Karen Brown 12/31/2013 MIAMI BEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139,www.miamibeac9Laov
OFFICE OF THE CITY CLERK, Robert Parcher,City Clerk
Tel: (305)673-7411, Fax: (305)673-7254
12/30/2011
Karen Brown
1450 Lincoln Road #310
Miami Beach, Florida 33139
Gay, Lesbian, Bisexual and Transgender
Congratulations! You have been reappointed by Mayor Matti Herrera Bower
to the above referenced agency, board or committee for a term ending: 1213112013.
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.
Sincerely,
O�
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Rebecca Wakefield
ATTACHMENTS:
Letter of Appointment
Oath
City Code Ordinance section, applicable to agency, board or committee
City Code Section 2-22, 2-23, 2724, 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 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
Employees
We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community.
m MIAMBEACH
City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachB.aov
OFFICE OF THE CITY CLERK, Robert Parcher,City Clerk
Tel: (305)673-7411,Fax: (305)673-7254
TO Karen Brown
RE: Gay, Lesbian, Bisexual and Transgender(GLBT)
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: 12/31/2013.
1 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 n ich 1 have served.
LZA
Karen Brown
Sworn to and subscribed before me this f-) Z ofd} / 012.
C
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 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.
MIAMIBEACH CITY OF MIAMI BEACH
BOARD AND COMMITTEE APPLICATION FORM
NAME: Brown Karen J
Last Name First Name Middle Initial
HOME ADDRESS: 310 1450 Lincoln Road Miami Beach FL 33139
Apt No. House No./Street City State Zip Code
PHONE: 7863826415 7865945888 7865945844
Home Work Fax Email Address
blf a
Business Name: The Angler's Boutique Resort Position: General Manager
W
iii
Address: 660 Washington Ave. Miami Beach FL 33139
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 ownershipAnterest 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
• Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six(6) months: Yes
•Are you a registered voter in Miami Beach: Yes
• (Please circle one): I am now a resident of: South Beach
• I am applying for an appointment because I have special abilities, knowledge and experience. Please list below:
Have 19 years of hotel/hospitality experience in South Florida and especially Miami Beach. Have worked with GMCVB
entire time. I am currently on the GLBT cmte.
•Are you presently a registered lobbyist with the City of Miami Beach? 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)
Art in Public Places Committee Miami Beach Commission for Women
Board of Adjustment* Miami Beach Human Rights Committee
Budget Advisory Committee Miami Beach Sister Cities Program
capital Improvements Projects Oversight Committee Normandy Shores Local Gov't Neigh. Improvement
Committee on the Homeless Parks and Recreation Facilities Board
Committee for Quality Education in MB Personnel Board
Community Development Advis2U Planning Board*
Community Relations Board Police Citizens Relations Committee
Convention Center Advisory Board Production Industry Council
Debarment Committee Public Safet Advisory Committee
Design Review Board* Safety Committee
Disability Access Committee Sin le Family Residential Review Panel
Fine Arts Board Sustainability Committee
Gay, Lesbian, Bisexual and Trans ender GLB Transportation and Parking Committee
Golf Advisory Committee [11 Visitor and Convention Authority
Health Advismy Committee Waterfront Protection Committee
Health Facilities Authority Board Youth Center Advisory Board
Hispanic Affairs Committee
Historic Preservation Board
Housing Authorit
Loan Review Committee I I * 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: No Years of Service:
2. Present participation in Youth Center activities by your children No 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: rj
.,Wave you ever been convicted of a felony: No If yes, please explain in detail:
• Do you currently have a violation(s) of City of Miami Beach codes: No If yes, please explain in detail:
• Do you currently owe the City of Miami Beach any money: No If yes, explain in detail
• Are you currently serving on any City Boards or Committees: Yes If yes; which board?
GLBT Business Enhancement Committee
• What organizations in the City of Miami Beach do you currently hold membership in?
Name: MDGLCC Title: Member
Name: Miami Beach Gay Pride Title: Entertainment Committee
• List all properties owned or have an interest in, which are located within the City of Miami Beach:
1450 Lincoln Road#310 Miami Beach, FL 33139
• I am now employed by the City of Miami Beach: No Which department?
• Pursuant to City Code Section 2-25(b): Do you have a 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: Female Race: White
Ethnic Origin: Check one only (1)
White
Physically Challenged: No
Employment Status: Employed 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:
• Prohibition from directly or indirectly lobbying city personnel (Miami Beach City Code section 2-459).
• Prohibition from contracting with the city(Miami-Dade County Code section 2-11.1).
• 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).
• 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. c
"I hereby attest to the accuracy and truthfulness of the application and have received, read and will abide bp:ha*r 2;^
Article VII—of the City Code "Standards of Conduct for City Officers, Employees and Agency Members." I
n
I Karen Brown agreed to the following terms on 7/12/2011 7:30:04 PM
Received in the City Clerk's Office by: /✓E Date:_/_/_Control No. Date:�/_�_
Name of Deputy Clerk m
IJ
MIAMI BEACH
City of Miami Beach,
1700 Convention Center Drive,
Miami Beach, Florida 33139,
www.miamibeachfl.aov
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: n't��`-}
understand that no later than July 1, of.each ey ar 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 ofthe 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.fife, 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.
Signature. Date:
h
MIAMI.
¢� ��UFt.CE OF,INCO1 E STATEMENT
Please.Print.or Type First Name Middle Name Initial Last Name Disclosure
j
Q _ For Tax Year
Name: C�O Endinwl/)
Mailing Address:
City./State/zip:
Cnri � ■��1ii Nrrm�SAC
Filing as a: ® County Employee:
E3 Municipal Employee of:
Position held or sought:
Board .where serving' �j -� Term or:Em774 .t Z
Began an:
Department where employed:
Work.Address:
If your home addressis exempt from public records Pursuant to Work Telephone:
Florida statutes§.119.07 please check here(read instructions); P
-Home Address: Street Address
City state. Zip Code
Please Test below in descending order with the largest source first, the same, 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:
Descripeioo of the Principal
Nance of Source of Income
Address Business Activi
T hereby swear(:or affirm)thatthe:aforesaid information is:a true and correct statement,
Signature f parson di sing Date signed