Ida Percal 12/31/2008f~N!fht
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
Ida Percal
2555 Regatta Ave.
Miami Beach, Florida 33140
.SUBJECT: Miami Beach Commission For Women
Congratulations! You have been reappointed by Mayor 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.
Sincerely, .P
i~
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Maria E. Martinez
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 ad 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.aov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel: (305) 673-7411, Fax: (305) 673-7254
TO Ida Percal
RE: Maami Beach Commission for Women
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 ~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 calend r year on which I have served.
~.-
Ida Percal
Sworn to and subscribed before me this ~- day of , 200_0
~ ,sue /,~-~-c-.~-~ --
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.
--
NAME: ~ ~ C A ~ ~ ~ ~'
Last Name First Name Middle Initial '/
HOME ADDRESS: ~ S S S ~~° 6' ~/~J"'g /'~' U.e _ /'~/~ ~~ ~ 33 ~Y G
No. Street City State Zip Code
PHONE: C ~V ~~ ~' ~~~7G 7l ~°.~d S~~~iI -r~.~/J-
Home Work Fax Email address
Business Name: ~" /f "' ~~ifj"-~`~,yC~7 Position:
Address:
No. Street / Ciiy State Zip Code
Professional License (describe) ~_ C~,3L ~~ 5,6 Expires:
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 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: `res or No
• Demonstrate an ownership/interest in a business in M' mi Beach for a minimum of six (6) months: Yes or No
• Are you a registered voter in Miami Beach: Yes or No
. (Please check one): I am now a resident of: North Beach South Beach Middle Beach L/
• I am applying for an appointment because I have special abilities, knowledge, experience. Please list below:
Please list your preferences in order of ranking [1] first choice [2J second choice, and [3] third choice. Please note that only three (3)
choices will be observed by the Citv Clerk's Office. (Regular Boards of City)
Art in Public Places Committee
Beach Preservation Board
Beautification Committee
Board of Adjustment"
Budget Advisory Committee
i= Committee on Homeless
Committee for Quality Education in MB
Community Development Advisory"
Community Relations Board
Convention Center Advisory Board
Debarment Committee
Design Review Board'
Disability Access Committee
Fine Arts Board ^
Golf Advisory Committee C/?')
Health Advisory Committee
_ Health Facilities Authority Board
3.FN~panic Affairs Committee
Historic Preservation Board'`
Housing Authority"
Loan Review Committee*
Marine Authority'`
Miami Beach Cultural Arts Council
Miami Beach Commission for Women
_ Miami Beach Florida Sister Cities
Normandy Shores Local Gov't Neigh. Improvement
Oversight Committee for General Obligation Bond
Parks and Recreation Facilities Board
Personnel Board`
Planning Board"
Police Citizens Relations Committee
Production Industry Council
~ublic Safety Advisory Committee
7.8a ety Committee
Transportation and Parking Committee
Visitor and Convention Authority"
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:
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:
Child's name: Age: Program:
Child's name:
Age: Program:
.Have you ever been convicted of a felony: Yes r No If yes, please explain in detail:
• Do you currently have a violation(s) of City of Miami Beach codes: Yes r No . If yes, please explain in detail:
• Do you currently owe the City of Miami Beach any money: Yes r No If yes, explain in detail
• Are you currently serving on any City Boards or Co/mmittees es or No If yes; which board?
~~iliU / it ~~C/~~ / /4.t ~® J,f~ ~,. _
• What organizations in the City of Miami Beach c16 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:
• I am now employed by the City of Miami Beach: Yes or No .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):
This section is "not required" but desired: Age: years old Gender: Male r Female
Ethnic Origin (Check one)
White ~ African-American/Black - Hispanic: ~ Asian or Pacific Islander =American Indian or Alaskan Native
Employment Status: Employed _ 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,
icle VII - of th City Code "Standards of Conduct for City Officers, Employees and Agency Members."
~ z ~7 ~ .~~. ~~2c~
Applicant's Signature D to Name of Applicant (PLEASE PRINT)
Please attach a copy of your resume to this application
NOTE: Applications will remain on file for a period of one (1) calendar year.
Received in City Clerk's Office by Date ~ 2 ~ 7 D~
Name of Deputy Clerk ~j
Document Control Number (Assigned by the City Clerk's Office) ~' _ Entered By Date ~ 7 D
Revise 10129/20 L. Hatfield
2