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Steven Haas 12/31/2008 lD ..... City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Floridn 33139, www.miamibeachA.gav OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk TEL: (305) 673-7411 , FAX: (305) 673-7254 02/05/2007 Steven Haas 10000 W. Bay Harbor Drive Miami Beach, Florida 33154 l~ijl~g~J; Visitor and Convention Authority Congratulations! You have been appointed by the City Commission to the above referenced agency, board or committee for a term ending: 12/31/2008. If you are unable to accept this appointment, please notify the City Clerk's Office at (305) 673-7411. Please read the enclosed material carefully. Again, congratulations and good luck. Sincerely, ~e~ /bl0 City Clerk cc: Saul Frances, Parking Director Grisette Roque 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, 2-2458, 2-459 Ordinance 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 Employees We are committed to providing excel/ent public service and safety to 01/ who live, work, and ploy in our vibrant, tropical, historic community lD "WF' city of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachA.gov OFFICE OF THE CITY ClERK, Robert Parcher, City Clerk TEl: (305) 673.7411 , FAX; (305) 673.7254 TO Steven Haas RE: Visitor and Convention Authority 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 andlor Committee, I must comply with the financial disclosure* require- ments of Miami-Dade County or the State of Florida (depending 0 the board or committee on which I serve) on July 1 st, following the closing of the calendar year 0 hich I have served. Sworn to and subscribed before 007 *Please visit the City of Miami Beach website at www.miamibeachfl,gov under City Clerk/Board and Committees for additional information regarding the Rnancial Disclosure Requirements. We ore committed to providing excel/ent public service ond sofety to 01/ who live, work, and ploy in our vibrant, tropical, historic community -.5f -e.J if) First Name l~-~, ~~~ Dr Street 7g(p -:>7i ~if Work (9 MIJ\lv\I BEACH NAME'~ Last ame HOME ADDRESS: _\ t)OOO No. PHONE: ~f- \3 ~ ~ Home Business Name ~~ (Y\'1 "",k Address: -t{ ..:: No. Street Professional License (describe) Fax J-I- Middle Initial ~~ ,Lh~ pt.- .3.3~1 .~ State Zip Code ~~ ' AA~ @ ~cA'''-a.sr; il Email address n, 1...f . ( d A1? Position: &,- '" , (Y\~ City -P-l- State "\~,~., Zip Code Expires: 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 of six months in a business established in the city. . Resident of Miami Beach for a minimum of six (6) months: Yes 0 or No ~ . Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six (6) months: Ye~r No 0 . Are you a registered voter in Miami Beach: Yes 0 or No p . (Please check one): I am now a resident of: North Beach 0 South Beach 0 Middle Beach 0 . 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 onlv three (3) choices will be observed bv the City Clerk's Office. (Regular Boards of City) o Art in Public Places Committee o Beach Preservation Board o Beautification 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 o Fine Arts Board o Golf Advisory Committee o Health AdvisoryCommittee o Health Facilities Authority Board o Hispanic Affairs Committee o Historic Preservation Board* * Board Required to File State Disclosure form 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 Normandy 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 ~D Tr sportation and Parking Committee isitor and Convention Authority* o uth Center Advisory Board F:\CLER\$ALL\B&C Applicatio[l\B&C Application Revised 0911 Of:) lakes.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 No! i Years of Service: 2, Present participation in Youth Center activities by your children Yes: No:. If yes, please list the names of your children, their ages, and which programs. List below: Child's name: Age: _ Program: Child's name: Age: Program: .Have you ever been convicted of a felony: Yes 0 or No '6 If yes, please explain in detail: · Do you currently have a violation(s) of City of Miami Beach codes: Yes 0 or No )Clf yes, please explain in detail: · Do you currently owe the City of Miami Beach any money: Yes 0 or No 1)Clf yes, explain in detail · Are you currently serving on any City Boards or Committees: Yes ~r No D. If yes; which board? VLk · What organizations in the City of Miami Beach do you currently hold membership in? Name: {f\ e C-e.- Title: ~~ 4 Ceo I..Kr ().) ~ \ Name: Title: · List all properties owned or have an interest in, which are located within the City of Miami Beach: · I am now employed by the City of Miami Beach: Yes 0 or Notr.'Which department? · Pursuant to City Code Section 2-25 (b): Do you have a parent 0, spouse c, child C, brother 0, or sister [J who is employed by the City of Miami Beach? Check all that apply, Identify the department(s): This section is "not required" but desired: Age:!f.!J-- years old Gender: MaleY Female 0 Ethnic Origin (Check one) White ~frican-American/Black 0 Hispanic: 0 Asian or Pacific Islander 0 American Indian or Alaskan Native 0 Emplo'yment Status: Employed 0 Retired 0 Home-maker 0 Other 0 t to the accuracy and truthfulness of the application and have received, read and will abide by Chapter 2, the City Code "Standards of Conduct for ity Officers, Employees and Agency Members." Name of Applicant (PLEASE PRINT) lease attach a copy of your resume to this application NOTE: Applications will remain on file for a peri d of one (1) Date Received in City Clerk's Office by Document Control Number (Assigned by the Ci Date 2 '--"/'/ F :\CLER\$AL L \8& C1;pp!iuil iem \8E~ C Re\/isc~d OD1'10fi jakes.doc