Luis Salom 12/31/08
in
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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 Porcher, City Clerk
TEL: (3051673.7411, FAX: 13051673.7254
01-22-2007
Luis Salom
815 North Shore Dr
Miami Beach, Florida 33141
SUBJECT: Oversight Committee for General Obligation Bond
Congratulations! You have been appointed by the City Commission
to the agency, board or committee named above for a term ending 12/31/2008.
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,
~~lJ1
City Clerk
cc: Saul Frances, Parking Director
Jorge Chartrand
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
6. Miami Beach Code Section 2-459
7. Miami-Dade County Code Section 2-11.1
We are commilted fa providing excellent public service and safety to all who live, work, and ploy in our vibrant, tropical, historic community
lD
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City of Miami ___h, 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: (3051673.7254
TO Luis Salom
RE: Oversight CommiUee for General Obligation 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 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 IC
I serve) on July 1 st, following the closing of the calendar year 0 which I have se
-
-
Deputy Clerk
*Please visit the City of Miami Beach website at www.miamibeachfl.gov under City Oerk/Board and Committees
for additional information regarding the Rnancial Disclosure Requirements.
We ore committed to providing excellent public seNice and safety to all who live, work, and ploy in our vibrant, tropical, historic community
lD
"'IIJIl!"
MIAMIBEACH
BOARDS AND COMMITTEE APPLICATION FORM
Pursuant to City Code section 2-22(4) 0 and b: Members of agencies, boards, and committees shall be affiliated with the city; this requirement shall
be fulfilled in the following ways: oj an individual shall have been 0 resident of the city for 0 minimum of six months; or b) on individual shall
demonstrate ownership/interest for 0 minimum of six months in a business established in the city.
Resident of Miami Beoch for a minimum of six (6) months: Yes ~'or No [ ) .. ./
Demonstrate on ownership/interest in 0 business in Miami Beoch for 0 minimum of six (6) monlhs: Yes [.I or No l,.f
I am applying for a Boord appointment because I have sp ial abilities, knowledge, experience: Yes M'
My special abilities, knowledge, or experience is:" t/S / tJ r s..5'
Are you a registered voter in Miami Beach: Yes or No 0
NAME: -s/.:; Io~ / t// 5
Last Name / /7 First Nome / / Middle Initial
Home.2.!S: dDIl-I/. -:5/7t7/Z e t/Jf-/ vi' ;I!/i,H; ~.<"/J tC/ 55/7'/
Address: No. 'Street City Stote Zip Code
PhOM :fs::i$1GY/6.lii: [oS"~"'~., AOV&,6? -/ 72 /;.,~"t2k/';;'.d Ne7
Harne Work Fax Email address
(Pleose check one): I arn now 0 resident of: North Beach South Beoch 0 Middle Beach 0
Business Name:J;e>{;;~/k"vJ ~5 t' ;,;;,..,,,,, Applicant's Position: (1w rUt/L.
46tJI/ e.
~ner
c; .t6 /'1 e
No.
idS
Streel
City
Stote
Zip Code
Address:
o Stockholder/Shareholder 0 Carp orate Officer 0 Other Explain:
Professional License (describe):
Attach a copy of the license listed above.
1. Have you ever been convicted of a felony: Yes 0 or
Expires:
No ~,please explain in detail:
3. Do you currently owe the City of Miami Beach any money: Yes 0 or No
If yes, explain in detail:
/
Yes 0 orNog/
If yes, please explain in detail:
2. Do you currently have a violation(s) of City of Miami Beach codes: Yes 0 ar No
4. Are you currently serving on any City Boards or Committees:
If yes; which board?
What 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:
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I am now employed by the City of Miami Beach: Yes 0 or No O. If yes, which department?
Pursuont to City Code Section 2.25 (bl: Do you have a parent OJ, spouse OJ, child OJ, brother OJ, or sister OJ who is
employed by the City of Miami Beach? Check all that apply. Identify the deportment(s):
Please list your preferences in order of ranking [1] first choice [2J second choice, ond [3J third choice. Pleose note thot only
three (3) choices will be observed by the City Clerk's Office.
Reaular Boards of Citv\
o Art in Public Places Committee DHousinn Authoritv
o Borrier Free Environment Committee OLeon Review Committee'"
o Beach Preservotion Board DMorine Authority'"
o Beautification Committee DMiami Beach Cultural Arts Council
o Boord of Adjustment (Flood Manaaement) '" OMiomi Beach Commission on Status of Women
o Bud;;;.t Advis~CommiHee DMiomi Beach Florida Sister Cities
o Committee on the Homeless ONorrnandv Shores local Gov. Neiohborhood Improvement
o Committee for Qualitv of Education in Miami Beach DNa1fh Beach Youth Center Oversiaht Committee
o Community Develoament Advisory Committee'" OOversight Committee for General Obligation Band
o Communitv Relations Board DPorks & Recreational Facilities Board
o Convention Center Advisory Boord o Personnel Board '"
o Debarment Committee o Plannina Board *
o Desion Review Board * o Police Citizens Relations Committee
o Fine Arts Board o Production lndustrv Council
o Golf Advisorv Committee o Public Safe~ Advisorv Committee
o Health Advisorv Committee o Safetv"Committee
o Health Facilities Authoritv o T ransDortation & Parkina Committee
DHispanic Affairs Committee o Visitor & Convention Authori"ty '"
DHistoric Presel'Yotion Board '" o Youth Center Advisory Board
"Boord Required to File State Disclosure form
Note: If opplying for Youth Advisory Boord, please indicate your affiliotion with the ScoH Rakow Youth
Center:
1. Past service on the Youth Center Advisory Board: Yes 0 No 0 Yeors of Service 0
2. Present participation in Youth Center activities by your children Yes 0 No O. If yes, please list the names of your children,
their ages, ond which progroms. List below:
Child's nome: Age: _ Progrom:
Child's name: Age: _ Progrom:
This section is "not required" but desired: Age: E1':y .Gender&or Femole 0
Ethnic Origin (Check one)
White 0 Africon-Americon/Block 0 Hisponic:
.. u.~iaoar f'acifLc IslonderO American Indian or Alaskan Native 0
Employment Stotus: Employed 0 Retired 0 Home.maker 0 Other 0
~c-! )
Er;J!oyriJ
,
Ja/li1 06
Date
Attachment: Please ottach 0
NOTE: A plications will remoi
o
and truthfulness of the opplication ond hove received, reod ond will obide by
ity Code .Stondards of Conduct for City Officers, Employees and Agency
i(/is ~Iol"f
Nome of Applicont (PLEASE PRINT)
Y of your resume ta your application.
o file for a period of one (1) calendar year.
Received in City Clerk's Office
Document Control Number (Assigne
Deputy Clerk
Revised 11/15/05
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