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Andres Asion Application PackageCITY OF MIAMI BEACH BOARD AND COMMITTEE APPLICATION FORM AsionAndres NAME: First Name Last Name Middle Initial FL33139 HOME ADDRESS : 1000 S Pointe Dr Apt 2204Miami Beach Home No./StreetState Apt No.City Zip Code AAsion@FortuneIntlGroup.com 305-351-1000 PHONE : WorkEmail Address Home Vice President of Sales Business Name: Fortune Development Sales Position: 1300 Brickell Avenue MiamiFL33131 Address: State CityZip Code Street Pursuant to City Code section 2-22(4) a and b: Members of agencies, boards, and committees shall be affiliated requirement shall be fulfilled in the following ways: a) an indi   months; or b) an individual shall demonstrate ownership/interest Yes No Yes circle one): I am now a resident of:  18 years of Real Estate experience, lifelong beach resident, und No 123Please note that only three (3) Please list your preferences in order of ranking [] first choice [] second choice, and [] third choice. choices will be observed by the City Clerk’s Office. (Regular Boards of City) Choice 1:Planning Board Choice 2:Design Review Board Choice 3: Convention Center Advisory Board Note: If applying for Youth Advisory Board, please indicate your aff 1. Past service on the Youth Center Advisory Board: No Years of Service: if yes, please list the names of your children, their No 2. Present participation in Youth Center activities by your chil ages, and which programs. List below: No Have you ever been convicted of a felony:If yes, please explain in detail: Do you currently have a violation(s) of City of Miami Beach code No If yes, please explain in detail: Do you currently owe the City of Miami Beach any money:No If yes, please explain in detail: Yes Are you currently serving on any City Boards or Committees:If yes, which board? Community Relations What organizations in the City of Miami Beach do you currently h NameTitle Chamber of CommerceMember List all properties owned or have an interest in, which are loca Property 1000 S. Pointe Dr #2204 Miami Beach, FL 33139 450 Alton Rd #4004 Miami Beach, FL 33139 400 Alton Rd #3007 Miami Beach, FL 33139 265 Palm Ave Miami Beach, FL 33139 No I am now employed by the city of Miami Beach:Which department? The following information is voluntary and is neither part of yo being asked to comply with federal equal opportunity reporting r Gender:Male Race/Ethnic Categories What is your race? Mark one or more races to indicate what you consider yourself t White Other Description: Are you Spanish/Hispanic/ Latino? Mark the "No" box if not Spani Yes Physically Challenged:No NOTE:  If appointed, you will be required to follow certain laws which These laws include, but are not limited to, the following:    Prohibition from directly or indirectly lobbying city personnel o    Prohibition from contracting with the city (Miami-Dade County Co o    Prohibition from lobbying before board/committee you have served o Beach Code section 2-26).    Requirement to disclose certain financial interests and gifts (M o (re: CMB Community Development Advisory Committee):  prohibiti from having   any interest in or receiving any benefit from Co or those with whom you have business or immediate family ties Upon request, copies of these laws may be obtained from the “I hereby attest to the accuracy and truthfulness of the applica VII – of the City Code “Standards of Conduct for City Officers, I Andres Asion agreed to the following terms on 12/9/2015 5:27:5 Received in the City Clerk's Office by: Name of Deputy Clerk Control No.Date