADDRESS:. �' !,- �I��OO;�C,
a
Apt - House No. /Street City = Sta Zip Code
P , •
PHONE: `305 l - COr rum -
, . Home ..:,. < � • -. . , Work' fax Email address .
Business Name: RAJ . LIME
?flop uGjrfoN-S - , i t C , Position: fee'S) .���`
• Address: ', 9/6 /ale .2✓ 57 i alYl l 36
No: Street' City i State Zip Code
Professional License (describe) Expires: Attach a copy of the license.
Pursuant to City Code section 242(4) a and b: Members of agencies, boards, and committees shall be affiliated w ith 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 by an individual shall demonstrate ownership /interest fora minimum of six months in a business established in the city.
• Resident`of Miami Beach for a minimum of six (6) months: Yes /or No ❑ '
• Demonstrate an ownership /interest in, a• Miami Beach for a minimum of six (6) months: Yes ❑ or No ❑
• Are you a registered voter. in Miami Beach: Yes 0 or No ❑ ,
• (Please circle one): I am now 'a resident of: worth Beach) South Beach Middle Beach
• I am applying for an appointment because I have s� p al a i i ies, knowledge and experience. Please list below`
• Are you presently a registered lobbyist with the City of Miami Beach? Yes ❑ 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 -bv the Citv Clerk's Office. (Regular Boards of City)
0 Affordable Housing Advisory Committee T arine Authority
Art in Public Places Committee ❑ Miami Beach Commission for Women
0 Beautification Committee ❑ Miami Beach. Cultural' Arts Council ~ -
0 Board of Adjustment* 0 Miami Beach Human Rights Committee
' ❑ Budget Advisory Committee . 0 Miami Beach Sister Cities Program
0 Capital Improvements Projects Oversight Committee 0 Normandy Shores Local Government Neigh. Improvement
0 Committee on the Homeless ❑ Parks and Recreation Facilities Board
0 Committee for Quality Education in MB 0 Personnel Board; '
Community Development Advisory '`. ❑ Planning Board*
, O'Cornmunity Relations Board 0 Police Citizens Relations Committee
❑ Convention Center Advisory Board (Production Industry Council .
0 Debarment Committee ` ❑ Public Safety Advisory Committee
0 Design Review. Board* ... ❑ Safety Committee
0 Disability Access Committee - ❑ Single Family Residential Review Panel
0 Fine Arts Board 0 Sustainability Committee . •
0 Gay, Lesbian, Bisexual and Transgender (GLBT) 0 Transportation . and Parking Committee
0 Golf Advisory Committee - -_ 0 Visitor and Convention Authority
❑ Health Advisory Committee - Waterfront: Protection Committee '
o Health Facilities Authority Board _ ❑ Youth Center Advisory Board
0 Hispanic Affairs Committee
0 Historic Preservation Board .- ,
-0 Housing`Authority
0 Loan Review Committee *Board Required to File State Disclosure. Form
Note: If applying for Youth Advisory Board please indicate your affiliation withAhe'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 0. If yes, please list the names of .your children, their
ages, : and which prograrns. List below:
Child's name:' Age: :.Program
Child's name; Age: Program:
F : \CLER \$ALL \aFORMS \BOARD. AND COMMITTEES \BC Application.doc
, •Have you ever been convicted of a felony: Y 0 o r No If y es, please explain in detail:
Y Y
•- Do you 'currently have a violation(s) of City - of Miami Beach codes:. Yes 0 or No If yes, please explain in detail;
• Do you currently owe the City of Miami Beach any money: Yes 0 or No ..*If yes, explain in detail
• Are you currently serving on any City Boards or Committees: Yes or No D. If yes; which board?
w6 1= (wM PCOT CC I f'j
• What organizations in the City of Miami Beach do you currently hold membership in?
Name: (Ni PC... . 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: Yes
es.❑ or No/.Which department?
• Pursuant to City Code Section. 2 - 25 (b): Do you have a parent ❑, spouse d, child: ❑, brother ❑, or sister ❑ 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 o comply with federal equal opportunity reporting requirements,
Gender: Male 0 Female
thnic Origin: Check one only (1).
White (Not of Hispanic Origin): All Persons having origins in an of the original - e North Africa or the'Middle East. peoples of Europe; ) p 9 any P P P,
African- American /Black (Not. of Hispanic Origin): All persons having origins in any of the Black racial groups, of Africa. ,
❑ Hispanic: All persons of Mexican, Puerto Rican; Cuban Central or South American, or 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
- the Pacific Islands. This area includes, for example, China, India, Japan, Korea, the Philippine' Islands and Somoa.
.. ❑ American Indian or Alaskan N All persons having origins in any of the original peoples of North America, and who maintain
Cultural identification through tribal affiliation or community recognition.
Physically Challenged: Yes ❑ or Noll..
Employment Status: Employed ❑ Retired ❑ Homemaker ❑ . 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 (Miarni' Beach City Code section 2 -459).
o Prohibition from contracting with the city (Miami-Dade 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,
"1 hereb 1' ttest to the accuracy and truthfulness of the application and have received, read and will abide by Chapter 2,
Article II9- f the City Code "Standards of Condu t for City Officers, Employees and Agency Members."
�� . 'Z 5 7 ( PI C .',1C +fin i n? / , Applicant s'�$ignature . D Name of Applicant (PLEASE PRINT) z.
Received in the City Clerk's Office, by : ' .,' ' ' Date: _/ /2010 Control No _ Date: _ %_/2010 y 9„
m e of Deputy Clerk . . ;
,. ..
, .. ,
if-.._- MIAMIBEACH .. .
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: ' p-ui. C.Ori Fa,1-6-bmf36)
• 1 understand no :later than July 1 of each year all members of Boardsand 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 -
A "Financial Statement" (attached( or] •
3. A Copy of the person 'e current Federal Income Tax Return
Failure tp file, according to the Miami -Dade County Code Chapter 1, General Provision,
Section. -5 may subject the person or firm
y 1 p 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.
1 j
Signaturz` , • Date: ,
F: \CLER \$ ALL \aFORMS \BOARD AND COMMITTEES \BC Application.doc .
MIAMI•DADE
SOURCE OF INCOME STATEMENT
Please Print or Type First Name Middle Name /Initial Last Name
Disclosure
For Tax Year
Name: .
�� tJ �� ��� � - l�� �1 Endin
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- d
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Mailing Address: - 41/AJG. ■
6l +9 L 3 ) 3
City/State/Zip: - �� � L.:
Social Security Number:
Filing as a: 0 County Employee:
0 : Municipal Employee of
Position held or sought:
Board where serving: ,
9�� Gv��..�� �sLO�'E�1"iQ� C��'r11'�ft�'" or Employment
Began, on
Department where employed:
Work Address:
If your home address is exempt from public records pursuant to
le Work Telephone: t
f
Florida Statutes § 119.07 please check here instructions): 3 g ' *ei
Home Address: 0 f)O L- 4/Alo
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
1.u? LI P U4L. 1(0 Aft ` 2100 1- 'v\ f12.011ucititii0
I here , y swear (or affirm) that the aforesaid information is a true and correct statement.
20
S r e of person disclosing Dat signed