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Manuel Minagorri 12/31/2013 ® MIAMI BEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139,www.miamibeachfl.aov OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk Tel: (305) 673-7411, Fax: (305) 673-7254 02-28-2012 01 Manuel Minagon 1065 Fairway Drive Miami Beach, Florida 33141 SUBJECT. Design Review Board 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, el-,l Robert Parcher City Clerk cc: Saul Frances, Parking Director Thomas Mooney 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. ® MIAMI BEACH City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.aov OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk Tel: (305) 673-7411, Fax: (305)673-7254 TO Manuel Minagorri RE: Design Review Board 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. Man - Sworn to and subscribed before me this day of 1�6A'21 G , 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. _ MIAMI BERCH CITY OF MIAMI BEACH BOARD AND COMMITTEE PPLICATION FORM NAME: 144 wO�i2 ,�I/lV 2 L /�'// Last Name First Name Middle Initial HOME ADDRESS:-1,96s- Apt No. . House No treet 0C.tj City State Zip Code PHONE: 30.f - 63,V/7PJ _ _30S 773,660 f , Home Work Fax Email address Business Name: "o Position: B/-- Address: 35 eve / /rte 33/YZ No. Street City State Zip Code Professional License(describe) Expires: 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 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 iryryMiami Beach for a minimum of six(6)months:Yes e'or No ❑ •Are you a registered voter in Miami Beach: Yes Vor No ❑ • (Please circle one): I am now a resident of: <t rth Beac South Beach Middle Beach • I am applyin for an ppointment because I have special abilities, knowledge anp experience. Please list below: oUlh 0<7, --7,-1 �e S/ o//// - •Are you presently a registered le�ist with the y of Mi each?Yes 196r 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 ❑Historic Preservation Board ❑Art in Public Places Committee ❑ Housing Authority ❑ Beautification Committee ❑ Loan Review Committee 0 Board of Adjustment* ❑Marine Authority ❑ Budget Advisory Committee ❑Miami Beach Commission for Women ❑Capital Improvements Projects Oversight Committee 1 ❑Miami Beach Cultural Arts Council ❑Committee on the Homeless ❑Miami Beach Human Rights Committee ❑Committee for Quality Education in MB r]Miami Beach Sister Cities Program 0 Community Development Advisory Normand Shores Local Government Neigh. Improvement ❑Community Relations Board 0 Parks and Recreation Facilities Board ❑Convention Center Advisory Board ❑Personnel Board ❑Debarment Committee ❑Plannin Board* Iesi n Review Board* ❑Police Citizens Relations Committee ❑Disability Access Committee 0 Production Industry Council ❑Fine Arts Board 0 Safetv Committee 0 Gay, Lesbian, Bisexual and Trans ender GLBT ❑Single Family Residential Review'Panel ❑Golf Advisory Committee ❑Sustainability Committee ❑Health Advisory Committee ❑Transportation and Parking Committee ❑Health Facilities Authority Board ❑Visitor and Convention Authority ❑Hispanic Affairs Committee ❑Waterfront Protection Committee ❑Youth Center Advisory 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 E. If yes, please list the names of your children, their ages, and which programs. List below: X31 - 11 Child's name: Age: Program: u:`I._i �I] Child's name: Age: Program: t FACLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC Application.doc !'i i t j,, •- ' ned •Have you ever been convicted of a felony: Yes❑or No If yes, please explain in detail: • Do you currently have a violation(s)of City of Miami Beach codes: Yes ❑or No V!If yes, please explain in detail: • Do you currently owe the City of Miami Beach any money: Yes❑or No Vlf yes, explain in detail •Are you currently serving on any City Boards or Committees: Yes C'or No❑. If yes; which board? •What organizations in the City of Miami Beach do you currently hold membership in? Name: eh ail?d,, Title:one 70w Name: Title: S`lor • List all properties owned or have an interest in, which are located within the City of Miami Beach: w g X :/� 1011�­� • I am now employed by the City of Miami Beach: Yes ❑or NoC,-Which department? • Pursuant to City Code Section 2-26(b): Do you have a parent❑,spousehild❑, 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: 5/Male ❑ 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. Vfrican-American/Black (Not of Hispanic Origin):All persons having origins in any of the Black racial groups of Africa. ispanic: 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 Noull� Employment Status: Employed V 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: d Prohibition from directly or indirectly lobbying city personnel (Miami Beach City Code section 2-459). c� Prohibition from contracting with the city(Miami-Dade County Code section 2-11.1). d 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). 0/ 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–of the City Code"Standards of Conduct for City Officers, Employees and Agency Members." 'Appficfinyif Sig ature ate Name of Applicant(PLEASE PRINT) Received in the City Clerk's Office by: —Date:—/ /2010 Control No. Date:_/_/2010 Name of Deputy Clerk h M® SOURCE DF INCOME STATEMENT Please.Print.or Type First Name Middle Name/Initial Last Name Disclosure For Tax Year Name U�'I Endin�� Mailing Address; city/state/Zip: c /. Social.Security Number: — Filing as a: ® County Employee: ® Municipal Employee of: Position held or sought: Board where serving: _n/2 Term or Employment '.Began on: Department where employed: Work Address: If your game address is exempt from public records puramnt tD 3�- 0 13 'Work Telephone: Florid®Statutes j 119.67 please check here(read instructlons); P Nome Address: /O 6 �et '� ddress City fit;. .Zip Code Pleasze.list bellow in descending order with'the largest source first,the riame, address and principal business activity .of every source of your income including public salary you business r h or use during the disclosure pia ec r r� .income of y any person received our spouse or any partnenead not be disclosed, If continued an.1a separate sheet, check here: 13 Description of the Principal Name of Source of Income Address Business Activ I hereby awaHr (or affirm)that the aforesaid information is:e true.and �orcect statement, .sign .Date signed • MIAM I BEACH city of Miami Reach, 1700 Convention Cenier Drive, Miami Beach, Florida 33139, www.rniamlbaachfl.aov CITY CLERK Office CRyClerk @m iarnl6eachfl.9ov Tel: 305.673.7411 , Fax:305.673.7254 Acknowledgement of fines/suspension for Board Meru bars for failure to comply with Miami-Dade County Financial Disclosure Code Provision Code Section 2-11.1(i) .(2) Board Member name: de understand that no later than.Jul 1 , of each year all members of.Boards and Committees of the City of Miami Beach, including those of a purely advisory nature, are -requiredto comply with Mlaml-Dade County Disclosure Requirements. This meansthatthe 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 fi le One of the following with the Clty 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 lax 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 fi ne not to.exceed $500.00 or by imprisonment in the county jail for a period not to exceed sixty days, or both. e, Z� a / 5i.gn ure: ate: i a mrco. Plan ning&Design G R o u n Manufacturers of Store Fixtures& Superior in design s craftsmanship Custom Woodwork MICKEY MINAGORRI Executive Vice President 5851 N.W.35TH Avenue, Mlaml,FL 33142 Ph(305)638-1785 Ext 210•FAX(305)638-0018 Cell(305)773-6609•E-mail:mickey @ortcogroup.com www.artcogroup.com 1 -- -