Loading...
Dale A. Gratz board and committee application MIAMI BEACH BOARD AND COMMITTEE APPLICATION FORM C--V-r,r1+z Last irarrig First Name Middle Initial a/S F. San 612,hiroVtr M13, FY �3,3 1�3 9 Home Address City State Zip Code 1�3 tot r-a+ e4- 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 01,0'r No • Demonstrates ownership/interest in a business inMiami Beach for a minimum of six months: Yes�_.J or No •Are you a registered voter in Miami Beach: Yes 0or No �_.J , • I am now a resident of: North Beach �J South Beach LJ Middle Beach vr • I am applying for an ap ointment becau e I have special abilities, knowledge and experience. PI ase list below: , •Are you presently a registered lobbyist with thle 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 Committee Centennial Celebration ❑Health Advisory Committee ❑Parks and Recreation Facilities Board°O Affordable Housing Advisory Committee ❑Health Facilities Authority Board ❑Personnel Board ❑Art in Public Places Committee ❑Hispanic Affairs Committee ❑Planning Board ❑Board of Adjustment* ❑Historic Preservation Board ❑Police Citizens Relations Committee ❑Budget Advisory Committee ❑Housing Authority ❑Production Industry Council ❑Committee on the Homeless ❑Marine&Waterfront Protection Authori ❑Sustainability Committee ❑Committee for Quality Education in MB Miami Beach Commission for Women ❑Transportation,Parking,&Bicycle-Pedestrian Facilities Committee ❑Convention Center Advisory Board fMiami Beach Cultural Arts Council ❑Visitor and Convention Authority ❑Design Review Board* ❑Miami Beach Human Rights Committee ❑Disability Access Committee ❑Miami Beach Sister Cities Program ❑Gay,Lesbian,Bisexual and Transgender ❑Normandy Shores Local Government Enhancement Committee GLB Neighborhood Improvement * Board members are required to file Form 1 —"Statement of Financial Interest"with the State. *1f you seek appointment to a professional seat(e.g., lawyer, architect, etc.) on the Board of Adjustment, Design Review Board, Historic Preservation Board or Planning Board, attach a copy of your currently-effectively license, and furnish the following information: Type of Professional License License Number License Issuance Date License Expiration Date 1S 11E � L IAN h101 Page 1 of 4 F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEESSC APPLICATION REVISED.docx } V °O Note: If applying for the Youth Center positions of the Parks and Recreations Facilities Board, please indicate your affiliation with the Scott Rakow Youth Center and/or the North Shore Parks Youth Center: • Please describe your past service with the City's Youth Centers(include dates of service): • Present participation in Youth Center activities by your children:Yes ID No U 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 I1 or No 10 If yes, please explain in detail: • Do you currently have a violation(s)of City of Miami Beach Code?Yes ID or N flf yes, please explain in detail: • Do you currently owe the City of Miami Beach any money?Yes Zi or No If yes,explain in detail: •Are you currently serving on any City Board or Committee?Yes 0"Or No ID If yes,which board/commift wt-• In what organization(s)in the City of Miami�Beach do you currently hold membership? °�' Ord�' '�'�'� 4 i -Pe_ ro to M 6ez I~ c7r Q l Uc1'�'`�, Cl-)U.r)C l D-:P t` h Cep®m t0 r-� Na e I -/ Position-Pw Name !Z.G' r�l S n'1-e r&-,s !n P*tsbvp • 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 �, spouse U, 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 co ply with City diversity reporting requirements. Gender: Male LJ Female Race/Ethnic Categories What is your race? 1 , frican-American/Black Caucasian/ White Asian or Pacific Islander �1 Native-American/American Indian Other-Print Race: Page 2 of 4 F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED.docx Do you consider yourself to be Spanish, Hispanic or Latino/a?Mark the "No"box if not Spanish, Hispanic, Latino/a. &dNo : 1 Yes Do you consider yourself Physically Disabled? 4; No ZJ 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." �. a of - Applicant's Signature Da e Name o pplican (PLEASE PRINT) Received in the City Clerk's Office by Name of Deputy Clerk Control No. Date PLEASE 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 REVISED docx MIAN/\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: L2 IC . 6�72: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" 2. A "Statement of Financial Interests (Form 1)" 3. A Copy of your latest 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. /0&_�2LD 1��, f 11`2 Signature Date Updated: Monday,June 02,2014 Page 4 of 4 F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED.docx G e-J ! A�/")O co/n3 r m 0, s ti-f- No rr el I ss ct hd Zvi iq vu,� �' �► ��cem ��r � ao /y, � Cyan-f i n -4-v �o /� n �-e��- !n T rr-i � l� ��4fi Shd /om .s mon-� hl(� �c� z�r�" F� ��'n9 � h � n a r--y��)C)?