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Sheila Duffy-Lehrman 12/31/2009 City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.oov OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk Tel: (305) 673-7411, Fax: {305) 673-7254 12/21 /2007 Sheila Duffy-Lehrman 3090 Alton Rd Miami Beach, Florida 33140 ~S~~JI3JEGT:" Production Industry Council Congratulations! You have been reappointed by Commissioner Jonah M. Wolfson to the above referenced agency, board or committee for a term ending: 1213112009. 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, ~ ~ ~ ~ ~i.~'~~l ~ ~~ obert Parcher City Clerk cc: Saul Frances, Parking Director Graham Winick 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 fo 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 Sheila Duffy-Lehrman RE: Production Industry Council 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 Pub/ic Dicers 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 Florid n the board or co ittee on which I serve) on July 1st, following the closing oft calendar year on whi I hav erved. .- f r' J .~- n is puny-~er~rnan - ,-- Sworn to and subs ribed before me thi day of , 200 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 commitfed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community. NAME: HOME ADDRESS: No. PHONE:.~V.~ ' Home Business Name: IIL Address: Name ax Email address CO is - No. ~ ~ Street City State Professional License (describe) Expires: Zip Code 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 shalt 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) month .Yes or No • Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six (6) months: Yes or No • Are you a registered voter in Miami Be h: Yes or No • (Please check one): I am now a resident of: North Beach South Beach ~ le Beach • 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 City Clerk's Office (Regular Boards of City) Art in Public Places Committee Beach Preservation Board ~ Housing Authority* Beautification Committee ~~ Loan Review Committee* Board of Adjustment* ~ Marine Authority* Budget Advisory Committee `~ Miami Beach Cultural Arts Council C Committee on Homeless Miami Beach Commission for Women ~ Committee for Quality Education in MB Miami Beach Florida Sister Cities ~~ Community Development Advisory* ~ Normandy Shores Local Gov't Neigh. Improvement (sCommunity Relations Board ~ Oversight Committee for General Obligation Bond v ~ Convention Center Advisory Board _ Parks and Recreation Facilities Board Debarment Committee ~ Personnel Board* Design Review Board* =Planning Board* Disability Access Committee ~ Police Citizens Relations Committee Fine Arts Board production Industry Council ! Golf Advisory Committee Public Safety Advisory Committee _ Health Advisory Committee -Safety Committee Health Facilities Authority Board `Transportation and Parking Committee Hispanic Affairs Committee =Visitor and Convention Authority* Historic Preservation Board* ~ Youth Center Advisory Board "Board Required to File State Disclosure form 1 first me ~~`~Y/~~ Middle Initial ~~t Sta ~~ ~~~ Y to Zip Code L~ •6 vets ~ 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 ~ No If yes, please explain in detail: __ _\~ • Do you currently have a violation(s) of City of Miami Beach codes: Yes 'or No`s . 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 servi anry City Boards or Committees: ~.es-ior No If yes; which board? I ~~.. • 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: • I am now employed by the City of Miami Beach: Yes Cyr 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 ~, 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 th c cy and tr ess of the application and have received, read and will abide by Chapter 2, ~Ckieie-VIT oTffi~ o "S~and~~~~~duct for~City Officers, Employees and Agency Members.,' /~S~/~~ S (~~t (l~ ail i~~ - ~ rl ~ A-t1~ Appl Date Name of Applicant (PLEASE PRINT) Please attach a copy~6f yoUdFerSunOe'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 Name of Deputy Clerk Document Control Number (Assigned by the City Clerk's Office) Entered Date / Revis d 10/29/2007 L. Hatfield