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Jeffrey Gibbs 12/31/2009_t ~ - ~ ~ r ~ City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.aov OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk Tet: (305) 673-7411, Fax: (305) 673-7254 02/21 /2008 Jeffery Gibbs 5960 LaGorce Drive Miami Beach, Florida 33140 SUBJECT: Community Relations Board Congratulations! You have been reappointed by Jorge M. Gonzalez, City Manager 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, ,- ~~~~~~{' Robert Parcher City Clerk cc: Saul Frances, Parking Director Barbara Hawayek 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 a!I who live, work and play in our vibrant tropics/, historic community. Ci1~- of iMioeni d~ach, 1700 Convention Center Drive, Miami Beach, Fbrido 33139, www.miamibeachA.gov OFFICE OF THE CITY CLERK, Robert Parcher, Ciy Clerk TEL: (305) 673-7411, FAX: (305) 673-7254 TO Jeffery Gibbs RE: Community Relations Board 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/o~ida Commission on Ethics Guide to the Sunshine Amendment and Code of Ethia for Public ~cers 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. effery Gibbs Sworn to and subscribed before m s ~ day of L.~i~~i~ c~ /~~-" ~ ~ ~~ Silvia Prieto Deputy Clerk *Please visit the City of Miami E~each website at www.miamibeachfl.gov under City Clerk/Board and Committees for additional information regarding the Financial Disdosure Requirements. We are commined to providing excellent public service and safey to oll who live, work, and play in our vibrant, tropicol, historic communiy !' MIAM,IB~ACH ^ ~~ ~Z,l Q -~ ~ Z,Z Pursuant to City Code section 2-22(4) a and b: Members of agencies, boards, and committees shall be affiliated with t it requirement shall be fulfilled in the following ways: a) an individual shall have been a resident of the city for a minimum o 'x th 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 (6) months: Yes ~or No ^ Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six (ti) months: Yes i~'or No am applying for a Board appointment because 1 have~speci bil' 'es, knowledge, experience: Yeses ~ ~ My special abilities, knowledge, or experience is:~t' i C'~ ~t c 'r Are you a registered yQter!n iami Beach: Yes ,_, or Non , ( r ` ,~ ~ ~ ~ ~ ~l ~ 1 NAME: ~ QCV . Last Name First Name Middle Initial Home: Address: ~~ 4~1.~ J ^~ct ~"~ f~ CZ'_ ~ ~r ~ IG ~ 1 ~t~~ ~ 3~~ Ll~ No. Street City State Zip Code Phone: ~©S ~G ><~'~ Oy 3 3L - ~o~~ 3os ~r ~ i ~ ~.- I~,es 4:' ~ -lS ,'-1C~-: ome Work Fax mail a ress (Ptease ctaec r,€~e3. ( sr.' ~.~ a ~ rat o-;f: Nc> , i~ ^ ~ q~ .~~~~,t~ ^ f~~i~tdle ~act~ Business Na me: ~ ~~ ~ ~-~~ eS~MtN j ~,"Applicants Position: C.1C~ n~T C ^ ? ' Add J t~~ ~~ C 1JC~ U ~- ~ ~J ~~ ~ ~ C ~ . ress: / cMt 'GC: r - I No. Street Ciiy State Zip Code ~~ D~Owner ^ Stockholder/Shareholder ^ Corporate Officer ^ Other Explain: Professional License (describe) C ~-`- 1` ~ ~~ 1 ~~(, m;, .~vf ~ Expires: ~ _.. _. __ Attara~f~ a co~a~ r~~ ??=a a xra~ 1. Have you ever been convicted of a felony: Yes ^ or No'~1'If yes, please explain in detail: 2. Do you currently have a violation(s) of City of Miami Beach codes: Yes ^ or No dyes, please explain in detail: 3. Do you currently owe the City of Miami Beach any money: Yes ^ or No f7. If yes, explain in detail 4. Are you currently serving on any City Boards or Committees: Yes ^ or No If yes; which board? What organiizatio~n±s in the Cityt Hof Miami Beach do you curcently hold membership in? ~ ~C~ U Mc~G,~eC3 JOG Title: Name: T~tip• 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 ^ or Noteyes, which department? F:IGLE_R;~Rt_LSE3KC RI~~,Iic~ii,~~7tE:t&C AppliCatkm Revised C1;i11%)Fi Guc y~2 ~GJ' y C~ 'Pur..uant to City Code Section 2-25 (b): Do you have a parent ', .!, spouse l ,child 'i ', 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. (Regular Boards of City) Housing Authority* Ci Art in Public Places Committee i= Loan Review Committee* ^ Barrier Free Environment Committee C' Marine Authority* ^ Beach Preservation Board ::,~ Miami Beach Cultural Arts Council ^ Beautification Committee ~ ~ Miami Beach Commission on Status of Women ^ Board of Adjustment* a Miami Beach Florida Sister Cities ,tC.l Budget Advisory Committee ~~ Normandy Shores Local Gov't Neigh. Improvement ^ Committee on Homeless a Oversight Committee for General Obligation Bond ^ Committee for Quality Education in MB ^ Parks and Recreation Facilities Board ^ Community Development Advisory* Li Personnel Board* ^ Community Relations Board 3 ~~ Planning Board* ^ Convention Center Advisory Board ^ Police Citizens Relations Committee ^ Convention Center Capital Projects Overs ight ^ Production Industry Council ^ Debarment Committee ^ Public Safety Advisory Committee ^ Design Review Board* ^ Safety Committee ^ Fine Arts Board ^ Transportation and Parking Committee ^ Golf Advisory Committee ^ Visitor and Convention Authority* ^ Health Advisory Committee ^ Youth Center Advisory Board ^ Health Facilities Authority Board ^ Historic Preservation 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 i~ 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: This section is "not required" but desired: Age: ~ye rs old Gender: Male L~ Female ^ Ethnic Origin (Check one) White~fa~African-American/Black ^ Hispanic: ^ Asian or Pacific Islander ^ American Indian or Alaskan Native ^ Employment Status: Employed Retired ^ Home-maker ^ Other ^ "1 hereby attest to the accur cy and truthfulness of the application and have received, read and will abide by Chapter 2, A cle I - of the Ci Code ` rds of Conduct for City Officers, Employees and Agency Me bers." .- A ica ignat re ate ~ L ~ ame Applicant (PLEASE RINT) A h Ple a att c py o your resume to your applica ion. NOTE: Applications wi r i on for a period of one (1) calendar year. Received in City Clerk's Office by D uty Clerk Date _ _ Document Control Number (Assigned by the City Clerk's Office) ~_ Entered By Date ~ ~ `' R ised 9/11/06 Ih F:AGLEfit~Ai_i~~E3c~C P,pt>Sicai'E~ t~1L3~t:~ Ra,i~Eic~tita3~~ R~vi~~r+ f)u3