Stephen Zack 12/31/08
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City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miornibeochfl.gov
OFFICE OF THE CITY CLERK, Robert Porcher, City Clerk
TEl: 13051673.7411, FAX: 13051673.7254
01-22-2007
Stephen Zack
100 SE 2nd St #2800
Miami, Florida 33131
_~~ Debarment 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. Please read the enclosed materials carefully.
Congratulations again and good luck.
Sincerely,
~rt~/~
City Clerk
cc: Saul Frances, Parking Director
Gus Lopez
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 ore commi/ted to providing excellent public 5efYice and safely to all who jive, work, and ploy in our vibrant, tropical, hisloric community
JAN-26-2007 11:37
CITY MIAMI BCH CLERK DEPT
305 6737254
P.05
CIIr at _ ~ 1700 Con...._ C_ Dri... Miami IIoach, FIorIllo 33139. www,Mlamibo<KhR.g..
OFFICE Of lMl: CITY CLERK, Robert ,..c...., City CIa...
TEL: (3051 673-7~11, FAX: 13~ 673.725.
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TO ,Stephen Zack
RE: Debarment Committee
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I do'sol~mnly swear or affirm to boar true faith. loyalty and allegiance to the Govemment of the
United Stales, the SIBle 01 Flo~d., and Ihe City 01 Miami eaach. and to pertorm alllhe dulies of
a member of the above-menlloned board or committee of Ihe City of Miami Beach 10 which I have
been aj,pointed lor a term ending: 12{31/2oo8.
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"have been issued e copy of Secl\On 2-11.1 ollhe Miami.Dade County Code (Conflict 01 Inlarest
and Code of Ethics Ordinance), as ....N as theFlotidd Commission on Ethics Guide to tM Sun5hint!
Am~nt and Cotk of Ethics for Public Officers and EmplOYees, and understand that as a member
ola CItY of Miami Beach Board andfor Committee, I musl comply with the financial disclosure. require.
menta 01 Miami-Dade Counly or the State 01 Florida (dep&nding on Ihe board or committee on which
I $8rve~on July 1st. fOllowing the dosing 01 the calendar year on which I have served,
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Stephen Zack
SWorn to and subscribed belore me Ihls J.l.- day 01 'J'iYIU-1~, 200]
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Deputy Clark
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*Please vtsh: the Oty of Miami Bead1 website. at www.miamibeMhR.gov under City Oerk/Board and Committees
for additional inlonnabon regardng the Financial Di$dosure Requirements.
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W. Oft' ~rmPIlrred 10 plQ'iIdlff9 e~lIen1 plJb!lc 3e'tVlce and ~ty 10 all who II..., ....or., and ploy 111 OOf vibtcw. tropK:a/. hi3/Dnc commlinrty
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TOTAL P.05
JAN-26-2007 11:37
CITY MIAMI BCH CLERK DEPT
P.03
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'."!FMIAMI BEACH
NAME:
ZAc.K
Middle Initiai
Last Name
305 6737254
CITY OF MIAMI BEACH
80ARD:" ANI) Cor.nMIlTEE APPUCATION FORM
STcPHE,J
N
First Neme
HOME ADDRESS:
No,
fI'ttONE~305) ~ 1 Y - 8 8 <.:, 6
'. HOlM
II E. DILIDO DRIVE MIAMIBEACH FL331"2:,9
Street ( 3 () 5) City Stat. Zip Code
('3 OS )539 - 8 Y OC) 530-"1535 -5 'Z.AC~ BSFLLP.(,O~
Work Fax Email addre..s
Business Nsme: 1301ES. 50-1 ILLER ~ F LEX/II fR uP Position: A DM IN IS TI<. A T I V E.
Addreaa 100 Sf. ::z sr~EEJ .5o..ln::',280o MIAM I FL
No. Street City Stale
Pt:tR,TNEf(
3?:>131
Zip Code
_..~I L1cens. Idtsetib.)
