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Calvin Kohli 12/31/08 tD ...... City of Miami leach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miomibeachfl.gov OFfiCE Of THE CITY CLERK, Robert Porcher, City Clerk TEl: 1305) 673-7411, fAX: (3051 673-7254 01-22-2007 Calvin Kohli 6039 Collins Ave #929 Miami Beach, Florida 33140 ~~"'rj";~ Fine Arts Board ~~0"'00'''0 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 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, ~~){j?b Robert Parcher City Clerk cc: Saul Frances, Parking Director Gary Farmer 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 We are committed to providing excellent public service and safety to all who live. work. and ploy in our vibrant, tropical. historic community tD ...... City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov OffiCE Of THE CITY CLERK, Robert Porcher, City Clerk TEl: 1305)673-7411, fAX: 13051 673-7254 TO Calvin Kohli RE: Fine Arts 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 tenm 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 andlor Committee, I must comply with the financial disciosure' require- ments of Miami-Dade County or the State of Florida (depending on the board or committee on which I serve) on Juiy 1 st, following the closing of the calendar year on which I have served. ~ o~~ ~L ~alVin Kohl; Sworn to and subscribed before me this ~ day of -reo:.", ~~ ,200J ~~- --... J) --- Deputy Clerk *Please visit the Gty of Miami Beach website at www.miamibeachfl.gov under City Clerk/Board and Committees for additional information regarding the Rnancial Disclosure Requirements. We are committed to providing excellenf public service and safety to all who live, work, and play in our vibrant, tropical, historic community m - MIAMI BEACH k \)~\ ~ Last Name HOME ADDRESS: 6n '> 't No. PHONE: 1~- ~ '-{$ &~ \~ Home NAME: MIAMI BEACH BO/,RDS AND COMMITTEE APPLICATION FORM y' I J \,..,) Irs ame c C'\ \\, ~, Street ! cS-~'(l-"')~O Work Business Name: ~ (0 &-eS ~E:I/W.t('> Address: ,~ 2. ~ () \.:.E:: \T'" ~ No. Professional License (describe) ~~SIw ~ Street \_\ (~uYo Middle Initial ((d... ~L 1j\~q State Zip Code L \<"0"'\' C!) ~L. G::l Email address ~ r ~1.<t. 6\\0..... City 'SaS 't"\1 b\J\ '\ Fax Position: { t. (;. ~ "'k- fL- City 1~\ )'\. State Zip Code .~,-e.tIr'" Expires: Af[.;;(;ff d CD,OY ofth~: !i{;ens(} 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 shaH 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 ownershiplinterest 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 i:k1fNo 0 . Demonstrate an ownershiplinterest in a business in Miami Beach for a minimum of six (6) months: Yes Q.6fNo 0 . Are you a registered voter in Miami Beach: Yes ,p..er No 0 . (Please check one): I am now a resident of: North Beach 0 South Beach iJ.M'fddle Beach 0 . I am applying for an appointment because I have special abilities, knowledge, experience. Please list below: Please list your preferences in order of ranking [1] first choice [2] second choice, and [3] third choice. Please note that onlv three 131 choices will be observed bv the Citv Clerk's Office. (Regular Boards of City) o Art in Public Places Committee o Beach Preservation Board o Beautification Committee o Board of Adjustment' o Budget Advisory Committee o Committee on Homeiess o Committee for Quality Education in MB o Community Development Advisory' o Community Relations Board o Convention Center Advisory Board o Debarment Committee o Design Review Board' &- 0 ~ability Access Committee C!)II'F.iDe Arts Board o Golf Advisory Committee o Health AdvisoryCommittee D Health Facilities Authority Board o Hispanic Affairs Committee o Historic Preservation Board' * Board Required to File State Disclosure form o Housin9 Authority' o Loan Review Committee' o Marine Authority' (Dl>>1IAiami Beach Cultural Arts Council o Miami Beach Commission on Status of Women o Miami Beach Florida Sister Cities o Normandy Shores Local Gov't Neigh. Improvement o Oversight Committee for General Obligation Bond o Parks and Recreation Facilities Board o Personnel Board' o Planning Board' o Police Citizens Relations Committee o Production Industry Council o Public Safety Advisory Committee o Safety Committee o Transportation and Parking Committee U) ~sitor and Convention AotKority' o Youth Center Advisory Board F:\CLER\$ALL\B&C Application\B&C Application Revised 091106jakes.doc 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 11 Years of Service: 2. Present participation in Youth Center activities by your children Yes! 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: Age: Program: .Have you ever been convicted of a felony: Yes 0 or N9~lease explain in detail: . Do you currently have a violation(s) of City of Miami Beach codes: Yes 0 or N~ease explain in detail: . Do you currently owe the City of Miami Beach any money: Yes 0 or No O~Plain in detail . Are you currently serving on any City Boards or Committees: Yes ~ No O. If yes; which board? fl~ ~~ ~~~. . What organizations in the City of Miami Beach do you currently hold membership in? ~~~ .~~ :::::: \i~: ~~ Name: ( ....~ ~~ ~ Name: . List all properties owned or have an interest in, which are located within the City of Miami Beach: be:> '!."I ~\\toJ( ~ ~~ \\ 'l\.\k' ~J... 'R... )? ~~ . I am now employed by the City of Miami Beach: Yes 0 or No;;J..Which department? . 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): 1-J\1J.\ This section is "not required" but desired: Age: years old Gender: Male ~ t-emale 0 Ethnic Origin (Check one) White 0 African-American/Black 0 Hispanic: 0 Asian or Pacific Islander 0 American Indian or Alaskan Native 0 Employment Status: Employed 0 Retired 0 Home-maker 0 Other 0 '" hereby attest to the accuracy and truthfulness of the appifcation and have received, read and will abide by Chapter 2, Article VII- of ty Code "Standards of Conduct for City Officers, Employees and Agency Members." C V-N \~~\. Name of Applicant (PLEASE PRINT) Applicant's Signature Please attach NOTE: Ap your resume to this application Ions will remain on file for a period of one (1) calendar year. Received in City Clerk's Office by ~-R.5t ~ "'L('---'J Name of Deputy Clerk Document Control Number (Assigned by the City Clerk's Office) Entered By Date Dale Revised 1125107jo 2 F:\CLER\SALL\B&C Appllcatlon\B&C Application Revised OH1106 jakes.doc