Barbara Gillman 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
01 /03/2008
Barbara Gillman
1'6 Island Avenue
Miami Beach, Florida 33139
SUB~IECT: Safety Committee
Congratulations! You have been reappointed by Commissioner Jonah M. Wolfson
to the above referenced agency, -board or committee for a term ending: 1213112008.
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,
f
Robert Parcher {j
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 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.aov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel: (305) 673-7411, Fax: (305) 673-7254
TO Barbara Gillman
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
Amendment and Code of Ethics for Public ricers 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 y~a on which I have s~tv~d.
Sworn to and subscribed before
~2ti~
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 al! who live, work and play in our vibrant, tropical, historic community.
Silvia Prieto
~#
i~-1
~~
Pursuant to City Code section 2-22(4) a and b: Members of a encies bo 1
requirement shall be fulfilled in the following ways: a) an individua shall have been a esidentnof the cit atoba m nlimud with the city; this
b) an individual shall demonstrate ownership/interest for a minimum of six months in a business establ shed in the city. of six months; or
Resident of Miami Beach for a minimum of six (6) months: Yest:,;•t~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 !7
My special abilities, knowledge, or experience is:
Are you a registere~oter in Miami Beach: es C! or No C•
NAME: (_.- !/ r /1~1A~. ~ /~~/.~ ~IJ,~ .dL
Home: -~
Address:
~' No.
Phone: /~
(Plc~~s~ c:#, ~ ~ .
Business Name: ~~"~~i ~,~- ~ ~
Address: ~(
Street
/ ~`v
Fax
(~ /I e Initial~~/
=~L 'T~ A
~~,~
r tale Zip Code
/~ ~ ,
Email address ~~,. ,~,a _ ,
„~A licant's Posrtion:_4 v ''v
' ""• Street '
City State Zip
Owner CStockholder/Shareholder L~ Corporate Officer a Other Explain:
C~
Professional License (describe)
~irf«~e~ia :~ c,}+.~ ~.Ff :r . , a .f-., Expires:
1. Have you ever been convicted of a felony: Yes 0 or No ^ If yes, please explain in detail: / v y
2. Do you currently have a violation(s) of City of Miami Beach
3. Do you currently owe the City of Miami Beach any money: Yes ^ or No
If yes, explain in detail
in
4• Are you currently serving on any City Boards or Committees: Ye or No p. If yes; which board? ~ ~7~
What organizations in the City of Miami Beach do you currently hold membership in?
Name:
Name:
Title:
List all properties ovmed or have an interest in, which are located within the Ciry of Miami Beach:
I am now employed by the City of Miami Beach: Yes ~ or
tae If yes, which department?
1
please
F=:ICLER1SALttC3&C A_pplicatontEt<~,C R..~~o~4catic~r7 i?eviaed 011 ~Ot;.d4G
Pursuant to City Code Section 2-25 (b): Do you have a parent
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 Cterk's Office. (Regular Boards of City)
'_: Art in Public Places Committee
^ Barrier Free Environment Committee
[~ Beach Preservation Board
^ Beautification Committee
i ~ Board of Adjustment*
i7 Budget Advisory Committee
^ Committee on Homeless
^ Committee for Quality Education in MB
^ Co munity Development Advisory*
^ mmunity Relations Bo
rrveetian_Cent Boar
^ Conventio Center Capital Pro)ects Oversight
^ Debarment Committee
^ Design Review Board*
^ Fine Arts Board
Golf Advisory Committee
^ Health Advisory Committee
^ Health Facilities Authority Board
^ Historic Preservation Board*
Housing Authority*
Loan Review Committee*
Marine Authority'
Miami Beach Cultural Arts Council
.:Miami Beach Commission on Status of 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*
[i Planning Board*
olive Citizens Relations Committee
Production Industry Council
~, ub' a dvisory Committee
r~ Safety Committee
~; ransp nd Parking Committee
G. Visitor and Convention Authority*
iJ 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:
Thls section is "not required" but desired: Age: years old Gender: Male ^ Female ^
Ethnic Origin (Check one) °
White ^Afrivan-American/Black ^ Hispanic: ^ '
Asian or Pacific Islander ^ American Indian or Alaskan Native ^
Employment Status: Employed ~~ Retired ^ Home-maker ~~ Other Ci
"I hereby t to the accur cy and truthfulness of the application and h received, read and will abide by Chapter 2,
Article VI the City Code " ndar of Conduct for Ci Offic rs, Empl a nd A~jenvy Members:'
~~ l~~ ~~~
Applican ' Ignature D to Name of Applicant (PLEASE PRINT)
Attachment: Please attach a copy of your resume to your application.
NOTE: Applications will remain on file for a pe ' of one (1) calendar year. ~,
Received in City Clerk's Office ~ ~ by eputy Clerk Date
Document Control Number (Assigned by the City Clerk's ) Entered B Date fr
evised /11/O61h
spouse ! ,child ', brother , or sister ' who is employed by the City of Miami
FaCI.ER\$ALI_1E~&G An(i!;;Sh~ ~~ t,~.C; ~~,~~ i:'.a~~~ ~.._~.~ c9 ?:; ~ ^ _~~ tint;