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Steve BerkeCITY OF MIAMI BEACH BOARD AND COMMITTEE APPLICATION FORM BerkeSteve NAME: First Name Last NameMiddle Initial 1881 Washington Ave FL33139 HOME ADDRESS : 11HMiami Beach #11H Home No./StreetState Apt No.City Zip Code steveberke@gmail.com 203500203020350020303058957500 PHONE : WorkEmail Address Home Fax Business Name: Position: 1400 NE Miami Gardens Drive North Miami BeachFL33179 Address: Ste 202 State No. CityZip Code Street Real Estate Sales Associate3/31/13 Expires: Attach a copy the license Professsional License (describe): Pursuant to City Code section 2-22(4) a and b: Members of agencies, boards, and committees shall be affiliated requirement shall be fulfilled in the following ways: a) an indi months; or b) an individual shall demonstrate ownership/interest Yes No Yes South Beach circle one): I am now a resident of:  Have been involved in the local art community for nearly a decad No 123Please note that only three (3) Please list your preferences in order of ranking [] first choice [] second choice, and [] third choice. choices will be observed by the City Clerk’s Office. (Regular Boards of City) Affordable Housing Advisory CommitteeLoan Review Committee Art in Public Places CommitteeMarine Authority Beautification CommitteeMiami Beach Commission for Women Board of Adjustment*Miami Beach Cultural Arts Council Budget Advisory CommitteeMiami Beach Human Rights Committee Capital Improvements Projects Oversight CommitteeMiami Beach Sister Cities Program Committee for Quality Education in MBNormandy Shores Local Gov’t Neigh. Improvement Committee on the HomelessParks and Recreation Facilities Board [3]Community Development AdvisoryPersonnel Board Community Relations BoardPlanning Board* Convention Center Advisory BoardPolice Citizens Relations Committee Debarment CommitteeProduction Industry Council Design Review Board*Safety Committee Disability Access CommitteeSingle Family Residential Review Panel [1]Fine Arts BoardSustainability Committee Gay, Lesbian, Bisexual and Transgender (GLBT)[2]Tennis Advisory Committee Golf Advisory CommitteeTransportation and Parking Committee Health Advisory CommitteeVisitor and Convention Authority Health Facilities Authority BoardWaterfront Protection Committee Hispanic Affairs CommitteeYouth Center Advisory Board Historic Preservation BoardYouth Center Advisory Board Housing Authority Note : If applying for Youth Advisory Board, please indicate your aff 1. Past service on the Youth Center Advisory Board: No Years of Service: if yes, please list the names of your children, their No 2. Present participation in Youth Center activities by your chil ages, and which programs. List below: Age:Program: Child's name: Age:Program: Child's name: No Have you ever been convicted of a felony:If yes, please explain in detail: Do you currently have a violation(s) of City of Miami Beach code No If yes, please explain in detail: No Do you currently owe the City of Money Beach any money:If yes, please explain in detail: No Are you currently serving on any City Boards or Committees:If yes, which board? What organizations in the City of Miami Beach do you currently h Name:Title: Name:Title: List all properties owned or have an interest in, which are loca No I am now employed by the city of Miami Beach: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 departme The following information is voluntary and is neither part of yo being asked to comply with federal equal opportunity reporting r Gender:Female Ethnic Orgin: Check one only (1) No Physically Challenged: Employment Status: NOTEIf appointed, you will be required to follow certain laws which :   These laws include, but are not limited to, the following: Prohibition from directly or indirectly lobbying city personnel o Prohibition from contracting with the city (Miami-Dade County Co o Prohibition from lobbying before board/committee you have served o Beach Code section 2-26). Requirement to disclose certain financial interests and gifts (M o (re: CMB Community Development Advisory Committee):  prohibiti from having   any interest in or receiving any benefit from Co or those with whom you have business or immediate family ties Upon request, copies of these laws may be obtained from the “I hereby attest to the accuracy and truthfulness of the applica VII – of the City Code “Standards of Conduct for City Officers, I Steve Berke agreed to the following terms on 11/13/2012 11:32: Received in the City Clerk's Office by:Date: / /2012Control No.Date: / /2012 Name of Deputy Clerk Hatfield, Liliam From:steve berke [steveberke@gmail.com] Sent:Tuesday, November 27, 2012 11:48 PM To:Hatfield, Liliam Subject:Re: Board and Committee Application Received by S. Berke 1. Cultural Arts Council 2. Tennis Advisory Committee 3. Community Development Advisory Thank you, Steve On Tue, Nov 27, 2012 at 3:05 PM, Hatfield, Liliam <LiliamHatfield@miamibeachfl.gov> wrote: I believe so, but via your email will serve to make the change. Please change below and resend email. 1. Fine Arts Board 2.Tennis Advisory Committee 3.Community Development Advisory Thanks, Regards, BEACH MIAMI Liliam Hatfield, Office Associate V CITY CLERK'S OFFICE 1700 Convention Center Drive, Miami Beach, FL 33139 Tel: 305-673-7411/ Fax: 305-673-7254 / www.miamibeachfl.gov We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community. From: steve berke [mailto:steveberke@gmail.com] Sent: Tuesday, November 27, 2012 10:50 AM To: Hatfield, Liliam Subject: Re: Board and Committee Application Received by S. Berke 1 Hi Lilliam, I meant to apply for Cultural Arts Council---did I check the wrong box? Regards, Steve On Tue, Nov 27, 2012 at 9:44 AM, Hatfield, Liliam <LiliamHatfield@miamibeachfl.gov> wrote: Attached please find Board and Committee Application and Resume received by Steve Berke, who is interested in serving in one of the following boards or committees: 1. Fine Arts Board 2.Tennis Advisory Committee 3.Community Development Advisory BEACH MIAMI Liliam Hatfield, Office Associate V 2 CITY CLERK'S OFFICE 1700 Convention Center Drive, Miami Beach, FL 33139 Tel: 305-673-7411/ Fax: 305-673-7254 / www.miamibeachfl.gov We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community. 3