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Christian Folland 12/31/2008 in ....,. city of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachR.gov OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk TEL: (305) 673-7411 , FAX: (305) 673-7254 02-08-2007 Christian Folland 1053 Michigan Ave #8 Miami Beach, Florida 33139 SOBJECT: Beach Preservation Board Congratulations! You have been appointed by Commissioner Matti H. Bower 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 1 st, 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, ~ Robert Parcher City Clerk J~ cc: Saul Frances, Parking Director Jordanna Rubin 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 ore commiffed ro providing excellent public service and safety to all who live, work, and play in our vibrant, tropical, historic community in ~ city of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miomibeochR.gov OFFICE OF THE CITY CLERK, Robert Porcher, City Clerk TEL: (3051 673-7411, FAX: 13051 673-7254 TO Christian Folland RE: Beach Preservation 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 t e board or committee hich I serve) on July 1 st, following the closing of the calendar year on whi have serv ,2007 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 ore commiffed fa providing excellent public service and safety to 011 who live, work, and play in our vibrant, tropical, historic community m MIA!\J\\ BEACH (i (fJt~ if f()?1 1:' I ~) ~I<.'f 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/interest for a minimum yrsix months in a business established in the city. Resident of Miami Beach for a minimum of six (6) months: Yes .~ No /' Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six (6) months: Yes t..:n5f No I. I am applying for a Board appointment because I have ecial abilities, knowledge, experience: Yes i] My special abilities, knowledge, or experience is: ::;:u a registere~i,~!:i:m~~each: Yes \ ~ ~/IJ;q ^ f Last Name First Name IV Middle Initial Home: Home Address: 227 No. .' 4~ Street -)f:: 2 t;:J Fax Statp Zip Code ~?../?.C}fr Email ad r ss Phone: (Pt(~':2-S<;~ y ~l n'Jl~~~':~:(~~';':;'" \ [J ,';:-7,(>:,;th F(,;.:~: c h [J Business Name: Address: ~.2OJ Zip Code No. &wner C Stockholder/Shareholder [J Corporate Officer [J Other Explain: State Professional License (describe) "~.U.~lch t:,: .!.I,:t Expires: 1. Have you ever been convicted of a felony: Yes C or No ~f yes, please explain in detail: 2. Do you currently have a violation(s) of City of Miami Beach codes: Yes [j or NO~lf yes, please explain in detail: 3. Do you currently owe the City of Miami Beach any money: Yes [1 or NOt!' If yes, explain in detail 4. Are you currently serving on any City Boards or Committees: Ye~ or No O. If yes; which board? What organizations in the City of Miami Beach do you currently hold membership in? Name: Title: Name: Title: jvt- t; r"" I' A \...< ~H' /0 I I List all properties owned or have an interest in, which are 10,cat, ed )Nithin the Cft'f of Miami Beach: 227 95~- 32(r g Sk.o~"-< Uf. I am now employed by the City of Miami Beach: Yes [J or Nofx If yes, which department? F,\CLEf~\SALL \u&e ,iI,pplicatoll\H8,C f.,!plic:atlon Pevise[i OU110G doc Pursuant to City Code Section 2-25 (b): Do you have a parent Beach? Check all that apply. Identify the department(s): /(/) spouse child ',brother who is employed by the City of Miami or sister 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 L Normandy Shores Local Gov't Neigh. Improvement Oversight Committee for General Obligation Bond Parks and Recreation Facilities Board Personnel Board* I Planning Board* :; Police Citizens Relations Committee .- Production Industry Council ~.; Public Safety Advisory Committee rl Safety Committee C Transportation and Parking Committee Visitor and Convention Authority* CJ Youth Center Advisory Board Art in Public Places Committee Barrier Free Environment Committee ~each Preservation Board [1 Beautification Committee I Board of Adjustment* iJ Budget Advisory Committee o Committee on Homeless o Committee for Quality Education in MB o Community Development Advisory* [j Community Relations Board [J Convention Center Advisory Board o Convention Center Capital Projects Oversight o Debarment Committee o Design Review Board* o Fine Arts Board LJ Golf Advisory Committee o Health Advisory Committee o Health Facilities Authority Board o Historic Preservation Board* *Board Required to File State Disclosure form Note: If applying for Youth Advisory Board pi Center: V. indicate your affiliation with the Scott Rakow Youth 1. Past service on the Youth Center Advisory Board: Yes cc No" Years of Service: 2. Present participation in Youth Center ctivities by your children YesD No u. If yes, please list the names of your children, their ages, and which programs. List below: " / J Child's name: i../ // Age: _ Program: This section is "not required" but desired: Age: _ years old Ethnic Origin (Check one) Whit,.(] African-American/Black [J Hispanic: [J Asian or Pacific Islander [J American Indian or Alaskan Native [J Employment Status: Employe~ Retired [J Home-maker [1 Other c:i "I hereby attes~~, the accura<:Y?,;Ul~ruth!LJllleSS of the application and have received, read an, d will abide by Chapter 2, A...... VII~~: C) ,'_ ~condU~~;',d; ';;e~) EmPIOY(2S .n;sene~:~~~,.." APPIi~n' . nafure '~ Date Name of Applicant (PLEASE PRINT) Attachment: Please attach a copy of your resume to your application. NOTE: Applications will remain on file for a perio of one (1) calendar year. Child's name: Received in City Clerk's Office Document Control Number (Assig F:\CLER\$ALL\B&C ,Apu!l\';atlCii';\H,.;'~C: /".pr~;l!._'.:::ll!(;;' ~-<ev;:;:~~:ri UU1-; ~_.IC ~j(~C ..; Age: _ Program: / Male! Female [] Gender: Entered By Deputy Clerk Date 2