The URL can be used to link to this page

Stephen G. Hertz application package� � i < 1 l O I I I _ i � Rl= A 1-- i \A 0'!R,..1 D ACOM?N-4—T PP I i i C-N' -;-,i F'`9 RACE TZ A6� Last Name First Name Middle Initial 476-W1qR,2&e Z�*P/7/ W Home Address city State Zip Code S-,P12 Home Telephone Work Telephone Cellular Telephone Email address 4 7-7-QRA.V--Z Business Name 066-u pation Business Address city State Zip Code Professional License(describe): -Id 7-70-AA)WY Expires: Please attach a copy of currently effective professional license. Pursuant to City Code section 2-22(4)a & 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 ownershiplinterest for a minimum of six months in a business established in the City for a minimum of six months. • Resident of Miami Beach for a minimum of six(6) months: Yes or No • Demonstrates ownership/interest in a business in Miami Beach for a minimum of six months: Yes or No I-D • Are you a registered voter in Miami Beach: YesW 0 or No ZI • I am now a resident of: North Beach South Beach L—J Middle Beach • I am appl ing for an appointment because I have special abilities, knowledge and experience. Please list below: • 12� Are you presently a registered lobbyist with the City of Miami Beach?Yes�or 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. ❑Affordable Housing Advisory Committee I ❑Fine Arts Board ❑Normandy Shores Local Government I Neighborhood Improvement ❑Art in Public Places Committee ❑Disability Access Committee ❑Parks and Recreation Facilities Board 1 ❑Beautification Committee n-Gay, I esbian, Bisexual and Transgender ❑Personnel Board —Enhancement Committee(GLBT) ❑Bicycle-Pedestrian Advisory Committee ❑Golf Advisory Committee ❑Planning Board ❑Board of Adjustment's * ❑Health Advisory Committee ❑Police Citizens Relations Committee ❑Budget Advisory Committee ❑Health Facilities Authority Board ❑Production industry Council ❑Capital Improvements Projects I ❑Hispanic Affairs Committee ❑Safety Committee Oversight Committee ❑Committee on the Homeless -0 Historic Preservation Board ❑Single Family Residential Review Panel ❑Committee for Quality Education in MB ❑Housing Authority ❑Sustainability Committee ❑Community Development Advisory ❑Loan Review Committee ❑Tennis Advisory Committee ❑Communi!y Relations Board Ll Marine Authority DJransportation and Parking Committee ❑Convention Center Advisory Bo ❑Miami Beach Commission for Women isitor and Convention Authority ❑Debarment Committee ❑Miami Beach Cultural Arts Council 0 Youth Center Advisory Board '0 0 1 V A V 1. 111U 1.Protection Committee ❑Design Review Board* Cl Miami Beach Human Rights Committee laterfront Prot ❑Miami Beach Sister Cities Program 31,)1JJ0 J 6 1 :C 114d 9 7.330 E I 9Z 'D?-3 G r Page 1 of 4 • 0' Note: if applying for Youth Center Advisory Board, please indicate your affiliation with the Scott Rakow Youth Center: 1. Past service on the Youth Center Advisory Board:Yes __._No Dates of Service: 2. Present participation in Youth Center activities by your children:Yes ID No If yes, please list below the names of your children,their ages and the programs in which they participate: Child's name: Age: Program: Child's name: Age: Program: • Have you ever been convicted of a felony?Yes or No If yes, please explain in detail: • Do you currently have a violation(s) of City of Miami Beach Code?Yes or Nolf yes, please explain in detail: •Do you currently owe the City of Miami Beach any money?Yes or Nolf yes,explain in detail: •Are you currently serving on any City Board or Committee?Ye or No If yes,which board/committee? • In what organization(s)in the City of Miami Beadh do you currently hold membership? 