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Aaron Perry 12/31/2012 M!AMHE1 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 09 -15 -2011 Aaron Perry 5133 North Bay Road Miami Beach, Florida 33140 10.0.64k- C , Visitor and Convention Authority Congratulations! You have been appointed by the City Commission to the agency, board or committee named above for a term ending: 12 /31/2012. 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, LL, Robert Parcher City Clerk . cc: Saul Frances, Parking Director Grisette Roque 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. c AA 1Am M 1 AW1 BEACH CITY OF MIAMI BEACH BOARD AND COMMITTEE APPLICATION FORM NAME: V 1.0- Last Name First Name Middle Initial "Vt HOME ADDRESS: y).\\44ANI‘M AtiA , VA k,. ‘A40 Apt No. House No. /Street S' v� } 77 d�' ��I��a� . ` tate 'p Code PHONE: `�'�" '-- Home W . rk A Fax mail address Business Name: t ,1. `'". ``\� \ �1► + L Position: U M—A vt NS►_� Address: ' 'I 1 wt., !C ..L1 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 ior No ❑ • Demonstrate an ownership/interest in a business i9 Miami Beach for a minimum of six (6) months: Yes for No 0 • Are you a registered voter in Miami Beach: Yes L'or No ❑ • (Please circle one): I am now a resident of: North Beach South Beach , fiddle Beac • I am applying for an appointment because I have special abilities, knowledge and experience. - =me list below: • Are you presently a registered lobbyist with the City of Miami Beach? Yes door No ❑ Please list your preferences in order of ranking [1] first choice [2] second choice, and [3] third choice. Please note that oniv three (3) choices will be observed by the City Clerk's Office. (Regular Boards of City) 0 Affordable Housing Advisory Committee 0 Marine Authority 0 Art in Public Places Committee 0 Miami Beach Commission for Women ❑ Beautification Committee 0 Miami Beach Cultural Arts Council 0 Board of Adjustment* 0 Miami Beach Human Rights Committee ❑ Budget Advisory Committee ❑ Miami Beach Sister Cities Program ❑ Capital Improvements Projects Oversight Committee 0 Normandy Shores Local Govemment Neigh. Improvement 0 Committee on the Homeless 0 Parks and Recreation Facilities Board D Committee for Quality Education in MB ❑ Personnel Board 0 Community Development Advisory ❑ Planning Board* 0 Community Relations Board ❑ Police Citizens Relations Committee 0 Convention Center Advisory Board 0 Production Industry Council 0 Debarment Committee 0 Public Safety Advisory Committee ❑ Design Review Board* 0 Safety Committee 4 ❑ Disability Access Committee 0 Single Family Residential Review Panel , Z �"" - 0 Fine Arts Board 0 Sustainability Committee `. Lesbian, �'""' rrt ❑ Gay, Bisexual and Transgender (GLBT) ❑ Transportation and Parking Committee r " = ta c) 0 Golf Advisory Committee 311/isitor and Convention Authority ❑ Health Advisory Committee 0 Waterfront Protection Committee ❑ Health Facilities Authority Board 0 Youth Center Advisory Board :IF �C 0 Hispanic Affairs Committee Z ,. 0 Historic Preservation Board -*I • ❑ Housing Authority Fi 1 : 3 in CD Cr 0 Loan Review Committee *Board Required to File State q to 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 0 No 0 Years of Service: 2. Present participation in Youth Center activities by your children Yes❑ No 0. If yes, please list the of ages, and which programs. List below: names o your children, th ;'r Child's name: Age: Program: Child's name: Age: Program: 1 , �Fgp, : F : \CLER \$ALL \aFORMS \BOARD AND COMMITTEES \BC Application.doc , "" 40 0 4 4 N., v •Have you ever been convicted of a felony: Yes ❑ or No /If yes, please explain in detail: • Do you currently have a violation(s) of City of Miami Beach codes: Yes ❑ or No Ki! If yes, please explain in detail: • Do you currently owe the City of Miami Beach any money: Yes ❑ or No 41f If yes, explain in detail • Are y u currently serving on any ay Boards or Committees: Yes Zr No 0. If yes; which board? \■ ViN v NTINsiaee- • What organizations in g e C A of iami Beach do you currently hold membership in? Name: \ ICI... \\,. Vt,<r8`. %'A\1'±, t. ok,AwC!' ! Title: \1.1170 `il. ���� 'Z,11� 'er`t' l Name: Title: • List all properties owned or have an interest in, which a re located within the City of Miami Beach: \‘' Oc\SSVe , • I am now employed by the City of Miami Beach: Yes 0 or NoElVhich department? • Pursuant to City Code Section 2 -25 (b): Do you have a parent 0, spouse 0, child 0, brother 0, or sister 0 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 ❑ Female Etpnic 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 ❑ or Noi/! Employment Status: Employed V 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, 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 th - accuracy and truthfulness of the application and have received, read and will abide by Chapter 2, Article VII o - j' Code "S • . ards of Conduct for City Officers, Employees and Agency Members." A449.‘ lice j ? It1 \ ,, .. A pp n s i _ nature/ Date Name of Applicant (PLEAS PRINT) i d Received in the City Clerk's Office by : Date _/ 010 Control No ys Date: / /2010 4 ,0 i ( Name of Deputy e P Y rk M IAMIBEACH City 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 Aaron B. Perry RE: Visitor and Convention Authority 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 o committee of the City of Miami Beach to which I have been appointed for a term ending: 12/31/2012. 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* 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. Aaron B. Per Sworn to and subscribed before me this / d ay of _41:, . 011. / ' � 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 Finant ial Disclosure Requirements. We are committed to providing excellent puLiic service and safety to all who live, work and play in our vibrant, tropical, historic community.