Michael Adler 12/31/2008
&
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl gov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel 305673-7411, Fox 305-673-7254
01-08-2007
Michael Adler
4549 Pinetree Dr
Miami Beach, Florida 33140
SUEWECT: Beach Preservation Board
Congratulations! You have been appointed by Commissioner Jerry Libbin
to the agency, board or committee named above for a term ending: 12/31/2008.
Pursuant to Ordinance No. 2006-3543, commencing with terms beginning on or after
January 1st, 2007, the term of board members who are directly appointed by a member of
the City Commission shall automatically expire on December 31 of the year the appointing
elected official leaves office.
If you are unable to accept this appointment or have any questions, please call the City
Clerk's Office at 305-673-7411. Please read the enclosed materials carefully.
Congratulations again and good luck.
Sincerely,
'~Rd~;('f'
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Jordanna Rubin
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ATTACHMENTS:
1. City Code Ordinance section, applicable to agency, board or committee
2. General Provisions of Ordinance NO.97-3086 Amended by Ordinance No. 2006-3543
3. Ordinance No. 97-3105
4. Citywide parking permit application - Return completed application to the Parking
Department located at Palm Court Building, 309 23rd Street, Suite 200 - Tel: 305-673-7505
5. Guide to the Sunshine Amendment and Code of Ethics for Public Officers and Employe
6. Miami Beach Code Section 2-459
7. Miami-Dade County Code Section 2-11.1
I, i'C' ure (~::':'T:i;\':<1 pr',,\/'~In:.~ i;")fCt.:"";,I,;".:ri;' l.:d:i:( :,e"";'.-e ,,'::,\;' .~:~dl.:-""" :" '.o"hc) i;-.'e, ~'V'Ork. !Jnd piGI' in .'~<.ii VdJiCJf1i, :I~)pi(()!. hi:..toric communiiy'
&
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, wwwmiamibeachflgov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel 305-673-7411 , Fox 305-673-7254
TO Michael Adler
RE: Beach Preservation Board
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: 12/31/2008.
I 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 theFlorida Commission on Ethics Guide to the Sunshine
Amendment 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 finaAcial disclosure* require-
ments of Miami-Dade County or the State of Florida (depending on the board or committee on which
I serve) on July 1 st, following the closing of the calendar year on which I have served.
Deputy Clerk
*Please visit the City of Miami Beach website at www.miamibeachfl.gov under City Clerk/Board and Committees
for additional information regarding the Financial Disclosure Requirements.
,~c:n,rT,'i,;\'o'd ,'() p.retvid;ng (\)lc,:.,i!!.:."_:rrt
-,-, ,--",ho i!ve, \"'/ork, unci pfo}i in \ldxoni,
historic communii'y'.
lD
IB
CITY OF MIAMI BEACH
BOARDS AND COMMITTEE APPLICATION FORM (") ~
--l c::::I
Pursuant to City Code section 2-22(4) a and b: Members of agencies, boards, and committees shall be affiliatect witge ~this
requirement shall be fulfilled in the following ways: a) an individual shall have been a resident of the city for a minimfim of ~ mo~s; or
b) an individual shall demonstrate ownership/interest for a minimum of six months in a business established in the c~ N ':
r.' -.l . n
Resident of Miami Beach for a minimum of six (6) months: Yes )i'or No 0 ;::;<:
Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six (6) months: Yes~ or No 0 U) ~
<
m
o.
~
I am applying for a Board appointment because I hav special abilities, knowledge experience: Yes-g
My special abilities, knowledge, or experience is: ns ~ 0 10
Are you a registered voter in Miami Beach: Yes 'Itf or No 0
ADle/L.
Last Name
NAME:
H 1~(}eL
First Name
k
Middle Initial
Home:
lf5V9 .(J//J.(l., 1r-te- ])/l,r\/L M/m,,' g~~. U ~3/Yb
No. Street City State Zip Coae
'5 ~ ~ . 4~J~ ('OS) ., q 2. LIDO J t3()~j 3CIl.-l/Wy h)AOL.etl@ ~C~
Work Fax Emall address d
Address:
Phone: ~ 305)
Home
(Please check one): ! am now a resident of: North Beach 0 South Beach g Middle Beach 0
CJh\. a'/"'fA~
K.
State
?'~/72.
Zip Code
Business Name:.A~\-tL Gro\AP Applicant's Position: e.G.-O
Address: I \fOD NW (01 Ave- M ,'AMi
No. Street City
~ Owner D Stockholder/Shareholder D Corporate Officer D Other Explain:
Professional License (describe)
Attach a copy of the license listed above.
e~w e~cAw
Expires:
1. Have you ever been convicted of a felony: Yes D or No g If yes, please explain in detail:
2. Do you currently have a violation(s) of City of Miami Beach codes: Yes D or No$ If yes, please explain in detail:
3. Do you currently owe the City of Miami Beach any money: Yes D or No)i. If yes, explain in detail
4. Are you currently serving on any City Boards or Committees: Yes 0 or No l8,. If yes; which board?
What organizations in the City of Miami Beach do you currently hold membership in?
