Elsa Urquiza 12/31/2008
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City of Miami leach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachR.gov
OFFICE OF THE CITY CLERK, Robert Porcher, City Clerk
TEL: (305) 673-7411, FAX: (305) 673-7254
03/22/2007
Elsa Urquiza
227 E. Rivo Alto Dr
Miami Beach, Florida 33139
S~SJECT: Personnel Board
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.
s~CereIY,
~~(~.t<.c~\VR
Robert Parcher (- (
City Clerk
cc: Saul Frances, Parking Director
Mayra Buttacavoli
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 excellent public service and safety /0 all who live. work, and pia}' in our vibrant, tropical. historic community
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city of Miami leach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachR.gov
OFFICE OF THE CITY CLERK, Robert Porcher, City Clerk
TEL: (305) 673-7411, FAX: (305) 673-7254
TO Elsa Urquiza
RE: Personnel 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 andlor 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 ,e<ve) 0" July "t. follo";"9 the 010""9 of the cale"d?:S:'~~V~ ,e<ved
Elsa Urquiz
Sworn to and subscribed before me t~ay of
*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 commined 10 providing excellent public service and safety fa off who live, work, and play in our vibrant, tropical, historic community
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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 ownershlplinterest 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 :h No '
Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six (6) months: Yes CJ or No
I am applying for a Board appointment because I
My special abilities, knowledge, or experience is:
Are you a register~d voter in Miami Beach: Yes
NAME: ()/?a.UI2ec
Last Name
Home: ,.;)
Address: ,5(~R7 ~ ((I ~
No.
Phone:(3(?5)5-j g_.~c. 3'1-
Home
J.:' 15/1
First Name
Middle Initial
/l!1, 11.
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City
(3:-'6)~j 3X '1.)C.j 3
Fax Email address
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State
33/3 7
Zip Cede
Street
(305) .yq,/ - 90&5
Work
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Business Name: A f~,q 5
Address: (.LJ 12/0 tJ...s
No.
4; -/ 5
Applicant's Position:
OU/)i';;'T
Street
City
State
Zip Code
DOwner 0 Stockholder/Shareholder 0 Corporate Officer 0 Other Explain:
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Expires: :2tJO<;
1. Have you ever been convicted of a felony: Yes 0 or No ~s, please explain in detail:
2. Do you currently have a violation(s) of City of Miami Beach codes: Yes [1 or No ~es, please explain in detail:
3. Do you currently owe the City of Miami Beach any money: Yes 0 or Na~f yes, explain in detail
4. Are you currently serving on any City Boards or Committees: Yes 0 or No ~es; which board?
What arganizatians in the City of Miami Beach do you currently hold membership in?
Name: lltJ-..k
.
Title:
Name: Title:
List all pr9fterties o~ed or have an interest in, which are located within t~7 City of ~iami Beach:,.;'. ~'7 L: ~',~ A //zA-. -
1. ' cz......... - 1010 s"! - qOI tst- - j'fol l!cM/J;~ - It.j;l-J<f r.c:: r,' J.,~ -, g;J./ ll(,c.~i
() 3 b ;,r:J, /6..... flre- /3"?-} tJCf f ~. 13~ 7 {,.)e~ f ~ - 4/ '/ J e,d.t./..--, {(.~ 4
I am now employed by the City of Miami Beach: Yes [J or No~es, which department?
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ICLEmSALL\IJ&C Appl!cakliJ'tl's,C ,c..}.'pHsdllon Pevlsed OU11Q6 doc
Pursuant to City Code Section 2-25 (b): Do you have a pprent ,spouse . child " brother or sisler who is employed by the City of Miami
Beach? Check all that apply. Identify the department(s): /L. c"
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)
.<ousing 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 Neigh. Improvement
Oversight Committee for General Obligation Bond
Parks and Recreation Facilities Board
IIYPersonnel Board*
II Planning Board*
Police Citizens Relations Committee
" Production Industry Council
'.: Public Safety Advisory Committee
{l Safety Committee
Transportation and Parking Committee
Visitor and Convention Authority*
] Youth Center Advisory Board
,I Art in Public Places Committee
Barrier Free Environment Committee
rJ Beach Preservation Board
[J Beautification Committee
'J Board of Adjustment*
iJ Budget Advisory Committee
J Committee on Homeless
[] Committee for Quality Education in MB
~Community Development Advisory*
u Community Relations Board
o Convention Center Advisory Board
o Convention Center Capital Projects Oversight
o Debarment Committee
~esign Review Board*
o Fine Arts Board
iJ 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, please indicate your affiliation with the Scott Rakow Youth
Center:
1. Past service on the Youth Center Advisory Board: Yes Ci No co Years of Service:
2. Present participation in You er activities by our children YesO No .J. If yes, please list the names of your children, their ages,
and which programs. List bel
Child's name: Age: _ Program:
Child's name:
This section is "not required" b t desired: Age: (;0 years old
.Ethnic Origin (Check one)
White 0 African-American/Black [J Hispanic:
Asian or Pacific Islander C American Indian or Alaskan Native [J
Employment Status: Employed L Retired 7Home-maker C.J Other Ll
Age: _ Program:
Gender:
-.,:;.
Male 0
Female ~/
"I hereby attest to the accuracy and truthfulness of the application and have received, rea~ and will abide by Chapter 2,
A~-~e ~j~ ~ode :'Standards of Conduct for Ci~ Officers, ~mPloyees an~, A~ency! ~~mb.ers."
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Applicant's Signature 0 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 period of one (1) calendar year.
Deputy Clerk
Received in City Clerk's Office
Document Control Number (Assig ed by the City Clerk's Office)
Date
Date
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