Patxi Pastor 05/31/2008I•
Cit~r of Miooni d~ach, 1700 Convention Center Drive, Miami Beach, Fbrida 33139, www.miamibeachfl.gov
OFFICE OF THE CITY CLERK, Robert Parcher, Ciy Clerk
TEI: 1305) 673-7411, FAX: (305) 673-7254
07-12-2007
Patxi Pastor
605 Lincoln Rd #240
Miami Beach, Florida 33139
SUBJECT. Mayor's Green Ad-Hoc Committee
Congratulations! You have been appointed by Commissioner Jerry Libbiin
to the agency, board or committee named above for a term ending: 05/31/2008.
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,
d ~ Il ~ ~~ - aVJ
~. ~~
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
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 committed to providing excellent public service and safety to all who live, work, and play in our vibrant, tropical, histo+ic community
'~ ,
Cihr of Miami Bach, 1700 Convention Center Drive, Miami Beach, Fbrida 33139, www.miamibeachfl.gov
OffICE OF THE CITY CLERK, Robert Parcher, City Clerk
TEL: (305) 673-7411, FAX: (305) 673-7254
TO Patxi Pastor
RE: Mayor's Green Ad-Hoc Committee
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: 05/31/2008.
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 theF/o~ida Commission on Ethics Guide to the Sunshine
Amendment and Code of Ethics for Public ~cers 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
serve) on July 1st, following the closing of the calendar year on which I have served.
Sworn to and subscribed
*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 excellent public service and safety to all who live, work, and play in our vibrant, tropical, historic communiy
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Last Name First Name
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HOME ADDRESS: ~ . sV` V~(, ~Z 3 ~,(•!^,K
No. Street - City ~ State Zip Code
PHONE: _ pS~ 3 8 ~ Z ~ ? 3 rh~~ ~ ,~.~ ~,- , ~ -
Home
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Business Name: Position
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No• / Street
Professional License {describe) •J
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City ` State Zip Code
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Pursuant to Ctty Cods 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 ownershiprnterest for a mi'nim~m of six months in a business established in the city.
s Resident of Miami Beach for a minimum of six (6) months: Yes 3~d'or No O
• Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six (Ei) months: Yes l~ or No ^
• Are you a registered voter in Miami Beach: Yes ^ or No '!~
s {Please check one): I am now a resident of: North Beach ^ South Beach ^ Middle Beach (~
• t am applying for an appointmen# because 1 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 on! three f31
wi I be bserved the Cit Clerk's Office. (Regular Boards of City}
D Art in Public Places Committee
D Beach Preservation Board
D Beautification Committee
D Board of Adjustment"
D Budget Advisory Committee
0 Committee on Homeless
^ Committee for Quality Education in MB
D Community Development Advisory"
^ Community Relations Board
D Convention Center Advisory Board
D Debam~ertt Committee
D Design Review Board'
^ Disability Access Committee
D Fine Arts Board
D Golf Advisory Committee
^ Health AdvisoryCommittee
^ Health Facilities Authority Board
^ Hispanic Affairs Committee
^ Historic Preservation Board'
Board Required to File State Disclosure form
D Housing Authority"
D Loan Review Committee*
^ Marine Authority"
D Miami Beach Cultural Arts Council
D Miami Beach Commission on Status of Women
D Miami Beach Florida Sister Cities
D Normandy Shores Local Gov't Neigh. Improvement
D Oversight Committee for General Obligation Bond
D Parks and Recreation Facilites Board
0 Personnel Board"
fl Planning Board*
D Police Citizens Relations Committee
^ Production Industry Council
^ Public Safety Advisory Committee
D Safety Committee
O Transportation and Parking Committee
^ VVisitor and Convention Authority'
r'' \outh Center Advisory rd
1
F:ICLERI$ALL1B$C ApplicationlB&C Application Revised OJ11pfi iakes.doc
Notd: 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 !_i No ! !Years of Service:
2. Present participation in Youth Center activities by your children Yes' No ;_i. if yes, please list the names of your children, their
ages, and which programs. List,bel
Child's name: ~ ~ Age: Program:
Child's name: ~ "~ .~ '(r ~ _ Age: Program:
.Have you ever been convicted of a felol~y: Yes ^ or No~S' If yes, please explain in detail:
• Do you currently have a violation(s) of City of Miami Beach codes: Yes [] or No . If yes, please explain in detail:
• Do you currently owe the City of Miami Beach any money: Yes D or No t~ If yes, explain in detail
• Are you currently serving on any City Boards or Committees: Yes D or Nom If yes; which board?
• What organizations in the ity of Miami Beach do you currently hold membership in?
Name: Title:
Name: Title:
• List all properties owned or have an interest in, which are located within the City of Miami Beach:
~-
• 1 am now employed by the City of Miami Beach: Yes ^ or N~ Which department?
• Pursuant to City Code Section 2-25 (b): Do you have a parent ^, spouse D, child D, lxother G, or sister D who is empbyed by the
City of Miami Beach? Gheck all that apply. Identify the department(s): A' ~
'`~ ~
This secti is "not required" but desired: Age: ~ years old Gender, ale Female ^
Ethnic lgin (Check one}
White African-AmericanBlack ^ Hispanic: ^ Aslan or Pacific islander ^ American Indian or Alaskan Native ^
Employment Status: Employed ^ Retired ^ Home-maker ^ Other ^
"I hereby attest a accuracy and truthfulness of the application and have received, read and will abide by Chapter 2,
Arttcfa VII - he ; Code "Standards of Conduct fo :City Officers, Empioyees~nd Agency Members."
~/0 7 f'rwa~~ ~S rte-, a rL.
Name of Applicant (PLEASE PRINT)
P sas• a co y of your resume to this application
1'E• pltcatto swill remain on file for a period of one (1) calendar year
Received in City Ggrk's Ottire ~ ~-°°~ s.:%'f"'~..
I ame of Deputy CI ~~kk ~ Date
Document Control Number (Assigned t City Clerk's OfRce) ~~!'~~~ Entered By ~ ' Date
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F:ICLERI$ALLtB&C Apl~licaiioniFi&C Appliratin~~ Rcvis~;d p<)11g6 iakc~s.doc