Regina Suarez 12/31/08
&
City of Miami Beach, 17(}() Cr1iW(',I'or '>,nlcl Drive, Miami Beach, Florida 33139, www n,imnibcochfl DOV
OFFICE OF THE CiTY CLERK. Roher't Porcher, City Clerk
Tel. 305673.741 i, fox. 30.';.6737254
01-17-2007
Regina Suarez
4410 Alton RD.
Miami Beach, Florida 33140
Itli.)eCT: Police Citizens Relations Committee
Congratulations! You have been appointed by Commissioner Saul Gross
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 1 st, 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,
---:!2 ' . :.j L
c~i 'J &-f't: ~+) (... '~il Lc~ / GCJ:rJ . J
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Donald Delucca v'"
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
'.- ,.,(~. u;e C;;':::~:.'\'~} fY',",',',j,'''': '-:,-')f;'.',:,.';,_,,;,' C:" flr. '.' ,.:'\.; 1';;,(0.:.":/ ~() ,_;I.... .....),(; liVP. i,'l/()fk. tJfid (~.f(J)' Fn ~~;~If \I,b:Uni. ~/~]P.".GI. hiY()fjC cornrnuniiy
&
City of Miami Beach, 1700 Canvenlion Center Drive, Miami Beach, Florida 33139, wwwmiomibeachflgov
OFFICE OF THE CITY CLERK, Rober! Parcher, City Clerk
Tel 305.673-7411, Fox 305-673-7254
TO Regina Suarez
RE: Police Citizens Relations 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.
Sworn
*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.
\, ,Ie
u:nrr:;!tccJ i(; P(Ov:'~'f..:nq (-'YCr.:.'"fi<':"fi!
J'G .....;ho five, \'v'ork. Clnd p!O\i
\;.,fY(Jni, tr:...Jpicol, h;~,tor;c cornmurJiiy.
m
~I\IA^/\I BEACH
Pursuant to City Code section 2-22(4) a and 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_
Resident of Miami Beach for a minimum of six (6) months: Yes"f;or No
Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six (6) months: Yes
or No
I am applying for a Board appointment because I have special abilities, kno,wledge, experience: Y~s ;,~
My special abilities, knowledge, or experience is: ~._)A-..-t! .A .1.. .~ L,.iLAu,-.J."_K'j--",,,
Are you a registElred voter in Miami Beach: Yes ',_ r No . ,.
,"
<:(:,~yU I't.~) -<<:. .2-
'-I 'J Last~am
Home:
\.i~~,,-
c:c
r
,,( ""'\_,. C;:. (; \ /)'--.
'l
First/Name
Middle Initial
NAME:
" No.
t' . ,-
Phone: \3 U J
Home
Street
-7) - u l-Y1 ":.- (/~ \21.3 .. ctJ tJ C0
Work
" -., '/7
; ,:Je( "-- J ::CA
City
"'''l~
~-"
State
55/vd
Zip Code
Address:
(Pi(:,:?s:.:: ctj;,;"c ~
",. ~
[J
Zax
,-',:': : t ',. , :' ~,~ r.: "~ ", r' f "-
".,... ....,.,.v..' [J
/L" C \ :: i./?\ k~_ -c' 2..4, '
ail address
1 /j
(,1 ,(0v1
Business Name:
Applicant's Position:
Address:
No.
Street
City
State
Zip Code
DOwner C Stockholder/Shareholder 0 Corporate Officer [j Other Explain:
Professional License (describe)
~;u-.;:1{:h ,:; 't:.,'...<- ,.<'
Expires:
"
1. Have you ever been convicted of a felony: Yes 0 or No Ox:lf yes, please explain in detail:
2. Do you currently have a violation(s) of City of Miami Beach codes: Yes C or No Gilf yes, please explain in detail:
3. Do you currently owe the City of Miami Beach any money: Yes [I or NoiJ;{ If yes, explain in detail
4. Are ~.OY currentlY. se.rving on ~~y C(ity.Boards q~ommittees: Yes'rr,or No O. If yes; which board?
\j 6 l \C:€..,. J e.. I 4-'\.?e.~';;, ,
VYhat organizations in the City of Miami Beach do you currently hold membership in?
Name:
Title:
Name:
Title:
List all properties owned or have an interest in, which are located within the City of Miami Beach:
I am now employed by the City of Miami Beach: Yes 0 or NoO( If yes, which department?
F\CLU~\SALUI.'1&C i1pplicah'Hl\I'\,<;C f..pploca!ion ReVised O~!110G Joe
Pursuant to City Code Section 2-25 (b): Do you have a parent . spouse . child ,brother or sister who is employed by the City of Miami
Beach? Check all that apply, Identify the department(s)
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)
Housing Authority*
Loan Review Committee'
Marine Authority'
- Miami Beach Cultural Arts Council
Miami Beach Commission on Status of Women
Miami Beach Florida Sister Cities
, Normandy Shores Local Gov't Neigh. Improvement
Oversight Committee for General Obligation Bond
Parks and Recreation Facilities Board
Personnel Board*
I Planning Board*
~olice Citizens Relations Committee
,- Production Industry Council
:.1 Public Safety Advisory Committee
n Safety Committee
Transportation and Parking Committee
Visitor and Convention Authority.
~J Youth Center Advisory Board
Art in Public Places Committee
Barrier Free Environment Committee
lJ Beach Preservation Board
cJ Beautification Committee
~i Board of Adjustment'
i] Budget Advisory Committee
J Committee on Homeless
o Committee for Quality Education in MB
o Community Development Advisory'
[j Community Relations Board
o Convention Center Advisory Board
o Convention Center Capital Projects Oversight
o Debarment Committee
o Design Review Board'
o Fine Arts Board
o Golf Advisory Committee
o Health Advisory Committee
o Health Facilities Authority Board
o Historic Preservation 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 No" Years of Service:
2. Present participation in Youth Center activities by your children Yesil No ,~. If yes, please list the names of your children, their ages,
and which programs. List below:
Child's name: Age: _ Program:
Child's name:
This section is "not required" but. desired: Ag:r-e: years old
Ethnic Origin (Check one)
White 0 African-American/Black :J Hispanic: ..,
Asian or Pacific Islander [J American Indian or Alaskan Native [J
Employment Status: Employed C Retired [j Home-maker [J Other !l
Age: _ Program:
Gender:
Female ./
Maler]
"I hereby attest to the ac:curacy and truthfulness of the application and have received, read and will abide by Chapter 2,
Article VII- of the Ci,~ Code "Standards of Conduct for City Officers, Employees and Agency Members."
"" .. . /<:<.. ,;.'------ /' ( t.!..l.t._<./ '7 "., , I I '" '-- . ) .e) f\ C r::::-2
Applicant's Signatur~) 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 period of one (1) calendar year.
Received in City Clerk's Office by
Document Control Number (Assign d by the City Clerk's Office)
F:\CLEmSALL\B&C ApJ}!!tE!iICI'\!'.,"C ".1'1"1".'1;", ;i,'v;."."(i '.),)1 C'C ..PC
Deputy Clerk
~IN - EoIe'" By 'fp
Date
DateJM ~'1
eVlsed 9/11/06 Ih
2