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Lawrence Fuller 12/31/2013 f �,! r•, i City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov OFFICE OF THE CITY CLERK, Rafael Granado, City Clerk Tel: (305)673-7411, Fax: (305)673-7254 3/26/2013 Lawrence Fuller 925 North Shore Dr Miami Beach, Florida 33141 SUBJECT Disability Access Committee Congratulations! You have been reappointed by Commissioner Jerry Libbin to the above referenced agency, board or committee for a term ending: 1213112013. 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. y Sincerely, Ra el E. Granado City Clerk cc: Saul Frances, Parking Director Jay Fink 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. r MIA/01BEACH City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov OFFICE OF THE CITY CLERK, Rafael Granado,City Clerk Tel: (305)673-7411, Fax: (305)673-7254 Email CityClerk @miamibeach.gov TO Lawrence Fuller RE: Disability Access 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. I 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 comply with the financial disclosure*requirements of Miami-Dade County or ithe State of Florida (depending on the boar committ w ' e)on July 1, following the closing of the calendar year on v hich I ha 1 erved. Lawrence Fuller Sworn to and subscribed before a this day of , 2013. c c Silvia Prieto 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. MIAMICITY OF MIAMI BEACH BOARD AND COMMITTEE APPLICATION FORM /zG '� Z114 Ii9 ?/c�- A Last Name Fir t Name ' Middle Initial Home Addres r- Ity State 'Zip Code �� — ��/9 �� Home Telephone Work Telephone Cellular/Telephone Email address Fa Q L4: j.�FU L,1,6—R a9S�' /A7"9 Position: AL � Business Name 12,00-0 91,S�M#JS UOP Z11 / Z2 Business Address City r State Zip Code Professional License(describe) ;/�,, / +� Z1Y 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 for a minimuin of six months. _ • Resident of Miami Beach for a minimum of six(6) months: Yes a or No�q • Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six months: Yes�or No • Are you a registered_voter in Miami Beach: Yesca or No • I am now a resident of: North Beach South Beach 0 Middle Beach • I m applying for an appointment because I have special abilities, knowledge and experience. Please list below: h-I LZ L-Aw • Are you presently a registered lobbyist with the City of Miami Beach?Yes Uor 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 bv the 9ky Clerk's Office. (Regular Boards of City) ❑Affordable Housing Advisory Committee ❑ Fine Arts Board ❑Normandy Shores Local Government Neighborhood Improvement ❑Art in Public Places Committee ❑Gay, Lesbian, Bisexual and Transgender ❑ Parks and Recreation Facilities Board Enhancement Committee GLB 0 Beautification Committee ❑Golf Advisory Committee ❑Personnel Board 0 Board of Adjustment* ❑Health Advisory Committee 0 Planning Board* ❑Budget Advisory Committee ❑Health Facilities Authority Board ❑Police Citizens Relations Committee ❑Capital Improvements Projects ❑ Hispanic Affairs Committee ❑Production Industry Council Oversight Committee ❑Committee on the Homeless 0 Historic Preservation Board El Safety Committee . C Cc:r:riµac to.�.,uaiiiV Lui:CailUi i in Wiiu 1 u Housing Authority ❑Single Family Residential Review Panel 0 Community Development Advisory 0 Loan Review Committee 0 Sustainability Committee 0 Community Relations Board ❑Marine Authority ❑Tennis Advisory Committee 0 Convention Center Advisory Board ❑Miami Beach Commission for Women ❑Transportation and Parking Committee 0 Debarment Committee ❑Miami Beach Cultural Arts Council ❑Visitor and Convention Authority ❑Design Review Board* ❑Miami Beach Human Rights Committee ❑Youth Center Advisory Board Disability Access Committee ❑Miami Beach Sister Cities Program ❑Waterfront Protection Committee * Board Required to File State Disclosure Form �s If you seek appointment to a professional seat(e.g., lawyer,architect)on the Board of Adjustment, Design Review Board, Historic Preservation Board,or Planning Board,attach a copy of your currently-effectively license,and furnish the following information: Type of Professional License }7TOR/�� License Number License Issuance Date q and License Expiration Date � a C:\Users\LarryFuller\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\61 KLD504\BC Application.doc 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 LJ No LJ Years of Service: 2. Present participation in Youth Center activities by your children Yes ID No 0. 