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Daniel Novela 12/31/2015 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 2/11/2013 Daniel Novela 5242 Pine Tree Drive Miami Beach, Florida 33140 SUBJECT Miami Beach Cultural Arts Council Congratulations! You have been reappointed by the City Commission 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, R fae4E. ranado City Clerk cc: Saul Frances, Parking Director Gary Farmer 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 Granado,City Clerk Tel: (305)673-7411, Fax: (305)673-7254 Email CityClerk @miamibeach.gov TO Daniel Novela RE: Miami Beach Cultural Arts Council 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 o e board or committ on which I serve)on July 1, following the closing of the calendar year on whi PIlave rved. aniel Novel viy� Sworn to and subscribed before me this day of , 2013. Silvia Prieto 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 oil who live, work and play in our vibrant,tropical,historic community. MIAMI BEACH BOARD AND COMMITTEE APPLICATION FORM - tl��(0- � (C Last Name First Name Middle Initial 5d VO P- CL 3? Home Address City State Zip Code ZF6 S-Y6 J46" �S 7(6 c)L< A Oltljve!�14a, Home Tel phone i L Work Telephone Cellular Telephone Email address Business Name Occupation 13170 6 r( L ff LJ 20U 14(4yu r� � Business Address / City State Zip Code Professional License(describe): �` 6VI 4L c4.x- 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 — • Demonstrates ownership/interest in a business in Miami Beach for a minimum of six months: Yes IZ or No • Are you a registered voter in Miami Beach: Yes ZI or No ID • I am now a resident of: North Beach�J South Beach 0 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�-.a 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 ❑ Normandy Shores Local Government Neighborhood Improvement ❑Art in Public Places Committee ❑ Disability Access Committee ❑ Parks and Recreation Facilities Board ❑Beautification Committee ❑Gay, Lesbian, Bisexual and Transgender ❑ Personnel Board Enhancement Committee GLBT ❑ Bicycle-Pedestrian Advisory Committee ❑ Golf Advisory Committee ❑ Planning Board ❑Board of Adjustment* ❑ Health Advisory Committee ❑ Police Citizens Relations Committee ❑Budget Advisory Committee ❑ Health Facilities Authority Board ❑ Production Industry Council ❑Capital Improvements Projects ❑ Hispanic Affairs Committee ❑Safety Committee Oversight Committee ❑Committee on the Homeless ❑ Historic Preservation Board ❑Single Family Residential Review Panel ❑Committee for Quality Education in MB ❑ Housing Authority ❑Sustainabilit Committee ❑Community Development Advisory ❑Loan Review Committee ❑Tennis Advisory Committee ❑Community Relations Board ❑ Marine Authority ❑Transportation and Parking Committee ❑Convention Center Advisory Board ❑ Miami Beach Commission for Women ❑Visitor and Convention Authority ❑ Debarment Committee TMiami Beach Cultural Arts Council ❑Youth Center Advisory Board °O ❑ Design Review Board** ❑ Miami Beach Human Rights Committee ❑Waterfront Protection Committee ❑ Miami Beach Sister Cities Program 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 LJ 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 I or N If yes, please explain in detail: d • Do you currently owe the City of Miami Beach any money?Yes La or No 0 If yes,explain in detail: •Are you curre ly sing on any City Board or Committee?Yes 17—for No 4J If yes,which board/committee? AE • In what orr7 ganization(s)in the City of Miami Beach do you currently hold membership? C/ d aq Name Position Name Position • List all properties owned or in which xou hav n interg st wiWin he.City of Miami Beach: coffe,NVA 3 3-1/ � `tee � •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 U, spouse U, child U brother La or sister LJ 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? U African-American/Black U Caucasian/White II Asian or Pacific Islander 4�Native-American/American Indian Other—Print Race: Page 2 of 4 r— 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? 'M 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). 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 OFFICER EMPLOYEES AND AGENCY MEMBERS AND ALL OTHER APPLICABLE COUNTY AND/OR STATE LAWS AND STATUTES, C RDI LY." ('� � 3 C�, :� ( --e/t/ zu C)oe�A -A 1 Applicant's Signature Date Name of Applicant(PLEASE PRINT) �= Received in the City Clerk's Office by: o Name of Deputy Clerk Control No. bate 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 M I A M I•DADE SOURCE OF INCOME STATEMENT Please Print or Type First Name Middle Name/Initial Last Name Disclosure CL �-lq F or Tax Year Name: �l d C� ��) Z-- Mailing Address: City/State/Zip: er. Filing as a: ® County Employee: ® Municipal Employee of: Position held or sought: Board where serving:&& mot" - Term or Employmen Began on: v NC t L Department where employed: Work Address: If your home address is exempt from public records pursuant to Florida Statutes§119.07 please check here(read instructions): ® Work Telephone: Home Address: Street Address City State Zip Code Please list below in descending order with the largest source first, the name, address and principal business activity of every source of your income including public salary you received or any person received for your benefit or use during the disclosure period. The income of your spouse or any business partner need not be disclosed. If continued on a separate sheet,check here: Description of the Principal Name of Source qf Income ddress jBusinessActivity ©,�e 1-770 6rl At-,) I hereby swear(or affirm)that the aforesaid information is a true and correct statement. (e �f (3 Signature o person disclosing Date signed I AM BEACH city of Miami Beach, 1700 Convention Center Drive, Miami Beach,Florida 33139, vN w.miamibeochfi.nov CITY CLERK Office CityClerkCmiarnibeachfl.gov Tel: 305.673.741 1 , Fax: 305.673.7254 Acknowledgement of fines/.suspension for Board Mein bers for.failure to comply with Miami-Dade County Financial.Disclosure Code Provision Code Section 2-11.1(1) (2) Board Member name: I understand that no .later than July L 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 Disclosure Requirements..This means that-the members of City Advisory:Boards, whose.sole -or primary:responsibI li -is to recommend legislation or give advice to-the City Commission,must-file,even-though you may have..been recently appointed. You must file one ofthe following with the City Clerk of Miami Beach, 1700 Convention Center.Drive, Miami Beach, Florida,.by.July 1 each:year. 1. A"Source of.Income.Statement' (attached) or 2. A"Financial Statement' (attached(or] 3. A Copy of the person's current Federal income Tax'Return Failure to fife., according to the Miami-Dade:County Code Chapter 1, General Provision, Section 1-5 may subject the.person or firm to a H ne not to exceed .$500.00 or by imprisonment-in the county.jail for.a period not-to exceed sixty clays, or both. Date: Signature: