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OFFICE OF THE Cl N CLERK Robert Parcher Gty Clerk t�- z ? r+s r Y , t,
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�� £ Ivette Isabel Borrello , '• >� 4€ — 1, ,K < ,�,l s _ri
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.e-r, P . n� S�U�BJLECT= Committee for Quality Education in MB 1 vim-€
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;'"- ,r`�, g ' Congratulations' You havebeenF reappointed by Commissioner Jonah M Wolfson
-0F -' e) u t to the above referenced-agency board or committee for a tern ending-- f213112013 =
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-'-,,f1f i '4k4,yM If you are unable to accep}t�this appointment, please notify the City Clerk's Office at g
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T t, (305) 673-7411; y v F r
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V',.r'l r 120 Please read the enclosed,material carefully Again congratulations and good luck
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'� 1- 11 FY? Sincerely a. `: i+W ,, i x 1 r f, cC�{ sf' y! • Y pP'.';.\ i,r r
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�rr�y�>' �()tot, + 4 ' y, \-, t -4 I , 0 i F3 k o- r - q, �,Y4
if'4 ,{x �, Robert Parcher ��-' « a ,Y l 5'' --, ,,rk , r, _ ti 1,,4 NI�
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r r{ ^ cc Saul Frances, Parking Director, F 9'd tri`1.� ` - ^ 5 r a
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�t'` I's Leslie Rosenfeld - Tr yb f - ,
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ATTACHMENTS ' ° aF - ,
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t� l`� ° �1 ,fir t 't ,~ k t r ., ti
Letter of Appointment q` r 4 1, L r'r t =' cAte
1 a , , IG 'Y' H \
, l '� , i 1 Y k 1 Kn7
Oath s b_,, T x7 v J,,,,,,
' +', 3 + 'wS t i I �"eE.
City Code Ordinance section applicable to agency board or committee d '' 44
FI ■"�., "37 `k `F „6. ' ��'
City Code Section 2 22 2-23 2'--2_4'1,2-25'2-26 2-2458',2-459 k:l -
Ordinance 2006 3543 Amendment to City,Code Section 2-22 t„ - 'r� -^
„,',IL:: t ,i•i•. 1,r ,l e i=t psi — .ntll L• ;,:s.. Y
Miami-Dade County Code Sectio 2-1ti1t'1 -Conflict ofdnterest and'Cod"erof Ethics Ordinance
1 r„ %,---- .-=-,i' t �,-
City Wide Permit Application '(Parking Department Form) °s ~ , F y &e
iv rt+ >_,i t tai t� 1{T n -y
Booklet-Guide to the Sunshine Amendment and Code of Ethics for-Public Officers and ,z
Employees �r„a~ A ti ae M f 'F ��
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We are committed to providing excellent public service and safety to all who live work and play in our vibrant tropical historic commun!
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MIAMIBEACH
City of Mama Beach, 1700 Convenhon Center Drive Miami Beach Florida 33139 www.miamibeachH.gov
OFFICE OF>THE CITY CLERK Robert Parcher City Clerk
Tel (305)673 7411 Fax (305)673 7254
TO Ivette Isabel Borrello
RE Committee for Quality Education in MB
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 Miamii Beach to which I have
been appointed for a term ending 12/31/2013
I have been issued a copy of Section 2 11 1 of the Miami Dade CountyiCodej(Conflict of Interest
and Code of Ethics Ordinance) as well as theflonda Commission on Ethics Guide to the Sunshine f -
Amendment and Code of'Ethics for Public Officers and Employees,and understand that as a member r `
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) ?July-1st ,f (lowing the closing of thacalendar year on which I have served
A
ti T a
•I -tte Isabel Borrello
day of 20- Sworn to and subscribed before me this y 'R
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4/r g '/ °
r1 Deputy Clerk
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*Please visit the Citytof Miami,Beach website at www miamibeachfl gov under City Clerk/Board and Committees
for additional information regarding the Financial Disclosure Requirements
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We are committed to,pronding excellent public service and safety to all who live work and play our vibrant tropical historic community
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MIAMIBEACH
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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 Ivette Isabel Borrello .
