Robert Glick 12/31/2008
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city of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 331 39, www.miamibeachA.gov
OFFICE OF THE CITY CLERK, Robert Porcher, City Clerk
TEL: (305) 673.7411, FAX: (305) 673.7254
02-14-2007
Robert Glick
4960 Lakeview Drive
Miami Beach, Florida 33140
llfJiIJ!cT;;W Fine Arts Board
Congratulations! You have been appointed by Commissioner Richard l. Steinberg
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,
/j))/I~~,a/~I ~
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Gary Farmer
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 are committed to providing excel/ent public service and sofety to 01/ who live, work, and play in our vibrant, tropical. historic community
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city of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachA.gov
OFFICE OF THE CITY CLERK, Robert Porcher, City Clerk
TEl: (305) 673.7411, FAX: (3051 673.7254
TO Robert Glick
RE: Fine Arts 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 committee on which
I serve) on July 1 st, following the closing of the calendar year on which I have served.
Sworn
~--------
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 are committed to providing excel/ent public service and safety to 01/ who live, work, and play in our vibrant, tropical. historic community
,
CITY OF MIAMI BEACH BOARDS AND COMMITTEE
APPLICATION FORM
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 esident of the city for a minimum of six months; or b)
an individual shall demonstrate ownership/interest for a minimum of six mont In a business established in the city.
Resident of Miami Beach for a minimum of six (6) months: Yes [ or No [ ]
Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six (6) months: Yes [fi
I am applying for a Board appointment because I hav~ecial abilities, k wledge, experience: Yes fvf
My special abilities, knowledge, or experience is: rC~'t.. ,..", ( ~>-,..... Cl-
Are you a registered voter in Miami Beach: Yes V1 or No [ ]
NAME: (7c IL"- JQ)~~ '\
Last Name First Name
4 C, <.. "" ~ 4 "-2. V::W '"')..,.
Street
or No [ ]
Middle Initial
Home
Address: No.
City
State
Zip Code
.3 ~~ ~~(.,. .g~(\(" t5 ~~'\<O'\.'.:) ?- 6LILc:... e I-~J~~ ...../.
Home Work Fax Email address
I am now a resident of: North Beach [ ] South Beach [ ] Middle Beach [~
Business Name: )L "\ J F-.. "r -s 'i :Y Applicant's Position: P t'J 't,N e_
Address: 2 \.:: e; e, ). 1>",<, j tf ;>lL ()..t., e.- ~........,., F I ~ r Ij
No. Street City State Zip Code
Phone:
'7-=') ~,.( .t;::"-
[ ] Owner
] Stockholder/Shareholder [ vra;;porate Officer [ ] Other Explain:
Professional License (describe): L ''1 ~ Expires:
Attach a copy of the license listed above. ./'
1. Have you ever been convicted of a felony: Yes [ ] or No [ ...rtf yes, please explain in detail:
20'" ~
2. Do you currently have a violation(s) of City of Miami Beach codes: Yes [ ] or No [~es, please explain in detail:
Yes [ ] or No [ /'
3. Do you currently owe the City of Miami Beach any money:
If yes, explain in detail:
4. Are you currently serving on any City Boards or Committees: Yes [ ] or No [ ~
If yes; which board?
What organizations in the City of Miami Beach do you currently hold membership in?
Name: rJ ~ '-I "t... Title:
Name:
Title:
List all properties owned or have an interest in, which are located within the City of Miami Beach:
4"<'0 (~t:..~VL'Z..V ~ 'fr:dc- N<Q,-.Jr-:OZc"J't 0-
I am now employed by the City of Miami Beach: Yes [ ] or No [L.Y-'1f yes, which department.
Pursuant to City Code Section 2-25 (b): Do you have a par
is employed by the City of Miami Beach? Check all that ap
, ,or sister [ ] who
s :
~aAte-
F:\CLER\$ALL\ELIZABET\B&C\BCAPPLIC04.doc
/
Please list your preferences in order (, .nking [1] first choice [2] second choice, , ,[3] third choice. Please note that
only 3 choices will be observed by the City Clerk's Office.
(Regular Boards of City) (*Board Required to File State Disclosure form)
[ ] Art in Public Places
[ ] Audit Committee
[ ] Barrier Free Environment Committee
[ ] Beach Preservation Board
[ ] Beautification Committee
[ ] Board of Adjustment (Flood Mgmt.)*
[ ] Budget Advisory Committee
[ ] Committee on Homeless
[ ] Committee for Quality Education in MB
[ ] Community Development Advisory*
[ ] Community Relations Board
[ ] Convention Center Advisory Board
[ ] Convention Center Capital Projects Oversight
[ J2;Debment Committee
[ ] ign Review Board *
[ Fine Arts Board
[ ] Golf Advisory Committee
[ ] Health Advisory Committee
[ ] Health Facilities Authority
[ ] Hispanic Affairs Committee
[ ] Historic Preservation Board*
[ ] Housing Authority*
[ ] Loan Review Committee*
[ ] Marine Authority*
[ ] Miami Beach Cultural Arts Council
[ ] Miami Beach Commission on Status of Women
[ ] Miami Beach Florida Sister Cities
[ ] Normandy Shores Local Gov't Neighborhood Improvement
[ ] North Beach Youth Center Oversight Committee
[ ] Nuisance Abatement Board*
[ ] Oversight Committee for General Obligation Bond
[ ] Parks and Recreation Facilities Board
[ ] Personnel Board*
[ ] Planning Board*
[ ] Police Citizens Relations Committee
[ ] Production Industry Council
[ ] Public Safety Advisory Committee
[ ] Safety Committee
[ ] Transportation and Parking Board
[ ] Visitor and Convention Authority*
[ ] Youth Center Advisory Board
Note: If applying for Youth Ad~is/Jry Board, please indicate your affiliation with the Scott Rakow Youth
Center: r.: ( .~
1. Past service on the Youth Center Advisory Board: Yes [ ] No [ ] (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. rJ (' ""
Child's name: Age: _ Program:
Child's name: Age: _ Program:
This section is "not required" but desired: Age: [] Gender: M [ ] or F [ ]
Ethnic Origin (Check one)
White [ ] African-American/Black [ ] Hispanic: [ ]
Asian or Pacific Islander [ ] America ndian or Alaskan Native [ ]
Employment Status: Employed ['
] Other [
I hereby attest to the accuracy and truthfulness of the application and have received, read and will abide by
Chapter 2~, Art~ the ~e "Standards of Conduct for City Officers, Employees and Agency
Memb .; ~' \~'Y!3Jo-)' " ,
<.... . 0-!-~t-~ ? .., ''/-4..-;: (i "- ~,
Applicant's ignatu Date Name of Applicant (PLEASE PRINT)
Attachment: Please attach a cop-x of your resume to your application.
. ".. NOTE: ~ppli~tioJ:ls JliII remai~ ~. Vi file for j perio~r one, (~}calendar year.
Received In City Clerk's Officei/ /f:j &- by <, _- f :f?-'----~ (-:c.J:!:?:1/ Clerk
Document Control Number (Assigned by the City Clerk's Office) I ':) Rev #7- 01/08/04
F:\CLER\$ALL\ELIZABE1\B&C\BCAPPLIC04.doc
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