Dave Doebler Application packageCITY OF MIAMI BEACH
BOARD AND COMMITTEE APPLICATION FORM
DoeblerDavid
NAME:
First Name
Last Name
Middle Initial
FL33139
HOME ADDRESS
:
33C VENETIAN WAYMiami Beach
Home No./StreetState
Apt No.City
Zip Code
dave.doebler@gmail.com
9544157434
PHONE
:
WorkEmail Address
HomeFax
Director of Sales
Business Name:
Mission Critical Systems
Position:
1347 East Sample Road
Pompano BeachFL33064
Address:
State
CityZip Code
Street
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
Yes
Yes
South Beach
circle one): I am now a resident of:
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 Clerks Office.
(Regular Boards of City)
Choice 1:Sustainability Committee
Choice 2:
Choice 3:
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:
No
Have you ever been convicted of a felony:If yes, please explain in detail:
No
Do you currently have a violation(s) of City of Miami Beach codeIf yes, please explain in detail:
No
Do you currently owe the City of Money Beach any money:If yes, please explain in detail:
Yes
Are you currently serving on any City Boards or Committees:If yes, which board?
Sustainability Committee (2013)
What organizations in the City of Miami Beach do you currently h
List all properties owned or have an interest in, which are loca
Property
833 West Ave #404
No
I am now employed by the city of Miami Beach:Which department?
The following information is voluntary and is neither part of yo
being asked to comply with federal equal opportunity reporting r
Gender:Male
Race/Ethnic Categories
White
What is your race?
Mark one or more races to indicate what you consider yourself t
Other Description:
Are you Spanish/Hispanic/ Latino? Mark the "No" box if not Spani No
No
Physically Challenged:
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 David Doebler agreed to the following terms on 12/21/2013 6:09
Received in the City Clerk's Office by:
Name of Deputy Clerk Control No.Date