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Lidia Resnick 12/31/2015 I EACH 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 12/09/2013 Lidia Resnick 2700 Bay Ave Miami Beach, Florida 33140 SUBJECT° Beautification Committee Congratulations! You have been reappointed by Commissioner Joy Malakoff to the above referenced agency, board or committee for a term ending: 12/31/2015. 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. Sincerely, Rafael E. Granado City Clerk cc: Saul Frances, Parking Director John Oldenburg 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. MIAMIBEACH 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 Lidia Resnick RE: Beautification 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: 12/31/2015. 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 comply with the financial disclosure*requirements of Miami-Dade County or ithe State of Florida (depending on the board or committee on which I serve)on July 1, following the closing of the calendar year on which I have served. Lidia Resnick Sworn to and subscribed before me this ;Lday of V?W , 201 —Mari E. Martinez 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. It q c:n S--NAR—�D AND CONN-0-c—TEE APPUICM TION,fORIV,! • k" SEN C- Last Name First Name Middle Iftitial Tb Or 0'0 1 1`9-r1-7 Home Address City State Zio�CodqZ S> Qore lephone Work Telephone Cellular Telephone Email add-FEiss Business Name Occupation 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: Yes Or No ED • Demonstrates ownership/interest in a business in Miami Beach for a minimum of six months: Yes Zl'or No • Are you a registered voter in Miami Beach: Yes EZIor No D---j • I am now a resident of: North Beach ZIA South Beach � 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?Yes ED 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 ❑Fine Arts Board 0 Normandy Shores Local Government Neighborhood Improvement 0 Art in Public Places Committee ❑ Disability Access Committee ❑Parks and Recreation Facilities Board Z Beautification Committee ❑Gay, Lesbian, Bisexual and Transgender 0 Personnel Board Enhancement Committee(GLBT) ❑Bic cle-Pedestrian Advisory Committee ❑Golf Advisory Committee ❑ Planning Board ❑Board of Adjustment* * 0 Health Advisory Committee ❑Police Citizens Relations Committee 0 Budget Advisory Committee ❑Health Facilities Authority Board 0 Production Industry Council ❑Capital Improvements Projects ❑ Hispanic Affairs Committee ❑Safety Committee Oversight Committee ❑Committee on the Homeless ❑ Historic Preservation Board 0 Single Family Residential Review Panel ❑Committee for Quality Education in MB ❑Housing Authority ❑Sustainability Committee ❑Community Development Advisory ❑Loan Review Committee ❑Tennis Advisory Com,mitteq.-, ❑Community Relations Board 0 Marine Authority ❑Transportation and Parkin mmitt,ee 0 Convention Center Advisory Board ❑Miami Beach Commission for Women 0 Visitor and Convention`Autcority ❑Debarment Committee 0 Miami Beach Cultural Arts Council 0 Youth Center Advisory-'Boardi:10 0 Design Review Board* ❑Miami Beach Human Rights Committee 0 Waterfront Protection'Comr9Crqee 0 Miami Beach Sister Cities Program ::;7 cr� —U Page 1 of 4 °O 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 JI No LJ Dates of Service: 2. Present participation in Youth Center activities by your children:Yes I—D 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 .__.a or No ===All if yes, please explain in detail: • Do you currently have a violation(s) of City of Miami Beach Code?Yes 1-Di or Not– 'If yes, please explain in detail: • Do you currently owe the City of Miami Beach any money?Yes Zl–or No If yes, explain in detail: • Are you currently serving on any City Board or Committee?Yes or No E–D If yes,which board/committee? • In what organization(s) in the City of Miami Beach do you currently hold membership? Name Position 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 0l, spouse Z3–i, child ZD-1 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: Male ' Female Race/Ethnic Categories What is your race? African-American/Black Caucasian/White Asian or Pacific Islander Native-American/American Indian 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;Hispani , Latino/a. No Yes Do you consider yourself Physically Disabled? U No ID 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). • 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 ACCORDINGLY." Applicant's Signature Z ""Name of Applicant(PLEAS PRINT Received in the City lerk's Office b : Y Y am of Deputy Clerk Control No. 5ate 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 "0,1 AAA I B E`AC H City of Miami Beach 1700 Convention Center Drive, Miami Beach, Florida 33139, www.mlamlbeachfl.gov CITY CLERK'S OFFICE CityClerk @miamibeachfl.gov Telephone: 305.6 73.7411 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) • �� � G Board Member's Name: A 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 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 Date F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC Application revised 5-22-13 FINAL.doc Updated:Tuesday,September 24,2013 Page 4 of 4 MIAMI- DE SOURCE OF INCOME STATEMENT a Disclosure for Tax Year Ending Last Name First Name Middle Name/Initial Mailing Address—Street Number,Street Name,or P.O.Box O co City,State,Zip ID Number 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.❑ Mme Filing as an Employee -� R ❑County Employee ❑Municipal Employee, Name of Municipality: - T� Position held or sought �ez (J_' TIM Department where employed T Work address Work telephone Term began on Filing as a Board Member F-1 County Board Member Municipal Board Member, Name of Municipality: 4--e Board where serving Work address Work telephone Term began on is R 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.❑ Name of Source of Income Address Description of the Principal Business Activity aU5 *--— w1 F--e� t) ' \1l utv I hereby swear(or affirm)that the information above is a true and correct statement. RECEIVED BY ELECTIONS DEPARTMENT: ❑ Hardcopy ❑ Electronic Copy Signature of person disclosing Print name Date signed OFFICE USE ONLY Accepted: Y/ N Deficiency: Processed Date/Initials: _Scanned Date/Initials: _ 138 SP-14 ens