RE. Committee for Quality Education in MB ,..
I do solemnly swear or affirm to bear true faith, loyalty and allegiance to the Government of the
...;,... 1-.
United State-S,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 fiir a ternending: 12/31/2013.
.-:
I have been,issued:a copy-of-Section 2-11 1 of the Miami-Dade County Code(Conflict of Interest , -. , _
-
and Code,of.EthiC.:stordinance);as well as thehdrida'CommiSsion.bn Ethics -Guide to the Sunshine
Amendment and Code of Ethics for Public Officers and Employees,and understand that as a member
of a Ceity4of Miami,BeachBoard and/or Committee, I must comply with the financial disclosure*require-
_ , ,, •...._
---- , i' • _ ' r' •
m e rits-of Miami Dade CoUntkortherState of Flonda'.(depending on the boarcl,drcommittee on which
-.I.-Serve) July lit;f lioWindAeclosing of the calendar year on Whichl have served. -
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., .. ._ l -tte IsabBorrello .
'-,:,Sworn to and subscribed before me this g day ofj21....A41- , 2011,
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- ,, 1 >•,,SeL., (____ii , •• ... , ,,
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Deputy Clerk
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:-- *Please visit the City website at www.miamibeachfl.gov under City Clerk/Board and Committees
, , ,.- , ... ,
feadditional:inforMation,fegatding the Financial Disclosure Requirements.
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We are dip inniifted.to providing excellent public service and safety to all who live,woile'and;play:.in our vibrant tropical historic community .
es/ I AM I CITY OF MIAMI BEACH
BOARD ANCOMMITTEE APPLICATION FORM
NAME. 3cR� � �
Last Name F- t Name Middle Initial
HOME ADDRESS. 0 L S NI r-1--L1 3 c j c& 'V nvt, l ecie.A FL z 3 I
Apt No Hou a No./Street City State Zip Code
PHONE: (b0); LJ3y -(0`}624 (3ar� Sto2-/ eve e_borsre110 Iko � ntT Home Work Fax Email address
Business Name Position:
Address
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 ninimum 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 business in mi Beach for a minimum of six(6) months.Yes❑or No C3�
•Are you a registered voter in Miami Beach Yes 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❑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)
❑Affordable Housing Advisory Committee ❑ Housing Authority
❑Art in Public Places Committee ❑Loan Review Committee
❑ Beautification Committee ❑Marine Authority
❑Board of Adjustment* ❑Miami Beach Commission for Women
❑ Budget Advisory Committee ❑Miami Beach Cultural Arts Council
d- ErCapital Improvements Projects Oversight Committee ❑Miami Beach Sister Cities Program
❑Committee on the Homeless ❑Normandy Shores Local Government Neigh Improvement
I Ig-Committee for Quality Education in MB ❑Parks and Recreation Facilities Board
❑Community Development Advisory ❑Personnel Board
❑Community Relations Board. ❑Planning Board*
❑Convention Center Advisory Board ❑Police Citizens Relations Committee
❑Debarment Committee ❑Production Industry Council
❑Design Review Board* ❑Public Safety Advisory Committee
❑Disability Access Committee ❑Safety Committee
❑Fine Arts Board ❑Single Family Residential Review Panel
❑Gay, Lesbian, Bisexual and Transgender(GLBT) ❑Sustainability Committee
❑Golf Advisory Committee ❑Transparency Reliability&Accountability Committee"TRAC"
❑Health Advisory Committee . ❑Transportation and Parking Committee
❑Health Facilities Authority Board ❑Visitor and Convention Authority
❑Hispanic Affairs Committee ❑Waterfront Protection Committee
❑Historic Preservation Board - 3 LYsrouth Center Advisory Board
*Board Required to File State Disclosure Form
Note If applying for Youth Advisory Board, lease indicate your affiliation with the Scott Rpkow Y uth Center
tU s7L2_ , T ( G G ,zrn- r ' � fora r 6 ou-a ne L/ti c lit irrec
1 Past service on the Youth Center Advisory ory B�u d Yes❑ No.La�r ,-,f SService:
2. Present participation in Youth Center activities by your children' No . f yes, please list the names of your children, their
ages, and which rogfams. Lit below. /
Child's name- �0 tfIA. nne fY''e(L0 Age 1 ° Program. 4\W I
.. t f l' S-tom( e'sk
Child's name Srtcp 4 ( ° aa( � Age 4- Program.� nu k.--k1 f C1(04—
F\CLEW\$ALl-\afORMS\BCARD.AND COMMllt,:!-S\BC Applic ation062et 19 NEA'.doc
oo )
ul
•Have you ever been convicted ofelony. Yes 0 or N ❑ yes, please explaldetail
• Do you currently have a violation(s) of City of Miami Beach codes. Yes ❑or No . f yes, please explain in detail:
• Do you currently owe the City of Miami Beach any money. Yes ❑ or No..0-. If explain in detail
• Are you currently serving on any City Boards or Committees Yes❑or No❑. If yes, which board?