1��L✓1i Name y Position wit l/ -" _ - f Name Position • List all properties owned or in which you have an interest within the City.of Miami Beach: •Are you now employed by the City of Miami Beach?Yes or No Which department and title? • Pursuant to City Code.Section 2-25 (b): Do you have a parent 1—:1, spouse IZI, child ED brother or sister who is employed by the City of Miami Beach?Check all that apply- If"Yes,"identify person(s)and department(s): /V 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 City diversity reporting requirements. Gender: Male Female Race/Ethnic Categories What is Y our race? ,frican-American/Black aucasian/White ED Asian or Pacific Islander Native-American/American Indian Zk Other—Print Race: Page 2 of 4 • • Do you consider yourself to be Spanish, Hispanic or Latino/a?Mark the "No"box if not Spanish, Hispanic, Latino/a. , No Yes Do you consider yourself Physically Disabled? 0 Yes 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: o Prohibition from directly or indirectly lobbying City personnel(Miami Beach City Code section 2-459). o Prohibition from contracting with the City(Miami-Dade County Code section 2-11.1). o Prohibition from lobbying before the board/committee you have served on for period of one year after leaving office(Miami Beach City Code section 2-26). o Requirement to disclose certain financial interests and gifts(Miami-Dade County Code section 2-11.1). o 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). o Sunshine Law - Florida's Government-in-the-Sunshine Law was enacted in 1967. Today, the Sunshine Law regarding open government can be found in Chapter 286 of the Florida Statutes. These statutes establish a basic right of access to most meetings of boards,commissions and other governing bodies of state and local governmental agencies or authorities. o Voting conflict—Form 8B is for use by any person serving at the county, city or other local level of government on an appointed or elected board, council, commission, authority or committee. it applies equally to members of advisory and non-advisory bodies who are presented with a voting conflict of interest under Section 112.3143, Florida Statutes. 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 MIAMi BEACH CITY CODE, ENTITLED "STANDARDS OF CONDUCT FOR CITY OFFICERS, EMPLOYEES AND AGENCY MEMBERS AND ALL OTHER APPLICABLE COUNTY AND/OR STATE LAWS AND STATUTES ACCORDINGLY." App icant Signature Date Name of Applicant(PLEASE PRINT) �, 6 , �� Received in the City Clerk's Office b scx. k./7 y � �3 Na e of Deputy lerk Control No. D e PLEASE REMEMBER TO ATTACH A CURRENT RESUME, PHOTOGRAPH AND A COPY OF ANY APPLICABLE PROFESSIONAL LICENSE. ATTACH ADDITIONAL SHEETS, IF NECESSARY, TO PROVIDE REQUIRED INFORMATION. 1P11 Page 3 of 4 City of Miami Beath 1700 Convention Center Drive, Miami Beach, Florida 33139, v w.w.mismibeachfl.gov CITY CLERK'S OFFICE CityClerk@miamibeachfl.gov Telephone: 305.673.7411 Fox- 305.673.7254 Acknowledgement of fines/suspension for Board/Committee Members for failure to comply with Miami- Dade County Financial Disclosure Code Provision Code Section 2-11.1(1) (2) Board Member's Name: ��Y`e,� 62 J ,;�> 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 Financial 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 they may have been recently appointed. One of the following forms must be filed with the City Clerk of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida, no later than 12:00 noon of July 1, of each year. 1. A Source of Income Statement" For your convenience, the form is attached. The form can also be downloaded at- http://mvw.miari-Cidade.gov/elections/Librarv/*source of income statement.pdf 2. A "Statement of Financial Interests (Form 1)" For your convenience, the form is attached. The form can also be downloaded at: hftp://www.ethics.state.fl.usiethics/forms.htm1 3. A Copy of your 2012 Federal Income Tax Return Failure to file one of these forms, pursuant to the Miami-Dade County Code, may subject the person to a fine of no more than $500, 60 days in jail or both. Signature at F:\CLER\YAL L\aFORMS\BOARD AND COMMITTEES;BC Application revised 5-22-13 FINAL.doc Updated:Tuesday,September 24 201 3 Page 4 o'14 4_ y j ra � sir ,4v i� I y. '' r+ LAW OFFICES STEPHEN G. HERTZ 767 Arthur Godfrey Road Miami Beach, Florida 33140 GENERAL PRACTICE Telephone TRIAL PRACTICE-GENERAL Dade (305) 538-2344 TRIAL PRACTICE-PERSONAL INJURY AND WRONGFUL DEATH Fax (305) 538-0419 R E S U M E RESIDENCE. 