Mark Hayes 12/31/2013 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
1/11/2012
Mark Hayes
3001 Prairie Ave.
Miami Beach, Florida 33140
Community Development Advisory CommittE
Congratulations! You have been reappointed by Commissioner Jonah M. Wolfson
to the above referenced agency, board or committee for a term ending: 12/31/2013.
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,
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Brian Gillis
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, 2-2458, 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.
MW
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 Mark Hayes
RE: Community Development 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: 12/31/2013.
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 h e finan 'al disclosure*require-
ments of Miami-Dade County or the State of Florida (depen i boa d committee on which
I serve)on July 1st,following the closing of the calendar i I av erved.
ark Hayes
Sworn to and subscribed before me this 30 day of Ar , 2012.
- Silvia Pri o -----
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.
i
f xF.
NAME:
Last Name First Name ? i ddle Ia
HOME ADDRESS: r k9
Apt No. House No./Street City State Zip Code
PHONE: YrCG30 w i j11
Home` Work Fax Email address
Business Name: �Q � r�/� i l�i� Position: + 1 6_Vq
Address: A V _ PIA . C
No. Street City State 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 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 A-or No
• Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six(6)months: YesLyor No
•Are you a registered voter in Miami Beach: Yesp. or No
• (Please circle one): I am now a resident of: North Beach South Beach Middle Beacl
• I am applying for an appointment because I have special abilities, knowledge and experience. P ease 7 st below:
•Are you presently a registered lobbyist with the City of Miami Beach?Yes or Noo(
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
❑Capital Improvements Projects Oversight Committee ❑Miami Beach Sister Cities Program
❑Committee on the Homeless ❑Normandy Shores Local Government Neigh. Improvement
❑Committee for Quality Education in MB ❑Parks and Recreation Facilities Board
&ACommunity Development Advisor ❑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 Trans ender 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 ❑Youth Center Advisor Board
*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 No Years of Service:
2. Present participation in Youth Center activities by your children Yes 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:
0 0
•Have you ever been convicted of a felony: Yes or NOOP If yes, please explain in detail:
• Do you currently have a violation(s)of City of Miami Beach codes: Yes or Noff. If yes, please explain in detail:
• Do you currently owe the City of Miami Beach any money: Yes or Nq*,. If yes, explain in detail
• Are you currently serving on any City Boards or Committees: Yes or NoLg. 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:
-. Air
G M e 3'ac_� oz c2 r
• I am now employed by the City of Miami Beach: Yes or No<Which department?
• 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):
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:K' Male ❑ Female
Ethnic Origin: Check one only(1)
P<,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 N
Employment Status: EmployedK 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 s th curacy and truthfulness of the application and have received, read and will abide by Chapter 2,
Article % e e"Standards of Con ct f r City Officers, Employees and Agency Members."
/we/ �
Appl!#&S gnatd(ey to Name of Applicant(PLEASE PRINT)
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. Date:_/_/2 9
Nam of Deputy Clerk
KI ZC�L 0,eC3
�l
IWAM I BEACH
City of Miami Beach,
1700 Convention Center Drive,
Miami Beach, Florida 331 39,
www.miamibeochFl.QOy
CityClerkC
CITY CLERK Office rniarnibeochff.gov
Tel; 305.673.741 1 , Fax: 305.673.7254
Acknowledgement of fines/suspension for Board Mein hers for 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 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 soie-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 impriso ent'in the county Jail for-a period not to exceed sixty
days, or both /
20?
Signat re: te:
11
MIAMI,
� SOUR-CE OF INCOME STATEMENT
piease.Print-or Type First Name !diddle Name Initial Last Name Disclosure
For Tax Year
Ending: /
Name: .,1
mailing Address;
City/State/zip:
Filing as a: ® County Employee:
® Municipal Employee of:
position held or sought:
�
Board where serving -Term or'Empioyrnent
, i £�J� t'1_ '.Began on:
Department-where employed:
Work Address:
If your-home address is exempt from public records pursuant to � Worlc Telephone:
Fianda Statutes§119.07 pisase check here(reed instructions);
Hoene Andress: Street Address
City .state- :dip Code and
Please list below in descending order with the largest source first,the na r salary you
principal business ac rvity of every source of your income including public
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:
Descrip�ipn of the`Principal
Name of Source of Income Address Bus�jc
I hereby swear (:or affirms)that the aforesaid information is-a true and zDrrect statement.
Date signed
signature of person disclosing