Name: \ ) P
Tern pIe. E rn~"'lA -E' I Title: V) c..e - reS I dp-yj{) E. Xe eu{, vc &1"/1'7'
,
Name: M Du ()( 5"'1' fl a..:. I H 06' f II c~../ Title: 0 f~ Ice V-- ) E.x e ~Jfl Ve..- C!.-O m m .
Lis~~~~rtie~ or~t or~eea~ int1)~\j~t a~:t;~ed within the City of Miami Beach:
I am now employed by the City of Miami Beach: Yes D or No~ If yes, which department?
F:ICLERI$ALLIB&C Application\B&C Application Revised 091106.doc
Pursuant to City Code Section 2-25 (b): Do you have a parent 0, spouse 0, child 0, brother 0, or sister 0 who is employed by the City of Miami
Beach? Check all that apply. Identify the department(s):
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. (Regular Boards of City)
D Housing Authority*
D Loan Review Committee*
D Marine Authority*
D Miami Beach Cultural Arts Council
D Miami Beach Commission on Status of Women
D Miami Beach Florida Sister Cities
D Normandy Shores Local Gov't Neigh. Improvement
D Oversight Committee for General Obligation Bond
D Parks and Recreation Facilities Board
D Personnel Board*
D Planning Board*
D Police Citizens Relations Committee
D Production Industry Council
D Public Safety Advisory Committee
D Safety Committee
D Transportation and Parking Committee
D Visitor and Convention Authority*
D Youth Center Advisory Board
*Board Required to File State Disclosure form
Note: If applying for Youth Advisory Board, please indicate your affiliation with the Scott Rakow Youth
Center:
1. Past service on the Youth Center Advisory Board: Yes D No ~ears of Servi9El:
2. Present participation in Youth Center activities by your children YesD No EVTf yes, please list the names of your children, their ages,
and which programs. List below:
Child's name: Age: _ Program:
Child's name: Age: _ Program:
This section is "not required" but desired: Age: 5,f)years old Gender: Male ~
Ethnic Oljsin (Check one)
White ~frican-American'Black 0 Hispanic: 0
Asian or Pacific Islander 0 Amerjcan Indian or Alaskan Native 0
Employment Status: Employed wRetired 0 Home-maker 0 Other 0
D Art in Public Places Committee
D ~arrier Free Environment Committee
~Beach Preservation Board
D Beautification Committee
D Board of Adjustment*
D Budget Advisory Committee
D Committee on Homeless
D Committee for Quality Education in MB
D Community Development Advisory*
D Community Relations Board
D Convention Center Advisory Board
D Convention Center Capital Projects Oversight
D Debarment Committee
D Design Review Board*
D Fine Arts Board
D Golf Advisory Committee
D Health Advisory Committee
D Health Facilities Authority Board
D Historic Preservation Board*
Female D
ttest to the accuracy and truthfulness of the application and have received, read and will abide by Chapter 2,
- of he Ci .. ards of Conduct for City Officers, Employees and Agency Members."
/2..,22,..Q(,---M }.cW-A.eL M. A~\.etL-
Date Name of Applicant (PLEASE PRINT)
Attachment: Please attach a copy of your resume to your application.
NOTE: Applications will remain on file for a iod of one (1) calendar year.
Received in City Clerk's Office
Document Control Number (Assign d b
F:\CLER\$ALL\B&C Application\B&C Application Revised 091106.doc
Entered By
Date
Date
2
- ---
'-u..:,...
-' .t?c~~fSTAtr6'.eF,FLORIDA
. - .
:DEPAR~ Q~.i Bt1).nfEs~M$ piislEssrroNAt REGULAT10N
. "<?ONSTR.~~l'ON~~~%Jt'RYlr~cCENSINGBOARD SEQ# LO 60 8260 118.7
: . LIC~NSE._NBR
FS.
. '. _ _.' __.___0 ___ _ -_ .
ADLERr.MICH~EI,L.Mc,.i .......
ADLER GROUP CONSTRUCTION
1400 NW 107TH AVE
MIAMI
JEB BUSH
GOVERNOR
SIMONE MARSTILLER
SECRETARY
DISPLAY AS REQUIRED BY LAW
5T A TE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULA_iON
CONSTRUCTION INDUSTRY LICENSING BOARD
1940 NORTH MONROE STREET
TALLAHASSEE FL 32399-0783
(850) 487-1395
ADLER GROUP CONSTRUCTION,INC
1400 NW 107TH AVENUE 4TH FLOOR
MIAMI FL 33172
.
. STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND
. ...~~. PROFESSIONAL REGULATION
AC# 2 8 7 0 Y 7 7
QB0020174
10/03/06 060204343
QUALIFIED BUSINESS ORGANIZATION
ADLER GROUP.CONSTRUCTION,INC
(NOT A LICENSE TO PERFORM WORK.
ALLOWS COMPANY TO DO BUSINESS IF
IT HAS A LICENSED QUALIFIER.)
IS QUALIFIED under the provisione of ch.489 FS.
.lIxpi:::ation date: AUG 31, 2007 L06100300328
DETACH HERE
r"C# 2 8 7 0 4 7 7
5T A TE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD SEQ#L06100300328
~89 FS..
WORK~ THIS ALLOWS
HAS A QUALIFIER.}
JEB BUSH
GOVERNOR
D~Pt_A.Y AS REQUIRED BY LA"N
SIMONE MARSTILLER
SECRETARY