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Carolyn Baumel 12/31/2015 � I Y l`'��1 A A A I �E d`'a C 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 02-10-2014 Carolyn Baumel 1700 W: 25th Street Miami Beach, Florida 33140 SUBJECT Miami Beach Sister Cities Program Congratulations! You have been appointed by Mayor Philip Levine to the agency, board or committee named above for a term ending: 12/31/2015. Pursuant to Ordinance No. 2006-3543, commencing with terms beginning on or after January 1, 2007, the term of board members who are directly appointed by a member of the City Commission shall automatically expire on December 31 of the year the appointing elected official leaves office. If you are unable to accept this appointment or have any questions, please call the City Clerk's Office at 305-673-7411. Please read the enclosed materials carefully. Congratulations again and good luck. Sincerely, R ael E. Granado City Clerk cc: Saul Frances, Parking Director Desiree Kane 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, 2-458 and 2-459 Ordinance No. 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 Employee We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community. 1 N, B r`� C CATION FO y A Last Name First Name Middle Initial Home Address City c State Zip Code -7-7b Home Telephone Work Telephone Cellular Telephone Email address 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 I—aor No�D— • Demonstrates ownership/interest in a business in Miami Beach for a minimum of six months: Yes IZI or No 10 • Are you a registered voter in Miami Beach: Yes 0 or No E3 • I am now a resident of: North Beach E. South Beach � Middle Beach • I am applying for an appointment because I have special abilities, knowledge and experience. Please list below: T i�1(1� PL)FF U C- f LJ9 CECS ` O M rn i _(° /-iii�NnOc k l^�l/�A-Q(— �`�r M L—1 `i l Y k I (�J S �J L�L�l gs �l.i vl V A , f�'�'A-N K a l3LC O2T(ry J S 1 N I�\/ O w t L � L-©v e .g v i Liz (NCB Rifv —.T. L iR v' o Are you presently a registered lobbyist with the City of Miami Beach? Ye D Y y s �,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 ❑Disability Access Committee ❑Normandy Shores Local Government Neighborhood Improvement ❑Affordable Housing Advisory Committee ❑Fine Arts Board ❑Parks and Recreation Facilities Board Art in Public Places Committee /� ❑Gay, Lesbian,Bisexual and Transgender ❑Personnel Board l Enhancement Committee(GLBT ❑Beautification Committee Golf Advisory Committee ❑Planning Board ❑Bicycle-Pedestrian Advisory Committee ❑Health Advisory Committee ❑Police 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 ❑Sustainabilit Committee ❑Committee for Quality Education in MB ❑Loan Review Committee ❑Tennis Advisory Committee ❑Community Development Advisory Committee ❑Marine Authorit y ❑Transportation and Parkinq Committee ❑Community Relations Board ❑Miami Beach Commission for Women 9visitor and Convention Authority f ❑Convention Center Advisory Board ❑Miami Beach Cultural Arts Council ❑Youth Center Advisory Board ❑Waterfront Protection Committee * Board members are required to file Form 1 —"Statement of Financial Interest"with the State. If you seek appointment to a professional seat (e.g., lawyer, architect, etc.) on the Board of Ad'14strrmnt, Design Review Board, Historic Preservation Board or Planning Board, attach a copy of your currently-effectively,- epxe, andy#urnish the following information: c..._ Type of Professional License License Number License Issuance Date License Expiration Date - Page 1 of 4 F:\CLER\SALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION 46 BOARDS 12-16-2013.doc ; f a cO 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 E—J No IZI 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 EZ3 or No[2(If yes, please explain in detail: • Do you currently owe the City of Miami Beach any money?Yes Zi or No E-4-j If yes,explain in detail: • Are you currently serving on any City Board or Committee?Yes E—D or No a-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 1—D or No Which department and title? • Pursuant to City Code Sec_tion 2-25 (b): Do you have a parent E--j spouse E--3--,, child brother[_:1 or sister ZI who is employed by the City of Miami Beach? Check all that apply. d ONE 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 LM Race/Ethnic Categories What is your race? ED African-American/Black Caucasian/White - Asian or Pacific Islander Native-American/American Indian Other—Print Race: Page 2 of 4 FACLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION 46 BOARDS 12-16-2013.doc Do you consider yourself to be Spanish, Hispanic or Latino/a? Mark the "No"box if not Spanish, Hispanic, Latino/a. No E)Yes Do you consider yourself Physically Disabled? �No 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 88 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." OOLjub( l J/4 CftR,-_oLy" �m-L Appiicant's ignakjre Date ame of Applicant(PLEASE PRINT) //Received in the City Clerk's Office by: p q3,!5 Name of Deputy Clerk Control No. Date 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\3ALL\aFORMS1%BOARD AND COMMITTEES0C APPLICATION 46 BOARDS 12-16-2013.doc -R w DRIVER n IC'ai4SE GLASS E B540-1` -4F-3-902-C, ��-4 3-902-e, CAROLYN P BAUMEL 1700 W 2M ST MIAMI BEAbK M 33140 DOM 11-02-4M SEX.F SAFE ORir/ER operation of a motor vahiele'constitutes consent to any sobrietytest required by law. STATE OF FLORIDA AC- .e7.3 4 6 5 3 2 DEPARTMENT- OF BUSINESS AND , . -PROFESSIONAL REGULATION . . SL619580 09/07/12 128072478 . t REAL ESTATE' SALES ASSOCIATE BAUMEL, CAROLYN I { IS LICENSED under the provisions of Ch.475 FS. Expiration date::SEP 30, 2014 L12090703129 "i i t 9 /\,A 'l BEACH City of Miami Beach 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov 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: A 2 0 L>4,j u NA e L_ 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.htm1 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 16,2013 Page 4 of 4 F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION 46 BOARDS 12-16-2013.doc "IAMI- DE SOURCE OF INCOME STATEMENT Disclosure for Tax Year Ending Last Name First Name Middle Name/Initial Mailing Address—Street Number,Street Name,or P.O.Box 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.❑ Filing as an 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 ❑ County Board Member Municipal Board Member, Name of Municipality: Board where serving Work address Work telephone Term began on 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 fly use�,v t�'e I hereby swear(or affirm)that the information above is a true and correct statement. RECEIVED BY ELECTIONS DEPARTMENT: ❑ Hardcopy ❑ Electronic Copy Signature of p rson 6isclosing 0-A 'l20 L 'N � qu M t /-? Print name Date signed OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/Initials: Scanned Date/Initials: 138-SP-1" 2/13