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Lawrence Fuller 12/31/2009 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 01 /03/2008 Lawrence Fuller 925 North Shore Dr Miami Beach, Florida 33141 SUBJECT: Disability Access Committee Congratulations! You have been reappointed by Commissioner Jerry Libbin to the above referenced agency, board or committee for a term ending: 12131!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, ll~~, ~{ i~ 7 ~ Robert Parcher City Clerk cc: Saul Frances, Parking Director Robert Halfhill 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 Lawrence Fuller RE: Disability Access 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 theFlorida 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 o~r,the board or committee on which I serve) on July 1st, following the closing of the calendar year.,e-f4vhich I have ~rGe~. _~--~ jJ~ 1 Lawrence Fuller Sworn to and subscribed before me this ~ day of ,;~'~ ;~:~ < . ° i~, 200_ .• ,' ~" ~ y " 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. ~~~~~ 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_. abilities, knowledge, or experience Are you a registe NAME: ~l~ ~ voter in Miami Beach: Yes I~'or No ^ Last N_amer Home ~~~"~~ ~~ `~~ Address: No. Street City ~'r~ First Name Middle Initial 72L- ~.S ~ State Zip Code Phone: ~~ .~'~ ~ 7.~ ~~' ~,aJ ~~~/.~ / %~ 3~'S ~1...31~5 c~a y ,C. ! `~L~L°~' CG',y~ ~`G/LCFj~'~9'G.LG~,G`urlt Home Work Fax Email address (Please check one): I am now a resident of: North Beach ©'~outh Beach ^ Middle Beach ^ Business Name: t~~`~~ ~~, 1 G~~L~~ ~~ ~~~ Applicant's Position: Address: rr ~ t: c" ~` ~~~/ ~( %.~ C~ j) S %r~ ,~~~ ~' No. Street City ^ Owner ^ Stockholder/Shareholder ^ Corporate Officer ^ Other Explain: State Zip Code Professional License (describe}: ~ I 1 ~ ~ ~1 ~ ~, Expires: Attach a copy of the license listed above. ._., 1. Have you ever been convicted of a felony: Yes ^ or No L~'If yes, please explain in detail: 2. Do you currently have a violation(s) of City of Miami Beach codes: Yes ^ or No l7!ff~yes, please explain in detail: 3. Do you currently owe the City of Miami Beach any money: Yes ^ or No ~' If yes, explain in detail: 4. Are you currently serving on any City oards or Committees: Yes C~ or No ^. If yes; which board? ~ O SPA T~ L %~~/Y1 /lv~ C:\DOCUMENTS AND SETTINGS\COMPGARJ\LOCAL SETTINGS\TEMPORARY INTERNET FILES\OLK87\BC APPLICATION NOV 2005.DOC 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): 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. ~_r_ ,.c ~:a, .~ Ke uiar ~svU~cas ui ~.ii ^ Art in Public Places Committee ^Housin Authorit ~ Barrier Free Environment Committee ^Loan Review Committee* ^ Beach Preservation Board ^Marine Authority ^ 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 ^ Committee on the Homeless ^Miami Beach Florida Sister Cities ^Normand Shores Local Gov. Nei hborhood Im rovement ^ Committee for Qualit of Education in Miami Beach ^North Beach Youth Center Oversi ht Committee ^ Community Develo ment Advisory Committee* ^Oversight Committee for General Obligation Bond ^ Communit Relations Board ^Parks 8~ 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 ^ Public Safet Adviso Committee ^ Health Adviso Committee ^ Safet Committee ^ Health Facilities Authorit ^ Trans ortation & Parkin Committee ^Hispanic Affairs Committee ^ Visitor 8~ 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: 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: Child's name: This section is "not required" but desired: Age: ~'~` Age: Program: Age: Program: Ethnic Origin (Check one) WhiteB African-American/Black ^ Hispanic: ^ Asian or Pacific Islander ^ American Indian or Alaskan Native ^ Employment Status: Employed ~ Retired ^ Home-maker ^ Other ^ Gende . ate or Female @~ ~_ "I hereby attest to the accuracy and truthfulness of the application and have received, read and will abide by Chapter 2, Article VII - the City Code "Standards of Conduct for City Officers, Employees and ncy Mem ~.- _:-~-~ .~~ ~ fit. L ~I Z,~~ L_, l~~r L~(~ ~ ~1~~~`~ J ~~' plicant's Signature Date Name of Applicant (PLEASE PRINT) Aftachment: Please attach a copy of your resume to your application. NOTE: Applications will remain on file for a period of one (1) calendar year. C:\DOCUMENTS AND SETTINGS\COMPGARJ\LOCAL SETTINGS\TEMPORARY INTERNET FILES\OLK87\BC APPLICATION NOV 2005.DOC What organizations in the City of Miami Beach do you currently hold membership in? Name: Name an interest in, which are located within the City of Miami Beach: C:\DOCUMENTS AND SETTINGS\COMPGARJ\LOCAL SETTINGS\TEMPORARY INTERNET FILES\OLK87\BC APPLICATION NOV 2005.DOC