Michel Kadosh 12/31/08
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city of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeochfl.goV'
OFFICE OF THE CITY CLERK, Robert Porcher, City Clerk
TEl: 13051673.7411, FAX: 13051673.7254
02-01-2007
Michel Kadosh
323 Washington Ave
Miami Beach, Florida 33139
$i18Jec~~'i; Police Citizens Relations Committee
Congratulations! You have been appointed by Commissioner Michael Gongora
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,
~~MLti.I~
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Donald Delucca
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 Ordinance
City Wide Permit Application - (Parking Department Form)
Booklet - Guide to the Sunshine Amendment and Code of Ethics for Public Officers and Employee
We are commiffed to providing excellent pubJ;c service and safety to 01/ who live, work, ond play in our vibrant, Iropical, historic community
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city of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miomibeochA.gov
OFFICE OF THE CITY CLERK, Robert Porcher, City Clerk
TEL: 13051673.7411, FAX: 13051673.7254
TO Michel- Kadosh
RE: Poi ice Citizens Relations Committee
I do solemnly swear or affirm to bear true faith, loyalty and allegiance to the Govemment 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 andlor Committee, I must comply with the financial disclosure' require-
ments of Miami-Dade County or the State of Fiorida (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 to and subscribed before
200'7
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.
We are committed fa providing excellent public service and safely to all who live, work, and play in our vibranf, tropical, historic communify
~
MIAMI BEACH
<-,;
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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/lnterest 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.V;; No -
Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six (6) months: Yes :.J.6i No Ii
NAME:
AlIC~
First Name
Middle Initial
City
5;3/ .Y
State
Zip Code
Home
{Ple2.S0 CI'!b^:Y, (f~:::;: h~!!' (f-_\:;~d€:"nt 0t: fk,:'t!l >::I:::;;'t(.n 0 SO,-jfh 2; ;'c'C~1 [J ',m,'::k.!:'!' St'<~cl1 0
Business Name: lj// ?/..,r/ fi ~ ~ Applicanfs Position: 1!7~~ /'"'
Address ~kr{)?? ~72? ~e?4- a~
No. Street City
~er 0 Stockholder/Shareholder 0 Corporate Officer 0 other Explain:
q
State
-3 y/ S<;}
Zip Code
Professional License (describe)
AtUlcil 2 ...;t:,pv vi fj't' ;I;~"ni:,-' :h',
Expires:
ie',."""
1. Have you ever been convicted of a felony: Yes D or NoH!t'yes. please explain in detail:
2. Do you currently have a violation(s) of City of Miami Beach codes: Yes r No 0. If yes. please explain in detail:
3. Do you currentty owe the City of Miami Beach any money: Yes 0 or ~Ifyes, 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 currentty hold membership in?
Name:
10
Title:
Name:
Tille:
List all properties owned or have arynterest in. which are located within the Ci
~,u.. (,6" / 1?0~ >L
Kn
-
ea9l:
I am now employed by the City of Miami Beach: Yes 0 or No:a:1f yes, which department?
F':\CLER\SALl \B&C Apphcatoll\8&C j'.,j:.:!pli'::dfion Revised OH11(JG,doc
Pursuant to City Code Section 2.25 (b): Do you have a parent
Beach? Check alllhat apply. Identify the department(s):
,(/0
,spouse ,child ;, brother'
~
>'
or sister
who is employed by the City of Miami
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
c" Normandy Shores Local Gov't Neigh. Improvement
: Oversight Committee for General Obligation Bond
Parks and Recreation Facilities Board
I.~j ersonnel Board"
L-j lanning Board*
i olice Citizens Reiations Committee
:1 Production Industry Council
[J Public Safety Advisory Committee
{l Safety Committee
o Transportation and Parking Committee
'.. Visitor and Convention Authority'
u Youth Center Advisory Board
"IlolIrd 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 c; No ~ears of Servp:
2. Present participation in Youth Center activities by your children YesO No S' If yes, please list the names of your children, their ages,
and which programs. List below:
Child's name: Age: _ Program:
Thla asellon is "not required" but desired: Age: .....::.. years old
Ethnic ~gln (Check one)
White .r African-American/Black U Hispanic: 0
Mlan or Pacific Islander C American Indian or Alaskan Native 0
Employment Status: Employed "Retired [.1 Home-maker 0 Other [I
"I hereby attest to the accuracy and truthfulness of the application and have received, read and will abide by Chapter 2,
Article V11- of the City Code "Standards of Conduct for City OffIcers, Employees and Agency Mem~
4:<<~~// - /2 6:;/ t7~ Na~0~~t{PLEA~r::/1
,l Art in Public Piaces Committee
[; Barrier Free Environment Committee
U Beach Preservation Board
[J Beautification Committee
[I Board of Adjustment'
[J Budget Advisory Committee
o Committee on Homeless
D Committee for Quality Education in MB
o Community Development Advisory'
lJ Community Relations Board
D Convention Center Advisory Board
o Convention Center Capital Projects Oversight
o Debannent Committee
o Design Review Board'
o Fine Arts Board
u Golf Advisory Committee
o Health Advisory Committee
D Health Facilities Authority Board
o Historic Preservation Board'
Child's name:
Age: _ Program:
Gender:
Male LV'
Female D
Atblchmant: Please attach a copy of your resume to your application.
NOTE: Applications will remain on file for a period of one (1) calendar year.
Reoelved In City Clerk's Office
Document Control Number (Assi
F:\CLER\$ALL\B&C Applicat1cin\F;&C i\'f.Jpiicaliol' ReVised 091-)UG.dcIC
Date
Date
/ZJ 77/0 (.,
f f
Revised 9J11/06lh
2