The URL can be used to link to this page

Adam Greenberg 12/31/2012 City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139,www.miamibeachfl.gov OFFICE OF THE CITY CLERK, Rafael Granada,City Clerk Tel: (305) 673-741 1, Fax: (305) 673-7254 06-20-2012 Adam Greenberg 3193 Royal Palm Ave. Miami Beach, Florida 33140 SUB Community Development Advisory Committee Congratulations! You have been appointed by Commissioner Deede Weithorn to the agency, board or committee named above for a term ending: 12/31/2012. Pursuant to Ordinance No. 2006-3543, commencing with terms beginning on or after January 1, 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. SincerIj Rafael E. Granado City Clerk cc: Saul Frances, Parking Director Brian Gillis 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. I City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.aov OFFICE OF THE CITY CLERK, Rafael Granada,City Clerk Tel: (305)673-7411,Fax: (305)673-7254 TO: Adam L. Greenberg RE: Community Development Advisory 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: 12/31/2012. 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 epen ' g on the board or committee on which I serve) on July 1, following the closing of t al ear on which I have served. Adam L. Greenberg Sworn to and subscribed before me this,,L day of l�/✓� , 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 Requirement. We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community. r MIAMI BEACH _ CITY OF IVIIAIVII BEACH BOARD AND COMMITTEE APPLICATION FORM NAME: �C e@^ � AC�N- L Last Name First Name Middle Initial HOME ADDRESS: 3N 3 N`� IA�cw.,` (,Qccc�„ �'�� 331 G Apt No. House No./Street City State Zip Code PHONE: �U� Cllcb 16-3c 1 96G Suzy �b1fh��'SCC//he ( Home Work Fax Email address � � �^^ Business Name: 6_�46e-%a5V_ ��1 Position: A, Address: au' S �5c-�.r� (r?1.� ( �T1- lam— �(�M. (' %sk 3 / No. Street City State Zip Code Professional License(describe) �� a 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.mimum of six months in a business established in the city. • Resident of Miami Beach for a minimum of six(6)months: Yes o� r No ❑ • Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six(6)months: Yes eo-r No ❑ •Are you a registered voter in Miami Beach: Yes or No 0 • (Please circle one): I am now a resident of: North Beach South Beach Mid�Beac• I am appl ying for an appointment because I have special abilities, knowledge and experien elow: •Are you presently a registered lobbyist with the City of Miami Beach?Yes 0 or No-�3� 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 ❑ Budget Advisory Committee ❑Miami Beach Commission for Women ❑Capital Improvements Projects Oversight Committee 0 Miami Beach Cultural Arts Council ❑Co mittee on the Homeless ❑ Miami Beach Human Rights Committee ❑ ommittee for Quality Education in MB ❑ Miami Beach Sister Cities Program Community Development Advisory 0 Norman-dv Shores Local Government Neigh. Improvement 0 Community Relations Board ❑ 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 ❑Fine Arts Board ❑ Safety Committee ❑Gay, Lesbian, Bisexual and Trans ender GLBT ❑ Single Fa mil Residential Review Panel ❑ Golf Advisory Committee ❑Sustainability Committee ❑Health Advisory Committee 0 Transportation and Parking Committee ❑Health Facilities Authority Board ❑Visitor and Convention Authority ❑ Hispanic Affairs Committee 0 Waterfront Protection Committee 0 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 0 No Years of Service: 2. Present participation in Youth Center activities by your children Yeso 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 .Have you ever been convicted of a felony: Yes ro or Nol,--- yes, please explain in detail: • Do you currently have a violation(s) of City of Miami Beach codes: Yes ❑or Noyes, please explain in detail: • Do you currently owe the City of Miami Beach any money: Yes rl or No'f. f yes, explain in detail • Are you currently serving on any City Boards or Committees: Yes❑or Noe 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: Yes ❑or NQZ 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 federal equal opportunity reporting requirements. Gender: ANIale ❑ Female Eth"'" igin: 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. ❑ 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 community recognition. Physically Challenged: Yes❑or No❑. Employment Status: Employe ,0-�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 he y attest o ura nd truthfulness of the application and have received, read and will abide by Chapter 2, role VII— e City C "Standards of Co duct or City Officers, Employees and Agency Members." w ( Ij A�— ec Applicant's Signa re Da a Name of Applicant(PLEASE PRINT) it P e fr� 12 F Received in the City Clerk's Office by: _ Date !20: / 0 Control No. Date: !2010 Name of Deputy Clerk MIAMI BEACH City of Miami Beach, 1 700 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(1) (2) Board Member name: %o 1, 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 erson or firm nee not to exceed $500.00 or by imprisonment in the county jail f period ed sixty days, or both. Ce W ( ►� Signature: Date: F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC Application.doc M I A M MADE �� SOURCE OF INCOME STATEMENT Please Print or Type First Name Middle Name/Initial Last Name Disclosure For Tax Year Name: � N` C t�cCC�n rg Ending: i Mailing Address: 3\OXS J-o M X City/State/Zip: M 10^. A 3314-10 Social Security Number: Filing as a: ® County Employee: ® Municipal Employee of: Position held or sought: Board where serving: Term or Employment Began on: Department where employed: Work Address: If your home address is exempt from public records pursuant to �G r -� (Q '7,-f Florida Statutes§119.07 please check here(read instructions): )2r-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 Name of Source of Income Address Business Activity A, �'r.� �-5�►c 1w S 61SCo��c (: na\ L .4 LLC d-c+-- S P•sco••..-e-&-CC \ all-430C- A\�� \g'- 0'1� �1..A z (°yew I hereby swear(or a at the aforesaid in tion is a true and correct statement. Signature offerson disclosing Date signed