Jerry Marsch 12/31/2008
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
Jerry Marsch
6900 Bay Dr. #10-I
Miami Beach, Florida 33141
SUBJECT:. Safety Committee
Congratulations! You have been reappointed by Mavor Matti H. Bower
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.
Sincerelyf~, '~
/ :~ ~
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Clifford Leonard
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 alt who live, work and play in our vibrant, tropical, historic community.
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
TO Jerry Marsch
RE: Safety 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: 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 theF/orida Commission on Ethics Guide to the Sunshine
Amendmentand 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 1st, following the closing of the calendar year on which I have served.
Jer arsch
Sworn to and subscribed before me this ~ day of , 200 ~P
i'
Depu 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.
A/1 I AM 18 E,A,~ H
BOARDS AND COMMITTEE APPLICATION FORM
Pursuant to City Code section 2-2?_(A) a and b: Members of agencies, boards, and committees shall be offiliated with the city; this requirernent sf
be fulfilled in the following ways: a) on individual shall hove been a resident of the city for o minimum of six months; or b) on individual sF
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 (b) months: Yes ~ or No ( )
Demonstrate on ownership/interest in a business in Miami Beach for a minimum of six (b) months: Yes [ )
I am applying for a Board appointment because I have special abilities, knowledge, experience: Yes [~'
My special abilities, knowledge, or experience is:
Are you a register d voter in Miami Beach: Yes or No ^
NAME : •~,~ ~~ ~ ~ ~'~ ~/' (/` ~J
L st Name --
Home ~CJ G
Address: No. Street
~~ ~ ~~
City
Phone: (~ ~j ~ ~Q ~ ~---
Home Work
(Please check one): I am now a resident of
Business Name:
Address"~--~-
Applicant's Position:
No.
Street
City
^ Owner ^ Stockholder/Shoreholder ^ Corporate Officer ^ Other Explain:
State Zip Code
Professional License (describe):
Attach a copy of the license listed above.
or No~)
Expires:
Have you ever been convicted of a felon. ,pease exp ain in detail:
2. 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 2~.
If yes, explain in detail:
4. Are you currently serving on any City Boards or Committees: Yes ^ or N~
If yes; which board?
What organizations in the City of Miami Beach do you currently hold membershi in?
Name ~ e ~~ t ~~ G ~^~~~ ~ Titl~~~
Name: ___._.. Title: ~~
List all properties owned or have an interest in, which are located within the City of Miami Beach:
---~
Fax
First N~me Middle Initial
State Zip Code
Email address
North Beach D South Beach ^ Middle Beach ^
C:\DOCUMENTS AND SETTINGS\CLERGIBE\LOCAL SETTINGS\TEMPORARY INTERNET FILES\OLKt4\BC APPLICATION NOV 20051.DOC
I om now employed by the Gty of Miami Beach: Yes ^ or Nd~ if yes; which deportment?
Pursuant to City Code Section 2-25 (b): Do you hove a parent ^), spouse ,], ), brother ^l, or sister ^] who is
employed by the City of Miami Beach? Check all that apply. Identify the d pa m t( ):
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.
Re ular Boards of Cit
^ Art in Public Places Committee ^Housin Authorit
^ Barrier Free Environment Committee ^Loan Review Committee'
^ Beach Preservation Board ,
^ Beautification Committee ^Manne Authonty
^Miami Beach Cultural Arts Council
^ Board of Adjustment (Flood Mana ement * ^Miami Beach Commission on Status of Wome
^ Bud et Adviso Committee n
^Miami Beach Florida Sister Cities
^ Committee on the Homeless
^ Committee for Quolit of Education in Miami B
h ^Normond Shores Local Gov. Nei hborhood Im rovement
eac
^ Communi Development Advisory Committee* ^North Beach Youth Center Oversi ht Committee
^Oversight Committee for General Obli
ati
B
^ Communit Relations Board g
on
ond
^Parks & Recreational Facilities Board
^ Convention Center Advisory Board ^ Personnel Board *
^ Debarment Committee ^ Plannin Board
^ Desi n Review Board * ^ Police Citizens Relations Committee
^ Fine Arts Board ^ Production Indust Council
^ Golf Adviso Committee
^ Health Adviso Committee ^ Public Sofet Adviso Committee
^ Health Facilities Authorit Safe Committee
^Hispanic Affairs Committee ^ Trans ortation & Parkin Committee
^ Visitor & Convention Authority *
^Historic Preservation Board * ^ Youth Center Advisory 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:
Past service on the Youth Center Advisory Board: Yes ^ No ~ Years of Service ^
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:
This section is "not required" but desired: Age: ^ Gender: Male or Female ^
Ethnic Origin (Check one)
White African-American/Black ^ Hispanic: ^
...Asian or Pacific Islander ^ American In ian or Alaskan Native ^
__
Employment Status: Employed ^ Retired Home-maker ^ Other ^
"t 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 onduct for City Officers, Employees and Agency
M tiers." ~ ~ I (,-O
Appl' nt's ture Date Name of App icant (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.
Received in City Clerk's Office 2 aC0 by ~ )c~+L~"-'____--- Deputy Clerk
Document Control Number (Assigned y the City Clerk's Office) Revised 1 1 /15/05
C:IDOCUMENTS AND SETTINGS\CLERGIBE\LOCAL SETTINGS\TEMPORARY INTERNET FILES\OLKI 4\BC APPLICATION NOV 20051.DOC