William Warren, Jr. 12/31/2013 mIAMI BEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miomibeachfl.aov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel: (305) 673-7411, Fax: (305) 673-7254
03-22-2012
William Warren Jr.
810 11 th Street#202
Miami Beach, Florida 33139
SUBJECT ;rl Miami Beach Human Rights Committee
Congratulations! You have been appointed by Mayor Matti Herrera Bower
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 1st, 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,
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Ralph Granado
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 Porcher, City Clerk
Tel: (305) 673-7411, Fax: (305) 673-7254
TO william Warren Jr.
RE: Miami Beach Human Rights 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 theFlonda 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 finan al disclosure' require-
ments of Miami-Dade County or the State of Florida(depending on the board r committee on which
I serve)on July 1 st,following the closing of the calendar yeve7on which a served.
- ill' m Warren Jr�
Sworn to and subscribed before me this day of / 2012.
r
�Q_Silvia rieto
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.
IM MIAMI BEACH >° F I ' ;� 7 �
AND NAME: Warren,Jr. William H
Last Name First Name Middle Initial
HOME ADDRESS: 202 810 11th Street Miami Beach FL 33139
Apt No. Home No./Street City State Zip Code
PHONE: 305-495-3472 305-604-8035 305-604-8045 bwarren @bdrinsurances.com
Home Work Fax Email Address
Business Name: Benefits Design Resources,Inc. Position: President
Address: 11-H 407 Lincoln Road Miami Beach FL 33139
No. Street City State Zip Code
Professsional License(describe): Florida Insurance License Expires: April 2013 PttaCh a cony¢iae eicers;
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
• Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six(6)months: Yes
•Are you a registered voter in Miami Beach: Yes
• (Please circle one): I am now a resident of: South Beach
• I am applying for an appointment because I have special abilities, knowledge and experience. Please list below:
A resident of Miami Beach since 1994,have done work with 2 equlity organizations in Miami-D
•Are you presently a registered lobbyist with the City of Miami Beach? 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 Housing Authority
Art in Public Places Committee Loan Review Committee
Beautification Committee Marine Authority
Board of Adjustment' Miami Beach Commission for Women
Budget Advisory Committee Miami Beach Cultural Arts Council
Capital Improvements Projects Oversight Committee [1] Miami Beach Human Rights Committee
Committee for Quality Education in MB Miami Beach Sister Cities Program
Committee on the Homeless Normandy Shores Local Gov't Neigh. Improvement
Community Development Advisory Parks and Recreation Facilities Board
Community Relations Board Personnel Board
Convention Center Advisory Board Planning Board'
Debarment Committee Police Citizens Relations Committee
Design Review Board' Production Industry Council
Disability Access Committee Safety Committee
Fine Arts Board Single Family Residential Review Panel
Gay,Lesbian,Bisexual and Transgender(GLBT) Sustainability Committee
Golf Advisory Committee Transportation and Parking Committee
Health Advisory Committee Visitor and Convention Authority
Health Facilities Authority Board Waterfront Protection Committee
Hispanic Affairs Committee Youth Center Advisory Board
Historic Preservation Board
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: No Years of Service:
2. Present participation in Youth Center activities by your children 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: No If yes, please explain in detail:
• Do you current) have a violations of City of Miami Beach codes: No If es lease explain in detail:
Y Y ( ) Y yes, P
• Do you currently owe the City of Money Beach any money: No If yes, please explain in detail:
•Are you currently serving on any City Boards or Committees: No If yes,which board?
•What organizations in the City of Miami Beach do you currently hold membership in?
Name: Miami Beach Chamber of Commerce Title: Member
Name: Miami-Dade Gay and Lesbian Chamber Title: Member
of Commerce
• List all properties owned or have an interest in,which are located within the City of Miami Beach:
810 11 th Street,Apt.202
• I am now employed by the city of Miami Beach: No Which department?
• Pursuant to City code Section 2-25(b):do you have a relative 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: Male
Ethnic Orgin:Check one only(1)
African-American/Black
Physically Challenged: No
Employment Status: Employed
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).
• Prohibition from lobbying before board/committee you have served on for period of one year after leaving office(Miami
Beach 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—of the City Code"Standards of Conduct for City Officers,Employees and Agency Members."
I William Warren,Jr.agreed to the following terms on 1/16/2012 5:54:07 PM rf�w�I�L 1(
��-
' � 1 &/10 a Received in the City Clerk's Office by: b Date: 12 Control No. ate: / /20 2
Name of Deputy Clerk
M 1AM I BEACH
City of Miami Beach,
1700 Convention Center Drive,
Miami Beach, Florida 33 139,
www.miamibeachfl.aov
CITY CLERK Office CityClerk @miomibeochfl.gov
Tel: 305.673.741 1 , 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: W% \\k ftw Wae_ee►. T�Z
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 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 a period not to exceed sixty
days, or both.
Z
KO K r Date:
M'® .SOURCE OF INCOME .STATEMENT
Please.Print.orType First Name Middle Name Initial Last Name Disclosure
For'Tax Year
Marne: V�/ t� \� e- Ending: . �'t
y
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Mailing Address; - rz
City/.state/.Zip:
Ses�1"�ctrit�-D
Filing as a: ® County Employee:
® Municipal Employee of:
position held or sought: Lf�1R b
Board where serving: -Term or Emplvyme t
Began.on: Z Z
Department,where employed:
W ark Address; �� �7T�
V.-your home address is exempt from public records pursuant to
Florida Statutes.§ 119.07 piease.check here(read instructions); Worlc?eiePhvne:
Horne Address: b 4 � -
Address
Z't Cade
City .State. P
Me elow in descending .order with the largest source first; tise name, address and
siness activity of every source of your income inciudisng Public salary You
ny.person received for your.benefit.or use durin g the d"ssc6asure period. The
ur.spouse or any .business partner need not:be.disclosed• If continued.on e et,.check here:
'Description.Df'the"Principal
arose f Source of Income Add .ess misirmess-Activ
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VF
her y.3 r a Irmo)that the aforesaid information is:e true-and morrect statement.
re p On.discieesing Dat signed