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:Yes I1 or No 10 If yes, please explain in detail: • Do you currently have a violation(s)of City of Miami Beach codes:Yes 0 or No Pa. If yes,please explain in detail: • Do you currently owe the City of Miami Beach any money:Yes U or NAM@ If yes,explain in detail •Are you currently serving_ on any Cit Boards or Committees:Yeses or No 0. If yes;which board? t- 1 SAB 1L CT ft CCES I&PARID •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 U or Nom.Which department? • Pursuant to City Code Section 2-25(b): Do you have a parent U, spouse U, child M brother�,or sister who is employed by the City of Miami Beach?Check all that apply. Identify the department(s):___4 /„ 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. Ethnic Origin:Check one onl 1) Gender: Male Female {,White ("Jot of Hispanic Origin):All persons having origins in any of the original peoples of Europe,North Africa or the Middle East. �1 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,or 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 throu h tribal affiliation or community recognition. Physically Challenged: Yes or No flm Employment Status: Employed 1 Retired❑ Homemaker Q Other U Please remember to attach a current resume and a copy of any applicable professional license. Attach additional sheets, if necessary, to provide required information. C:\Users\LarryFuller\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\61 KLD504\BC Application.doc NOTE: IF APPOINTED,YOU WILL BE REQUIRED TO FOLLOW CERTAIN LAWS THAT 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). • 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 I HAVE RECEIVED, READ AND WILL ABIDE BY CHAPTER 2, ARTICLE VII — OF THE CITY CODE "STANDARDS OF CONDUCT FOR CITY OFFICERS, EMPLOYEE N�AGENCY M BER " 3 ppli nt's Signature Date Name of Applicant(PLEASE PRINT) Received in the City Clerk's Office by: Name of Deputy Clerk Control No. Date C:\Users\LarryFuller\AppData\Local\Nlicrosoft\Windows\Temporary Internet Files\Content.Outlook\61 KLD504\13C Application.doc M I AM I•DADE ® SOURCE OF INCOME STATEMENT Please Print or Type First Name Middle Name Initial Last Name Disclosure � For Tax Year Name: e& 6 1 f fi4 - Ending: Mailing Address: City/State/Zip: Social Security Number: Filing as a: ® County Empluyee: ® Municipal Employee of: Position held or sought: ffi fft'Uneo1 1>1191taAeceff Board where serving:. rA, A � ., erm or Employment Began on: Department where employed: Words Address: /2-000 e I SOAVAI9 'e U/) A4/AmI 7-tL 3 3 (?/ If youhrome address is exempt from public records pursuant to Florida Statutes§119.07 please check here(r ad instructions): ® Work Telephone: Home Address: Street Addre ` 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 ircom.e, irclz:t::::y p;;blic Sea-' 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 lei t A/A I hereby swear r affirm)that the afore information is a true and correct statement. 0 2 11113 Sijndture of person disc osing bate signed s DRIVER LICENSE CLASS E F460-521-49-088-0 s LAWRENCE ARTHUR FULLER 925 N SHORE DR MIAMI BCH,FL 33141000 D08:03-08-1949 SEX:M HGT:5-07 1 ISSUED:01-28-2009 E S: "48-2017 S120901280088 SAFE DRIVER Operatmn Of a motor vehicle constitutes consent to any sobnety test reginted by taw. LAWRENCE A. FULLER 12000 BISCAYNE BLVD., SUITE 609 NORTH MIAMI, FL 33181 305-891-5199 (Main) 954-463-6570 (Broward) 305-893-9505 (Facsimile) BAR MEMBERSHIP: Florida Bar, 1974 Ohio Bar, 2003 New York Bar, 2003 District of Columbia Bar, 2002 Dade County Bar Association, 1975 American Bar Association, 1975 Supreme Court of Florida, 1974 Supreme Court of New York, 2003 District of Columbia Court of Appeals, 2002 United States Court of Appeals, 5th Circuit, 1978 United States Court of Appeals, 11th Circuit, 1981 United States District Court, Southern District of Florida, 1975 United States District Court, Middle District of Florida, 1985 United States District Court, Eastern District of Michigan, 2003 United States District Court, Western District of Michigan, 2008 United States District Court, Northern District of Ohio, 2003 United States District Court, Southern District of Ohio, 2006 United States District Court, District of Columbia, 2004 United States District Court, Southern District of New York, 2004 United States District Court, Eastern District of New York, 2004 United States District Court, Western District of New York, 2007 United States District Court, Northern District of New York, 2008 United States District Court, Northern District of Texas, 2005 WORK EXPERIENCE: 3/01 to Present: FULLER, FULLER & ASSOCIATES, P.A. 12000 Biscayne Blvd., Suite 609 North Miami, Florida 33181 Partner - involved in all aspects of general law practice, includ- ing emphasis on trial practice, personal injury, wrongful death and appellate practice, and enforcement of Title II and III of the Americans With Disability Act of 1990. I 4/90 to 2/01: FULLER, MALLAH & ASSOCIATES, P.A. 1111 Lincoln Road, Suite 802 Miami Beach, Florida 33139 Partner - involved in all aspects of general law practice, includ- ing emphasis on trial practice, personal injury, wrongful death and appellate practice. 