Juan E. Rojas .
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CiTY OF MIAMI BEACH
BOARD AND COMMiTIEE APPLiCATION FORM
NAME: Rojas Juan E
Last Name First Name Middle Initial
HOME ADDRESS: 3220 SW 25 ST Miami FL 33133
Apt No. House No. /Street City State Zip Code
PHONE: 305 -613 -1699 305- 476 -1982 305 - 447 -6250 'ro'asQ ibraltar rivate.com
J J 5 P
Home
Work Fax Email address
Business Name: Gibraltar Private Bank & Trust Position:VP & Director of Community Development /CRA
Address: 400 Arthur Godfrey Road, 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 E or No ❑
• Demonstrate an ownership /interest in a business in Miami Beach for a minimum of six (6) months: Yes E or No
• Are you a registered voter in Miami Beach: Yes D or No ❑
• (Please circle one): I am now a resident of: North Beach South Beach Middle Beach
• I am applying for an appointment because I have special abilities, knowledge and experience. Please list below:
• Are you presently a registered lobbyist with the City of Miami Beach? Yes E 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 City Clerk's Office. (Regular Boards of City)
O Affordable Housing Advisory Committee ❑ Marine Authority
--- ❑ 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 Government Neigh. Improvement
❑ Committee on the Homeless ❑ Parks and Recreation Facilities Board
❑ Committee for Quality Education in MB ❑ Personnel Board
2 ❑ Community Development Advisory ❑Planning Board*
❑ Community Relations Board ❑ Police Citizens Relations Committee ci ��
❑ Convention Center Advisory Board ❑ Production Industry Council --i _�
❑ Debarment Committee ❑ Public Safety Advisory Committee --‹ --- }
❑ Design Review Board* ❑ Safety Committee r*i ;
❑ Disability Access Committee ❑ Single Family Residential Review Panel r , II
❑ Fine Arts Board ❑ Sustainability Committee
❑ Gay, Lesbian, Bisexual and Transgender (GLBT) ❑ Transportation and Parking Committee _
❑ Golf Advisory Committee 0 Visitor and Convention Authority r1. °n.
❑ Health Advisory Committee ❑ Waterfront Protection Committee L.) T1
❑ Health Facilities Authority Board ❑ Youth Center Advisory Board iNa
❑ Hispanic Affairs Committee "'�
❑ Historic Preservation Board
- , <D
❑ 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: Yes Li No ` ■ Years of Service:
2. Present participation in Youth Center activities by your children YesE No 0. 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:
•Have ou ever been convicted of a felony: Yes ❑ or No I( If yes, please explain in detail:
Y Y Y �p p
• Do you currently have a violation(s) of City of Miami Beach codes: Yes ❑ or No ®. If yes, please explain in detail:
• Do you currently owe the City of Miami Beach any money: Yes ❑ or No IN. If yes, explain in detail
• Are you currently serving on any City Boards or Committees: Yes ❑ or No a 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: Yes ❑ or Noff. Which department?
• Pursuant to City Code Section 2 -25 (b): Do you have a parent E, spouse 0, child ❑, brother W, 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 to comply with federal equal opportunity reporting requirements.
Gender: E Male ❑ Female
Ethnic Origin: Check one only (1)
❑ White (Not of Hispanic Origin): All persons having origins in any of the original peoples of Europe, North Africa or the Middle East.
❑ 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.
❑ 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 Native: 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 E or No?t.
Employment Status: Employed L 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 (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,
om having any interest in or receiving any benefit from Community Development Block Grant funds for either yourself ,
or ose with whom you have business or immediate family ties (CFR 570.611).
Up• re. est, copies of these laws may be obtained from the City Clerk.
"I her by \4. est 't the accuracy and truthfulness of the application and have received, read and will abide by Chapter 2,
• isle 11 `\.•'„the Code "Standards o C nduct for City Officers, Employees and Agency Members."
9 k Juan Rojas
Applic. i • = t ' re at Name of Applicant (PLEASE PRINT)
Received in the ity Clerk's Office by : Date: / /2010 Control No. Date: 1/2010
Nt.m c Deputy Clerk
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G / V\ 1 AM 1 BFACH
City of Miami Beach,
1 700 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- 11.1(i) (2)
Board Member name: Juan E Rojas
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
rrapure to f e, according to the Miami -Dade County Code Chapter 1, General Provision,
Seon 1- m- subject the person or firm to a fine not to exceed $500.00 or by imprisonment
\in th6 cou ,, jai for a period not to exceed sixty days, or both.
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Signature: D a e:
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F: \CLER \$ALL\aFORMS \BOARD AND COMMITTEES \BC Application.doc