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Michael Perlmutter Application package NAIAMI BEACH BOARD AND COMMITTEE APPLICATION FORM Last Name First Name Middle Initial (tA_:�7)�J )Q, �kv C Home Address City State Zip Code I sc, -0 . '3�10 t — s�4-ate �*e �ome Tele hone Work Telephone Cellular Telephone Email address sO S- ER. Q• P O-p,�&A`' Bu ' ss Name 7'rV Occu ation Cl�ru t�21I R"I 1�G - ��.5 �J 6�7 � 3 Business Address City State Zip Code Professional License(describe): 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 ownership/interest 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: YesELr No • Demonstrates ownership/interest in a business in Miami Beach for a minimum of six months: Yes 0 or No kQl • Are you a registered voter in Miami Beach: Yesor No Ca • I am now a resident of: North Beach ID South Beach Middle Beach ID • 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?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. ❑Ad Hoc Charter Review and Revision Board ❑Debarment Committee ❑Miami Beach Human Rights Committee ❑Ad Hoc Committee Centennial Celebration ❑Design Review Board* ❑Miami Beach Sister Cities Program ❑Ad Hoc Committee Flooding Task Force 0 Disability Access Committee ❑Normandy Shores Local Government Neighborhood Improvement ❑Affordable Housing Advisory Committee ❑Fine Arts Board ATarks and Recreation Facilities Board ❑Art in Public Places Committee ❑Gay, Lesbian,Bisexual and Transgender I ersonnel Board Enhancement Committee GLBT ❑Beautification Committee ❑Golf Advisory Committee tanning Board ❑Bicycle-Pedestrian Advisory Committee ❑Health Advisory Committee lice Citizens Relations Committee ❑Board of Adjustment* - * ❑Health Facilities Authority Board ❑Production Industry Council ❑Budget Advisory Committee ❑Hispanic Affairs Committee ❑Safety Committee ❑Capital Improvements Projects Oversight ❑Historic Preservation Board ❑Single Family Residential Review Panel Committee ❑Committee on the Homeless ❑Housing Authority 0 Sustainability Committee 11 Committee for Quality Education in MB ❑Loan Review Committee ❑Tennis Advisory Committee ❑Community Development Advisory Committee ❑Marine Authority ❑Transportation and Parking Committee ❑Community Relations Board ❑Miami Beach Commission for Women ❑Visitor and Convention Authority ❑Convention Center Advisory Board ❑Miami Beach Cultural Arts Council ❑Youth Center Advisory Board ❑Waterfront Protection Committee V Page 1 of 4 F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION 46 BOARDS 12092013.doc I oO 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 U 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 LA or No If yes, please explain in detail: • Do you currently have a violation(s)of City of Miami Beach Code?Yes U or Noftlf yes, please explain in detail: • Do you currently owe the City of Miami Beach any money?Yes U or No If yes, explain in detail: •Ar ou currently serving on any ty Board or Committee?Yes Psi or No IZI If yes,which board/committee? X-Qrvs Ki ltr` CV 4, (,—Fa z r>/vs o� Jv— • In what organization(s)in the City of Miami Beach do you currently hold membership? So Ir IV tot A-�s L.-c-kt-z Name osl on n yy � FQ�1-0 Name Position • List all properties owned or in which ou have an interest within the Ci of Miami Beach: �� `��1 •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 spouse , child brother or sister who is employed by the City of Miami Beach?Check all that apply. If"Yes,"identify person(s)and 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 City diversity reporting requirements. Gender: Mal Female Li Race/Ethnic Categories What is your race? African-American/Black IICaucasian/White ICI Asian or Pacific Islander 4�Native-American/American Indian Other—Print Race: Page 2 of 4 F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION 46 BOARDS 12092013.doc Do you consider yourself to be Spanish, Hispanic or Latino/a?Mark the "No"box if not Spanish, Hispanic, Latino/a. Xk No Yes Do you consider yourself Physically Disabled? 4x.LN o U 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: • 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). • 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). • 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). • 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. • 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 ACCORDI LY." AL Applicant's Signature Date Name of Applicant(PLEASE PRINT) Received in the City Clerk's Office by: v Name of D p Clerk Control No. at 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. Page 3 of 4 F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION 46 BOARDS 12092013.doc I MIAMI BEACH City of Miami Beach 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.qov CITY CLERK'S OFFICE CityClerk @miamibeachfl.gov Telephone: 305.673.7411 Fax: 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(i) (2) Board Member's Name: 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://www.miamidade.gov/elections/Library/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: http://www.ethics.state.fl.us/ethics/forms.html 3. A Copy of your 2013 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 Date Updated:Monday,December 09,2013 Page 4 of 4 F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION 46 BOARDS 12092013.doc MICHAEL PERLMUTTER 1000 South Pointe Drive #3701 Miami Beach, Florida 33139 Home Phone 305 535 9752 Mobile Phone 732 600 7825 OBJECTIVE: To continue my involvement in community service in my present home municipality QUALIFICATIONS I own and operate a chain of high-volume supermarkets in New Jersey and employ nearly 3000 employees. I have also served as a member of the NJ State Ethics Committee serving in a mediating position between attorneys and clients. I believe that my many years of experience in personnel matters gives me the ability to understand the complexities involved in running a City Government. MILITARY SERVICE 1966-1968: Served in the United States Army Presidential Honor Guard, Ft. Meyer, Arlington, Virginia EDUCATION Graduate: Lakewood High School, Lakewood, New Jersey Graduate: Rider University, Lawrenceville, New Jersey 1965 BS in Commerce EMPLOYMENT 1968-present: Sr. Vice President, Perlmart, Inc., 954 Route 166, Toms River, NJ 08753. Perlmart, Inc. owns and operates a chain of Shoprite Supermarkets in Ocean County, New Jersey. Adjunct Professor: Ocean County College COMMUNITY SERVICE 2010 Graduate, Citiizens' Police Academy, Miami Beach Class No. 40 Served as Secretary of New Jersey State 200 Club, an organization dedicated to helping State and local police officiers and their families. Lay member, NJ State Bar Ethics Committee, appointed by Governor, New Jersey for numerous terms Chairman, Environmental Committee, Wakefern Food Corporation Member, Wakerfern Labor Relations Committee: serve as a contract negotiator dealing with numerous retail trade unions with membership of more than 25,000 employees. PAGE 2 - MIC:HAEL.`PERLMUTTER Volunteer member,.First Aid Squad of Ocean County, NJ: served as an.a•mbulance driver and EMT for many years, Past President, Ocean County-Chamber,of Commerce: This position gave me experience-in dealing with community`and government dgencies. ' Member Board of Directors, Murano at Portofino, a condominium.in iami'Beach, FL Treasurer, SOFNA neighborhood,association PERSONAL Married to Marlene Perlmutter Personal interests: Golf, Boating, Reading. December T5; 2013 } A+ 1 �1 4 1 for_ -73Id Id