��� �a � Q n c4 G o n-f-�` n u e. 0. s cz� c-c�o r J-c�►-� -Pa r- ctI l C-0,(ec-�-i`o n s 0 n m) Pea cl),� 5 }eF- vim on __jh�- s �holarshi (� comm' �� e_, -for- Goon ci / off' �1et,6r s 6� 1"'c-own c �oOrr � pat,fIc. QI ,`5 4-r-,1 b Le +10 n (JJ r-xn i,> ,n60or--th "0�),n9 Aout the Honorees } r 441 Jo Asmundsson June Gross Jo Asmundsson has been making a difference in Miami Beach Dedication to our community and long hours of volunteer since she first arrived here 25 years ago. After leaving her native service are the reasons we are honoring Jane Dee Gross as a England (where she was a CEO of 5 companies!), Jo has served Miami Beach "Woman worth Knowing". Jane relocated to as board member and treasurer of the Miami Dade Gay &Lesbian Miami Beach in the early - 80's after a successful Corporate Chamber of Commerce and remains an active member. She is Marketing Career in Connecticut to work on many historic also a member of the board of Friends of the Miami Public Library preservation projects from the first Hotel Restoration on Ocean System and actively helps them with their book sales each year. A Drive, the Carlyle Hotel, to the first nightclub project, Club Z constant presence at Miami Beach's city hall, Jo was in her 5th (now Mansion) to the first commercial restoration and the year serving as president of the Miami Beach Taxpayers 1939 H & S Kress Building at 12th street and Washington Association and as co-chair of the governmental committee of the Avenue; met and married not yet Commissioner Saul Gross in Miami Beach Chamber of Commerce when she resigned to run for the late 80's and gave birth to Jonathan in 1990. Anonymous Miami Beach City commission. Among her proudest achievements benefit projects have always been Jane's favorites however, is getting 3000 votes and coming in 3rd in the race where she was she regularly volunteers for a wide variety of civic 1 woman against 6 men. She has served on the board of WLRN organizations; Temple Beth Shalom, Daily Bread Food Bank, (our local National Public Radio affiliate) for 3 years and hers is Community Partnership for the Homeless, New Life Family one of the voices you hear in their on-air fundraising drives. Jo Shelter, American Cancer Society, WLRN Radio Reading has also been a reader with WLRN's Radio Reading Service for 16 Services for the Blind, Miami Dade School System. She is a years. Jo takes great pride in having worked on the gubernatorial Board member of People Acting for Community Together campaigns of both Janet Reno and Bill McBride. Now, Jo serves (PACT), Miami Design Preservation League and the Miami on the Miami Beach Community Development Corp. where she Beach Community Health Center. A favorite quote of Jane's devotes her time and talent to supplying affordable housing in the is "Life is what happens to you when you're busy making other City of Miami Beach. Jo sums up her philosophy by saying "I plans"John Lennon 1980. usually go for people who've been given the wrong end of the stick." We are proud to introduce you to Jc Assmundson, a kind, Merle Weiss passionate, very funny woman - quite worth knowing. erle Weiss might be the most photographed worn on mi Beach. She is a South Beach institution, riginal, Dale Gratz inte ing and involved. She moved to Miami Bea in 1985 Ms. Gratz has lived in Miami Beach for over 40 years. She and her f prominent ganizations husband have three children and five grandchildren. Ms. Gratz ural Arts C uncil, DASH, received her degree from Sophie Newcomb College (today part of enter Sou Florida, Miami Tulane University) and spent several years as a social worker in esbian F' Festival, Dade New Orleans and Chicago. Throughout her 40 years on Miami Miami each Art in Public Beach, Ms. Gratz has never hesitated to give of herself to her a she ets things done. With community. She began her volunteer efforts with the National t o y knows how to make Council of Jewish Women and today is a lifetime member of that b she knows how to have organization. She served as a Guardian Ad Litem for 11 years, and/or planning committee advocating on behalf of abused and neglected children. Dale has onian FIU Museum, Miami volunteered in area public schools and served as a mentor for at- um of Contemporary Art and risk students. She has served on the Board of Trustees and the S her community involvement, School Board for Temple Beth Sholom, in addition to volunteering mi Beach retail industry. She in the synagogue's monthly "Feeding the Hungry" program for the Road in 1990, when the past 15 years. Eight years ago Dale signed on as poll worker we afraid to venture there earning minimum wage "to help make voting a more pleasant i a#alys that helped bring the experience" for the citizens of Miami Beach. Also, Ms. Gratz is a , , °i'� i,�' worke for Av-Med Health long-time member of the Commission on the Status of Women ernment. arried to Danny, until she was recently "termed out". We were sorry to see her go - sons and a randmother of but happy to honor her tonight. For Ms. Gratz is one of those five. Merle as always had an interest in others nd believes quiet, tireless worker bees. When told she would receive this in the po r of individuals to change the world. u will see award, she was shocked, overwhelmingly honored and most of all, Merle all the best and most important eve is and humble. "I've never done anything big or spectacular." However happe ings. If you want to go places you need to know her outlook on life sums it all up: "I've always felt fortunate in my Me r With sparkle and dazzle and the moxie to get t 'ngs life and felt I had to give back in some way or I would not be able d ne Merle Weiss is not only a Woman Worth Knowing she is to live with myself." woman everyone wants to know.