Loading...
Leslie Tobin 12/31/2013 MIAMIBEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139 www.miamibeachfl.gov OFFICE OF THE CITY CLERK, Rafael E. Granada, City Clerk Tel: 305.673.741 1, Fox: 305.673.7254 Email: CityClerk @miamibeachfl.gov June 15, 2012 Leslie Tobin 4464 Nautilus Drive Miami Beach, Florida 33140 SUBJECT: Design Review Board Dear Ms. Tobin: Congratulations! You have been appointed by the City Commission to the agency, board or committee named above for a term ending: 12/31/2013. 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, Ra ael E. Granado City Clerk c: 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 City Wide Permit Application - (Parking Department Form) Booklet - Guide to the Sunshine Amendment and Code of Ethics for Public Officers and MIAMI BEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139 www.miamibeachfl.gov OFFICE OF THE CITY CLERK, Rafael E. Granada, City Clerk Tel: (305)673-741 1, Fax: 13051673-7254 Email: CiyClerk @miamibeachfl.gov TO: Leslie Tobin RE: Design Review Board 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 Code of Ethics Ordinance), as well as the Florida 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* requirements of Miami-Dade County or the State of Florida (depending on the board or committee on which I serve) on July 1, following the closing of the calendar year on which I have served. �l IQ Leslie Tobin Sworn to and subscribed before methis I day of'JI-UAe 12012. F2, Silvia Prieto Deputy Clerk *Please visit the City of Miami Beach website at www.miamibeachfi.gov under City Clerk/Board and Committees for additional information regarding the Financial Disclosure Requirement. y' f A BE�WH CITY OF PJIIANIl BEACH BOARD AND A11MITTEE APPLICATION FORM NAME: Tobin Leslie H Last Name First Name Middle Initial HOME ADDRESS: 4464 Nautilus Drive Miami Beach FL 33140 Apt No. House No./Street City State Zip Code PHONE: 305-586-7828 305-675-0281 leslie @tobincrew.com Home Work Fax Email Address Business Name: Hauser Architects Position: President Address: FL No. Street City State Zip Code Professional License(describe): Rea.Architect AR16,493 FL Expires: 02128/2013 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 • Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six(6) months: No • Are you a registered voter in Miami Beach: Yes • (Please circle one): I am now a resident of: 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? 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) 3] Art in Public Places Committee Miami Beach Commission for Women 3 Beach Cultur2l Arts Cow Board of Adjustment' _ Miami Beach Human Rights Committee _ _I_Budget Advises Committee Miami Beach Sister Cities Program _I Capital Improvements Projects Oversight Committee Normandy Shores Local Gov't Neigh. Improvement I Committee on the Homeless Parks and Recreation Facilities Board rCommittee for Quality Education in MB Personnel Board Fcommunity Development Advisory r2l Planning Board" Community Relations Board Police Citizens Relations Committee Convention Center Advisory Board Production Inclustry Council Debarment Committee Public Safety Advisory Committee [1]_, Design Review Board" Safety Committee Disability Access Committee Single Family Residential Review Panel I Fine Arts Board Sustainabilit Committee Gay Lesbian, Bisexual and Transgender GLBT Transportation and Parking Committee Advisory Committee Visitor and Convention Authority _ Health Advisory Committee Waterfront Protection Committee I Health Facilities Authority Board Youth Center Advisory Board !_Hispanic Affairs Committee Historic Preservation Board Housing Authority Loan Review Committee 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: 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: 5 • Have-,you ever been convicted of a,felony: No If yes, please explain in detail: • Do you currently have a violation(s) of City of Miami Beach codes: No If yes, please explain in detail: • Do you currently owe the City of Miami Beach any money: No If yes, 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: 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: No Which department? • Pursuant to City Code Section 2-25(b): Do you have a 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: Female Race: White Ethnic Origin: Check one only (1) White Physically Challenged: No Employment Status: Home-maker 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 (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 Leslie Tobin agreed to the following terms on 1/10/2011 9:29:50 PM Please attach a copy of your resume to this application NOTE: Applications will remain on file for a period of one )Galen r year. Z 1 Received in the City Clerk's Office by: Date: 114/� Control No/ Date:/ /_/D �! Name of Deputy Clerk li MIAMI Mo SOURCE OF INCOME STATEMENT Please.Print.orType First Name Middle Name Initial Last Name Disclosure For'Tax Year Name: �G l Ending: Mailing Address: City/State/.Zip: Social.Security Number. Filing as a: ® County Employee: ® Municipal Employee of: position held or sought: Board where serving: "Term or Empli yment n b Began.on: Department-W. -hare employed: Work Address: it-your home address is exempt from public retards pursuanttD 3 WorlCTeia hone: Fiarids Statutes 1115.07 please check here(read instructions)t P Home Andress: Street Address City ate. Zip Code Please list below in descanding.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. ?he income of your.spouse or-any,business partner need not be Aisciosr-cL If continued on a separate sheet,.shack here: Descriprltiain.of the'Principal Name of Source of Income Address 13usiness vity A VT Z he by:swear (vr affirms)that the aforesaid information is-a true and =Drraet statemant, (� ►� 12, Si4nature of pars n bisciosing Date signed IMI MIAM I BEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miomibeachfl.gov CITY CLERK Office CityClerkCmiarnibeachfl.gov Tel:305.673.741 1 , 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) Board Member name: LA�/2�� 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. l� 12 Signature: Date: