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Michael Piazza 12/31/2012 MIAMIBEACH. City®f Miami Beach 1700 Convention.Center Drive,Miami Beach, Florida 331.39,www.miamibeachfl.gov OFFICE OF THE CITY CLERK, Robert Parcher,.City Clerk Tel: (305) 673-741 1,-Fax: (305)673-7254 1/25/2012 .Michael Piazza 1401 West 27th Street % .Miami:Beach, Florida 33140 . 7a-�flTiTsafifkEtiF}!ECT'I,-. °S9 Golf Advisory Committee S J Congratulations! You have been reappointed by .Commissioner Jonah M. Wolfson to the above referenced agency, board or committee for a term ending: 12/31/2012. 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, ;Obert Parcher City Clerk cc: Saul Frances, Parking:Director Kevin Smith ATTACHMENTS: Letter of Appointment Oath City Code Ordinance section, applicable to agency,:board or committee City Code'Section 2-22, 2-23,12-24,42-25, 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. ID MIAMIBEACH 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 Michael Piazza RE: Golf Advisory 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: 12/31/2012. 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 on which I have served. M i ael i Sworn to and subscribed before me this day of , 2012. ". 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. Board& Committee @ City of Miami Beach Page 1 of 3 eServices MIAMSEACH Offickd Websoe of Ow Coy of Miami NN4 BOARD AND COMMITTEE !� APPLICATION FORM - i Name I First Name Middle r Initial Last Name ^_ i Home Address Apt No. House#\Street Q LU City IMiami Beach State I Florida Zip Code Contact Information Home/Cell h©Gj 05glf Work Fax I E-mail Address Business Information f Business —� ti Name ---- �' Position Business Address Apt No. House#\Street City Miami Beach State Florida _ Zip Code Professional License(describe) _ Expires: 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 r 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:JeYes 0 No hDemonstrate an ownership/interest in a business in Miami Beach for a minimum of six(6)months: r Yes r No y g Are you a registered voter in Miami Beach: es r No (Please circle one): I am now a resident of: r North Beach r South Beach r Middle Beach Are you a politically or registered lobbyist with the City of Miami Yes r Now Beach I am applying for an appointment because I have special abilities,knowledge,experience. Please list below: y 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) Click here to view all available Boards and Committees. I 3- Affordable Housing Advisory Committee F--:J Loan Review Committee Art in Public Places Committee F-3- Marine Authority Beautification-Committee � Miami Beach Commission for Women I http://secure.miamibeachfl.gov/bcapp/bcapplication.aspx?ApplicationID=3351 1/25/2012 Board& Committee @ City of Miami Beach Page 2 of 3 - Board of Adjustment* Miami Beach Cultural Arts Council Budget Advisory Committee � Miami Beach Human Rights Committee Capital Improvements Projects Oversight Committee I J Miami Beach Sister Cities Program Committee for Quality Education in MB F- Normandy Shores Local Gov't Neigh.Improvement Committee on the Homeless F-3- Parks and Recreation Facilities Board Community Development Advisory � Personnel Board Community Relations Board F-:-I Planning Board* Convention Center Advisory Board F-3- Police Citizens Relations Committee I .J Debarment Committee Production Industry Council _:.1 Design Review Board* � Safety Committee Disability Access Committee [--3- Single Family Residential Review Panel Fine Arts Board F-3- Sustainability Committee Gay,Lesbian,Bisexual and Transgender(GLBT) F-37 Transportation and Parking Committee <R: Golf visor Commi � Visitor and Convention Authority Health Advisory Committee � Waterfront Protection Committee Health Facilities Authority Board Youth Center Advisory Board F- Hispanic Affairs Committee Historic Preservation Board Housing Authority 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: r Yes O(No Years of Service: 2. Present participation in Youth Center activities by your children r Yes r No If yes,please list the names of your children,their ages,and which programs. List below: Child's name: Age: I — Program: Child's name: _ Age: F— Program: Have you ever been convicted of a felony: r Yeso�No If yes,please explain in detail: Do you currently have a violation(s)of City of Miami Beach codes: r Yes kkVo If yes,please explain in detail: Do you currently owe the City of Miami Beach any money: r Yes CP<o If yes,explain in detail Are you currently serving on any City Boards or Committees: r Yes3(No If yes,explain in detail 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: r Yes 5 No Which department? Pursuant to City Code Section 2-25(b):Do you have a t:None r Parent r Spouse r Child r Brother r Sister who is employed by the City of Miami Beach?Check all that apply. http://secure.miamibeachfl.gov/bcappibcapplication.aspx?ApplicationID=3351 1/25/2012 Board& Committee @ City of Miami Beach Page 3 of 3 Identify the department(s): Gender:DN``ale r Female Ethnic Origin(Check one) Xwhite r African-American/Black r Hispanic r Asian or Pacific Islander r American Indian or Alaskan Native i Physically Challenged: r YesNo Employment c:None (7,Employed Retired Q Home-maker r Other If othe ______ 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: i 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). �i o Requirement to disclose certain financial interests and gifts(Miami-Dade County Code section 2-11.1). (re: CMB q 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 Gyourself,or those with whom you have business or immediate family ties(CFR 570.611). Ii, I Upon request,copies of these laws may be obtained from the City Clerk. NOTE:Applications will remain on file for a period of one(1)calendar year. "I hereby attest to the accuracy and truthfulness of the application and have received,read and will abide by Chapter 2,Article VII-of the City Code"Standards of Conduct for City Officers,Employees and Agency Members." pThe City Clerk's Office reserves the right to contact you for verification purposes. OAg ree Submit Form I i i t - i http://secure.miamibeachfl.gov/bcapp/bcapplication.aspx?ApplicationID=3351 1/25/2012 I M I A M hDADE M SOURCE OF INCOME STATEMENT Please Print or Type First Name Middle Name/Initial Last Name Disclosure For Tax Year Name: L Ending: Mailing Address: City/State/Zip: ` /�/ 31ft Social Security Number: Filing as a: ® County Employee: ® Municipal Employee of: Position held or sought: 19�� (,vjoyowy� Board where serving: Term or Employment Began on: ZO 10 Department where employed: Work Address: If your home address is exempt from public records pursuant to Florida Statutes§119.07 please check here(read instructions): ® Work Telephone: Home Address: 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 f Gc�✓ I hereby swear(or affirm)that aforesaid information is a true and correct statement. L2 g Signature pe on d' clos Date signed MIAMI BEACH city of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miami6eochf1-QOv CTY CLERK Office CityClerkCmiamibeachfl.gov Tel: 305.673.741 1 , Fax: 305.673.7254 Acknowledgement of fines/.suspension for Board Mein hers far.failure to comply with Miami-Dade County Financial .Disclosure Code Provision Code Section 2-11.1(i) .(2) Board Member name: l I understand that no later.than July 1, of .each erar 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-fiie,even though you may have.been recently appointed. YOU must file one of-the-following with the City Clerk of Miami Beach, 17.00 Convention -Center.Drive, Miami .Beach, Fiorida,.by July 1 each:year. "I. 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 f ne not to exceed ,$500.00 or by imprisonment'in the county Jail fora period nvt to exceed sixty days, or both. s �- Signature: .Date: