Elsa Urquiza 12/31/2007
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CIty of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139. www,miomibeochfl.gov
OfFICE Of THE CITY CLERK, Robert Parcher, City Clerk
TEL: (305)673.7411, FAX: (305)673.7254
01-24-2007
Elsa Urquiza
227 E. Rivo Alto Dr
Miami Beach, Florida 33139
SUBJECT: Community Development Advisory Committee
Congratulations! You have been appointed by Commissioner Michael Gongora
to the agency, board or committee named above for a term ending 12/31/2007.
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,
~&-teJft~~</~~
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Thomas Urriola
ATTACHMENTS:
Letter of Appointment
Oath
City Code Ordinance section, applicable to agency, board or committee
City Code Section 2-22, 2-23, 2-24, 2-25, 2-26, 2-458 and 2-459
Ordinance No. 2006-3543 - Amendment to City Code Section 2-22
Miami-Dade County Code Section 2-11.1 - Conflict of Interest and Code of Ethics
City Wide Permit Application - (Parking Department Form)
Booklet - Guide to the Sunshine Amendment and Code of Ethics for Public Officers and
We ore committed to providing excellent public service and safety 10 01/ who live, work. and ploy in our vibronf, tropical, historic community
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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: (305)673-7411, FAX: (305)673-7254
TO Elsa Urquiza
RE: Community Development Advisory 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: 12/31/2007.
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 1st, following the closing of the calendar year on which i have served.
--G~"~.lr
Sworn ~y 0 .200')
*Please visit the City of Miami Beach website at www.miamibeachft.gov under City Oerk/Board and Committees
for additional information regarding the Financial Disclosure Requirements.
We are committed fa providing excellent public service and safery to 01/ who live, work, and play in our vibrant, tropical, historic community
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MIAMI 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:1o: No
Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six (6) months: Yes i.j or No I.:
NAME:
E /..'2/1
First Name
Middle Initial
I am applying for a Board appointment because I
My special abilities, knowledge, or experience is:
Are you a register d voter in Miami Beach: Yes
Harne: :;;2
Address: 6(;(7 ~
No.
Phone{3e>5j 53& ~';{.:j1
Home
({,fit)
Ill/' It.
Street
fZ1fi
1-1
(365 ) "'-fC1<j. - ,/OW
Work Fax Email address
2 I'"f-~irient cf: Nc,nh 13''?:A(.n 0 South 3;~':>c';J ~~d~l;;'" 5i),~ch De /.:Je.-J/t4.t/,- u@ /:;u.US41..I.:t..-./,/fcr-
I/-f Is Applicanfs Position: lJU/Yl.9-r
City
(355J5 ~.()6j3
State
3313 '1
Zip Cede
(Ph?2S& Cf^j!:-Cii c;,::): '.:';\'1
Business Name: J:' J~"1f ;-
Address: vA 12 10 C)..>
No.
Street
City
State
Zip Code
DOwner C StockholderlShareholder 0 Corporate Officer 0 Other Explain:
Professional License (describe)
AiUU:ft ii (.GP.; (I; the:' 2t:.nr;:Ci:' fh_;.,-;,,~
1. Have you ever been convicted of a felony: Yes 0 or No ~s, please explain in detail:
c/..."/"r
Expires: -;ZtJcA
2. Do you currently have a violation(s) of City of Miami Beach codes: Yes 0 or No ~es, please explain in detail:
3.00 you currently owe the City of Miami Beach any money: Yes 0 or NO~fyeS, explain in detail
4. Are you currently serving on any City Boards or Committees: Yes 0 or No ~es; which board?
Wlat organizations in the City of Miami Beach do you currently hold membership in?
Name: Y?n "
t.i!: rv<.- Title:
Name:
I am now employed by the City of Miami Beach: Yes 0 or No . If yes, which department?
F\CLCH\SALL\B&C Applicatiol1\B&C t..ppli:;atIOl1 Revi6ed OrI110f.),doc
Pursuant to City Code Section 2-25 {b}: Do you have a rent ,spouse, child " brother ,or sister who is employed by the City of Miami
Beach? Check alllhat apply. Identify the department(s): i>
Please list your preferences in order of ranking [1J first choice 12] second choice, and (3) third choice. Please note that anly three (3)
choices will be observed by the City Clerk's Office. (Regular Boards of City)
~ousing Authority>
Loan Review Committee'"
Marine Authority>
Miami Beach Cultural Arts Council
Miami Beach Commission on Status of Women
. Miami Beach Florida Sister Cities
L Normandy Shores Local Gov't Neigh. Improvement
~ Oversight Committee for General Obligation Bond
. - Parks and Recreation Facilities Board
LW'Personnel Board.
t_ J Planning Board*
l_, Police Citizens Relations Committee
~ Production Industry Council
!J Public Safety Advisory Committee
fl Safety Committee
C: Transportation and Parking Committee
[-' Visitor and Convention Authority.
[J Youth Center Advisory Board
:J Art in Public Places Committee
[J Barrier Free Environment Committee
U Beach Preservation Board
o Beautification Committee
:1 Board of Adjustment>
iJ Budget Advisory Committee
o Committee on Homeless
o Committee for Quality Education in MB
1iYC0mmunity Development Advisory>
[j Community Relations Board
o Convention Center Advisory Board
o Convention Center Capita! Projects Oversight
o Debarment Committee
~esign 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 farm
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 'J No ,-' Years of Service:
2. Present participation in Youth Center activities by your children Yeso No iJ. If yes, please list the names of your children, their ages,
and which programs. List below:
Child's name: Age: _ Program:
Child's name:
Thla aection la "not required" but desired: Age: (;0 years old
~lhnJc Origin (Check one)
White 0 African-American/Black 0 Hispanic: 1;(
Aelan or Pacific Islander 0 American Indian or Alaskan Native 0
Employment Status: Employed 0 Retired r./Home,maker 0 other 11
Age: _ Program:
Gender: Male 0
Female ,y--'"
"I hereby attest ta the accurecy and truthfulness of the application and have received, reo:,,".! and will abide by Chapter 2,
A~e C' Code :'Standards of Conduct for City Officers, ~PIOyees and Agency j;mbers."
l-t..... '-n , ..L/~1L/- k / ~ /V1, {fa,)"?,,,,-
Applicant's Signature Date Name of Applicant (PLEASE PRINT)
Attachment: Please attach a capy af yaur resume ta your applicatian.
NOTE: Applications will remain on file for a perlad af one (1) calendar year.
Received In City Clerk's Office
Document ControJ Number (Assi
F:\CLER\$ALL\B&C Applical1on\LII':'C t\pp1icallol' H,?Vi5lXl Chil-1QG.dnc
Deputy Clerk
Date
Date
2