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Maria Harris 12/31/08 m City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 331 39, www,rniolTlibear:hflgov OFFICE OF THE CITY ClERK, Robert Parcher, City Clerk Tel 305.673.7411, Fa" 305.673.7254 12-20-2006 Maria Harris 5500 Collins Ave #2102 Miami Beach, FI33140 _it:ffli~ Beautification Committee Congratulations! You have been appointed by Mayor David Dermer 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. Piease read the enclosed materials carefully. Congratulations again and good luck. ~j,Jp~JJt Robert Parcher City Clerk cc: Saul Frances, Parking Director John Oldenberg 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- 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 V,:(;' ore :_'n!~'mi.;~c',:.d;(1 ,,'X(;C,IlC"PL' (;0,,(1,( ;.f;"'/,r-e ,;I'd VJiC"i to ~;/i '.'"11,:: ;.'\'1:', ',,,,;,yk, ()rid r;'!eJ')' in r~'cl! .,,;!xuni, t'()pi!~oI, h,'!,!()f':C communii)i m === "'- A ; \ H 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. 305.673.7411, Fox 305.673.7254 TO Maria Harris RE: Beautification 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 1st, following the closing of the calendar year on which I have served, Sworn .-/ ra,a Harris to and subscribed before me this ~ay 0 , 200::] Deputy Clerk *P1ease visit the City of Miami Beach website at www.miamibeachfl.gov under City Clerk/Board and Committees for additional information regarding the Finandal Disclosure Requirements. \,";/1' ore ,-:o:nrn;tl:o'(f 10 prc,\j,d;n~l eyce!t"fi! ,Gl{<'C ,.ervic(! ,';nd vi,"'!\' to uN ....,,1\0 !iv/:.', work, ond ploy in our ""bi<.:mJ, t1opicol, hi:,toric comrrllmiiy. lD - MIAMI BEACH BEACH APPl. FORM AND ~~~(A- First Name S5 0 0 GLL(P) (tVG, 2/0"2- No. Street PHONE: '?oi <6 b( - '21 g g H me Work NAME: -it M:.fZ- ( S Last Name :=s- . Middle Initial fL, W (Al-tc &611 City 33/({O Zip Code HOME ADDRESS: State .~ Email address Fax "'--- Position: Business Name: r--- Address: State Zip Code City Street No. - Atfi;?::f; <1 coPy of Ir,'0 I;cense Expires: ~ Professional License (describe) 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 individuai 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 ~ or No 0 . Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six (6) months: Yes 0 or No X . Are you a registered voter in Miami Beach: Yes )C,r No 0 . (Please check one): I am now a resident of: North Beach 0 South Beach 0 Middle Beach~ . 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 on Iv three 13\ choices will be observed bv the Citv Clerk's Office. (Regular Boards of City) 'ri(Art in Public Places Committee ti Beach Preservation Board ~eautification Committee o Board of Adjustment" o Budget Advisory Committee o Committee on Homeless 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" o Disability Access Committee _'pIlFine Arts Board o Golf Advisory Committee o Health AdvisoryCommittee o Health Facilities Authority Board o Hispanic Affairs Committee o Historic Preservation Board" 3 o Housing Authority" o Loan Review Committee' o Marine Authority" o Miami Beach Cultural Arts Council o Miami Beach Commission on Status of Women o Miami Beach Florida Sister Cities o Nomnandy 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 o Visitor and Convention Authority" o Youth Center Advisory Board J ;l. " Board Required to File State Disclosure fonn 1 F:\CLER\SALL\B&C ApplicationiB&C Application Revised 091106 jakes,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 [1 No! I Years of Service; 2. Present participation in Youth Center activities by your chiidren YesU No '1. If yes, please list the names of your chiidren, their ages, and which programs, List below; " I ~ Child's name; /l..L 1"1. Age; _ Program: Child's name; Age; Program: .Have you ever been convicted of a felony: Yes D or NO,&Jlf yes, please explain in detail: . Do you currently have a violation(s) of City of Miami Beach codes: Yes D or No pr:Jlf yes, please expiain in detail: . Do you currently owe the City of Miami Beach any money: Yes D or No rfO If yes, explain in detail . Are you currently serving on any City Boards or Committees: Yes III or No D. If yes; which board? ~~f~ f' . What Organizat~ons in the City of Miami Beach do you currently hold membe~~? Name; e Q.. JI. 0 oP. ~ . Title: e.;.~ Name;~-rs.:l~~ Title:~T<; - . List all properties owned or have an interest in, which are located within the City of Miami Beach: ky A.fT .. . I am now employed by the City of Miami Beach: Yes 0 or N~WhiCh department? . Pursuant to City Code Section 2-25 (b): Do you have a parent D, spouse u, child D, brother D, or sister D who is employed by the City of Miami Beach? Check all that apply. Identify the department(s); D This section is "not required" but desired: Age: years old Gender: Male 0 Female ~ Ethnic Origin (Check one) tV 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-make73 Other 0 "I hereby attest to the accuracy and truthfulness of the application and have received, read and will abide by Chapter 2, Article VII- of the City Code "Standards of Conduct for City Officers, Employees and Agency Members." PRINT) Applicant's Signature Please attach a copy of your resume to this application NOTE: Applications will remain on file fo period of one (1) calendar year. Document Control Number (Assigned by the City Clerk's Entered By Received in City Clerk's Office by 2 F:\CLER\SAlL\B&C Appllcatlon\B&C Application Revised 091106 jakes.doc ...