Noreen Legault-Mendoza 12/31/2013 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
1/11/2012
Noreen Legault-Mendoza
16305 SW 248 St.
Bechland, FI 33031
Production Industry Council
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,
b � sf
Robert Pa her
City Clerk
cc: Saul Frances, Parking Director
Graham Winick
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.
IM 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 Noreen Legault-Mendoza
RE: Production Industry Council
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 theF/orida 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 calen a ear on which hav ed.
N een Le ayl t-M//endoz
Sworn to and subscribed before me thiWlf14day of �G 012.
d
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 OF MIAMI BEACH
EI0ARDS AND COMMITTEE APP11CATIOy4Ff"�n�
NAME: Gi A El L 17- 6"2,A IQOQC_,��
Last Name First Name e Initial
No. Street city State Zip Code
Home Work Fax Email address w
Business Name: scx_�/_h A/U/"1W70s/,tion:
No. Street city 5tate Zip Code
Professional License(desc me) Expires: Attach a copy cv 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 �f 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 or No
• Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six(6) months: YeXor No
• Are you a registered voter in Miami Beach: Yes or No)<
• (Please check 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, experience. Please list below:
Please list your p,eheennoe in order ofranking [1] first choice [o] second choice, and [3]third choice. Please note that only three (3)
choices will be observed by the City Clerk's Office. (Regular Boards o/City)
U Art in Public Places Committee O Housing Authority*
UBeauh Preservation Board OLoen Review Committee*
U Beautification Committee O Mayor's Green Ad-Hoc Committee
u Board ofAdjustment* o Marine Authority*
u Budget Advisory Committee O Miami Beach Cultural Arts Council
O Committee onHomeless O Miami Beach Commission onStatun6fWomen
O Committee for Quality Education inMB O Miami Beach Florida Sister Cities
O Community Development Advisory* O Normandy Shores Local Gov't Neigh. Improvement
O Community Relations Board O Oversight Committee for General Obligation Bond
O Convention Center Advisory Board O Parks and Recreation Facilities Board
O Debarment Committee O Personnel Board*
O Design Review Board* O Planning Board*
O Disability Access Committee O Police Citizens Relations Committee
O Fine Arts Board �KPmduciion industry Council
O Golf Advisory Committee O Public Safety Advisory Committee
O Health Advisory Committee O Safety Committee
n Health Facilities Authority Board O Transportation and Parking Committae��� ���� �����A��
u Hispanic Affairs Committee O Visitor and ConvenhonAuthority*
��y�����K� �� ��N���N
O Historic Preservation Board* O Youth Center Advisory Board
~ Board Required»,File State Disclosure form
�
n:ozocunient»and Sao'nqmoomnvnunv�mm|8omnoonompomm|nteme nen'10mK1C�8C Application nev'sem foly 18 2007.0wn
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:
*Have you ever been convicted of a felony: Yes or No Xf 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 J\ If yes, 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?
Name: FITC 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 or NoXWhich 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): AU/
This section is "not required" but desired: Age: C 1 years old Gender: Male❑ Femalex
Ethnic Origin (Check one)
White❑African-American/Black❑ Hispanic: ❑Asian or Pacific Islander❑American Indian or Alaskan Native❑
Employment Status: Employed ❑ Retired ❑ Home-maker❑ Other❑
"I hereby attest to the accuracy and truthfulness of the application and have received, read and will abide by Chapter 2,
Article II—o e City C de"Standards of Conduct for City Officers, Employees and Agency Members."
;KppWant'6 Signat6fe Date Name of plicant (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 City Clerk's Office by Date ( ( r v
Name of Deputy Clerk
Document Control Number(Assigned by the City Clerk's Office) Entered By Date r v
Revised 1/25/07 jo
2
._.
(::`•,)ocuments mild"t',tting5�:"i'3rnpU?"t;n1+.i..C3C<.I SetflnC;i`;t"E;tTE JOre�.'y it?t£:f(lfr:'t:`t E:S?{..,I...ICl..,'?? .,r'':tJp'IC<3ttE}n ltE:v€Scil.iUl+j "i;;200J.C:t{Jf.,
MIAMI BEACH
City of Miami Beach,
1700 Convention Center Drive,
Miami Beach, Florida 33139,
WWW.miomibeachfl.aov
CITY CLERK Office CityClerOmiamibeochfl.gov
Tel: 305.673.7411 , Fax: 305.673.7254
Acknowledgement of fines/.suspension for Board Mem hers for.failure
to comply with Miami-Dade County Financial Disclosure Code Provision
Code Section 2-11.1(i) (2)
Board Member name: I�;f-d
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( orb
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.
ig ure: Date:
7r� _90URCE OF INCOME STATEMENT
Please.Print.or Type First blame Middle Name Initial Last Name
Disclosure
For Tax Year
Ending
Name: /
mailing Address: of /
City/State/Zip:
.•i � I���mharr
Filing as a: ® County Employee:
® Municipal Employee of:
Position held or sought:
Board where servin , , Term or:Employment
g:
u IU��PUS � � Began on:
Department where employed:
Work Address:
if your home address is exempt from public records pursuant to Work Telephone:
Florida statutes E 118.07 pisase check here(read instructions): P
Home Address: Street Address
City State. Zip Code
Please list below in descending order with the largest source first, the name, sa{� and
b
principal business activity of every source of your income including p ry 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
cti
Name of Source of Income Address Business A vi
poa
I
7 hereby svvear (:or affirm)that the aforesaid information is.a true and correct statement.
i re person di closing Date signed
'rat