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Saul Gross 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 3/22/2012 Saul Gross 2900 Flamingo Dr Miami Beach, Florida 33140 �S'UB T Capital Improvements Projects Oversight C 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. S, iinnce9r-elly, / Q Robert Parcher City Clerk cc: Saul Frances, Parking Director Fernando Vazquez 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 MIAMIBEACH City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeochA.aov OFFICE OF THE CITY CLERK, Robert Parcher,City Clerk Tel: (305)673-7411, Fax: (305)673-7254 TO Saul Gross RE: Capital improvements Projects Oversight 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. Saul Gross Sworn to and subscribed before me this�E day of 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 ploy in our vibrant, tropical, historic community. ®_ MIAMI BEACH CITY OF MIAMI BEACH ��JSS �ARD AND COMMITTEE APPLICATION FORM NAME: HOME ADDRESS; Last Name O G+M l Fiat Nalne ye, M 6 F1 Initial D Apt No.PHONE: �O S �35'�i"1 O y 30 3 House 52 3 �l D,S 36Ci d l 7 StS��Q'Wle l�ulll Home ` Work p Fax Email addre Business Name- 6p_a '] �IvxQ, 0 Y0 9osition: 0U)A � Address: C Z W t c S * 31 No. C reet city State Zip Code Professional License(describe) �v 01OW014''1 4" r 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 ownershipfinterest f7or inimum of six months in a business established in the city. • Resident of Miami Beach for a minimum of six(6)months:Yes No ❑ /or•Demonstrate an ownership/interest in a business i iami Beach for a minimum of six(6)months:Yes No ❑ •Are you a registered voter in Miami Beach:Yes V 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 11 or No(yJ' 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 ❑Board of Adjustment* 0 Marine Authority 0 BV6get Advisory Committee ❑Miami Beach Commission for Women a ital improvements Projects Oversight Committee ❑Miami Beach Cultural Arts Council ❑Committee on the Homeless ❑Miami Beach Human Rights Committee ❑Committee for Quality Education in MB ❑Miami Beach Sister Cities Program 0 Community Development Advisory 0 Normandy Shores Local Government Neigh. Improvement ❑Community Relations Board 0 Parks and Recreation Facilities Board ❑Convention Center Advisory Board ❑Personnel Board ❑Debarment Committee ❑Planning Board* ❑Design Review Board* ❑Police Citizens Relations Committee ❑Disability Access Committee ❑Production Industry Council [I Fine Arts Board ❑Safety Committee ❑Gay, Lesbian, Bisexual and Trans ender GLB ❑Sin le FamilV Residential Review Panel ❑Golf Advisory Committee 0 Sustainability Committee ❑Health Advisory Committee ❑Transportation and Parking Committee 0 Health Facilities Authority Board D 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 ❑. 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: ! Q]DNfSj°/BNqbGP SN T]CP BSE!BOE!DP N N JJFFT]CD!Bgq#bgpo/epd! •Have you ever been convicted of a felony: Yes❑or No/if es, please explain in detail: • Do you currently have a violation(s)of City of Miami Beach codes: Yes❑or No V11f yes, please explain in detail: • Do you currently owe the City of Miami Beach any money: Yes❑or No V./If yes, explain in detail •Are you c rren y serving on an Vty Boards or C mmittees: Yes or No❑. If yes;which board? � � S VV eV/S VL4 W I e,e/ •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, qoo F�uv►^ l� o YIV2 till- lSl �'' 2�- Z3� �Z '1 ` ��S 3 � ! • I am now employed by the City of Miami Beach: Yes❑or No hich 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): 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: ale ❑Female Ethic Origin: Check one only(1) lid 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 affiliatio r community recognition. Physically Challenged: Yes❑or Nol Employment Status: Employed Retired❑ Homemaker❑ Other❑ NOTE: If appointed,you will be required to follow certain laws which apply to city boardicommittee members. These laws include,but are not limited to,the following: • Prohibition from directly or indirectly lobbying city personnel(Miami Beach City Code section 2459). • Prohibition from contracting with the city(Miami-Dade County Code section 2-11.1). • 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 Cleric. "I he attest to the accuracy and truthfulness of the application and have received, read and will abide by Chapter 2, Arti a VII—of TF Ci Code"Stand rds of Co d �f r City Officers,Employees and Agenc Members." ` Applicant's Signa Date Name of Applicant(PLEASE PRINT) Received in the City Clerk's Office by: Date:_/ /2010 Control No. Date:_/_/2010 Name of Deputy Clerk lP M 1AM I BEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Flarido 33139, vrww.miami6eachfl.n0 v CITY CLERK Office CityClerk@miamibeachfl.gov Tel: 305.673.74 11 , Fax: 305.673.7254 Acknowledgement of fines/suspension for Board Mern bers for failure to comply with Miami-Dade County Financial Disclosure Code Provision Code Section 2-11 .1(i) (2) Board Member name: 5 IA J ` 6 eoSS 1 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, 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 Income7ax 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 a period not to exceed sixty days, or both. Signature: 4!t : M I A M FDADE ® SOURCE OF INCOME STATEMENT Please Print or Type First Name Middle Name Initial Last Name Disclosure 1 For Tax Year Name: Sal Ending: I 3� f Mailing Address: O 0 �&kVL'1 l Q�I�QJ City/State/Zip: Social Security Number: Filing as a: ® County Employee: ® Municipal Employee of: Position held or sought: C j-Q ®y�Y I�YUI l,c��htM1 1 ¢Q/ o °a Board where serving: Term or Employ e t Began on: 1112, Department where employed: Work Address: C—)0 (e.G(wt1kVt PYrO 2� If your home address Is exempt from public records pursuant to Florida Statutes§119.07 please check here(read instructions): ® Work Telephone: Home Address: L 0 Ftawlmp bf l ve/ n Street A rT 1 V -3 31 LIZ) V YCity Y3�"D,w"("J` State Zip Co( de Please list 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 a separate sheet, check here: Description of the Principal Name of Source of I ncome Address Business Activity ZRAI r::�g '-.K-,' I \1 I J--V�v I hereby swear(or affirm) that the aforesaid information is a true and correct statement. �� )--- 1 ")-- Signature of person disclosing Datetsign6d I C ^ 0 v \ � v r p; •e S 0 'L °' cn n C1 N V C � v o ° o � 0 �' 4- } N Y D Z N C (� Q .cL'C� N O O O C O O C V O a) N N N O -O Y � U CD a) N 3 0 O L ® O O O 2 IZ O 2 O m U 0 N } LL LL Z Z m LL CD m m m Q L -2 U U w _ � C C N � Q C m _ 0 >� U > cra ca E 0 L O C > C O O 0 W cu (� r N C r0 C Z O (t� N 'CO) � C O_ �co Y O °' I O cc M U :3 LC) V N N CO L O C) E 0 CO d — 4. � r � N W r CD I- o) 0 (/� U o •� Q r- N C) CD N M U) > O N Q NC1 0 U 06 O O N U 0 4� J -a m C J CO) U O C m CO a. +'�, O U Z CO) O C t d •ca ca Y V O N a Z (CO 0 m 0 CD N N CO > > ` N +, U LL m Q C °g C Q•� O O V cc J C Co c 'a c N E a C >+ N C_ N E N c` c OL O ` LL 3 N > U N U 0 A d E E O O o Q a0i m cc m m o Co •a o ate°, C� w m m t� V U Z cn a O Z U U M Z Q co m