Debra Leibowitz 12/31/2013 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
4/30/2012
Debra Leibowitz
8 W Rivo Alto Dr
Miami Beach, Florida 33139
ISJ JEC ability Committee,
Congratulations! You have been reappointed by Commissioner Deede Weithorn
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,
RVael E.. ado
City Clerk
cc: Saul Frances, Parking Director
Fred Beckmann
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 MIAMI BEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139,www.miamibeacEff aov
OFFICE OF THE CITY CLERK, Robert Parcher,City Clerk
Tel: (305)673-7411, Fax: (305)673-7254
TO Debra Leibowitz
RE: Sustainability 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 theftrida 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.
Z&d— "ijtf�'
Debra Leibowid
Sworn to and subscribed before me this 3a#(day of 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.
MIAMIBEACH
CITY OF MIAMI BEACH
Le 4l BOARD AND COMMITTEE APPLICATION FORM
NAME: Leo,�Ld�i I Z bpjo Yg" IV/ -
Last Name First Name Middle Initial
HOME ADDRESS: 2 btz— p►amm 8c4 (F_ 3 3 l 3
Apt No. Frouse No./Street City State Zip e
PHONE: 3U S 01 7 9 7 3 C)S S31 7 k?7 �C� t LZ-z.-,r-
Home/� ,J Work Fax I ,} Email address
Business Name: Ails 64c, I Ytc- Position:
Address: 'Sayre
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 a"minimum of six months in a business established in the city.
• Resident of Miami Beach for a minimum of six(6)months:Yes r_0r No ❑
• Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six(6)months:Yes ri or No
•Are you a registered voter in Miami Beach: Yes or No ❑
• (Please circle one): I am now a resident of. North Beach South Beac Middle Beach
• I am applying for an appointment because'l have special abilities, know e e 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 ❑Historic Preservation Board
❑Art in Public Places Committee ❑Housing Authority
❑Beautification Committee 0 Loan Review Committee
❑Board of Adjustment* 0 Marine Authority
0 Budget Advisory Committee ❑Miami Beach Commission for Women
0 Capital Improvements Projects Oversight Committee ❑Miami Beach Cultural Arts Council
0 Committee on the Homeless 0 Miami Beach Human Rights Committee
❑Committee for Quality Education in MB ❑ Miami Beach Sister Cities Program
❑Community Development Advisory ❑ Normand Shores Local Government Neigh. Improvement
0 Community Relations Board ❑ Parks and Recreation Facilities Board
0 Convention Center Advisory Board ❑ Personnel Board
❑Debarment Committee ❑ Planning Board*
0 Design Review Board* ❑Police Citizens Relations Committee
0 Disability Access Committee ❑Production Industry Council
0 Fine Arts Board ❑Safety Committee
0 Gay, Lesbian, Bisexual and Trans ender GLBT ❑Single Family Residential Review Panel
0 Golf Advisory Committee ity Committee
0 Health Advisory Committee 0 Transportation and Parking Committee
❑ Health Facilities Authority Board 0 Visitor and Convention Authority
0 Hispanic Affairs Committee 0 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:
FACLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC Application.doc
I�
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t✓ r
*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 Fl_eyes, please explain in detail:
• Do you currently owe the City of Miami Beach any money: Yes ❑or No C},/ yes, explain in detail
•Are you currently serving on any City Boards or Committees: Yes❑or No des; which board?
•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:
• I am now employed by the City of Miami Beach: Yes❑or Nom. 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):
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 fedZle al opportunity reporting requirements.
Gender: ❑ Male
Ethpic Origin: Check one only(1)
hate (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 ommunity recognition.
Physically Challenged: Yes❑or No
Employment Status: Employed B"" 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).
• 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 Clerk.
"I hereby attest to the accuracy and truthfulness of the application and have received, read and will abide by Chapter 2,
Arti a VII—of th City s Code"Standards of Conduct for City Officers, Employees and 2760bolf2_—y Members."
a
Applicant's ignature Dafe I Name of Applicant(PLEASE PRINT)
Received in the City Clerk's Office by: Date:_/ /2010 Control No/!?51 Date:_/_/2010 3 �y
Name of Deputy Clerk
m MIAMI BEACH
City of Miami Beach,
1700 Convention Center Drive,
Miami Beach,Florida 33139,
www.miomibeachfl.aov
CITY CLERK Office CityClerk @miamibeachfl.gov
Tel:305.673.7411 , Fax:305.673.7254
Acknowledgement of fines/suspension for Board Members for failure to comply with Miami-
Dade County Financial Disclosure Code Provision Code Section 2-11.1(i) (2)kuv��
Board Member name: Lebo, ,4
I 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( 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.
Signature: Date:
F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC Application.doc
EM SOURCE OF INCOME STATEMENT
Please Print or Type First Name Middle Name Initial Last Name
Disclosure
For Tax Year
Name: LP.Aoo Ending: Zp 11
Mailing Address: v b�
City/State/Zip: 33 3
Social Security Number:
Filing as a: ® County Employee:
® Municipal Employee of:
Position held or sought:
Board where serving: / j ' Term or Employme /� y
Began on: l
Department where employed:
Work Address:
If your home address is exempt from public records pursuant to
-Florida Statutes§119.07 please check here(read instructions): E3 Work Telephone:
Home Address:
.Street Address
City State Zip Code
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
NipMeldf.S urce of Income Address Business Activity
54
WEI
:I hereby swear(or affirm)that the aforesaid information is a true and correct-statement.
r/A):�A aL s3 ia-
Signature of person disclosinio Date signed