1976 thru 1990 FULLER, FEINGOLD & MALLAH, P.A. 1111 Lincoln Road, Suite 802 Miami Beach, Florida 33139 Partner- involved in all aspects of general law practice, includ- ing emphasis on trial practice, personal injury, wrongful death and appellate practice. 1975 thru 1976 STEPHENS, THORTON & SCHWARTZ, P.A. 19 West Flagler Street Miami, Florida 33130 Associate - trial practice, personal injury, wrongful death and appellate practice. 1974 thru 1975 FLORIDA SUPREME COURT i Chief Just e C. Adkins c Law Clerk 1971 thru 1973 FULLER AND FEINGOLD, P.A. 1684 Meridian Avenue Miami Beach, Florida 33139 Law Clerk 1969 thru 1971 HARVARD LAW SCHOOL LIBRARY Research Aide EDUCATION: BOSTON UNIVERSITY Cum Laude Graduate UNIVERSITY OF MIAMI, SCHOOL OF LAW, Coral Gables, FL Juris Doctor, 1974 i HONORS: Selected for National Directory of Who's Who in Executives and Professionals 1993-1994; University of Miami Moot Court Board Judge; Phi Delta Phi Legal Fraternity; 1St Place, Freshman Moot Court; 2nd Place, Junior-Senior Moot Court; selected Outstanding Member for Miami Beach Branch of Kiwanis International (1996-1997); Florida Bar Board Certified as a Specialist in Civil Trial Law (1983 - 2006); Kiwanian of the Year Honor for the years 1996, 1997 and 1998 from City of Miami Beach Kiwanis Club; President of Miami Beach Kiwanis Club (1999-2000). OTHER EXPERIENCE: Registered Real Estate Salesman; Florida Real Estate Commission; 1972 thru present. PROFESSIONAL ASSOCIATIONS: Academy of Florida Trial Lawyers (1993 - present); American Bar Association Tort& Insurance Practice Committee (1984 thru present); Director, Miami Beach Bar Association (1984 thru 1990); Dade County Equal Opportunity Board (1992 thru 1994); City of Miami Beach Tourist & Convention Center Expansion Authority (1991 thru 1994); City of Miami Beach Youth Center Advisory Board, (1991 thru 1992); City of Miami Beach Young Professionals Committee(1985 thru 1990); Group Insurance for Members of the Florida Bar Committee(1995 thru 1988); Dade County BarAssociation Professional Arbitration Committee(1986 thru 1987); Dade County Bar Association Medical Profession Liaison Committee (1984 thru 1985); City of Miami Beach Board Budget Advisory Committee (1982 thru 1985); Dade County Bar Association Public Relations&Information Committee(1980 thru 1981); Florida Bar Appellate Rules Committee (1978 thru 1980); Dade County Appellate Court Committee(1976 thru 1978); Member,American BarAssociation Section of Litigation; City of Miami Beach Convention Center Advisory Board (1994 thru 1997); City of Miami Beach Board of Adjustment (1998-1999); Beach Health Facilities Board (2000); Member, Miami Beach Kiwanis Club (1994 - present); City of Miami Beach Disability Access Committee (2006 - present); Board of Directors of Advocacy Center for Persons With Disabilities. References: Upon request. (Both the firm of Fuller, Fuller & Associates, P.A. and Lawrence A. Fuller are AV rated by Martindale-Hubbell). W.-1WPDocs14.D.AWRESUMESIFFA AttomeyslResume LAF(updated 3-10-11).wpd I MIAMI BEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach,Florida 33139, vrww.miamibeochfl.aov CITY CLERK Office CilyClarkCmiamibeachfi..gov Tel: 305.673.7-411 , Fax: 305.673.7254 Acknowledgement of fines/.suspension for Board Mern bers for.failure to comply with Miami-Dade County Financial .Disclosure Code Provision Code .Section 2-1 1.1.(i) .(2) Board Memb er.name. t S col I C C E SS I understand that no later.-than July I z 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 on*e of-the following with the City Clerk of Miami Beach, 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 Retum Failure to-file, according:to-the Miami-Dade .County Code Chapter 1, General Provision, Section 1 Z may subject the person-or firm to a f ne not to exceed .$500..00 or by imprisonment'in the county jail for-a period not to exceed sixty days, or both. ;. nature: lote: M I A M I•DADE ® SOURCE OF INCOME STATEMENT Please Print or Type First Name Middle Name/Initial Last Name Disclosure For Tax Year Name: �l �i" (•j Ending: . Mailing Address: City/State/Zip: ec: Filing as a: ® County Employee: ® Municipal Employee of: Position held or sought: Board where serving: Term or Employ71-5)1 t Began on: 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): ® 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: e c ci D s ,ri tion of the_Prin ,pal P Name of.Source of Income_ Address Business" ivi I hereby s r (or affir h said information is a true and correct statement. nature of person disclosing Date signed I