Jerry Marsch 12/31/08
~
City of Miomi Beach, 1700 Convention Center Drrve, Miami Beach, Florida 33139, wwwmiamibeochflgov
OFFICE OF THE CITY CLERK, Robert Porcher, City Clerk
Tel 305-673741 1, Fax 305-673-7254
01-16-2007
Jerry Marsch
6900 Bay Dr. #10-1
Miami Beach, Florida 33141
i.iI'lir~' Safety Committee
Congratulations! You have been appointed by Mayor David Dermer
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.
~r~f~Jif1'
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Ron Caplan
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
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City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, wwwmiamibeachfl.gov
OFFICE OF THE CITY CLERK, Robert Porcher, City Clerk
Tel 305-673-7411, Fax 305.673-7254
TO Jerry Marsch
RE: Safety Committee
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 financial 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.
.C\ fl. . -. ... ~~-kn.-
i~f~L~rry Marsch
Sworn to and subscribed before
*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.
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"0 '.vr?G J.i\'e. "'."lO!t oncl
in vib!(J()i, r1opicof.. historic commu{Jiiy
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MIAMI BEACH
BOARDS AND COMMIITEE APPLICATION FORM
Pursuant to City Code section 2-22(4) 0 and b: Members of agencies, boards, and committees sholl be affiliated with the city; this requirement ~
be fulfilled in the iollowing ways: 0) on individual sholl hove been 0 resident of the city for 0 minimum of six months; or b) on indiVidual s
demonstrate ownership/Interest for 0 minimum of SIX months in 0 business established In the city.
Resident of Miami Beach for 0 minimum of six (6) months: Yes Pel or No [ ]
Demonstrate on ownership/inferest in a business in Miami Beach for a minimum of six (6) months: Yes! 1
10m applying for 0 Boord appointment because I have special abilities, knowledge, experience: Yes i)(
My special abilities, knowledge, or experience is: _S~ "j ~
Are you a register. d ~oter in Miami Beach: Yes~r No 0 \ '
NAMEN 1("" ff. 11 <-J-Pt'V' ~
L st Name 4-( {Q First N me .
Home b!lo 0 ~(t-r Dk E Yv1/t; WAf 1>f;M f-I
Address: No, Street City
or No Xl
Middle Initial
f~-I1
State
Zip Code
Phone: 3x? )
Home
ob')
30 "to ~
Work
--
Fax
Email address
(Please check one): I am now a resident of:
North Beach 0 South Beach 0 Middle Beach 0
Business Name: v
Applicant's Position:
AddresS:---'
No.
Street
City
State
Zip Code
DOwner 0 Stockholder/Shareholder 0 Corporate Officer 0 Other Explain:
Professional License (describe): Expires:
Attach a copy of the license listed above.
- --- - ------
1, Have you ever been convicted of a!~IQQY;..Y~-N0-8*yes,-pte'c:iseexpTa'i~-'i~ detail:
2, Do you currently have a ~olatiOn(S} of C~ Miami Beach codes:~ 0 or N~ If yes, please explain in detail:
3, Do you currently owe the City of Miami Beach any money: Yes 0 or ~.
If yes, explain in detoil:
4. Are you currently serving on any City Boords or Comrnittees: Yes 0 or N~
If yes; which board?
What organizations in the ~ity of Miami Beach do you ~~rrently hold .:embe~~7 in?
Name~(; f "') VVl!OJfc {"It i'1G. [3:>t'f1cc--.pn;-'/Tit,r'--Uls
Name: ~-.._----_. Title: ----..._....
List 0/1 properties owned or have an interest in, which are located within the City of Miami Beach:
. -:;--...
~ Z'uO 'b.~ '\' D jz !;t /01-
C\DOCUMENTS AND SETTINGS\ClERGIBE\LOCAL SETTINGS\ TEMPORARY INTERNET FILES\OLK] 4\BC APPLICATION NOV 20051 DOC
I am now employed by the City of Miami Beach: Yes 0 or No"'~:Y/lf yes, whdl oeporlmenl2
.. \..
Pursuant to City Code Section 2-25 (b) Do you hove a parent OJ, spouse~J, I~J, brother OJ, or sister 0] who is
employed by the City of Miami Beach2 Check all that apply. Identify the d{p'a1~4}t(J): ___~___
Pleose list your preferenc!":'s in order of ranking [1] first choice [2] second choice, and [3] third choice. Please nate that only
three (3) choices will be observed by the City Clerk's Office.
Reqular Boards of City)
o Art in Public Places Committee OHousing Authority
o Barrier Free Environment Commitiee OLoan Review Committee.
o Beach Preservation Board OMarine Authority .
o Beautification Committee OMiami Beach Cultural Arts Council
o Boord of Adjustment (Flood Management) · OMiami Beach Commission on Status of Women
o Budget Advisory Committee OMiami Beach Florida Sister Cities
o Committee on the Homeless ONormandy Shores Local Gov. Neighborhood Improvement
o Committee for Quality of Education in Miami Beach ONorth Beach Youth Center Oversight Committee
o Community Development Advisory Committee. OOversight Committee for General Obligation Bond
o Community Relations Boord OParks & Recreational Facilities Board
o Convention Center AdVISOry Board o Personnel Board ·
o Debarment Commitiee o Planning Board ·
o Design Review Board · o Police Citizens Relations Committee
o Fine Arts Board o Production Industry Council
o Golf Advisory Committee o F'ublic Safety Advisory Committee
o Health Advis~ry Committee 'J;<t:Safety Committee
o Health Facilities AuthOrity o Transportation & Parkinq Committee
OHispanic Affairs Committee o Visitor & Convention Authority ·
OHistoric Preservation Boord · o Youth Center Advisory Boord
*Board Required to File State Disclosure form
Note: If applying for Youth Advisory Boord, please indicate your aHiliation with the Scott Rakow Youth
Center:
1. Past service on the Youth Center Advisory Boord: Yes 0 No ~ Yeors of Service 0
2, Present participation in Youth Center activities by your children Yes 0 No D. If yes, please list the nomes of your children,
their ages, and which programs. List below:
Y\. \F\ .
Child's name:
Child's name:
Age: _ Program:
Age: _ Program:
This section is "not required" but desired: Age: 0
Ethnic Origin (Check one)
White):l Africon-American/Black 0 Hispanic: 0
Asian or Pocific Islander 0 AmericanJn'pian or Alaskan Native 0
Employment Status: Employed 0 Retired l&l Home-maker 0 Other 0
Gender: Male or Femole 0
HI hereby ottest to the accuracy and truthfulness of the applicotion and hove received, read and will obide by
Chopter 2, A.rticle VII - of the City Code. "Standards of~nduct for City Officers, Employees and Agency
M~bers." 1-- \ c.-o 1 .
"\iA~-~ LA; Ob- ~'I'V i IJV\ f1t"<-Sp tf
AppiA::nt's. ture Date Nome of Appicant (PLEASE PRINT)
U- Attachment: Please attach a copy of your resume to your application,
NOTE: Applications will rernain on file for a period of one (l) calendar year.
Received in City Clerk's OHice \/~~/CXo by ,-.Jc-LK~-,---______m- Deputy Clerk
Document Control Number (Assigned y the City Clerk's OHice) Revised 11/15/05
C:\DOCUMENTS AND SETTINGS\CLERGIBE\LOCAL SETTINGS\ TEMPORARY INTERNET FILES\OLK 14\BC APPLICATION NOV 2005 1 DOC