Kathy Coulter 12/31/2009'a ~ ~ ~ `
fir. ~ratme!6Yrsi%;;doM`rmmi #,1»3~31?3'9i„vKwa~v~miamil~ucktff;~.
CITY CLERK'S OFFICE
Tel: 305-673-741 1 ,Fax: 305-673-7254
January 18, 2008
Kathy Coulter
1768 Daytonia Road
Miami Beach, Florida 33141
SUBJECT: COMMITTEE FOR QUALITY EDUCATION IN MIAMI BEACH
Dear Ms. Coulter:
Congratulations! You have been reappointed by Commissioner Libbin to the above-referenced
agency, board or committee for a term ending 12/31/09.
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,
~~~'~~
Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
City Liaison Leslie Rosenfeld
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) Palm Court Building 309 23~d St, Ste 200
Booklet -Guide to the Sunshine Amendment and Code of Ethics for Public Officers and Employees
Fa:~~LI19Slll~ , ~mmrrtit~~
~e €ua: comtiritteck to pr~uic~rng ~xcallent~pu;~iic sc~vacecar~d safety to aB who dkv~, work, and plv~! in our vibrant, tropical, historic corirrcacrnFly.
m MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK'S OFFICE
Tel: 305-673-741 1 ,Fax: 305-673-7254
TO: Kathy Coulter
RE: Committee for Quality Education in Miami Beach
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 F/orida Commission on Ethics Guide to the
SunshineAmendmentand Code ofEthicsforPub/icO~cersandunderstand that as a member of
a City of Miami Beach Board and/or Committee, I must comply with the financial disclosure*
requirements 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.
Kathy C u er
~~
Sworn to and subscribed before me this) day o , 200~'~
. ~,~~s~
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.
F:\CLER\$ALL\SILVIA\Oath forms\Oath.doc
We are committed to providing excellent public service and safely to all who live, work, and play in our vibrant, tropicol, historic community.
~ MIANtI BEACH ~ ~
~-~' ~ o
~ ~ ,
BOARDS AND COMMITTEE APPLICATION FORM f I 5
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 (b) months: Yes or No [ ]
Demonstrate an ownership/interest in a business in Miami Beach f r a minimum of six (b) months: Yes or No [
1 '
I am applying for a Board appointment because I have special abilities, knowledge, experience: Yes
My special' ~ ~bili~i~s~ ~ ~, knowledge, or experience
Are you a regls red
NAME:
Last Name
Home
voter in Miami Beach: Yes ~ or No ^
First Nar
•A ~
Initial
Address: No. Street s ~ i `City ~I State Zip Code
Phone: 2rx" .Gt (L (' lLr-T r ;5' ~~~~cS7 ~~ S ~~.~ U rL~,~~ ~ ~ ~YYt
Home a Work Fax ~~ // Email addr
(Please check one): I am now a resident of: North Beach~"South Beach ^ Middle Beach ^
Business Name: pplicant's Po""""""si~~\~~\tion:
Address: ~oC`iv ~~ ~~ ~~ 11 It~Y~( Y\,( -~ l~ ~~ 1
No. Street ~ ~ ~ City vState Zip Code
ner ^ Stockholder/Shareholder ^ Corporate Officer ^ Other Explain:
Professional License (describe):
Expires:
Aftach a copy of the license listed above.
1. Have you ever been convicted of a felony: Yes ^ or
No -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~
If yes, explain in detail:
4. Are you currently serving on any City Boards or Committees: Yes ^ or No L~!!
If yes; which board? C\
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):
No
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.
(Regular Boards of City)
^ Art in Public Places Committee ^Housin Authorit
^ 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
Committee for Qualit of Education in Miami Beach ^North Beach Youth Center Oversi ht Committee
^ Community Development Advisory Committee* ^Oversight Committee for General Obligation Bond
^ Communit Relations Board ^Parks & Recreational Facilities Board
^ Convention Center Advisory Board ^ Personnel Board
^ Debarment Committee ^ Plannin Board
^ Desi n Review Board * D Police Citizens Relations Committee
^ Fine Arfs 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 & 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:
Age: Program:
Age: Program:
This section is "not required" but desired: Age: ~ ~~'(
Ethnic Origin (Check one)
White'~African-American/Black ^ Hispanic: ^
Asian or Pacific Islander ^ Am ican Indian or Alaskan Native ^
Employment Status: Employed~Retired ^ Home-maker ^ Other ^
Gender: Male or Female ^
"I hereby attest to the accuracy and truthfulness of the application and have received, read and will
abid by Chapter 2, Article VII - of the City Code "Standards of Conduct for City Officers, Employees
and enc Me s." '
Appllcan s Ign u Date Name of Ap licant (PLEASE P INT)
Att chment: 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:
Title:
Name: Title:
List all properties owned or have 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