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Richard Baron Application PackgeMIAMI BEACH BOARD AND COMMITTEE APPLICATION FORM Last Name First Name EAIrl (\Arwi rd L Middle Initial 33 (O Home Address 94.—W n[i �[( �^ City Home Telephone Work lephone Cellular elephone {A,NotV j CPS l ; ry elk- -A-1 Business Name 110 c. �1�►�� �1-• )i-‘103 Business Address State Zip Code —oho CVOCC1AcAaPA4koN,i4LJ earn Email address Occupation 3 ac,k_ 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::. 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: YestO or No • Demonstrates ownership/interest in a business i Miami Beach for a minimum of six months: Yes • Are you a registered voter in Miami Beach: Yes �! or No • I am now a resident of: North Beach LJ South Beach "KI Middle Beach �l or NoK • 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 Li 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 Office of the City Clerk. E Affordable Housing Advisory Committee ❑ Health Advisory Committee ❑parks and Recreation Facilities Board °O L Public Places Committee 0 Health Facilities Authority Board 0 Personnel Board o dit Committee 0 lispanic Affairs Committee 6 -Planning Board** �j oard of Adjustment " `( CP iistoric Preservation Board* /);� 0 Police Citizens Relations`�ommittee 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 LGBT Advisory Committee 0 Sustainability Committee 0 Convention Center Advisory Board ❑ Marine & Waterfront Protection Authority 0 Transportation, Parking, & Bicycle -Pedestrian Facilities Committee 9 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: q h Type of Professional License�Q. r `�� License Number ©��10% " IS /kJ ) IA License Issuance Date t k** License Expiration Date i"-' 1 I Page 1 of 4 F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 06142016.docx oO 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 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 Nolf yes, please explain in detail: • Do you currently have a violation(s) of City of Miami Beach Code? Yes or Nolf yes, please explain in detail: • Do you currently owe the City of Miami Beach any money? Yes 4 E or Nolf yes, explain in detail: • Are you currently serving on any City Board or Committee? Yes or No 11 If yes, which board/committee? ao � • In what organization(s) in the City of Miami Beach do you currently hold membership? Name n 0 17" 44.0-yi&A-LA Name Position 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 LZ1 or N Which department and title? • Pursuant to City Code Section 2-25 (b): Do you ha - a parent , spouse , child -..i brother or sister EZI who is employed by the City of Miami Beach? Yes or N • ��` 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? African-American/Black Caucasian/White Asian or Pacific Islander Native-American/American Indian Page 2 of 4 F:\CLER\$ALL1aFORMS\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. Do you consider yourself Physically Disabled? N o 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 OFFICE'S, EMPLOYEES AND AGENCY MEMBERS AND ALL OTHER APPLICABLE COUNTY AND/OR STATE LAWS AND STATUTES CORDINGLY." Applicant'. Signature Received in the Office of the City Clerk by: //2--) Date -5✓ Name of A plicant (PLEASE PRINT) "4" 42t/).rr✓% -- //e) Name of Deputy Cl� erk Control No. i'lAV/zr Date 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 06142016.docx MIAMI BEACH City of Miami Beach 1700 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: t&t,64)-o (),1-9-bd 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. // 2 Signature' Date Updated: Tuesday, October 04, 2016 Page 4 of 4 F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 06142016.docx Richard Baton 1wll 11), 11I lr1!;;l,1t111 11ol1,1 Member Since 0178675 Since 1980 Richard Baron has been the managing principal of the Law Firm of Richard Baron & Associates and more recently, Baron, Breslin & Sarmiento. He specializes in Florida Bar and the Florida Board of Bar Examiner issues having represented hundreds of clients successfully. Richard was born on 10/27/45 in New York, NY. He is married to Nikki Baron and has three children; Nicole Goldner, Katherine Nullmlan and Stephen Baron. Mr. Baron graduated in 1967 from the American University with a B.A. in Government and Public Administration and attained his Juris Doctor degree from the University of New York at Buffalo, School of Law, in 1970. He was admitted New York Bar in 1970 and Florida Bar 1974. His employment history includes being a Trial Attorney with the Department of the Treasury 1970-1974 and the Tax Litigator at Greenberg Traurig 1974-1979. He has had his own law practice since 1979 and currently practices under the name of Baron Breslin & Sarmiento. Mr. Baron is Active in philanthropy; Trustee of Temple Beth Torah 1980-1985; Temple Beth Shalom 2001-2003 and Vice President, and Member of the Board of the Genetic Disease Foundation 1980-1984. He is the founder and has been the President of the Friends of the Drug Court, Inc., (FODC) since its inception in 2003. He is the recipient of the Dade County Pro Bono Award, The Sookie Williams Award for Community Service and numerous other awards. He is active in Green Peace and in 1981-1983 was the Commissioner from Antigua to the International Whaling Commission and cast the deciding vote that approved the ban on Commercial Whaling. The Ban is still in effect. Richard understands addiction and the necessary role of the FODC as he himself is a recovering addict and alcoholic since he joined the program on 10/10/85. The Friends of the Drug Court, Inc., is a 501(c)(3) charitable organization that raises and contributes in excess of a quarter of a million dollars annually to the support of the Miami -Dade County, Florida Drug Court as well as to education and housing grants to the participants of the Drug Court. Richard is a Charter member of Florida Lawyer's Assistant Program and monitor to dozens of lawyers with substance abuse issues in Miami -Dade County, Florida. He is the Facilitator of the Caduceus Group of Recovering Professionals under the auspices of Florida Lawyers Assistant Program and has been so since 1995. Since 1985, Richard has helped other addicts and alcoholics since his early recovery. Richard has sponsored numerous recovering addicts and alcoholics in the past 30 years and is responsible for helping countless people stay on the path to long term recovery. As an experienced trial lawyer, Richard represented hundreds of clients with drug and alcohol problems on a pro bono basis. He has been appointed numerous times as a Guardian Ad Litem to assist Family Court Judges in difficult cases with alcohol and drug issues, always without compensation.