Expires:
Alf.;H:ft (;I r,:Op}' tJf l~/l'~ IJ~f.'ft,'..'~~
PI/,."...t to City Code ..cllon 2.22(4) a and b: Members of agencies. boards, and commillees shaR be affiliated with th.. city; this '
raqul...ment shall be fulftUed In the following ways: a) an indillidual sha>> hav.. b....n a ",.id..nt of the city lor a mirrimum of six
monlhs; or b) an IndIVidual shaN demonstrate ownership',nte...t for a minimum of Six months In a business established in the c;ily,
. Reaident of Miami Beach for a minimum of six (6) months: Ves 0 or No 0
.,
. Demonstrate an ownershiplinlerest In a business in Miami Beach for a minimum of six (6) months: Ves iJ or No 0
. Are' you a registered voter in Miami Beach: Ve. 0 or No 0
:. (Please check one): I am now a resident of: North Beach 0 South 8each 0 Middle Beach 0
. I am applying for an appointment because I have special abilities, knowledge, experience. Please list below:
.....es list your pt6ference6 in order of ranking (1] first choi"" 12] second choice, and {3] third choic:o. Pl.... note that onlv three 13\
choICes *11I be observed by the Cl,ty Clark'. Office, (Regutar Boards of City)
o Art in Public Places Committee
o Beach Pre&eIVation Board
o Beautification Committee
o Board of Adjustment'
o Budget Advisory Committee
o Committee on Homeless
o Committe~ for Quality Education in MB
o Community Devolopmeht Advisory>
o Community Relations Board
o Convention Center Adllisory Board
)H:lebarmenl Committee
o Design Review BOard"
o Disability Access Committee
o Fine Arts Board
o Golf AdVisory Committee
o Heallh AdvillO/)'Committee
o Heallh Facili1les Aumority Board
o Hispanic Affai... Ccmn1l11ee
o Historic Preseivalion Board"
, ;: ~'IIi!<Iu1red to Fila 5\010 Dl......"'.1orm
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o Housing Authority"
o Loan ReView Committee'"'
o Marine Authority"
a Miami Beach Cultural Arts Council
a Miami Beach Commission on Status of Women
o Miami Beach Florida Sister Cities
o Normandy Shores Local GoYl Neigh, Improvement
o Oversight Committee for General Obligation Bond
o Parks and Recreation Facilities Board
o Personnel Board"
a Planning Board"
o Police Citizens Relations Committee
o Production Industry Counc"
o Public Safety Advisory Committee
o Safety Committee
o Transpotlation and Parking Committee
Cl Vis~or and Convention Authority"
o Youth Center Advisory Board
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F:~CLER\SALL\R&C API'lir;~tiof"\a&C AppliC;JljOIl RL1vlr.M 001106 ;akcs.ClOC
c0'd 11:1101
_e: If applying for Youth Advisory Board, please indicete your affiliation with Ihe Scott Rakow Youlh Canler:
,
1. Past service on lhe Youth Cenler Advisory Board: Ves: ,No I Years of Service:
2. Present participation in Youth Centet activities by your children Yes' No", If yes, please'list the names of your ch'ldren, their'
ages, and which programs. list below: .
Child'. name: Age: _ Program: '
Child'. name:
Age:
Program:
.Heve you eVer been convicted of a felony: Yo. [lor No !\0'f'yes, please explain in detail:
.00 you currently have a violatlon{s) of City of Miami Beach codes: Yes 0 or No ~s, please explain in detail:
. Do you currently owe the City of Miami Beach any money: Yes D or N~f yes, explein in detail
. Are you currently serving on any City Boards or Committees: Ves~r No D, If yes; which board?
e What organtzetions I~Ahe City of Miami Beach do you currently hold membership in?
Name: 11 fJ; Cll ff1Iu.Jw, 1~OJlLrllle
Name: Title:
. list all properties owned or have an interest in. which ere located within the City of Miami Beach:
lIE. DfLIOO DR. M/A-MI BEAcH FL.33139
I
. I am now employed by the City of Miami Beach: Yes a or NoVWhlCh department?
. Pu..uant to City Code Se<>tion 2-2$ (bl: Do you have a parent O. SPOUSll 0 child D. btolh., 0, or sisler 0 who is employed by the
;" City 01 M<ami Beach? Check all that apply. Identify tile depa_tts): M'A:
Thla section is "not required" but desired: Age' 5 9 yeers old Gender: Male ~ Female 0
EtMic Origin (Check one)
White !lI1\frican-AmericanlBlack 0 Hispanic: ~sian or Pacific Islander 0 American Indian or Alaskan Native 0
Employment Status: Employed ltRetired 0 Home-maker 0 OlIIer a
" heNby _5t to tile lICCuracy .nd truthfuln... of tile application and have rec:ltlved, _d and ..III abide t>Y CMpl.. 2,
Article VII _ of the CIty Code "S111."lanls of Conduct lor City OIllC8f$. EmploYHI and Agency Memblrs."
~icant,::i~ ,':: b'l of A~~C!n:(P~~RINT)
PI.... attach a copy of your resum. to thl. .,.pleatlon
NOTE: AIIp11c:ationl wllI........n on . period 01 one (1) calendar y_.
Received an City Clerk'!: otftca by
E.""'ed eV
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