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Jeff Gordon 12/31/20091 ..~ ... LD ~~~,~~ ~ ~~ City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk Tel: (305) 673-7411, Fax: (305) 673-7254 12/21 /2007 Jeff Gordon 4535 N. Michigan Ave Miami Beach, Florida 33140 ~,iEGT: Youth Center Advisory Board Congratulations! You have been reappointed by Commissioner Jonah M. Wolfson to the above referenced agency, board or committee for a term ending: 1213112009. 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. Sincere`,ly~, Robert Parcher City Clerk cc: Saul Frances, Parking Director Ellen Vargas 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 to a!! who five, work and play in our vibrant, tropical, historic community. 4 ~ ~~5 ~ ~ { 1 City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.oov OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk Tel: (305) 673-7411, Fax: (305) 673-7254 TO Jeff Gordon RE: Youth Center Advisory 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: 12/31/2009. 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/orida 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 I serve) on July 1st, following the closing of the calendar year on which I have served. Jeff Gordon .®- `/~ Sworn to and subscribed before me this ~ day of /1~ ~ , 200 ~~- 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 excellent public service and safety to all 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 a resident of the city for a minimum of six months; orb) 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 [~ or No [ ] Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six (6) months: Yes [v~or No [ ] I am applying for a Board appointment because I h e eci abilities, knowled e, experience: Y [t/r My special abilities, knowledge, or experience is: ~~ /YI~- ~ Are you a regis red v ter m Miami Beach: Yes or No [---- ~~~~ NAME: ~i-~(~ Last Name ,,/~ First Name ~/Middle Initial Home ~.,~~ ~f--/'/%c~ ~ ~aM ~ ~~ -{ Address: No. Stree ~ s~~36, City State Zip Code Phone: ~ds~-..~3~-9f ~ _~~ ~~ Home Work Fax ~1e~ ~' a~~Jv~cr~u~Ca~ email address I am now a resident of: North Beach [ ]South Beach [ ]Middle Beach (/~ Business Name: SCJee~' ~~w iv Applicant's Position: (, Address: No. Street City State Zip Code [ ~wner [ ]Stockholder/Shareholder [ ]Corporate Officer [ ]Other Explain: _ ~.~~ S'" Ili. /~7~'~ ~i~-.- l~ ~~ ~L 33f r~ ~/ Professional License (describe): _ gQ ~t ! Expire Attach acopy ofthe /icense listed above. 1. Have you ever been convicted of a felony: Yes [ ] or No [. If yes, please explain in detail: R/3d/o z. Do you currently have a violation(s) of City of Miami Beach codes: Yes [ ] or No [~If yes, please explain in detail: 3. Do you currently owe the City of Miami Beach any money: Yes [ ] or No [ il)' If yes, explain in detail: 4. Are you currently serving on any City Boards or Committees: Yes [ ] or No [l/J~ If yes•-which board? What organizRRati__o__ns in the/City of/Miami Beach do you currently hold membership i/n? Name: ~-o~l ©A(~ C~, Title•_ /Y~erh~c(' l Name: Title: List all pro rtes awned r have an interest in, which are I ted thin the Ci of Miami Beach: . ~ ~d~~.~~1~, I am now employed by the City of Miami Beach: Yes [ ] or No [ If yes, which department. Pursuant to City Code Section 2-25 (b): Do you have a parent [ ], spouse [ ], child [ ], brother ), or sister [ ]who is employed by the City of Miami Beach? Check all that apply. Identify the department(s): _~, F:\CLER\BALL\ELIZABE7IB&C\BCAPPLIC04.doc ......, Please list your preferences in order ~ ..eking [1] first choice [2] second choice, ~ _:1[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 [ 3 ]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 [ ]Debarment Committee [ ]Design Review Board* [ ]Fine Arts Board [ J Golf Advisory Committee [ ]Health Advisory Committee [ ]Health Facilities Authority [ ]Hispanic Affairs Committee [ ]Historic Preservation Board* [ ]Housing Authority* [ ]Loan Review Committee* Note: If applyi for Youth [ ]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 [ J 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 indicate your affiliation with the Scott Rakow Youth 1. Past service on the Youth Center Advisory Board: Yes [ ] No [ear f Service [ ] 2. Present participation in Youth Center activities by your children Yes [ ~ [ ]. If yes, please list the names of your children, their ages, and which programs. List below. //~~ Child's name: /'~!l7n,n Age: ~~ Program: Child's name: Age: Pr am: This section is "not required" but desireaF Age: Gender: M [~J or F [ ] Ethnic Origi (Check one) White [ African-American/Black [ ] Hispanic: [ ] Asian or Pacific Islander [ ]American Indian or Alaskan Native [ ] Employment Status: Employed [t/]~Retired [ ]Home-maker [ ]Other [ I hereby attest to the accuracy and truthfulness of the application and have received, read and will abide by Chapter 2, Article VII - of the City Code "Standards of Conduct for City Officers, Employees and Agency Mem er .~ (/ ~ ~~/ ~1 !1 p' nt's Signature Date Name of Applicant (PLEASE PRINT) Attachment: Please attacf] a copy of your resume to your application. NOTE~ppli will re in on file for a period of one (1) calendar year. Received in City Clerk's Offic - ' by +~, Clerk Document Control Number (Assigned by the City C 's Office) ~ e7 ~ Rev #7- 01/08/04 F:\CLERISALL\ELIZABET\B&C\BCAPPLIC04.dce