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Dorian Nicholson 12/31/2014r V;IAAM BEACH 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 Email CityClerk @miamibeach.gov 03-08-2013 Dorian Nicholson 6855 Abbott Ave. #701 Miami Beach, Florida 33141 SUBJECT: } 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: 12/31/2014. 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. Sincerely, 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. MIAMI BEACH 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)673-7411, Fax: (305)673-7254 Email CityClerk @miamibeach.gov TO Dorian Nicholson 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: 12/31/2014. 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 the Florida Commission on Ethics Guide to the Sunshine Amend- ment 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 co/lply with the financial disclosure* requirements of Miami-Dade County or ithe State of Florida (deper�tling on the board or committee on which I serve)on July 1,following the closing of the calendar year on which Ze served. r Dorian Nicholson Sworn to and subscribed before me this d_day of 1V,,7g , 2013. �C&Ci 4�_&;Silvi�rieto Deputy Clerk *Please visit the City of Miami Beach website at www.miamibeachfl.gov under City Clerk/Board and Comm 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. MIAMI BEACH CITY OF MIAMI BEACH BOARD :AND COPYNITTEE APPUCATION FORM NAME: Nicholson Dorian A Last Name First Name Middle Initial HOME ADDRESS: 701 6855 Abbott Ave Miami Beach FL 33141 Apt No. Home No./Street City State Zip Code PHONE: 4048389205 dnicks @me.com Home Work Fax Email Address Business Name: David Barton Gym Position: Fitness Instructor Address: 2323 Collins Ave Miami Beach FL 33139 No. Street City State Zip Code Professsional License(describe): Expires: Af{ach a copra Uhe//cense 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: 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(31 choices will be observed by the City Clerk's Office.(Regular Boards of City) Affordable Housing Advisory Committee Loan Review Committee Art in Public Places Committee Marine Authority Beautification Committee Miami Beach Commission for Women Board of Adjustment' Miami Beach Cultural Arts Council Budget Advisory Committee Miami Beach Human Rights Committee Capital Improvements Projects Oversight Committee Miami Beach Sister Cities Program Committee for Quality Education in MB Normandy Shores Local Gov't Neigh.Improvement Committee on the Homeless Parks and Recreation Facilities Board Community Development Advisory Personnel Board Community Relations Board Planning Board' Convention Center Advisory Board Police Citizens Relations Committee Debarment Committee Production Industry Council Design Review Board' Safety Committee Disability Access Committee Single Family Residential Review Panel [2] Fine Arts Board Sustainability Committee [3] Gay,Lesbian,Bisexual and Transgender(GLBT) Tennis Advisory Committee Golf Advisory Committee [1] 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 Youth Center Advisory Board Housing Authority 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 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 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: 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 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) Hispanic 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." 1(0 / - I Dorian Nicholson agreed to the following terms on 211912013 10:16:57 AM r Received in the City Clerk's Office by: f Date: / /2013 Control No. �O Date: / 12013 Name of Deput Clerk DORIAN A. NICHOLSON 6855 Abbott Ave Miami Beach,FL 33141 DNICKS @ME.COM 404-838-9205 EDUCATION Clark Atlanta University,Atlanta,Georgia Bachelor of Arts degree in Mass Media Arts December 2009 Concentration: Film GPA:3.5/4.0 scale Related Courses: Cinematography,News Writing,Writing for Radio Television and Film,Fundamentals of Film,Media Seminar Kingsborough Community College,Brooklyn,New York Pursued an Associate of Arts degree in Mass Communications,2004-2006 Related Courses: Film Creative Medium,Introduction to Broadcasting,Introduction to Mass Media WORK EXPERIENCE SALES MANAGER April,2012 UNFAMOUS TATTOO CULTURE,MIAMI TATTOO CO& FIRST CLASS TATTOO MIAMI BEACH,FL • Key Holder • Managing cash draws and sales • Personal consultations with clients to fully understand their creative vision then with the artist to best execute the idea • Following up with appointments and account balances TEAM LEAD/STOCK April,2008-Nov,2011 URBAN OUTFITTERS NY,NY • Assisted customers in the selection and purchase of casual apparel and accessories. • Created sales floor displays to enhance apparel marketability. • Maintained the organization and replenishment of apparel on sales floor displays. SALES ASSOCIATE/STOCK Nov,2007-Jan,2009 GAP Atlanta,Georgia Assisted customers in the selection and purchase of casual apparel and accessories. Created sales floor displays to enhance apparel marketability. • Maintained the organization and replenishment of apparel on sales floor displays. SALES ASSOCIATE July,2007-August,2007 Verizon Wireless Carle Place,New York • Greet customers and demonstrate strong knowledge of Verizon telecommunication products and services. • Demonstrate cell phone functionality in efforts to assist customers in purchasing the appropriate phone and service based on need. PROFESSIONAL ATTRIBUTES • Keen eye for detail. • Effective time management,organization,and multitasking abilities. • Editing knowledge: Final Cut Pro,Photoshop. • Microsoft Applications:Word, Excel,Power Point. • Basic navigation of Internet browsers. References available upon request. MIAMIBEACH City of Miami Beach, 1700 Convention Canter Drive, Miami Beach,Florida 33139, www.miamibeochfl.aov CITY CLERK Office Cil Clerk @miamibeachfl.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 2-1 1.1(i) �.(2) Board Member.nome: understand that no .later than Jul 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 meansthatthe members of City Advisory.Boards, whose.sole or primary responsibility -is to recommend legislation or give advice to-the City Commission,mustfile.,:even-though you mayhave.been recently appointed. You must rile one ofthe-following withthe.City Claris of Miami Bach, -17.00 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 maysubject the person or firm to a Tine not-to exceed .$500..00 or by imprisonment'in the county.jail fora period not to exceed sixty days, or both. Signature: Date: M I A M I-DADE ® SOURCE OF INCOME STATEMENT Please Print or Type First Name Middle Name/Initial Last Name /1 /� Disclosure For Tax Name: l/o I v t AA) A ����JZ S0" " Ending Y�ea�r, 2 T�13 Mailing Address: (�� *,7o City/State/Zip: ILL C? N O SeevrftT-NUMbeiF: Filing as a: ® County Employee: r ® Municipal Employee of: = 00 Position held or sought: = ng: v�. Term or Employment Began on: Z Zd 3 Department where employed: Work Address: Y_tve,0LAI If your home address is exempt from public records pursuant to Florida Statutes§119.07 please check here(read instructions): U Work Telephone: Home Address: h SCSI /A96 off /4-(�E# 170 Street Address mom;