• What organizations in the City of Miami Beach do you currently hold membership in? 0e
Name Title
Name. Title
• List all properties owned or have an interest in, which are lo ated within the City of Mia each
55 0 `J''rl d/t,+ kv�rLV / 1 N r L-e.w e -FL 33/39 )D ti�� IU -4 e l
• I am now employed the City of Miami Beach Yes ❑or N hick department? 33/({7--)
�� Y � �f
• Pursuant to City Code Section 2-25(b): Do you have a parent ❑, spouse❑,child❑, brother❑, or sister❑who is employed by the
City of Miami Beach?Check all that apply Identify the department(s) NQ
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 equa pportunity reporting requirements.
Gender: 0 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.
❑ A can-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 No❑.
Employment Status Employed 0 Retired ❑ Homemaker-e' Other 9- - - �� ttiLf
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 the accuracy and truthfulness of the application and have received, read and will abide by Chapter 2,
Article II- • the City ode "Sta dards of Conduct for City Officers, Employees and Agency embers."
, '/�jo iS a be) i u t-c CJ
Applic�t'- ' ignature Date Name of Applicant(PLEASE PRINT)
v� '
Please attach a copy of your resume to this application
NOTE:Applications will remain on file for a period of one(1)calendar year.
Received in the City Clerk's Office by Date._/ /2009 Control No)S / Date:il/ It 009
Name of De uty Clerk
61_,- MIAMI BEACH
City of Miami Beach,
1700 Convention Center Drive,
Miami Beach, Florida 33139,
www miamibeochfLoov_
CITY CLERK Office CityClerk@miamibeochfl.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(i) (2)
Board Member name: ,/-e �SQ 6-d &l?J2 / Q
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
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 period not to exceed sixty
days, or both.
"0 / , j‘ e ‘(? /7?,/,,/ 2_
ySi. atur : Dote:
MIAMI
COUNTY SOURCE OF INCOME STATEMENT
Please Print or Type First Name Middle Narnellnitial Last Name
// Disclosure
__1_ 5 e pd —ve�e � 0D e-C LD For Tax Year
Name: Ending:'
Mailing Address:
-
, -
Filing as a: ® County Employee:
® Municipal Employee of: 2 fWt/Uj /(
Position held or sought: c X J� `i.
Board where serving: 0 � Term or Employment
Began on: ///12c2)2 — /2-1 31 )20/
Department-where employed: N /
Work Address: Ap)-4 - e t.e p
If your home address is exempt from public records pursuant to
Florida Statutes§118.07 please check here(read instructions): D Work Telephone:
Home 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
1 Name of Source of Income Address B Business iness Activity
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Ctct �1C raC_ (Ave )76 Fc 73,39
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7 hereby swear(or affirm)thatthe aforesaid information is a true and correct statement.
,'Jr adittiaa. // /2-0
j.riguiature of •'rson-disclosing r Date signed