David Smith 12/31/2009
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
01 /03/2008
David Smith
4538 Sheridan Ave
Miami Beach, Florida 33140
SUBJECT: Community Development Advisory Commit
Congratulations! You have been reappointed by Commissioner Jerry Libbin
to the above referenced agency, board or committee for a term ending: 12/31/2009.
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, ,
r ,
` ~-~
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
John Quade
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 all 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 David Smith
RE: Community Development Advisory 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: 12/31/2009.
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 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.
4
David Smith
Sworn to and subscribed before me this ~? day of ~ 200
02 -- Silvia Prieto
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.
m MIAMIBEACH
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 or No
I am applying for a Board appointment because I have special abilities, knowledge, experience: Yes [~
My s ecial a ilities,/l knowledge, or experience
Are you a registered voter in Miami B ach: Yes r No ^
ll
NAME: ~ ~ !~ (_Jfii`~
Last Name
Home ~~3 ~~ ~~~v~-~~
Address: No. Street ~.~~ ~~
Phor~e:~Ls ~3~•~ 3"3 ~~37-~~-
~~ ome Work
First Name Middle Initial
C~ o~~ City
Cv~'3Z3~'
Fax
State Zip Code
Email address
(Please check]j one): 1 am now~~a /Iresident of: North Beach ^ South Beach ^ Middle Beach f~~
Business Name: tJ`-~~Pt't~ ~ V~~. Applicant's Position: ~ ~ ~ ~ M i c'~~''~ ~' ~'-~
~- 3 ~
~.. ~~(3
Address:
No. Street Cit~ State Zip Code
Id'Owner ^ Stockholder/Shareholder ^ Corporate Officer ^ Other Explain: G~ ~ ~ ti,,S
Professional License (describe): ~(?'aC~ ~ ;~c .~I 1~~ r~4-~
Expires: /~.~' ~ n ~'~
Attach a copy of the license listed above.
1. Have you ever been convicted of a felony: Yes ^ or No IlJ~lf yes, please explain 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 No Yd'
If yes, explain in detail:
4. Are you currently serving on any City Boards or Committees: Yes ^ or No
If yes; which board
C:\DOCUMENTS AND SETTINGS\COMPGARJ\LOCAL SETTINGS\TEMPORARY INTERNET FILES\OLK87\BC APPLICATION JAN 2006.DOC
.~
~~
I am now employed by the City of Miami Beach: Yes ^ or No L~l. 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):
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 Authori
^ Barrier Free Environment Committee ^Loan Review Committee
^ Beach Preservation Board ^Marine Authorit
^ Beautification Committee ^Miami Beach Cultural Arts Council
^ Board of Ad'ustment Flood Mana ement * ^Miami Beach Commission on Status of Women
^ Bud et Adviso Committee ^Miami Beach Florida.Sister Cities
^ Committee on the Homeless ^Normand Shores Local Gov. Nei hborhood Im rovement
^ mmittee for Qualit of Education in Miami Beach ^North Beach Youth Center Oversi ht Committee
Communi Develo ment Adviso Committee ^Oversi ht Committee for General Obli ation Bond
^ Communi Relations Board ^Parks & Recreational Facilities Board
^ Convention Center Adviso Board ^ Personnel Board
^ Debarment Committee ^ Plannin Board
^ Desi n Review Board * ^ Police Citizens Relations Committee
^ Fine Arts Board ^ Production Indust Council
^ Golf Adviso Committee ^ Public Safet Adviso Committee
^ Health Adviso Committee ^ Safe Committee
^ Health Facilities Authori ^ Trans ortation & Parkin Committee
^His anic Affairs Committee ^ Visitor & Convention Authori
^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:
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: !'~~~ S/~~"` Age: ~a Program: (LLT ~'-'~'- `~7
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 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
-- ~~Arti~cle VII - of the City Code "Standards of Conduct for City Officers, Employees and Agency
Memb s~
App~i'C'~In ig 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.
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What organizations in the City of Miami Beach do you currently hold membership in?
Name:
Name:
Title:
Title:
List all properties owned or have an interest in, which are located within the City of Miami Beach:
T4.CJ ~ ~r UnJ ~ ~
C:\DOCUMENTS AND SETTINGS\COMPGARJ\LOCAL SETTINGS\TEMPORARY INTERNET FILES\OLK87\BC APPLICATION JAN 2006.DOC