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Michael Perlmutter Application Packagev11AMI BEACH BOARD AND COMMITTEE APPLICATION FORM Last Name First Name Middle Initial fER Ak_u_ 1 Home Address 1)01A) -71 p City pi lei 1 B McL State FL. 1 O c S o �—r L l o 1 A)-71 D 2 3761 '7 3 •000 - r7 ?aS- Zip Code 33i3ct f ' =.49 Hornee Telephone Work Telephone E'R( h) R2T, e_ Business Name 151 ibL Cellular Telephone Business Address Email address c mu-RANOtt;ktg Occupation Taitc5 City State 6'6-73-3 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 or No zi • Demonstrates ownership/interest in a business i Miami Beach for a minimum of six months: Yes or No • Are you a registered voter in Miami Beach: Yes or No • I am now a resident of: North Beach ZI South Beach P r Middle Beach ZI • I am applying for an appointment because I have special abilities, knowledge and experience. Please list below: fl Co ,i.te ! o f v o .� ,�. p Iv / L t S .stj e-i`E 60-4-044e15 , t 494'.,;c • Are you presently a registered lobbyist with the City of Miami Beach? Yes or NoZI 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 Office of the City Clerk. ❑ Affordable Housing Advisory Committee ❑ Health Advisory Committee 0 Parks and Recreation Facilities Board oO ❑ Art in Public Places Committee 0 Health Facilities Authority Board 0 Personnel Board 0 Audit Committee 0 Hispanic Affairs Committee 0 Planning Board** 0 Board of Adjustment ** 0 Historic Preservation Board * 'Police Citizens Relations Committee / 0 Budget Advisory Committee 0 Housing Authority 0 Production Industry Council 0 Committee on the Homeless 0 Human Rights Committee 0 Sister Cities Program 0 Committee for Quality Education in MB 0 LGBTAdvisory Committee PSustainabi:,ity Committee 2- 0 Convention Center Advisory Board `g Marine & Waterfront Protection Authority 3 0 Transportation, Parking, & Bicycle -Pedestrian Facilities Committee 0 Cultural Arts Council 0 Miami Beach Commission for Women 0 Visitor and Convention Authority ❑ Design Review Board * 0 Normandy Shores Local Government Neighborhood Improvement 0 Youth Commission 0 Disability Access 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 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 /L/i/1 License Number License Issuance Date License Expiration Date Page 1 of 4 F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 06142016.docx °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: N T� Please describe your past service with the City's Youth Centers (include dates of service): N4 - Present participation in Youth Center activities by your children: Yes 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 or No If yes, please explain in detail: • Do you currently have a violation(s) of City of Miami Beach Code? Yes or NoU If yes, please explain in detail: • Do you currently owe the City of Miami Beach any money? Yes [ or No aIf yes, explain in detail: • Are you curre tly serving on any City Board 9% Committee? Yes' or No If yes, which board/committee? �zti L, c . ( CT"; `L0-3 Kt_ L,t.74.-'),4-..7 CP • In what organization(s) in the City of Miami Beach do you currently hold membership? 5 bFfuft /2 • ru 1iErc Name Position Name Position • List all properties owned or in which you have an interest within the City of Miami Beach: 140P.a— /l o< ��` 2. 1tic�. ��e I 33, L'7 • Are you now employed by the City of Miami Beach? Yes Ej or No W, Which department and title? • Pursuant to City Code Section 2-25 (b): Do you have a parent La, spouse LA, child brother or sister who is employed by the City of Miami Beach? Yes ZIor No 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 askedto comply with City diversity reporting requirements. am' Gender: Male lFemale Li Race/Ethnic Categories What is your race? Lj African-American/Black Caucasian/White I —�, Asian or Pacific Islander LZ9 Native-American/American Indian Page 2 of 4 F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 06142016.docx Other — Print Race: �! Do you consider yourself to be Spanish, Hispanic or Latino/a? Mark the "No" box if not Spanish, Hispanic, Latino/a. ZNo Yes Do you consider yourself Physically Disabled? a 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: o 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). o 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). o Requirement to disclose certain financial interests and gifts (Miami -Dade County Code section 2-11.1). o 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). o 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. o 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." Applica'htSignature Received in the Office of the City Clerk by: Date 0/ovi Name of Applicant (PLEASE PRINT) Name of Deputy Clerk //0316 Control No. Da e 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\$ALL1aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 06142016.docx MIAMI BEACH City of Miami Beach 1 700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov OFFICE OF THE CITY CLERK 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: I 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. !(-a?-PD/b Signature Date Updated: Tuesday, October 04, 2016 Page 4 of 4 F:\CLER\$ALL1aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 06142016.docx MICHAEL PERLMUITER 1000 South Pointe Drive #3701 Miami Beach, Florida 33139 Home Phone 305 535 9752 Mobile Phone 732 600 7825 OBJECTIVE: To continue my involvement in community service in my present home municipality QUALIFICATIONS I own and operate a chain of high-volume supermarkets in New Jersey and employ nearly 3000 employees. I have also served as a member of the NJ State Ethics Committee serving in a mediating position between attorneys and clients. I believe that my many years of experience in personnel matters gives me the ability to understand the complexities involved in running a City Government. MILITARY SERVICE 1966-1968: Served in the United States Army Presidential Honor Guard, Ft. Meyer, Arlington, Virginia EDUCATION Graduate: Lakewood High School, Lakewood, New Jersey Graduate: Rider University, Lawrenceville, New Jersey 1965 BS in Commerce EMPLOYMENT 1968 -present: Sr. Vice President, Perlmart, Inc., 954 Route 166, Toms River, NJ 08753. Perlmart, Inc. owns and operates a chain of Shoprite Supermarkets in Ocean County, New Jersey. Past Adjunct Professor: Ocean County College COMMUNITY SERVICE 2010 Graduate, Citiizens' Police Academy, Miami Beach Class No. 40 PAGE 2 - MICHAEL PERLMUTTER Served as Secretary of New Jersey State 200 Club, an organization dedicated to helping State and local police officiers and their families. Lay member, NJ State Bar Ethics Committee, appointed by Governor, of New Jersey for numerous terms Past Chairman, Environmental Committee, Wakefern Food Corporation over 300 Supermarkets. Member, Wakerfern Labor Relations Committee: served as a contract negotiator dealing with numerous retail trade unions with membership of more than 25,000 employees. Volunteer member, First Aid Squad of Ocean County, NJ: served as an ambulance driver and EMT for many years. Past President, Ocean County Chamber of Commerce: This position gave me experience in dealing with community and government agencies. Past Member Board of Directors, Murano at Portofino, a condominium in Miami Beach, FL. Served as both a Secretary and President of the Association. Past Treasurer, SOFNA neighborhood association in Miami Beach. Miami Beach Committees: Personnel Board, eventually Chairman. Police Citizens Advisory Council. PERSONAL Married to Marlene Perlmutter Personal interests: Golf, Boating, Reading November 03, 2016