Guy Simani 12/31/2013 ® 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
02-28-2012
Guy Simani
;IJBJ Affordable Housing Advisory Committee
Congratulations! You have been appointed by the City Commission to the agency,
board or committee named above for a term ending: 12/31/2013.
Pursuant to Ordinance No. 2006-3543, commencing with terms beginning on or after
January 1 st, 2007, the term of board members who are directly appointed by a member of
the City Commission shall automatically expire on December 31 of the year the appointing
elected official leaves office.
If you are unable to accept this appointment or have any questions, please call the City
Clerk's Office at 305-673-7411. Please read the enclosed materials carefully.
Congratulations again and good luck.
Sincerely,
l
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Richard Bowman
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, 2-458 and 2-459
Ordinance No. 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 Employee
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, 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 Guy Simani
RE: Affordable Housing 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(depe ing on the board or committee on which
I serve)on July 1st,following the closing of the calendar a �et\h I have served.
c
Guy Si lm''anii _n-
Sworn to and subscribed bef m s da of {�'/� , 2012.
U
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.
® MIAMI BEACH CITY OF MIAMI BEACH
BOARD AND COMMITTEE APPLICATION FORM
NAME: c v
Last Name ,�/�j t First acme p Middle Initial
HOME ADDRESS: Yy A / lro",:h,4 6.,t n��S� �«�r llvt[� rG �73/e/0
Apt No. ' House No./Street _ City State Zip Code
PHONE: 6 Z S �d �' 000 l • ZYf 60
Home qq Work // c Fax E it address
Business Name: Oef l //°!.� �il't cvfi Lc.J"j es Position: C.E&
Address: r F c 33�{ t
No //� treet City State Zip Code
Professional License(describe) i l'z- 6`i�s�<<` Expires: �' Z� 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 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:Yes❑or No ❑
•Are you a registered voter in Miami Beach: Yes 0 or No ❑
• (Please circle 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 and experience. Please list below.
•Are you presently a registered lobbyist with the City of Miami Beach?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 istoric Preservation Board Mp
❑Art in Public Places Committee ❑Housinq Authority
0 Beautification Committee ❑Loan Review Committee
_Tboard of Adjustment* 1 ❑Marine Authority
❑ Budget Advisory Commitfee ❑Miami Beach Commission for Women
@-Ca ital Improvements Projects Oversight Committee ❑Miami Beach Cultural Arts Council
❑Committee on the Homeless 0 Miami Beach Human Rights Committee
❑Committee for Quality Education in MB ❑Miami Beach Sister Cities Program
❑Community Develo ment Advisory ❑ Normandy Shores Local Government Neigh. Improvement
❑Community Relations Board ❑ Parks and Recreation Facilities Board
❑Convention Center Advisory Board ❑Personnel Board
❑Debarment Committee tannin Board* L
❑Design Review Board* ❑ Police Citizens Relations Committee
❑Disability Access Committee ❑ Production Industry Council
❑Fine Arts Board ❑Safety Committee
❑Gay, Lesbian, Bisexual and Trans ender GLBT ❑Single Family Residential Review Panel
❑Golf Advisory Committee ❑Sustainability Committee
❑ Health Advisory Committee ❑Trans ortation and Parking Committee
0 Health Facilities Authority Board 0 Visitor and Convention Authority
❑ Hispanic Affairs Committee ❑Waterfront Protection Committee
❑Youth Center Advisory Board
*Board Reg wired 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 0 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:
FACLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC Applicarion.doc
•Have you ever been convicted of a felony: Yes❑or00 If yes, please explain in detail:
• Do you currently have a violation(s) of City of Miami Beach codes: Yes ❑or o❑ If yes, please explain in detail:
• Do you currently owe the City of Miami Beach any money: Yes ❑ No❑.I yes, explain in detail
• Are you currently serving on any City Boards or Committees: Yes❑To❑. f yes; which board?
•What organizati ns in the Cit of Miami Bea do you currently hold membership in?
Name: cr u► •.. .. Title:
Name: Title:
• List all properties owned or have an ijUerest in, which are located within the City of Miami Beach:
c \ 1
� (LA
• I am now employed by the City of Miami Beach: es ❑ o❑. hich department?
s 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). �VG e.4__
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 ❑ Female
Ethnic Origin: Check one only(1)
13 th 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 No❑.
Employment Status: Employed 31"" 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:
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).
1n 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).
1 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 here ttest to curacy and truthfulness of the application and have received, read and will abide by Chapter 2,
Articl II– e City C45cle"Standards of Conduct for City Officers,Employees and Agency Members."
p' an u Date Name of ppiicant(PLEASE PRINT)
�� n - — , t f
a 3 /D _ zLO�
R ive � he City Clerk's Office by': � Date: �20 0 Control No. Date: /_/2010
Name of Deputy Clerk
M 1 AM I B EAC H
city of Miami Beach,
1700 Convention Center Drive,
Miami Beach, Florida 33139,
WWW miaml6eachfl.aoy
OTY CLERK Office CIIyCIerkC m i amibeochfl..gov
Tel: 305.673.7411 , 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:
understand that no later than July I , 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 Clty Commission,-must file, even though you maybave been
recently appointed.
YDu must file one of the following with the Olty Clerk of Miami Bea ah, 17DO 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 lax Return
Failure to file, according to the Miami-Dade .County Code Chapter 1, General
Provision, Section 1 Z may subject the person or firm to a fl ne not to.exceed
$500.00 or by imprisonment in the county}ail for a.period n®t to exceed sixty
days, or both.
3_ zo 7-15 t-2-
n u Date:
H
M® SOUR-CE OF INCOME STATEMENT
Please.Print.orType First Name Middle Name/Initial Last Name
Disclosure
For Tax Year
Ending^�//
Name:
Mailing Address:
City/state/zip:
r r
Filing as a: ® County Employee:
® Municipal Emp'Ioyae of:
position held or sought:
Board where sandng: y� Term or Employment
'.Began on: � Z l �—
Department'w.here employer:
Work Address:
V your home address is exempt from public records pursuant to .� WOr1C Telephone:eDne:
Florid® Statutes§ 1,1.8.07 please check here(reed instructions); P
Home Address: Street Address
City see .Zip Code
please.fist 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-e
separate sheet, check here:
Description of the Principal
Name of Source of Income Address Business AcLivilty
_o
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♦ lawl � ►.t .
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tVr►
1 here r affirm)that the aforesaid information We true.and morr'ect statement.
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i
!:;X 2v• 20(2
iDate signed
a parson disciosing