Karen Fryd 12/31/2013 IM 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
1/4/2012
Karen Fryd
1708 W. 25th ST
Miami Beach, Florida 33140
'SUBJCT.,� Community Development Advisory Commit
Congratulations! You have been reappointed by Mayor Matti Herrera Bower
to the above referenced agency, board or committee for a term ending: 12131/2013.
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.
m MIAMI BEACH
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 Karen Fryd
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 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 1 st,following the closing of the calendar year on which I have served.
__ � ---
Karen Fryd
Sworn to and subscribed before me thisa\0 day of 2011.
ft 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.
CITY MIAMI BEACH
r - MIAMI CTY OF H
{n, 1 ,BOARD AND COMMITTEE APPLICATION FORM
NAME: r ,�'�-1 kareh) F
Last N rfe First Name Middle Initial
HOME ADDRESS: MS`S W gym S �8 F11A, 3�1
Apt No. m House No./Street �ry city State Zip Code
PHONE: 4� 3`� �� 1 -3-sS3� 13-0 d _2pJS3y))bs Ka reA 0S.,r (f -0
Home Work Fax Email address
Business Name: So o4o 'F)o, �jQo4y\ -MW Position:
Address: M%c ki 1 5P(k) e1r!�, ocs(h etc. 31 3 y
No. Street City State Zip Code
Professional License(describe) Expires: Attach a copy of the Hconse,
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 minimum of six months in a business established in the city.
. Resident of Miami Beach for a minimum of six(6)months:YesAor No ❑
• Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six(6)months:Yes No
Are you a registered voter in Miami Beach:Yesr No ❑
• (Please circle one): I am now a resident of North Beach South Beach fiddle Bea
• I am applying for an appointment because I havespecial abilities, knowledge and experience. ease list below:
5vc-�C(_1 °�'h — pV\ilc.w}jrDV-1
•Are you presently a registered lobbyist with the City of Miami Bach?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 ❑Marine Authority
❑Art in Public Places Committee ❑Miami Beach Commission for Women
0 Beautification Committee ❑Miami Beach Cultural Arts Council
❑ Board of Adjustment* 0 Miami Beach Human Rights Committee
❑ Budget Advisory Committee 0 Miami Beach Sister Cities Program
0 Capital Improvements Projects Oversight Committee ❑Normandy Shores Local Government Neigh. Improvement
❑Committee on the Homeless ❑Parks and Recreation Facilities Board
❑ ommittee for Quality Education in MB ❑Personnel Board
VCommunity Development Advisory ❑Planning Board*
❑Community Relations Board ❑Police Citizens Relations Committee
❑Convention Center Advisory Board ❑Production Industry Council
0 Debarment Committee ❑Public Safety Advisory Committee
❑Design Review Board* ❑Safety Committee
❑Disability Access Committee ❑Single Fa mil Residential Review Panel
❑Fine Arts Board ❑Sustainabili!y Committee
❑Gay, Lesbian, Bisexual and Trans ender GLBT 0 Transportation and Parking Committee
❑Golf Advisory Committee _ ❑Visitor and Convention Authority
❑Health Advisory Committee ❑Waterfront Protection Committee
❑Health Facilities Authority Board ❑Youth Center Advisory Board
❑Hispanic Affairs Committee
0 Historic Preservation Board
❑Housing Authority
❑ Loan Review Committee *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 i Years of Service:
2. Present participation in Youth Center activities by your children Yesi_ 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:
FACLER\$ALL\c:�ORMS\BOARD AND COMMITTEES\3C Application.doc
• *Have you ever been convicted of a felony: Yes or No A yes, please explain in detail:
• Do you currently have a violation(s) of City of Miami Beach codes: Yes or No If yes, please explain in detail:
• Do you currently owe the City of Miami Beach any money: Yes ❑or No-, If yes, explain in detail
•Are you currently serving on any Gity Boards or Committees: Yes j or No --. If yes; which board? to
G bA v u Ch
• 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: Yes I-or Nstl"Which department?
• Pursuant to City Code Section 2-25(b): Do you have a parent 11, spouse child'' brother i i, or sister who is employed by the
City of Miami Beach?Check all that apply. Identify the department(s): fl�o
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 Ora(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.
❑ ican-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 ❑ Retired ❑ Homemaker❑ Other❑ 7NmL Oar Don.-_OJT
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).
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).
• 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 VII— f the City Code"Standards of Conduct for City Officers,Employees and Agency Members."
aUci(�l 12— karelo -Fe�A-E)
Applicant's Signature 13afe Name of Applicant(SASE PRINT)
Please attach a copy of your resume to this application
NOTE:Application wil em in on file for a period of one(1)calendar year.
Received in the City Clerk's Office by: Date 20110 Control No. Date:_/_/2010
Name o Deputy Clerk
I-P MIAMI BEACH
city of Miami Beach,
1700 Convention Center Drive,
Miami Beach, Florida 33139,
vrww miamibeachfl.aov
CITY CLERK Office CityClerk@miamibeachfLgov
Tel; 305.673.741 1 , Fax;305.673.7254
Acknowledgement of fines/suspension for Board Mem bers for.failure
to comply with Miami-Dade County Financial Disclosure Code Provision
Code Section 2-11 .1(i) (2)
Board Member name:
understand that no later than July L 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, Fiorida, 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 14 may subject the person or firm to a f ne not to exceed
$500.00 or by imprisonment-in the county.jail for a period not to exceed sixty
days, or both.
Ja iu-
Signature: D te:
-� J
i
SOURCE OF INCOME STATEMENT
Please Print or Type First Name Middle Name Initial Last Name Disclosure
,-� For Tax Year
A2c� Ending: t j ;6
Name:
iMailing Address:
City/State/Zip:
( ,A �A ► 06Z.A[a
Social Security Number:
Filing as a: ® County Employee: !-�,A-11, ,�j,,,,c4
® Municipal Employee of: t`1
Position held or sought: $a A,L a �2
Term or Employme
Board where serving: t A C i;-OA IL 4 Began on: Zo (t'
Department where employed:
Work Address:
If your home address is exempt from public records pursuant to E3 ,work Telephone:
Florida Statutes§119.07 please check here(read instructions):
Z 5
Home Address: 'fro $ W. Street A ress Lk 0
City State Zip Code
Please list below in descending order with the largest source first,the name,address annd
principal business activity of every source of your income including p salary Y
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: 13
Description of the P cnrf the opal
Name of Source of Income
Address Business Activ'
4 yt, 14,c,4 AJ, r_ c5V nt'
kAX)^& n�
I hereby swear(or affirm)that the aforesaid information is a true and correct statement.
I
A
2 � ?.a u T-
Date signed
Sig ture of person d4closing