565 NORTH SHORE DRIVE, MIAMI BEACH, FLORIDA 33141 OFFICE: 767 ARTHUR GODFREY ROAD, MIAMI BEACH, FLORIDA 33140 EDUCATION: ELEMENTARY SCHOOL - NORTH BEACH ELEMENTARY MIDDLE SCHOOL - NAUTILUS HIGH SCHOOL - MIAMI BEACH HIGH SCHOOL (1958) COLLEGE - UNIVERSITY OF FLORIDA (BS-1962) LAW SCHOOL - UNIVERSITY OF MIAMI (JD-1965) OCCUPATION: ATTORNEY- PRIVATE PRACTICE OF LAW SINCE 1965 MARITAL: MARRIED TO JACQUELINE S. HERTZ CHILDREN: SCOTT; HOWARD; AND BRADLEY PROFESSIONAL: FLORIDA BAR-MEMBER OF REAL PROPERTY, PROBATE & TRUST SECTION; TRIAL LAWYERS SECTION; ELDER LAW SECTION MIAMI BEACH BAR ASSOCIATION - PRESIDENT 2003 DIRECTOR SINCE 1995 to Present DADE COUNTY TRIAL LAWYERS ASSOCIATION PAST MEMBER ASSOCIATION OF TRIAL LAWYERS OF AMERICA PAST MEMBER FLORIDA STATE GUARDIANSHIP ASSOCIATION 1. Board of Directors 8/10 - Present 2 . Membership Chair 2003-2004 3. Convention Committee 4 . By-Laws Committee SOUTH FLORIDA GUARDIANSHIP ASSOCIATION - SECRETARY 2002 - Present CIVIC DUTIES: CITY OF MIAMI BEACH PLANNING BOARD (11/89-11/93) NORMANDY SHORES HOMEOWNER' S ASSOCIATION BOARD OF DIRECTORS (1992 - Present) Vice President 2006 to 2010 Treasurer 2010 to Present NORTH SHORE IMPROVEMENT DISTRICT ADVISORY BOARD (12/93 - 1998) . CITY OF MIAMI BEACH NUISANCE ABATEMENT BOARD (2/5/98 - 6/19/02) Co-Chairman MIAMI D SOURCE OF INCOME STATEMENT Disclosure for Tax Year Ending Last Name First Name Middle Name/Initial 2012 HERTZ STEPHEN G. Mailing Address—Street Number,Street Name,or P.O.Box 565 NORTH SHORE DRIVE City,State,Zip ID Number MIAMI BEACH, FLORIDA 33141 If your home address is your mailing address,and your home address is exempt from public records pursuant to Fla.Stat.§119.07,read instructions on the following page and check here.F1 Filing as are Employee County Employee []Municipal Employee,Name of Municipality: Position held or sought Department where employed Work address Work telephone Term began on Filing as a Board Member F1 County Board Member ✓Z Municipal Board Member,Name of Municipality: Board where serving BUDGET ADVISORY COMMITTEE Work address Work telephone Term began on MIAMI BEACH CITY HALL 01/01/2013 List below every source of income you received,along with the address and the principal activity of each source.Include your public salary. Place the sources of income in descending order,with the largest source first.Also,include any source of income received by another person for your benefit.However,the income of your spouse or any business partner need not be disclosed.If continued on a separate sheet,check here.n Name of Source of Income Address Description of the Principal Business Activity ANGEL CARE MANAGEMENT, INC MIAMI BEACH, FLORIDA CARE MANAGEMENT STEPHEN G. HERTZ LAW OFFICE MIAMI BEACH, FLORIDA ATTORNEY AT LAW RENTAL PROPERTY VARIOUS-NONE ON MIAMI BEACH RENTAL PROPERTY , STOCKS & BONDS VARIOUS BROKERS INVESTMENTS BANK ACCOUNTS & MORTGAGES VARIOUS BANKS & LOANS SAVINGS & INTEREST EARNINGS I hereby swear(or affirm)that the information above is a true and correct statement. RECEIVED BY ELECTIONS DEPARTMENT: ❑Hardcopy ❑Electronic Copy Signa a of person disclosing STEPHEN Go HERTZ G Print name D sig ndd OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/Initials: Scanned Date/Initials: 138 SP-14 2/13